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  1. Mapping of Regional Myocardial Strain and Work During Ventricular Pacing

    PubMed Central

    Prinzen, Frits W.; Hunter, William C.; Wyman, Bradley T.; McVeigh, Elliot R.

    2007-01-01

    OBJECTIVES The purpose of this study was to determine the spatial distribution of myocardial function (myofiber shortening and work) within the left ventricular (LV) wall during ventricular pacing. BACKGROUND Asynchronous electrical activation, as induced by ventricular pacing, causes various abnormalities in LV function, perfusion and structure. These derangements may be caused by abnormalities in regional contraction patterns. However, insight into these patterns during pacing is as yet limited. METHODS In seven anesthetized dogs, high spatial and temporal resolution magnetic resonance-tagged images were acquired in three orthogonal planes. Three-dimensional deformation data and LV cavity pressure and volume were used to determine midwall circumferential strain and external and total mechanical work at 192 sites around the left ventricle. RESULTS During ventricular pacing, systolic fiber strain and external work were approximately zero in regions near the pacing site, and gradually increased to more than twice the normal value in the most remote regions. Total mechanical work, normalized to the value during right atrial pacing, was 38 ± 13% (right ventricular apex [RVapex] pacing) and 61 ± 23% (left ventricular base [LVbase] pacing) close to the pacing site, and 125 ± 48% and 171 ± 60% in remote regions, respectively (p < 0.05 between RVapex and LVbase pacing). The number of regions with reduced work was significantly larger during RVapex than during LVbase pacing. This was associated with a reduction of global LV pump function during RVapex pacing. CONCLUSIONS Ventricular pacing causes a threefold difference in myofiber work within the LV wall. This difference appears large enough to regard local myocardial function as an important determinant for abnormalities in perfusion, metabolism, structure and pump function during asynchronous electrical activation. Pacing at sites that cause more synchronous activation may limit the occurrence of such derangements

  2. Regional Framework for Self Paced Learning Modules. South Fraser Health Region.

    ERIC Educational Resources Information Center

    Blenkinsopp, John

    The purpose of this manual is to provide a guide for developing consistent, effective self-directed learning modules for the Surrey Memorial Hospital staff, physicians, and volunteers in the South Fraser Region. Eleven sections include: (1) "Philosophy for Self Paced Learning"; "What's Exciting?"; "What's the Challenge?"; (2) "Purpose"; (3)…

  3. Improvement of Right Ventricular Hemodynamics with Left Ventricular Endocardial Pacing during Cardiac Resynchronization Therapy

    PubMed Central

    HYDE, EOIN R.; BEHAR, JONATHAN M.; CROZIER, ANDREW; CLARIDGE, SIMON; JACKSON, TOM; SOHAL, MANAV; GILL, JASWINDER S.; O'NEILL, MARK D.; RAZAVI, REZA; RINALDI, CHRISTOPHER A.

    2016-01-01

    Background Cardiac resynchronization therapy (CRT) with biventricular epicardial (BV‐CS) or endocardial left ventricular (LV) stimulation (BV‐EN) improves LV hemodynamics. The effect of CRT on right ventricular function is less clear, particularly for BV‐EN. Our objective was to compare the simultaneous acute hemodynamic response (AHR) of the right and left ventricles (RV and LV) with BV‐CS and BV‐EN in order to determine the optimal mode of CRT delivery. Methods Nine patients with previously implanted CRT devices successfully underwent a temporary pacing study. Pressure wires measured the simultaneous AHR in both ventricles during different pacing protocols. Conventional epicardial CRT was delivered in LV‐only (LV‐CS) and BV‐CS configurations and compared with BV‐EN pacing in multiple locations using a roving decapolar catheter. Results Best BV‐EN (optimal AHR of all LV endocardial pacing sites) produced a significantly greater RV AHR compared with LV‐CS and BV‐CS pacing (P < 0.05). RV AHR had a significantly increased standard deviation compared to LV AHR (P < 0.05) with a weak correlation between RV and LV AHR (Spearman rs = −0.06). Compromised biventricular optimization, whereby RV AHR was increased at the expense of a smaller decrease in LV AHR, was achieved in 56% of cases, all with BV‐EN pacing. Conclusions BV‐EN pacing produces significant increases in both LV and RV AHR, above that achievable with conventional epicardial pacing. RV AHR cannot be used as a surrogate for optimizing LV AHR; however, compromised biventricular optimization is possible. The beneficial effect of endocardial LV pacing on RV function may have important clinical benefits beyond conventional CRT. PMID:27001004

  4. A Fast-Start Pacing Strategy Speeds Pulmonary Oxygen Uptake Kinetics and Improves Supramaximal Running Performance

    PubMed Central

    Turnes, Tiago; Salvador, Amadeo Félix; Lisbôa, Felipe Domingos; de Aguiar, Rafael Alves; Cruz, Rogério Santos de Oliveira; Caputo, Fabrizio

    2014-01-01

    The focus of the present study was to investigate the effects of a fast-start pacing strategy on running performance and pulmonary oxygen uptake () kinetics at the upper boundary of the severe-intensity domain. Eleven active male participants (28±10 years, 70±5 kg, 176±6 cm, 57±4 mL/kg/min) visited the laboratory for a series of tests that were performed until exhaustion: 1) an incremental test; 2) three laboratory test sessions performed at 95, 100 and 110% of the maximal aerobic speed; 3) two to four constant speed tests for the determination of the highest constant speed (HS) that still allowed achieving maximal oxygen uptake; and 4) an exercise based on the HS using a higher initial speed followed by a subsequent decrease. To predict equalized performance values for the constant pace, the relationship between time and distance/speed through log-log modelling was used. When a fast-start was utilized, subjects were able to cover a greater distance in a performance of similar duration in comparison with a constant-pace performance (constant pace: 670 m±22%; fast-start: 683 m±22%; P = 0.029); subjects also demonstrated a higher exercise tolerance at a similar average speed when compared with constant-pace performance (constant pace: 114 s±30%; fast-start: 125 s±26%; P = 0.037). Moreover, the mean response time was reduced after a fast start (constant pace: 22.2 s±28%; fast-start: 19.3 s±29%; P = 0.025). In conclusion, middle-distance running performances with a duration of 2–3 min are improved and response time is faster when a fast-start is adopted. PMID:25360744

  5. Efficacy of paced breathing for insomnia: enhances vagal activity and improves sleep quality.

    PubMed

    Tsai, H J; Kuo, Terry B J; Lee, Guo-She; Yang, Cheryl C H

    2015-03-01

    Fourteen self-reported insomniacs (SRI) and 14 good sleepers (GS) had their cardiac neuronal activity assessed by heart rate variability (HRV) under controlled respiration at a slow frequency rate of 0.1 Hz, and a forced rate of 0.2 Hz during daytime rest. Nighttime sleep was measured by polysomnography. The SRI showed depressed high frequency power of HRV compared to the GS. An increased total power of HRV was observed among the SRI during slow, paced breathing compared with spontaneous breathing and 0.2 Hz. Sleep onset latency, number of awakenings, and awakening time during sleep were decreased and sleep efficiency was increased if SRI practiced slow, paced breathing exercises for 20 min before going to sleep. Our results indicate that there is autonomic dysfunction among insomniacs, especially in relation to vagal activity; however, this decreased vagal activity can be facilitated by practicing slow, paced breathing, thereby improving sleep quality. PMID:25234581

  6. "U-Pace" Instruction: Improving Student Success by Integrating Content Mastery and Amplified Assistance

    ERIC Educational Resources Information Center

    Reddy, Diane M.; Pfeiffer, Heidi M.; Fleming, Raymond; Ports, Katie A.; Pedrick, Laura E.; Barnack-Tavlaris, Jessica L.; Jirovec, Danielle L.; Helion, Alicia M.; Swain, Rodney A.

    2013-01-01

    "U-Pace," an instructional intervention, has potential for widespread implementation because student behavior recorded in any learning management system is used by "U-Pace" instructors to tailor coaching of student learning based on students' strengths and motivations. "U-Pace" utilizes an online learning…

  7. "U-Pace" Instruction: Improving Student Success by Integrating Content Mastery and Amplified Assistance

    ERIC Educational Resources Information Center

    Reddy, Diane M.; Pfeiffer, Heidi M.; Fleming, Raymond; Ports, Katie A.; Pedrick, Laura E.; Barnack-Tavlaris, Jessica L.; Jirovec, Danielle L.; Helion, Alicia M.; Swain, Rodney A.

    2013-01-01

    "U-Pace," an instructional intervention, has potential for widespread implementation because student behavior recorded in any learning management system is used by "U-Pace" instructors to tailor coaching of student learning based on students' strengths and motivations. "U-Pace" utilizes an online learning environment to integrate content mastery…

  8. Muscle ischemic preconditioning does not improve performance during self-paced exercise.

    PubMed

    Tocco, F; Marongiu, E; Ghiani, G; Sanna, I; Palazzolo, G; Olla, S; Pusceddu, M; Sanna, P; Corona, F; Concu, A; Crisafulli, A

    2015-01-01

    Muscle ischemic preconditioning (IP) has been found to improve exercise performance in laboratory tests. This investigation aims at verifying whether performance is improved by IP during self-paced exercise (SPE) in the field. 11 well-trained male runners performed 3 randomly assigned 5 000 m self-paced running tests on an outdoor track. One was the reference (RT) test, while the others were performed following muscle IP (IPT) and a control sham test (ST). Average speeds were measured during each test. Mean values in oxygen uptake (VO2), aerobic energy cost (AEC) during race and post-race blood lactate (BLa) were gathered. Data showed that none of the studied variables were affected by IPT or ST with respect to the RT test. Average speeds were 4.63±0.31, 4.62±0.31 and 4.60±0.25 m·s(-1) for the RT, the ST and the IPT tests, respectively. Moreover, there was no difference among tests in speed reached during each lap. VO2 was 3.5±0.69, 3.74±0.85 and 3.62±1.19 l·min(-1). AEC was 1.04±0.15, 1.08±0.1 and 1.09±0.15 kcal·kg(-1)·km(-1). Finally, post-race BLa levels reached 12.85±3.54, 11.88±4.74 and 12.82±3.6 mmol·l(-1). These findings indicate that performance during SPE is not ameliorated by ischemic preconditioning, thereby indicating that IP is not suitable as an ergogenic aid. PMID:25264861

  9. In Heart Failure Patients with Left Bundle Branch Block Single Lead MultiSpot Left Ventricular Pacing Does Not Improve Acute Hemodynamic Response To Conventional Biventricular Pacing. A Multicenter Prospective, Interventional, Non-Randomized Study

    PubMed Central

    Sterliński, Maciej; Sokal, Adam; Lenarczyk, Radosław; Van Heuverswyn, Frederic; Rinaldi, C. Aldo; Vanderheyden, Marc; Khalameizer, Vladimir; Francis, Darrel; Heynens, Joeri; Stegemann, Berthold; Cornelussen, Richard

    2016-01-01

    Introduction Recent efforts to increase CRT response by multiSPOT pacing (MSP) from multiple bipols on the same left ventricular lead are still inconclusive. Aim The Left Ventricular (LV) MultiSPOTpacing for CRT (iSPOT) study compared the acute hemodynamic response of MSP pacing by using 3 electrodes on a quadripolar lead compared with conventional biventricular pacing (BiV). Methods Patients with left bundle branch block (LBBB) underwent an acute hemodynamic study to determine the %change in LV+dP/dtmax from baseline atrial pacing compared to the following configurations: BiV pacing with the LV lead in a one of lateral veins, while pacing from the distal, mid, or proximal electrode and all 3 electrodes together (i.e. MSP). All measurements were repeated 4 times at 5 different atrioventricular delays. We also measured QRS-width and individual Q-LV durations. Results Protocol was completed in 24 patients, all with LBBB (QRS width 171±20 ms) and 58% ischemic aetiology. The percentage change in LV+dP/dtmax for MSP pacing was 31.0±3.3% (Mean±SE), which was not significantly superior to any BiV pacing configuration: 28.9±3.2% (LV-distal), 28.3±2.7% (LV-mid), and 29.5±3.0% (LV-prox), respectively. Correlation between LV+dP/dtmax and either QRS-width or Q-LV ratio was poor. Conclusions In patients with LBBB MultiSPOT LV pacing demonstrated comparable improvement in contractility to best conventional BiV pacing. Optimization of atrioventricular delay is important for the best performance for both BiV and MultiSPOT pacing configurations. Trial Registration ClinicalTrials.gov NTC01883141 PMID:27124724

  10. Improved myocardial contractility with glucose-insulin-potassium infusion during pacing in coronary artery disease.

    PubMed

    McDaniel, H G; Rogers, W J; Russell, R O; Rackley, C E

    1985-04-01

    The metabolic and mechanical effects of a solution of glucose-insulin-potassium (G-I-K) were investigated in 18 patients who underwent diagnostic cardiac catheterization for coronary artery disease. All patients were paced at a rate of approximately 140 beats/min before and after infusion of G-I-K. Basal and paced left ventricular (LV) end-diastolic pressure, dP/dt, arterial substrate levels and osmolarity were measured in all 18 patients. In 13 patients cardiac index was also measured. In 5 patients arterial-coronary sinus measurements of oxygen, carbon dioxide, glucose, free fatty acids, lactate, alanine, glutamate, glutamine, ammonia and urea were made, in addition to coronary sinus blood flow. G-I-K increased the blood sugar level to approximately 200 mg/dl and raised the serum osmolarity 9 mosmol. Pacing alone raised the cardiac index 4% and pacing with G-I-K increased the cardiac index 6% (p less than 0.05). Pacing before G-I-K augmented dP/dt (21%) and pacing with G-I-K increased it (30%) (p less than 0.01). The metabolic changes noted included a shift in the respiratory quotient from 0.77 to 0.96 with G-I-K infusion (p less than 0.05). During G-I-K infusion the myocardial oxygen consumption at rest increased from 17.1 to 21.8 ml/min (23%, p less than 0.05). Myocardial oxygen consumption during pacing was similar before and after G-I-K infusion. Before G-I-K infusion nitrogen balance was slightly positive; after G-I-K infusion it was negative with regard to the nitrogen-containing compounds measured.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3885708

  11. Using "U-Pace" Instruction to Improve the Academic Performance of Economically Disadvantaged Undergraduates

    ERIC Educational Resources Information Center

    Fleming, R.; Stoiber, L. C.; Pfeiffer, H. M.; Kienzler, S. E.; Fleming, R. R.; Pedrick, L. E.; Barth, D. J.; Reddy, D. .

    2016-01-01

    This study was undertaken to evaluate whether the student success associated with the "U-Pace" instructional approach, which integrates mastery-based learning with proactive instructor support in an online learning environment, would replicate for both economically disadvantaged students and students who are not economically…

  12. Protein-Pacing from Food or Supplementation Improves Physical Performance in Overweight Men and Women: The PRISE 2 Study

    PubMed Central

    Arciero, Paul J.; Edmonds, Rohan C.; Bunsawat, Kanokwan; Gentile, Christopher L.; Ketcham, Caitlin; Darin, Christopher; Renna, Mariale; Zheng, Qian; Zhang, Jun Zhu; Ormsbee, Michael J.

    2016-01-01

    We recently reported that protein-pacing (P; six meals/day @ 1.4 g/kg body weight (BW), three of which included whey protein (WP) supplementation) combined with a multi-mode fitness program consisting of resistance, interval sprint, stretching, and endurance exercise training (RISE) improves body composition in overweight individuals. The purpose of this study was to extend these findings and determine whether protein-pacing with only food protein (FP) is comparable to WP supplementation during RISE training on physical performance outcomes in overweight/obese individuals. Thirty weight-matched volunteers were prescribed RISE training and a P diet derived from either whey protein supplementation (WP, n = 15) or food protein sources (FP, n = 15) for 16 weeks. Twenty-one participants completed the intervention (WP, n = 9; FP, n = 12). Measures of body composition and physical performance were significantly improved in both groups (p < 0.05), with no effect of protein source. Likewise, markers of cardiometabolic disease risk (e.g., LDL (low-density lipoprotein) cholesterol, glucose, insulin, adiponectin, systolic blood pressure) were significantly improved (p < 0.05) to a similar extent in both groups. These results demonstrate that both whey protein and food protein sources combined with multimodal RISE training are equally effective at improving physical performance and cardiometabolic health in obese individuals. PMID:27187451

  13. Protein-Pacing from Food or Supplementation Improves Physical Performance in Overweight Men and Women: The PRISE 2 Study.

    PubMed

    Arciero, Paul J; Edmonds, Rohan C; Bunsawat, Kanokwan; Gentile, Christopher L; Ketcham, Caitlin; Darin, Christopher; Renna, Mariale; Zheng, Qian; Zhang, Jun Zhu; Ormsbee, Michael J

    2016-01-01

    We recently reported that protein-pacing (P; six meals/day @ 1.4 g/kg body weight (BW), three of which included whey protein (WP) supplementation) combined with a multi-mode fitness program consisting of resistance, interval sprint, stretching, and endurance exercise training (RISE) improves body composition in overweight individuals. The purpose of this study was to extend these findings and determine whether protein-pacing with only food protein (FP) is comparable to WP supplementation during RISE training on physical performance outcomes in overweight/obese individuals. Thirty weight-matched volunteers were prescribed RISE training and a P diet derived from either whey protein supplementation (WP, n = 15) or food protein sources (FP, n = 15) for 16 weeks. Twenty-one participants completed the intervention (WP, n = 9; FP, n = 12). Measures of body composition and physical performance were significantly improved in both groups (p < 0.05), with no effect of protein source. Likewise, markers of cardiometabolic disease risk (e.g., LDL (low-density lipoprotein) cholesterol, glucose, insulin, adiponectin, systolic blood pressure) were significantly improved (p < 0.05) to a similar extent in both groups. These results demonstrate that both whey protein and food protein sources combined with multimodal RISE training are equally effective at improving physical performance and cardiometabolic health in obese individuals. PMID:27187451

  14. Pace Yourself.

    ERIC Educational Resources Information Center

    Small, Ann R.

    1979-01-01

    Suggests techniques and behaviors teachers can use to optimize the flow and pacing of their music lessons. Included are techniques for timing the lesson, keeping students involved, and minimizing interruptions and transitions. (SJL)

  15. Keeping Pace

    ERIC Educational Resources Information Center

    Henderson, Nancy

    2008-01-01

    This article describes the struggles of two tough moms who team up to start their own company. Fed up with a lack of stylish, properly-fitting shoes for their children with cerebral palsy, they established "Keeping Pace" which currently offers a selection of stylish girls' and boys' athletic sneakers and casual dress shoes for boys, all sold…

  16. Improving Responsiveness to Intervention for English-Language Learners: A Comparison of Instructional Pace on Letter Naming Rates

    ERIC Educational Resources Information Center

    Gilbertson, Donna; Bluck, John

    2006-01-01

    An alternating treatments design was used to compare the effects of a 1-s and a 5-s paced intervention on rates of letter naming by English Language Learners (ELL). Participants were four kindergarten students performing below the average letter naming level and learning rate than other ELL classmates. The fast paced intervention consisted of a…

  17. Regional myocardial blood flow and coronary vascular reserve in unanesthetized ponies during pacing-induced ventricular tachycardia

    SciTech Connect

    Parks, C.; Manohar, M.; Lundeen, G.

    1983-08-01

    To examine the effects of tachycardia on coronary circulation, transmural distribution of myocardial blood flow (MBF, 15-micron diameter radionuclide-labeled microspheres) was studied in six healthy adult ponies at rest (heart rate . 60 +/- 7 beats . min-1), during ventricular pacing at 150 and 200 beats . min-1, as well as with ventricular pacing at 250 beats . min-1 before and during maximal coronary vasodilatation (iv adenosine infusion; 4 mumole . kg-1 . min-1). Mean aortic pressure and cardiac output were unchanged from control values with ventricular pacing. Whereas ventricular pacing at 150 and 200 beats . min-1 resulted in a progressive uniform increase in transmural MBF and well-maintained endo:epi perfusion ratio, pacing at 250 beats . min-1 did not result in a further increase in MBF compared to pacing at 200 beats . min-1 and the left ventricular (LV) subendocardial:subepicardial (endo:epi) perfusion ratio was significantly less than 1.00 (0.87 +/- 0.05). Blood flow to the LV papillary muscles and subendocardium was significantly less than that recorded at 200 beats . min-1. The LV endo:epi perfusion ratio with ventricular pacing at 250 beats . min-1 during adenosine infusion resulted in a decrease in mean aortic pressure (63% of control value) and a marked further reduction in blood flow to the LV papillary muscles as well as the LV subendocardium, while MBF increased dramatically in the LV subepicardium compared to values observed during ventricular pacing at 250 beats . min-1 alone. These data demonstrate that coronary vasomotion functions to maintain LV subendocardial blood flow in the pony myocardium at a heart rate of 200 beats . min-1, while at 250 beats . min-1 exhaustion of coronary vasodilator reserve in the deeper layers limits further increase in MBF.

  18. PACE Status Update

    SciTech Connect

    M., Zimring,; Hoffman, I.; Fuller, M.

    2010-08-11

    The Federal Housing Finance Agency (FHFA) regulates Fannie Mae, Freddie Mac, and the 12 Federal Home Loan Banks (the government-sponsored enterprises - GSEs). On July 6, 2010, FHFA and the Office of the Comptroller of the Currency (OCC) concluded that Property Assessed Clean Energy (PACE) programs 'present significant safety and soundness concerns' to the housing finance industry. This statement came after a year of discussions with state and federal agencies in which PACE, a novel mechanism for financing energy efficiency and renewable energy improvements, has gone from receiving support from the White House, canonization as one of Scientific American's 'World Changing Ideas' and legislative adoption in 24 states to questionable relevance, at least in the residential sector. Whether PACE resumes its expansion as an innovative tool for financing energy efficiency and clean generation depends on outcomes in each of the three branches of government - discussions on a PACE pilot phase among federal agencies, litigation in federal court, and legislation in Congress - all highly uncertain. This policy brief addresses the practical impacts of these possible outcomes on existing and emerging PACE programs across the United States and potential paths forward.

  19. Project for Program Improvement through the Utilization of Self-Paced Individualized Instruction Concepts Industrial Equipment Technology. Final Report.

    ERIC Educational Resources Information Center

    Crowley's Ridge Vocational Technical School, Forrest City, AR.

    The general objectives of an Arkansas technical school's self-paced individualized instruction program were designing, field testing, and disseminating an instructional management system with support materials that identify and justify the need for a program of instruction. Eight specific objectives have been developed to facilitate students'…

  20. PACE4: a subtilisin-like endoprotease with unique properties.

    PubMed Central

    Mains, R E; Berard, C A; Denault, J B; Zhou, A; Johnson, R C; Leduc, R

    1997-01-01

    PACE4 is one of the neuroendocrine-specific mammalian subtilisin-related endoproteases believed to function in the secretory pathway. The biosynthesis and secretion of PACE4 have been studied using transfected neuroendocrine and fibroblast cell lines. as well as primary pituitary cultures. ProPACE4 (approx. 106 kDa) is cleaved intracellularly before secretion of PACE4 (approx. 97 kDa); the N-terminal propeptide cleavage is accelerated in a truncated form of PACE4 lacking the Cys-rich C-terminal region (PACE4s). Neither PACE4 nor PACE4s is stored in regulated neuroendocrine secretory granules, whereas pro-opiomelanocortin-derived peptides and prohormone convertase I enter the regulated secretory pathway efficiently. The relatively slow cleavage of the proregion of proPACE4 in primary anterior pituitary cells, followed by rapid secretion of PACE4, is similar to the results for proPACE4 in transfected cell lines. The enzyme activity of PACE4 is distinct from furin and prohormone convertases, both in the marked sensitivity of PACE4 to inhibition by leupeptin and the relative insensitivity of PACE4 to inhibition by Ca2+ chelators and dithiothreitol; PACE4 is not inhibited by the alpha1-antitrypsin Portland variant that is very potent at inhibiting furin. The unique biosynthetic and enzymic patterns seen for PACE4 suggest a role for this neuroendocrine-specific subtilisin-like endoprotease outside the pathway for peptide biosynthesis. PMID:9032441

  1. Permanent cardiac pacing in pediatric patients.

    PubMed

    Lotfy, Wael; Hegazy, Ranya; AbdElAziz, Osama; Sobhy, Rodina; Hasanein, Hossam; Shaltout, Fawzan

    2013-02-01

    Pediatric pacemaker (PM) implants comprise less than 1 % of all PM implants. This study aimed to investigate permanent cardiac pacing among the pediatric population, identifying different indications and complications of pediatric cardiac pacing, especially focusing on the effect of the pacing sites, the PM lead type, and the indications for pacing. The current work is a cross-sectional study of 103 procedures for permanent PM insertion in pediatric patients between January 2001 and December 2010. The patients were followed up 1, 3, and 6 months after implantation, then every 6 months or as needed. Evaluation included routine clinical examination, electrocardiography, chest X-ray, echocardiography, and a full analysis of the pacing system measurements. The ages of the patients ranged from 0.09 to 12 years (median, 2.3 years). The most common indication for pacing was postoperative complete heart bock, noted in 54 patients (52.4 %). Transvenous endocardial PM insertion was performed in 92 procedures (89.3 %), whereas transthoracic epicardial insertion was performed in 11 procedures (10.7 %). The most common site of pacing was the right ventricular apex (n = 64, 62 %), followed by the right ventricular outflow tract (n = 25, 24.3 %). Transthoracic epicardial PM insertion was associated with a significantly higher percentage and greater severity of complications. In this study, 65 % of the patients with left ventricle (LV) dilation before pacing showed a significant improvement in LV dimensions and function after pacing. This was noted only in those with endocardially inserted PM leads in both the congenital and the postoperative groups regardless of the pacing site. Endocardial PM insertion in children is a safe procedure with fewer complications and a lower ventricular threshold than the epicardial route. Permanent single-chamber right ventricle pacing is safe and can lead to significant improvement in LV function and dimensions. However, long-term follow

  2. Reversal of Pacing-Induced Cardiomyopathy by Normal QRS Axis Pacing

    PubMed Central

    Yang, Ji Hyun; Kim, Ju Youn; Kim, Sung-Hwan

    2016-01-01

    Right ventricular apical pacing has been a commonly used method for placement of permanent pacemaker, but it is known to be associated with ventricular dyssynchrony and may lead to heart failure. Septal pacing could be an alternative method to improve this complication but the results have been conflicting; hence, other strategies are needed. This case is about a patient with pacing-induced cardiomyopathy who showed much improvement after repositioning the leads to a site different from that of normally paced QRS axis. PMID:27275181

  3. Self-Paced Fortran.

    ERIC Educational Resources Information Center

    Burnett, James

    1979-01-01

    This paper describes the instructional format of the lecture and the self-paced methods of teaching FORTRAN at Michigan State University and compares end-of-term grades of students taking a second computer science course based on whether they took the first course in the self-paced or the traditional lecture format. (Author/BB)

  4. Development and evaluation of the feasibility and effects on staff, patients, and families of a new tool, the Psychosocial Assessment and Communication Evaluation (PACE), to improve communication and palliative care in intensive care and during clinical uncertainty

    PubMed Central

    2013-01-01

    Background There are widespread concerns about communication and support for patients and families, especially when they face clinical uncertainty, a situation most marked in intensive care units (ICUs). Therefore, we aimed to develop and evaluate an interventional tool to improve communication and palliative care, using the ICU as an example of where this is difficult. Methods Our design was a phase I-II study following the Medical Research Council Guidance for the Development and Evaluation of Complex Interventions and the (Methods of Researching End-of-life Care (MORECare) statement. In two ICUs, with over 1900 admissions annually, phase I modeled a new intervention comprising implementation training and an assessment tool. We conducted a literature review, qualitative interviews, and focus groups with 40 staff and 13 family members. This resulted in the new tool, the Psychosocial Assessment and Communication Evaluation (PACE). Phase II evaluated the feasibility and effects of PACE, using observation, record audit, and surveys of staff and family members. Qualitative data were analyzed using the framework approach. The statistical tests used on quantitative data were t-tests (for normally distributed characteristics), the χ2 or Fisher’s exact test (for non-normally distributed characteristics) and the Mann–Whitney U-test (for experience assessments) to compare the characteristics and experience for cases with and without PACE recorded. Results PACE provides individualized assessments of all patients entering the ICU. It is completed within 24 to 48 hours of admission, and covers five aspects (key relationships, social details and needs, patient preferences, communication and information status, and other concerns), followed by recording of an ongoing communication evaluation. Implementation is supported by a training program with specialist palliative care. A post-implementation survey of 95 ICU staff found that 89% rated PACE assessment as very or

  5. Physiological cardiac pacing: Current status.

    PubMed

    Das, Asit; Kahali, Dhiman

    2016-01-01

    Adverse hemodynamics of right ventricular (RV) pacing is a well-known fact. It was believed to be the result of atrio-ventricular (AV) dyssynchrony and sequential pacing of the atrium and ventricle may solve these problems. However, despite maintenance of AV synchrony, the dual chamber pacemakers in different trials have failed to show its superiority over single chamber RV apical pacing in terms of death, progression of heart failure, and atrial fibrillation (AF). As a consequence, investigators searched for alternate pacing sites with a more physiological activation pattern and better hemodynamics. Direct His bundle pacing and Para-Hisian pacing are the most physiological ventricular pacing sites. But, this is technically difficult. Ventricular septal pacing compared to apical pacing results in a shorter electrical activation delay and consequently less mechanical dyssynchrony. But, the study results are heterogeneous. Selective site atria pacing (atrial septal) is useful for patients with atrial conduction disorders in prevention of AF. PMID:27543481

  6. Promoting continence in nursing homes in four European countries: the use of PACES as a mechanism for improving the uptake of evidence-based recommendations

    PubMed Central

    Harvey, Gill; Kitson, Alison; Munn, Zachary

    2012-01-01

    Background Multi-faceted approaches are generally recognised as the most effective way to support the implementation of evidence into practice. Audit and feedback often constitute one element of a multi-faceted implementation package, alongside other strategies, such as interactive education and facilitated support mechanisms. This paper describes a multi-faceted implementation strategy that used the Joanna Briggs Institute Practical Application of Clinical Evidence System (PACES) as an online audit tool to support facilitators working to introduce evidence-based continence recommendations in nursing homes in four different European countries. Aims/objectives The paper describes the experience of using PACES with an international group of nursing home facilitators. In particular, the objectives of the paper are: to describe the process of introducing PACES to internal facilitators in eight nursing homes; to discuss the progress made during a 12-month period of collecting and analysing audit data using PACES; to summarise the collective experience of using PACES, including reflections on its strengths and limitations. Methods Descriptive data were collected during the 12-month period of working with PACES in the eight nursing home sites. These data included digital and written notes taken at an initial 3-day introductory programme, at monthly teleconferences held between the external and internal facilitators and at a final 2-day meeting. Qualitative analysis of the data was undertaken on an ongoing basis throughout the implementation period, which enabled formative evaluation of PACES. A final summative evaluation of the experience of using PACES was undertaken as part of the closing project meeting in June 2011. Results The nursing home facilitators took longer than anticipated to introduce PACES and it was only after 9–10 months that they became confident and comfortable using the system. This was due to a combination of factors, including a lack of audit

  7. Transferring PACE Assessments Upon Home Sale

    SciTech Connect

    National Renewable Energy Laboratory; Coughlin, Jason; Fuller, Merrian; Zimring, Mark

    2010-04-12

    A significant barrier to investing in renewable energy and comprehensive energy efficiency improvements to homes across the country is the initial capital cost. Property Assessed Clean Energy (PACE) financing is one of several new financial models broadening access to clean energy by addressing this upfront cost issue. Recently, the White House cited PACE programs as an important element of its 'Recovery through Retrofit' plan. The residential PACE model involves the creation of a special clean energy financing district that homeowners elect to opt into. Once opted in, the local government (usually at the city or county level) finances the upfront investment of the renewable energy installation and/or energy efficiency improvements. A special lien is attached to the property and the assessment is paid back as a line item on the property tax bill. As of April 2010, 17 states have passed legislation to allow their local governments to create PACE programs, two already have the authority to set up PACE programs, and over 10 additional states are actively developing enabling legislation. This policy brief analyzes one of the advantages of PACE, which is the transferability of the special assessment from one homeowner to the next when the home is sold. This analysis focuses on the potential for the outstanding lien to impact the sales negotiation process, rather than the legal nature of the lien transfer itself. The goal of this paper is to consider what implications a PACE lien may have on the home sales negotiation process so that it can be addressed upfront rather than risk a future backlash to PACE programs. If PACE programs do expand at a rapid rate, the chances are high that there will be other cases where prospective buyers uses PACE liens to negotiate lower home prices or require repayment of the lien as a condition of sale. As a result, PACE programs should highlight this issue as a potential risk factor for the sake of full disclosure. A good example of this

  8. Self-Paced Studies.

    ERIC Educational Resources Information Center

    Faust, Norma Jean

    1995-01-01

    Discusses the use of self-paced units. Development suggestions include determining the form of the units, including goals, responsibilities, and definitions of terms; keeping them short; including a variety of activities; and requiring that all lessons be completed at school. Contains sample units on climatology and meteorology, the sun, and…

  9. Cardiac pacing and aviation.

    PubMed

    Toff, W D; Edhag, O K; Camm, A J

    1992-12-01

    Certain applicants with stable disturbances of rhythm or conduction requiring cardiac pacing, in whom no other disqualifying condition is present, may be considered fit for medical certification restricted to multi-crew operations. The reliability of modern pacing systems appears adequate to permit restricted certification even in pacemaker dependent subjects except for certain models of pacemakers and leads known to be at increased risk of failure. These are to be avoided. There is little evidence to suggest that newer devices are any more reliable than their predecessors. Single and dual chamber systems appear to have similar reliability up to 4 years, after which time significant attrition of dual chamber devices occurs, principally due to battery depletion. All devices require increased scrutiny as they approach their end of life as predicted from longevity data and pacing characteristics. Unipolar and bipolar leads are of similar reliability, apart from a number of specific bipolar polyurethane leads which have been identified. Atrial leads, particularly those without active fixation, are less secure than ventricular leads and applicants who are dependent on atrial sensing or pacing should be denied certification. Bipolar leads are to be preferred due to the lower risk of myopotential and exogenous EMI. Sensor-driven adaptive-rate pacing systems using active sensors may have reduced longevity and require close scrutiny. Activity-sensing devices using piezoelectric crystal sensors may be subject to significant rate rises in rotary wing aircraft. The impracticality of restricted certification in helicopters will, in any event, preclude certification. Such devices would best be avoided in hovercraft (air cushioned vehicle) pilots. Only minor rate rises are likely in fixed-wing aircraft which are unlikely to be of significance. Anti-tachycardia devices and implanted defibrillators are inconsistent with any form of certification to fly. PMID:1493823

  10. Optimized multisite ventricular pacing in postoperative single-ventricle patients.

    PubMed

    Havalad, Vinod; Cabreriza, Santos E; Cheung, Eva W; Aponte-Patel, Linda; Wang, Alice; Cheng, Bin; Wang, Daniel Y; Silver, Eric; Bacha, Emile A; Spotnitz, Henry M

    2014-10-01

    Ventricular dyssynchrony is associated with morbidity and mortality after palliation of a single ventricle. The authors hypothesized that resynchronization with optimized temporary multisite pacing postoperatively would be safe, feasible, and effective. Pacing was assessed in the intensive care unit within the first 24 h after surgery. Two unipolar atrial pacing leads and four bipolar ventricular pacing leads were placed at standardized sites intraoperatively. Pacing was optimized to maximize mean arterial pressure. The protocol tested 11 combinations of the 4 different ventricular lead sites, 6 atrioventricular delays (50-150 ms), and 14 intraventricular delays. Optimal pacing settings were thus determined and ultimately compared in four configurations: bipolar, unipolar, single-site atrioventricular pacing, and intrinsic rhythm. Each patient was his or her own control, and all pacing comparisons were implemented in random sequence. Single-ventricle palliation was performed for 17 children ages 0-21 years. Pacing increased mean arterial pressure (MAP) versus intrinsic rhythm, with the following configurations: bipolar multisite pacing increased MAP by 2.2 % (67.7 ± 2.4 to 69.2 ± 2.4 mmHg; p = 0.013) and unipolar multisite pacing increased MAP by 2.8 % (67.7 ± 2.4 to 69.6 ± 2.7 mmHg; p = 0.002). Atrioventricular single-site pacing increased MAP by 2.1 % (67.7 ± 2.4 to 69.1 ± 2.5 mmHg: p = 0.02, insignificant difference under Bonferroni correction). The echocardiographic fractional area change in nine patients increased significantly only with unipolar pacing (32 ± 3.1 to 36 ± 4.2 %; p = 0.02). No study-related adverse events occurred. Multisite pacing optimization is safe and feasible in the early postoperative period after single-ventricle palliation, with improvements in mean arterial pressure and fractional area shortening. Further study to evaluate clinical benefits is required. PMID:24827078

  11. TCP Pacing Developed

    NASA Technical Reports Server (NTRS)

    Ivancic, William D.

    2002-01-01

    Transmission control protocol (TCP) was conceived and designed to run over a variety of communication links, including wireless and high-bandwidth links. However, with recent technological advances in satellite and fiber-optic networks, researchers are reevaluating the flexibility of TCP. The TCP pacing and packet pair probing implementation may help overcome two of the major obstacles identified for efficient bandwidth utilization over communication links with large delay-bandwidth products.

  12. Controlled transient respiratory arrest along with rapid right ventricular pacing for improving balloon stability during balloon valvuloplasty in pediatric patients with congenital aortic stenosis--a retrospective case series analysis.

    PubMed

    Gupta, Sampa Dutta; Das, Soumi; Ghose, Tapas; Sarkar, Achyut; Goswami, Anupam; Kundu, Sudeshna

    2010-01-01

    Rapid right ventricular pacing is safe, effective, and established method to provide balloon stability during balloon aortic valvuloplasty (BAV). Controlled transient respiratory arrest at this point of time may further reduce left ventricular stroke volume, providing an additional benefit to maintain balloon stability. Two groups were studied. Among the 10 patients, five had rapid pacing alone (Group A), while the other five were provided with cessation of positive pressure breathing as well (Group B). The outcomes of BAV in the two groups of patients were studied. One patient in Group A had failed balloon dilatation even after the fourth attempt, while in Group B there were no failures. The peak systolic gradient reduction was higher in Group B (70.05% in comparison to 52.16% of group A). In Group A, five subjects developed aortic regurgitation (grade 2 in four and grade 3 in one, while no grade 3 aortic regurgitation developed in any patient in Group B). Controlled transient respiratory arrest along with rapid ventricular pacing may be effective in maintaining balloon stability and improve the outcome of BAV. PMID:20826965

  13. Enact legislation supporting residential property assessed clean energy financing (PACE)

    SciTech Connect

    Saha, Devashree

    2012-11-15

    Congress should enact legislation that supports residential property assessed clean energy (PACE) programs in the nation’s states and metropolitan areas. Such legislation should require the Federal Housing Finance Agency (FHFA) to allow Fannie Mae and Freddie Mac to purchase residential mortgages with PACE assessments while at the same time providing responsible underwriting standards and a set of benchmarks for residential PACE assessments in order to minimize financial risks to mortgage holders. Congressional support of residential PACE financing will improve energy efficiency, encourage job creation, and foster economic growth in the nation’s state and metropolitan areas.

  14. [The best of cardiac pacing in 1999].

    PubMed

    Deharo, J C

    2000-01-01

    Since the first clinical application to man forty years ago, for the treatment of bradycardia, cardiac pacing has been the object of continuous technological innovation in parallel with those in electronics and computerisation. However, independently of these expected advances, there has been a surprising widening of the field of application of pacing into those of haemodynamics and rhythmology. The recent publication of the long-term results of the Pacing in Cardiomyopathy (PIC) study confirmed the sustained decrease of intraventricular pressure gradient, of NYHA functional stage and improved quality of life of patients with hypertrophic obstructive cardiomyopathy paced in the DDD mode. The investigators also underlined the placebo effect of the pacemaker. The decrease in risk of sudden death and the reduction in ventricular remodelling have not been demonstrated yet. More recently, biventricular pacing has been proposed for the treatment of dilated cardiomyopathy and a French study showed a long-term improvement in NYHA stage and effort capacity. Several prospective randomised trials are under way to validate this indication. Acute haemodynamic evaluations have confirmed the efficacy of biventricular stimulation but also underline the value of left ventricular pacing alone. The effects on mortality, the selection of patients and the optimal configuration of pacing remain to be defined. In the field of prevention of atrial arrhythmias, the results of the multicenter SYNBIAPACE study, investigating biatrial pacing in patients with interatrial conduction defects, only showed a tendency to an increase in the delay before recurrence of atrial fibrillation. The value of the memory functions of pacemakers and the algorithms of prevention of atrial arrhythmias are still under investigation. Haemodynamic transducers have been introduced in some recent pacemakers to assess myocardial contractility and have applications in the evaluation of different pacing modes and in the

  15. Noninvasive external cardiac pacing for thallium-201 scintigraphy

    SciTech Connect

    Feldman, M.D.; Warren, S.E.; Gervino, E.V.; Aroesty, J.M.; Royal, H.D.; Parker, J.A.; Silverman, K.J.; Kolodny, G.M.; Zoll, P.M.; McKay, R.G.

    1988-01-01

    Improvements in noninvasive external cardiac pacing have led to a technique with reliable electrical capture and tolerable patient discomfort. To assess the use of this modality of pacing in combination with thallium scintigraphy as a noninvasive pacing stress test, we applied simultaneous noninvasive cardiac pacing, hemodynamic monitoring, and thallium-201 scintigraphy in 14 patients undergoing cardiac catheterization for chest pain syndromes. Two patients had normal coronary arteries, while the remaining 12 had significant coronary artery disease. Thallium scintigraphic responses to pacing were compared to routine exercise thallium stress testing in nine of these 14 patients. All patients were noninvasively paced to more than 85% of the age-predicted maximum heart rate. Twelve patients demonstrated reversible thallium defects, which corresponded in 11 cases to significant lesions seen on coronary angiography. Of nine patients who underwent both pacing and exercise thallium stress tests, comparable maximal rate-pressure products were achieved. Moreover, thallium imaging at peak pacing and during delayed views did not differ significantly from exercise thallium scintigraphy. A limiting factor associated with the technique was local patient discomfort, which occurred to some degree in all patients. We conclude that noninvasive external cardiac pacing together with thallium scintigraphy is capable of detecting significant coronary artery disease and may be comparable to routine exercise thallium stress testing. This new modality of stress testing could be useful in patients unable to undergo the exercise required for standard exercise tolerance testing, particularly if improvements in the technology can be found to reduce further the local discomfort.

  16. Self-Paced Instruction: Hello, Education

    ERIC Educational Resources Information Center

    Leuba, Richard J.; Flammer, Gordon H.

    1975-01-01

    Answers criticisms of self-paced instruction (SPI) by citing advantages of SPI over lecture methods. Concludes that criticisms of SPI are useful since they indicate in which areas further research should be conducted to improve this method of instruction. (MLH)

  17. Sectoral approaches to improve regional carbon budgets

    SciTech Connect

    Smith, Pete; Nabuurs, Gert-Jan; Marland, Gregg

    2008-06-01

    Humans utilise about 40% of the earth s net primary production (NPP) but the products of this NPP are often managed by different sectors, with timber and forest products managed by the forestry sector and food and fibre products from croplands and grasslands managed by the agricultural sector. Other significant anthropogenic impacts on the global carbon cycle include human utilization of fossil fuels and impacts on less intensively managed systems such as peatlands, wetlands and permafrost. A great deal of knowledge, expertise and data is available within each sector. We describe the contribution of sectoral carbon budgets to our understanding of the global carbon cycle. Whilst many sectors exhibit similarities for carbon budgeting, some key differences arise due to differences in goods and services provided, ecology, management practices used, landmanagement personnel responsible, policies affecting land management, data types and availability, and the drivers of change. We review the methods and data sources available for assessing sectoral carbon budgets, and describe some of key data limitations and uncertainties for each sector in different regions of the world. We identify the main gaps in our knowledge/data, show that coverage is better for the developed world for most sectors, and suggest how sectoral carbon budgets could be improved in the future. Research priorities include the development of shared protocols through site networks, a move to full carbon accounting within sectors, and the assessment of full greenhouse gas budgets.

  18. Protein-Pacing and Multi-Component Exercise Training Improves Physical Performance Outcomes in Exercise-Trained Women: The PRISE 3 Study †

    PubMed Central

    Arciero, Paul J.; Ives, Stephen J.; Norton, Chelsea; Escudero, Daniela; Minicucci, Olivia; O’Brien, Gabe; Paul, Maia; Ormsbee, Michael J.; Miller, Vincent; Sheridan, Caitlin; He, Feng

    2016-01-01

    The beneficial cardiometabolic and body composition effects of combined protein-pacing (P; 5–6 meals/day at 2.0 g/kg BW/day) and multi-mode exercise (resistance, interval, stretching, endurance; RISE) training (PRISE) in obese adults has previously been established. The current study examines PRISE on physical performance (endurance, strength and power) outcomes in healthy, physically active women. Thirty exercise-trained women (>4 days exercise/week) were randomized to either PRISE (n = 15) or a control (CON, 5–6 meals/day at 1.0 g/kg BW/day; n = 15) for 12 weeks. Muscular strength (1-RM bench press, 1-RM BP) endurance (sit-ups, SUs; push-ups, PUs), power (bench throws, BTs), blood pressure (BP), augmentation index, (AIx), and abdominal fat mass were assessed at Weeks 0 (pre) and 13 (post). At baseline, no differences existed between groups. Following the 12-week intervention, PRISE had greater gains (p < 0.05) in SUs, PUs (6 ± 7 vs. 10 ± 7, 40%; 8 ± 13 vs. 14 ± 12, 43% ∆reps, respectively), BTs (11 ± 35 vs. 44 ± 34, 75% ∆watts), AIx (1 ± 9 vs. −5 ± 11, 120%), and DBP (−5 ± 9 vs. −11 ± 11, 55% ∆mmHg). These findings suggest that combined protein-pacing (P; 5–6 meals/day at 2.0 g/kg BW/day) diet and multi-component exercise (RISE) training (PRISE) enhances muscular endurance, strength, power, and cardiovascular health in exercise-trained, active women. PMID:27258301

  19. Protein-Pacing and Multi-Component Exercise Training Improves Physical Performance Outcomes in Exercise-Trained Women: The PRISE 3 Study.

    PubMed

    Arciero, Paul J; Ives, Stephen J; Norton, Chelsea; Escudero, Daniela; Minicucci, Olivia; O'Brien, Gabe; Paul, Maia; Ormsbee, Michael J; Miller, Vincent; Sheridan, Caitlin; He, Feng

    2016-01-01

    The beneficial cardiometabolic and body composition effects of combined protein-pacing (P; 5-6 meals/day at 2.0 g/kg BW/day) and multi-mode exercise (resistance, interval, stretching, endurance; RISE) training (PRISE) in obese adults has previously been established. The current study examines PRISE on physical performance (endurance, strength and power) outcomes in healthy, physically active women. Thirty exercise-trained women (>4 days exercise/week) were randomized to either PRISE (n = 15) or a control (CON, 5-6 meals/day at 1.0 g/kg BW/day; n = 15) for 12 weeks. Muscular strength (1-RM bench press, 1-RM BP) endurance (sit-ups, SUs; push-ups, PUs), power (bench throws, BTs), blood pressure (BP), augmentation index, (AIx), and abdominal fat mass were assessed at Weeks 0 (pre) and 13 (post). At baseline, no differences existed between groups. Following the 12-week intervention, PRISE had greater gains (p < 0.05) in SUs, PUs (6 ± 7 vs. 10 ± 7, 40%; 8 ± 13 vs. 14 ± 12, 43% ∆reps, respectively), BTs (11 ± 35 vs. 44 ± 34, 75% ∆watts), AIx (1 ± 9 vs. -5 ± 11, 120%), and DBP (-5 ± 9 vs. -11 ± 11, 55% ∆mmHg). These findings suggest that combined protein-pacing (P; 5-6 meals/day at 2.0 g/kg BW/day) diet and multi-component exercise (RISE) training (PRISE) enhances muscular endurance, strength, power, and cardiovascular health in exercise-trained, active women. PMID:27258301

  20. Improving image segmentation by learning region affinities

    SciTech Connect

    Prasad, Lakshman; Yang, Xingwei; Latecki, Longin J

    2010-11-03

    We utilize the context information of other regions in hierarchical image segmentation to learn new regions affinities. It is well known that a single choice of quantization of an image space is highly unlikely to be a common optimal quantization level for all categories. Each level of quantization has its own benefits. Therefore, we utilize the hierarchical information among different quantizations as well as spatial proximity of their regions. The proposed affinity learning takes into account higher order relations among image regions, both local and long range relations, making it robust to instabilities and errors of the original, pairwise region affinities. Once the learnt affinities are obtained, we use a standard image segmentation algorithm to get the final segmentation. Moreover, the learnt affinities can be naturally unutilized in interactive segmentation. Experimental results on Berkeley Segmentation Dataset and MSRC Object Recognition Dataset are comparable and in some aspects better than the state-of-art methods.

  1. Restructuring VA ambulatory care and medical education: the PACE model of primary care.

    PubMed

    Cope, D W; Sherman, S; Robbins, A S

    1996-07-01

    The Veterans Health Administration (VHA) Western Region and associated medical schools formulated a set of recommendations for an improved ambulatory health care delivery system during a 1988 strategic planning conference. As a result, the Department of Veterans Affairs (VA) Medical Center in Sepulveda, California, initiated the Pilot (now Primary) Ambulatory Care and Education (PACE) program in 1990 to implement and evaluate a model program. The PACE program represents a significant departure from traditional VA and non-VA academic medical center care, shifting the focus of care from the inpatient to the outpatient setting. From its inception, the PACE program has used an interdisciplinary team approach with three independent global care firms. Each firm is interdisciplinary in composition, with a matrix management structure that expands role function and empowers team members. Emphasis is on managed primary care, stressing a biopsychosocial approach and cost-effective comprehensive care emphasizing prevention and health maintenance. Information management is provided through a network of personal computers that serve as a front end to the VHA Decentralized Hospital Computer Program (DHCP) mainframe. In addition to providing comprehensive and cost-effective care, the PACE program educates trainees in all health care disciplines, conducts research, and disseminates information about important procedures and outcomes. Undergraduate and graduate trainees from 11 health care disciplines rotate through the PACE program to learn an integrated approach to managed ambulatory care delivery. All trainees are involved in a problem-based approach to learning that emphasizes shared training experiences among health care disciplines. This paper describes the transitional phases of the PACE program (strategic planning, reorganization, and quality improvement) that are relevant for other institutions that are shifting to training programs emphasizing primary and ambulatory care

  2. Factors influencing pacing in triathlon

    PubMed Central

    Wu, Sam SX; Peiffer, Jeremiah J; Brisswalter, Jeanick; Nosaka, Kazunori; Abbiss, Chris R

    2014-01-01

    Triathlon is a multisport event consisting of sequential swim, cycle, and run disciplines performed over a variety of distances. This complex and unique sport requires athletes to appropriately distribute their speed or energy expenditure (ie, pacing) within each discipline as well as over the entire event. As with most physical activity, the regulation of pacing in triathlon may be influenced by a multitude of intrinsic and extrinsic factors. The majority of current research focuses mainly on the Olympic distance, whilst much less literature is available on other triathlon distances such as the sprint, half-Ironman, and Ironman distances. Furthermore, little is understood regarding the specific physiological, environmental, and interdisciplinary effects on pacing. Therefore, this article discusses the pacing strategies observed in triathlon across different distances, and elucidates the possible factors influencing pacing within the three specific disciplines of a triathlon. PMID:25258562

  3. An Undergraduate Intern Program at PACES

    NASA Technical Reports Server (NTRS)

    Starks, Scott A.

    1997-01-01

    The University of Texas at El Paso (UTEP) established the Pan American Center for Earth and Environmental Studies (PACES) in 1995 to conduct basic and applied research that contributes to NASA's Mission to Planet Earth. Specifically, PACES provides a repository of remote sensing and other information that supports investigations into an improved understanding of geological, ecological and environmental processes occurring in the southwestern United States and Northern Mexico. Approximately 85% of UTEP's students come from El Paso County, a fast growing urban region representative of many large cities in the Southwest that have, or will soon have, a majority of their population composed of groups currently underrepresented in the scientific and technical workforce. UTEP's student population has an ethnic distribution (63% Hispanic, 32% Anglo, 3% African American, 1.5 % Asian American, and less than 1% Native American) that closely matches the demographics of the region it serves. Thus, UTEP has a mission to serve a multicultural population where minority students comprise the majority. Most Hispanic students at UTEP are primarily of Mexican origin. A large number are first or second-generation U.S. citizens. Characteristics that unite Hispanic students, in particular those of Mexican-origin, are a strong sense of family loyalty and a belief that all family members are responsible for contributing to the economic stability and well-being of the family. Most of their families are larger in number than the national average, and a variety of generations live together or share considerable resources. Thus, many young people feel an obligation and a desire to go to work at a young age and to continue working while in college, thereby assisting their parents and other family members. Older siblings understand that they have responsibilities to do household chores, to aid their younger siblings economically, and to assist elderly family members. This "work ethic" within the

  4. Health Information System Simulation. Curriculum Improvement Project. Region II.

    ERIC Educational Resources Information Center

    Anderson, Beth H.; Lacobie, Kevin

    This volume is one of three in a self-paced computer literacy course that gives allied health students a firm base of knowledge concerning computer usage in the hospital environment. It also develops skill in several applications software packages. This volume contains five self-paced modules that allow students to interact with a health…

  5. Historical highlights in cardiac pacing.

    PubMed

    Geddes, L A

    1990-01-01

    The benchmarks in cardiac pacing are identified, beginning with F. Steiner (1871), who rhythmically stimulated the chloroform-arrested hearts of 3 horses, 1 donkey, 10 dogs, 14 cats, and 8 rabbits. The chloroform-arrested heart in human subjects was paced by T. Greene in the following year (1872) in the UK. In 1882, H. Ziemssen in Germany applied cardiac pacing to a 42-year old woman who had a large defect in the anterior left chest wall subsequent to resection of an enchondroma. Intentional cardiac pacing did not occur until 1932, when A.A. Hyman in the US demonstrated that cardiac pacing could be clinically practical. Hyman made a batteryless pacemaker for delivery in induction shock stimuli (60-120/min) to the atria. His pacemaker was powered by a hand-wound, spring-driven generator which provided 6 min of pacemaking without rewinding. Closed-chest ventricular pacing was introduced in the US in 1952 by P.M. Zoll et al. Zoll (1956) also introduced closed-chest ventricular defibrillation. W.L. Weirich et al. (1958) demonstrated that direct-heart stimulation in closed-chest patients could be achieved with slender wire electrodes. S. Furman and J.B. Schwedel (1959) developed a monopolar catheter electrode for ventricular pacing in man. In the same year, W. Greatbatch and W.M. Chardack developed the implantable pacemaker. PMID:18238328

  6. Improving Regional Air Quality with Wind Energy

    SciTech Connect

    Not Available

    2005-05-01

    This model documentation is designed to assist State and local governments in pursuing wind energy purchases as a control measure under regional air quality plans. It is intended to support efforts to draft State Implementation Plans (SIPs), including wind energy purchases, to ensure compliance with the standard for ground-level ozone established under the Clean Air Act.

  7. Four chamber pacing in dilated cardiomyopathy.

    PubMed

    Cazeau, S; Ritter, P; Bakdach, S; Lazarus, A; Limousin, M; Henao, L; Mundler, O; Daubert, J C; Mugica, J

    1994-11-01

    A 54-year-old man received a four chamber pacing system for severe congestive heart failure (NYHA functional Class IV). His ECG showed a left bundle branch block (200-msec QRS duration) with 200-msec PR interval, normal QRS axis, and 90-msec interatrial interval. An acute hemodynamic study with insertion of four temporary leads was performed prior to the implant, which demonstrated a significant increase in cardiac output and decrease of pulmonary capillary wedge pressure. A permanent pacemaker was implanted based on the encouraging results of the acute study. The right chamber leads were introduced by cephalic and subclavian approaches. The left atrium was paced with a coronary sinus lead, Medtronic SP 2188-58 model. An epicardial Medtronic 5071 lead was placed on the LV free wall. The four leads were connected to a standard bipolar DDD pacemaker, Chorus 6234. The two atrial leads were connected via a Y-connector to the atrial channel of the pacemaker with a bipolar pacing configuration. The two ventricular leads were connected in a similar fashion to the ventricular channel of the device. The right chamber leads were connected to the distal poles. The left chamber leads were connected to the proximal poles of the pacemaker. Six weeks later, the patient's clinical status improved markedly with a weight loss of 17 kg and disappearance of peripheral edema. His functional class was reduced to NYHA II. Four chamber pacing is technically feasible. In patients with evidence of interventricular dyssynchrony, this original pacing mode probably provides a mechanical activation sequence closer to the natural one.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7845801

  8. Slow Pace for Race to Top Spending

    ERIC Educational Resources Information Center

    McNeil, Michele

    2012-01-01

    Almost two years into the federal Race to the Top program, states are spending their shares of the $4 billion prize at a snail's pace--a reflection of the challenges the 12 winners face as they try to get ambitious education improvement plans off the ground. Through the end of March, the 11 states and the District of Columbia had spent just 14…

  9. Optogenetic pacing in Drosophila melanogaster

    PubMed Central

    Alex, Aneesh; Li, Airong; Tanzi, Rudolph E.; Zhou, Chao

    2015-01-01

    Electrical stimulation is currently the gold standard for cardiac pacing. However, it is invasive and nonspecific for cardiac tissues. We recently developed a noninvasive cardiac pacing technique using optogenetic tools, which are widely used in neuroscience. Optogenetic pacing of the heart provides high spatial and temporal precisions, is specific for cardiac tissues, avoids artifacts associated with electrical stimulation, and therefore promises to be a powerful tool in basic cardiac research. We demonstrated optogenetic control of heart rhythm in a well-established model organism, Drosophila melanogaster. We developed transgenic flies expressing a light-gated cation channel, channelrhodopsin-2 (ChR2), specifically in their hearts and demonstrated successful optogenetic pacing of ChR2-expressing Drosophila at different developmental stages, including the larva, pupa, and adult stages. A high-speed and ultrahigh-resolution optical coherence microscopy imaging system that is capable of providing images at a rate of 130 frames/s with axial and transverse resolutions of 1.5 and 3.9 μm, respectively, was used to noninvasively monitor Drosophila cardiac function and its response to pacing stimulation. The development of a noninvasive integrated optical pacing and imaging system provides a novel platform for performing research studies in developmental cardiology. PMID:26601299

  10. Obstacles to activity pacing: assessment, relationship to activity and functioning.

    PubMed

    Cane, Douglas; McCarthy, Mary; Mazmanian, Dwight

    2016-07-01

    Activity pacing is frequently included among the strategies provided to individuals with chronic pain to manage pain and improve functioning. Individuals with chronic pain may, however, limit their use of activity pacing because they perceive significant obstacles to its use. This study describes the development of a measure to assess obstacles to activity pacing and examines the relationship of this measure to activity patterns and functioning. A sample of 637 individuals with chronic pain completed items describing potential obstacles to activity pacing as part of their pretreatment assessment. Item analyses were used to construct a 14-item measure of obstacles to activity pacing. A subset of these individuals completed the measure again after completion of a group treatment program. The resulting measure demonstrated excellent internal consistency and was minimally affected by social desirability. Correlations with measures of activity and psychosocial functioning provided initial construct validity for the measure. Sex differences were found with women initially identifying more obstacles to activity pacing. Fewer obstacles were identified by both men and women after treatment, and these changes were related to modest changes in activity patterns and functioning. The present results identify a number of obstacles that may limit the use of activity pacing by individuals with chronic pain. Treatment may result in a decrease in the number of obstacles identified, and this change is related to changes in the individual's activity pattern and psychosocial functioning. PMID:26963845

  11. Diaphragm pacing: the state of the art

    PubMed Central

    Legras, Antoine; Arame, Alex; Pricopi, Ciprian; Boucherie, Jean-Claude; Badia, Alain; Panzini, Capucine Morelot

    2016-01-01

    Diaphragm pacing (DP) is an orphan surgical procedure that may be proposed in strictly selected ventilator-dependent patients to get an active diaphragm contraction. The goal is to wean from mechanical ventilation (MV) and restore permanent efficient breathing. The two validated indications, despite the lack of randomised control trials, concern patients with high-level spinal cord injuries (SCI) and central hypoventilation syndromes (CHS). To date, two different techniques exist. The first, intrathoracic diaphragm pacing (IT-DP), based on a radiofrequency method, in which the electrodes are directly placed around the phrenic nerve. The second, intraperitoneal diaphragm pacing (IP-DP) uses intradiaphragmatic electrodes implanted through laparoscopy. In both techniques, the phrenic nerves must be intact and diaphragm reconditioning is always required after implantation. No perioperative mortality has been reported and ventilator-weaning rate is about 72% to 96% in both techniques. Improvement of quality of life, by restoring a more physiological breathing, has been almost constant in patients that could be weaned. Failure or delay in recovery of effective diaphragm contractions could be due to irreversible amyotrophy or chest wall damage. Recent works have evaluated the interest of IP-DP in amyotrophic lateral sclerosis (ALS). After some short series were reported in the literature, the only multicentric randomized study including 74 ALS patients was prematurely stopped because of excessive mortality in paced patients. Then, another trial analysed the place of IP-DP in peripheral diaphragm dysfunction but, given the multiple biases, the published results cannot validate that indication. Reviewing all available literature as in our experience, shows that DP is an effective method to wean selected patients dependent on ventilator and improve their daily life. Other potential indications will have to be evaluated by randomised control trials. PMID:27195135

  12. Diaphragm pacing: the state of the art.

    PubMed

    Le Pimpec-Barthes, Francoise; Legras, Antoine; Arame, Alex; Pricopi, Ciprian; Boucherie, Jean-Claude; Badia, Alain; Panzini, Capucine Morelot

    2016-04-01

    Diaphragm pacing (DP) is an orphan surgical procedure that may be proposed in strictly selected ventilator-dependent patients to get an active diaphragm contraction. The goal is to wean from mechanical ventilation (MV) and restore permanent efficient breathing. The two validated indications, despite the lack of randomised control trials, concern patients with high-level spinal cord injuries (SCI) and central hypoventilation syndromes (CHS). To date, two different techniques exist. The first, intrathoracic diaphragm pacing (IT-DP), based on a radiofrequency method, in which the electrodes are directly placed around the phrenic nerve. The second, intraperitoneal diaphragm pacing (IP-DP) uses intradiaphragmatic electrodes implanted through laparoscopy. In both techniques, the phrenic nerves must be intact and diaphragm reconditioning is always required after implantation. No perioperative mortality has been reported and ventilator-weaning rate is about 72% to 96% in both techniques. Improvement of quality of life, by restoring a more physiological breathing, has been almost constant in patients that could be weaned. Failure or delay in recovery of effective diaphragm contractions could be due to irreversible amyotrophy or chest wall damage. Recent works have evaluated the interest of IP-DP in amyotrophic lateral sclerosis (ALS). After some short series were reported in the literature, the only multicentric randomized study including 74 ALS patients was prematurely stopped because of excessive mortality in paced patients. Then, another trial analysed the place of IP-DP in peripheral diaphragm dysfunction but, given the multiple biases, the published results cannot validate that indication. Reviewing all available literature as in our experience, shows that DP is an effective method to wean selected patients dependent on ventilator and improve their daily life. Other potential indications will have to be evaluated by randomised control trials. PMID:27195135

  13. The PACES Summer Science Trek: A Pre-College Science

    NASA Technical Reports Server (NTRS)

    Smith, Michelle B.

    1997-01-01

    The University of Texas at El Paso (UTEP) received five-year funding to form the Pan American Center for Earth and Environmental Studies (PACES) in July 1995. PACES has as its goals to conduct research contributing to NASA's Mission to Planet Earth and to develop skilled scientists and engineers. PACES seeks to gain a more comprehensive understanding of geological, ecological and environmental processes and changes taking place in the southwestern United States and northern Mexico region. The PACES center has collaborative ties with two NASA field center (Goddard Space Flight Center and Ames Research Center) and the Jet Propulsion Laboratory. The original proposal contained no provision for outreach programs. However, at a meeting in the fall of 1995, Dan Goldin, NASA Administrator, issued the challenge that in order to accomplish NASA's goals to educate more of the citizenry in science and engineering, the Centers should take a broader perspective aimed at younger children.

  14. Presentation Time Concerning System-Paced Multimedia Instructions and the Superiority of Learner Pacing

    ERIC Educational Resources Information Center

    Stiller, Klaus D.; Petzold, Kirstin; Zinnbauer, Peter

    2011-01-01

    The superiority of learner-paced over system-paced instructions was demonstrated in multiple experiments. In these experiments, the system-paced presentations were highly speeded, causing cognitive overload, while the learner-paced instructions allowed adjustments of the presentational flow to the learner's needs by pacing facilities, mostly…

  15. Satellite Sounder Data Assimilation for Improving Alaska Region Weather Forecast

    NASA Technical Reports Server (NTRS)

    Zhu, Jiang; Stevens, E.; Zavodsky, B. T.; Zhang, X.; Heinrichs, T.; Broderson, D.

    2014-01-01

    Data assimilation has been demonstrated very useful in improving both global and regional numerical weather prediction. Alaska has very coarser surface observation sites. On the other hand, it gets much more satellite overpass than lower 48 states. How to utilize satellite data to improve numerical prediction is one of hot topics among weather forecast community in Alaska. The Geographic Information Network of Alaska (GINA) at University of Alaska is conducting study on satellite data assimilation for WRF model. AIRS/CRIS sounder profile data are used to assimilate the initial condition for the customized regional WRF model (GINA-WRF model). Normalized standard deviation, RMSE, and correlation statistic analysis methods are applied to analyze one case of 48 hours forecasts and one month of 24-hour forecasts in order to evaluate the improvement of regional numerical model from Data assimilation. The final goal of the research is to provide improved real-time short-time forecast for Alaska regions.

  16. Improving cumulative effects assessment in Alberta: Regional strategic assessment

    SciTech Connect

    Johnson, Dallas Lalonde, Kim; McEachern, Menzie; Kenney, John; Mendoza, Gustavo; Buffin, Andrew; Rich, Kate

    2011-09-15

    The Government of Alberta, Canada is developing a regulatory framework to better manage cumulative environmental effects from development in the province. A key component of this effort is regional planning, which will lay the primary foundation for cumulative effects management into the future. Alberta Environment has considered the information needs of regional planning and has concluded that Regional Strategic Assessment may offer significant advantages if integrated into the planning process, including the overall improvement of cumulative environmental effects assessment in the province.

  17. Improvements in Representations of Cloud Microphysics for BBHRP and Models using Data Collected during M-PACE and TWP-ICE

    SciTech Connect

    Greg M. McFarquhar

    2010-02-22

    In our research we proposed to use data collected during the 2004 Mixed-Phase Arctic Cloud Experiment (MPACE) and the 2006 Tropical Warm Pool International Cloud Experiment (TWP-ICE) to improve retrievals of ice and mixed-phase clouds, to improve our understanding of how cloud and radiative processes affect cloud life cycles, and to develop and test methods for using ARM data more effectively in model. In particular, we proposed to: 1) use MPACE in-situ data to determine how liquid water fraction and cloud ice and liquid effective radius (r{sub ei} and r{sub ew}) vary with temperature, normalized cloud altitude and other variables for Arctic mixed-phase clouds, and to use these data to evaluate the performance of model parameterization schemes and remote sensing retrieval algorithms; 2) calculate rei and size/shape distributions using TWP-ICE in-situ data, investigate their dependence on cirrus type (oceanic or continental anvils or cirrus not directly traced to convection), and develop and test representations for MICROBASE; 3) conduct fundamental research enhancing our understanding of cloud/radiative interactions, concentrating on effects of small crystals and particle shapes and sizes on radiation; and 4) improve representations of microphysical processes for models (fall-out, effective density, mean scattering properties, rei and rew) and provide them to ARM PIs. In the course of our research, we made substantial progress on all four goals.

  18. Science Unit Plans. PACE '94.

    ERIC Educational Resources Information Center

    Schoon, Kenneth J., Ed.; Wiles, Clyde A., Ed.

    This booklet contains mathematics unit plans for Biology, Chemistry, and Physical Science developed by PACE (Promoting Academic Excellence In Mathematics, Science & Technology for Workers of the 21st Century). Each unit plan contains suggested timing, objectives, skills to be acquired, workplace relationships, learning activities with suggested…

  19. Mathematics Unit Plans. PACE '94.

    ERIC Educational Resources Information Center

    Wiles, Clyde A., Ed.; Schoon, Kenneth J., Ed.

    This booklet contains mathematics unit plans for Algebra 1, Geometry, Math for Technology, Mathematical Problem Solving, and Pre-Algebra developed by PACE (Promoting Academic Excellence In Mathematics, Science & Technology for Workers of the 21st Century). Each unit plan contains suggested timing, objectives, skills to be acquired, workplace…

  20. Diaphragmatic pacing in spinal cord injury.

    PubMed

    Dalal, Kevin; DiMarco, Anthony F

    2014-08-01

    After cervical spinal cord injuries, many patients are unable to sustain independent ventilation because of a disruption of diaphragm innervation and respiratory functioning. If phrenic nerve function is preserved, the patient may be able to tolerate exogenous pacing of the diaphragm via electrical stimulation. Previously this was accomplished by stimulation directly to the phrenic nerves, but may be accomplished less invasively by percutaneously stimulating the diaphragm itself. The benefits, when compared with mechanical ventilation, include a lower rate of pulmonary complications, improved venous return, more normal breathing and speech, facilitation of eating, cost-effectiveness, and increased patient mobility. PMID:25064791

  1. Did recent world record marathon runners employ optimal pacing strategies?

    PubMed

    Angus, Simon D

    2014-01-01

    We apply statistical analysis of high frequency (1 km) split data for the most recent two world-record marathon runs: Run 1 (2:03:59, 28 September 2008) and Run 2 (2:03:38, 25 September 2011). Based on studies in the endurance cycling literature, we develop two principles to approximate 'optimal' pacing in the field marathon. By utilising GPS and weather data, we test, and then de-trend, for each athlete's field response to gradient and headwind on course, recovering standardised proxies for power-based pacing traces. The resultant traces were analysed to ascertain if either runner followed optimal pacing principles; and characterise any deviations from optimality. Whereas gradient was insignificant, headwind was a significant factor in running speed variability for both runners, with Runner 2 targeting the (optimal) parallel variation principle, whilst Runner 1 did not. After adjusting for these responses, neither runner followed the (optimal) 'even' power pacing principle, with Runner 2's macro-pacing strategy fitting a sinusoidal oscillator with exponentially expanding envelope whilst Runner 1 followed a U-shaped, quadratic form. The study suggests that: (a) better pacing strategy could provide elite marathon runners with an economical pathway to significant performance improvements at world-record level; and (b) the data and analysis herein is consistent with a complex-adaptive model of power regulation. PMID:23879745

  2. Two-channel gastric pacing in patients with diabetic gastroparesis

    PubMed Central

    Lin, Zhiyue; Sarosiek, Irene; Forster, Jameson; Ross, Robert A.; Chen, Jiande D.Z.; McCallum, Richard W.

    2011-01-01

    Background Our primary goals were to investigate the effects of two-channel gastric pacing on gastric myoelectrical activity, and energy consumption with the secondary intent to monitor gastric emptying and symptoms in patients with severe diabetic gastroparesis. Methods Four pairs of temporary pacing wires were inserted on the serosa of the stomach at the time of laparotomy to place the Enterra™ System in 19 patients with severe gastroparesis not responding to standard medical therapies. Two of the pairs were for electrical stimulation and the other two for recording. Five days after surgery the optimal pacing parameters for the entrainment of gastric slow waves in each patient were identified by serosal recordings. Two-channel gastric pacing was then initiated for 6 weeks using a newly developed external multi-channel pulse generator. Electrogastrogram (EGG), total symptom score (TSS), and a 4-hour gastric emptying test were assessed at baseline and after 6 weeks of active gastric pacing. Enterra™ device was turned OFF during the duration of this study. Key Results Two-channel gastric pacing at 1.1 times the intrinsic frequency entrained gastric slow waves and normalized gastric dysrhythmia. After 6 weeks of gastric pacing, tachygastria was decreased from 15±3 to 5±1% in the fasting state and from 10±2 to 5±1% postprandially (P<0.05), mean TSS was reduced from 21.3±1.1 to 7.0±1.5 (P<0.05) and mean 4-hour gastric retention improved from 42% to 28% (P=0.05). Conclusions& Inferences Two-channel gastric pacing is a novel treatment approach which is able to normalize and enhance gastric slow wave activity as well as accelerate gastric emptying in patients with diabetic gastroparesis with a good safety profile. PMID:21806741

  3. Pacing the Heart with Genes: Recent Progress in Biological Pacing.

    PubMed

    Cho, Hee Cheol

    2015-08-01

    The heartbeat originates within the sinoatrial node (SA node or SAN), a small highly specialized structure containing <10,000 genuine pacemaker cells. The ~5 billion working cardiomyocytes downstream of the SAN remain quiescent when it fails, leading to circulatory collapse and fueling a $6B/year electronic pacemaker industry. The electronic pacemaker devices work quite well. But, device-related problems persist. These include lead failure/repositioning, finite battery life, and infection. For pediatric patients, the children outgrow the length of the leads, necessitating replacement with longer leads. These pitfalls have motivated creation of biological pacing. that are free from all hardware. Toward this goal, we and others have tested the concept of biological pacemakers. Combined with efforts to create clinically relevant, large animal models of biological pacing, the field is moving beyond a conceptual novelty toward a future with clinical reality. PMID:26116393

  4. Trust regions in Kriging-based optimization with expected improvement

    NASA Astrophysics Data System (ADS)

    Regis, Rommel G.

    2016-06-01

    The Kriging-based Efficient Global Optimization (EGO) method works well on many expensive black-box optimization problems. However, it does not seem to perform well on problems with steep and narrow global minimum basins and on high-dimensional problems. This article develops a new Kriging-based optimization method called TRIKE (Trust Region Implementation in Kriging-based optimization with Expected improvement) that implements a trust-region-like approach where each iterate is obtained by maximizing an Expected Improvement (EI) function within some trust region. This trust region is adjusted depending on the ratio of the actual improvement to the EI. This article also develops the Kriging-based CYCLONE (CYClic Local search in OptimizatioN using Expected improvement) method that uses a cyclic pattern to determine the search regions where the EI is maximized. TRIKE and CYCLONE are compared with EGO on 28 test problems with up to 32 dimensions and on a 36-dimensional groundwater bioremediation application in appendices supplied as an online supplement available at http://dx.doi.org/10.1080/0305215X.2015.1082350. The results show that both algorithms yield substantial improvements over EGO and they are competitive with a radial basis function method.

  5. Self-Paced Instruction: A Review

    ERIC Educational Resources Information Center

    Allison, Elisabeth

    1975-01-01

    Discussed the benefits and costs of self-paced instruction (SPI) based on brief summaries of experiences in teaching introductory economics at seven universities. Provided also is a six-step pattern for setting up a self-paced course. The author concludes that the evidence on the educational benefits of self-paced instruction is at present…

  6. 42 CFR 460.186 - PACE premiums.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false PACE premiums. 460.186 Section 460.186 Public...) Payment § 460.186 PACE premiums. The amount that a PACE organization can charge a participant as a monthly premium depends on the participant's eligibility under Medicare and Medicaid, as follows: (a)...

  7. Characterization and comparison of polysaccharides from Lycium barbarum in China using saccharide mapping based on PACE and HPTLC.

    PubMed

    Wu, Ding-Tao; Cheong, Kit-Leong; Deng, Yong; Lin, Peng-Cheng; Wei, Feng; Lv, Xiao-Jie; Long, Ze-Rong; Zhao, Jing; Ma, Shuang-Cheng; Li, Shao-Ping

    2015-12-10

    Water-soluble polysaccharides from 51 batches of fruits of L. barbarum (wolfberry) in China were investigated and compared using saccharide mapping, partial acid hydrolysis, single and composite enzymatic digestion, followed by polysaccharide analysis by using carbohydrate gel electrophoresis (PACE) analysis and high performance thin layer chromatography (HPTLC) analysis, respectively. Results showed that multiple PACE and HPTLC fingerprints of partial acid and enzymatic hydrolysates of polysaccharides from L. barbarum in China were similar, respectively. In addition, results indicated that β-1,3-glucosidic, α-1,4-galactosiduronic and α-1,5-arabinosidic linkages existed in polysaccharides from L. barbarum collected in China, and the similarity of polysaccharides in L. barbarum collected from different regions of China was pretty high, which are helpful for the improvement of the performance of polysaccharides from L. barbarum in functional/health foods area. Furthermore, polysaccharides from Panax notoginseng, Angelica sinensis, and Astragalus membranaceus var. mongholicus were successfully distinguished from those of L. barbarum based on their PACE fingerprints. These results were beneficial to improve the quality control of polysaccharides from L. barabrum and their products, which suggested that saccharide mapping based on PACE and HPTLC analysis could be a routine approach for quality control of polysaccharides. PMID:26428094

  8. Pacing the right ventricular outflow tract septum: time to embrace the future.

    PubMed

    Hillock, Richard J; Mond, Harry G

    2012-01-01

    Transvenous pacing has revolutionized the management of patients with potentially life-threatening bradycardias and at its most basic level ensures rate support to maintain cardiac output. However, we have known for at least a decade that pacing from the right ventricle (RV) apex can induce left ventricle (LV) dysfunction, atrial fibrillation, heart failure, and maybe an increased mortality. Although pacemaker manufacturers have developed successful pacing algorithms designed to minimize unnecessary ventricular pacing, it cannot be avoided in a substantial proportion of pacemaker-dependent patients. Just as there is undoubted evidence that RV apical pacing is injurious, there is emerging evidence that pacing from the RV septum is associated with a shorter duration of activation, improved haemodynamics, and less LV remodelling. The move from traditional RV apical pacing to RV septal pacing requires a change in mindset for many practitioners. The anatomical landmarks and electrocardiograph features of RV septal pacing are well described and easily recognized. While active fixation is required to place the lead on the septum, shaped stylets are now available to assist the implanter. In addition, concerns about the stability and longevity of steroid-eluting active fixation leads have proven to be unfounded. We therefore encourage all implanters to adopt RV septal pacing to minimize the potential of harm to their patients. PMID:21846639

  9. DDD pacing in hypertrophic cardiomyopathy: a multicentre clinical experience.

    PubMed Central

    Slade, A. K.; Sadoul, N.; Shapiro, L.; Chojnowska, L.; Simon, J. P.; Saumarez, R. C.; Dodinot, B.; Camm, A. J.; McKenna, W. J.; Aliot, E.

    1996-01-01

    BACKGROUND--DDD pacing has been advocated as an effective treatment for drug refractory obstructive hypertrophic cardiomyopathy. This study reports the outcome of pacing in 56 patients with refractory symptoms referred to four tertiary centres. METHODS--Core data on symptoms, drug burden, and left ventricular outflow tract gradient were recorded. Patients underwent a temporary pacing study with optimisation of the atrioventricular (AV) delay for greatest gradient reduction without haemodynamic compromise. Patients were assessed after implantation in terms of changes in symptoms, drug load, and outflow tract gradient. RESULTS--56 patients underwent pacing assessment. The mean (SD) left ventricular outflow tract gradient before pacing was 78 (31) mm Hg. At temporary study the mean (SD) left ventricular outflow tract gradient was 38 (24) mm Hg with a median (range) optimised sensed AV delay of 65 (25-125) ms. Fifty three patients were implanted and followed up for a mean (SD) of 11 (11) months. The median (range) programmed sensed AV delay was 60 (31-200) ms. Left ventricular outflow tract gradient at follow up was 36 (25) mm Hg. Forty four patients had improved functional class. Although a correlation (r = 0.69) was shown between acute and chronic left ventricular outflow tract gradient reduction, there was no correlation between magnitude of gradient reduction and functional improvement, and no appreciable change in pharmacological burden. CONCLUSION--This series confirms symptomatic improvement after DDD pacing in hypertrophic cardiomyopathy. There remains, however, a discrepancy between perceived symptomatic benefit and modest objective improvement. Furthermore, the optimal outcome has been achieved only with continued pharmacological treatment. Current methods of temporary evaluation do not predict functional outcome which seems to be independent of the magnitude of gradient reduction. PMID:8624871

  10. Improving and Communicating Workforce Skills: A Regional Initiative

    ERIC Educational Resources Information Center

    Baird, Dee

    2011-01-01

    The demand for improved workplace skills in the U.S. is rapidly rising, and U.S. industries, employees, and educational systems are struggling to respond. This paper describes the Skills Advantage program, an effort led by employers and facilitated by Kirkwood Community College to address regional employment needs. This work-ready certificate…

  11. Improved location features for linkage of regions across ipsilateral mammograms.

    PubMed

    Tanner, Christine; van Schie, Guido; Lesniak, Jan M; Karssemeijer, Nico; Székely, Gábor

    2013-12-01

    Improved performance has been reported for computer aided detection (CADe) methods using information from multiple mammographic views over single-view CADe approaches. Linkage across the views is based on assuming that location and image features from the same lesion depicted in both views will be similar. In this study we investigate if the location features can be improved and what effect such an improvement has on the linkage of lesions across ipsilateral views. Performance of different methods to define the location features was first assessed with respect to the location of 137 manually annotated and linked masses. Taking the median result from five complementary methods (based on pectoral muscle boundary, breast shape and intensity signature) increased the mean accuracy compared to the current standard (7.1 vs. 6.3 mm). Thereafter the impact of this best method on the automatic linkage of detected regions across views was assessed for a second, independent dataset of 131 mammogram pairs. Linkage was based on the combination of location and single-view image features by a linear discriminate analysis classifier trained to differentiate between links of corresponding true-positive (TP) regions versus links including TP and false-positive (FP) regions. Nested cross-validation results showed that using the improved location features significantly increased the classification performance and the percentage of correctly linked regions. PMID:23731758

  12. Optical pacing of the adult rabbit heart.

    PubMed

    Jenkins, Michael W; Wang, Y T; Doughman, Y Q; Watanabe, M; Cheng, Y; Rollins, A M

    2013-01-01

    Optical pacing has been demonstrated to be a viable alternative to electrical pacing in embryonic hearts. In this study, the feasibility of optically pacing an adult rabbit heart was explored. Hearts from adult New Zealand White rabbits (n = 9) were excised, cannulated and perfused on a modified Langendorff apparatus. Pulsed laser light (λ = 1851 nm) was directed to either the left or right atrium through a multimode optical fiber. An ECG signal from the left ventricle and a trigger pulse from the laser were recorded simultaneously to determine when capture was achieved. Successful optical pacing was demonstrated by obtaining pacing capture, stopping, then recapturing as well as by varying the pacing frequency. Stimulation thresholds measured at various pulse durations suggested that longer pulses (8 ms) had a lower energy capture threshold. To determine whether optical pacing caused damage, two hearts were perfused with 30 µM of propidium iodide and analyzed histologically. A small number of cells near the stimulation site had compromised cell membranes, which probably limited the time duration over which pacing was maintained. Here, short-term optical pacing (few minutes duration) is demonstrated in the adult rabbit heart for the first time. Future studies will be directed to optimize optical pacing parameters to decrease stimulation thresholds and may enable longer-term pacing. PMID:24049683

  13. 42 CFR 460.60 - PACE organizational structure.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Administrative Requirements § 460.60 PACE organizational structure. (a) A...

  14. 42 CFR 460.34 - Duration of PACE program agreement.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Program Agreement § 460.34 Duration of PACE program agreement. An agreement...

  15. 42 CFR 460.34 - Duration of PACE program agreement.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Program Agreement § 460.34 Duration of PACE program agreement. An agreement...

  16. 42 CFR 460.34 - Duration of PACE program agreement.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Program Agreement § 460.34 Duration of PACE program agreement. An agreement...

  17. 42 CFR 460.60 - PACE organizational structure.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Administrative Requirements § 460.60 PACE organizational structure. (a) A...

  18. 42 CFR 460.60 - PACE organizational structure.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Administrative Requirements § 460.60 PACE organizational structure. (a) A...

  19. 42 CFR 460.34 - Duration of PACE program agreement.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Program Agreement § 460.34 Duration of PACE program agreement. An agreement...

  20. 42 CFR 460.60 - PACE organizational structure.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Administrative Requirements § 460.60 PACE organizational structure. (a) A...

  1. 42 CFR 460.34 - Duration of PACE program agreement.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Program Agreement § 460.34 Duration of PACE program agreement. An agreement...

  2. 42 CFR 460.60 - PACE organizational structure.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Administrative Requirements § 460.60 PACE organizational structure. (a) A...

  3. Cardiac Pacing - Is Telemonitoring Now Essential?

    PubMed

    Burri, Haran

    2013-11-01

    Modern pacemakers and implantable defibrillators are able to automatically perform tests executed manually during in-office visits; such as measurement of sensing and pacing thresholds. In addition, the devices also record a wealth of diagnostic data that are of clinical relevance. The advent of wireless technology in these devices allows automatic transmission of these data that can be consulted remotely by the physician. There is now solid evidence indicating that remote device follow-up can safely reduce the number of in-office visits, thereby improving convenience for patients and caregivers alike. Remote monitoring with automatic alerts for arrhythmias, heart failure and technical issues, has been shown to dramatically reduce delay to diagnosis of these events compared with standard follow-up; potentially improving patient safety and outcome. For these reasons, remote device management is becoming the standard of care. PMID:26835047

  4. Hospital-Based Coalition to Improve Regional Surge Capacity

    PubMed Central

    Terndrup, Thomas E.; Leaming, James M.; Adams, R. Jerry; Adoff, Spencer

    2012-01-01

    Introduction Surge capacity for optimization of access to hospital beds is a limiting factor in response to catastrophic events. Medical facilities, communication tools, manpower, and resource reserves exist to respond to these events. However, these factors may not be optimally functioning to generate an effective and efficient surge response. The objective was to improve the function of these factors. Methods Regional healthcare facilities and supporting local emergency response agencies developed a coalition (the Healthcare Facilities Partnership of South Central Pennsylvania; HCFP-SCPA) to increase regional surge capacity and emergency preparedness for healthcare facilities. The coalition focused on 6 objectives: (1) increase awareness of capabilities and assets, (2) develop and pilot test advanced planning and exercising of plans in the region, (3) augment written medical mutual aid agreements, (4) develop and strengthen partnership relationships, (5) ensure National Incident Management System compliance, and (6) develop and test a plan for effective utilization of volunteer healthcare professionals. Results In comparison to baseline measurements, the coalition improved existing areas covered under all 6 objectives documented during a 24-month evaluation period. Enhanced communications between the hospital coalition, and real-time exercises, were used to provide evidence of improved preparedness for putative mass casualty incidents. Conclusion The HCFP-SCPA successfully increased preparedness and surge capacity through a partnership of regional healthcare facilities and emergency response agencies. PMID:23316266

  5. [Permanent cardiac pacing in women--light and shadow].

    PubMed

    Małecka, Barbara; Wysokińsk, Andrzej

    2015-01-01

    Permanent cardiac pacing has survived a sharp increase in quality improvement and frequency of usage. Nowadays particular aspects of this method of treatment are being considered. In this paper distinctiveness of women population treated by permanent pacing is discussed. Indications for heart pacing in women appear at a later age than in men. Moreover, women remain longer in follow-up, therefore their prognosis is better. The most serious late pacing complications, i.e., infections are less frequent in women. However, implantations procedures seem to be more difficult in female gender, most probably due to a smaller body size, especially of afferent veins. This leads to a higher periprocedural complication rate and refers especially to endocardial lead implantation, which in women is connected with double risk of pneumothorax. Late complications of permanent pacing are effectively treated by transvenous lead extraction. Female gender has been demonstrated as an independent risk factor of extraction failure. It seems that reasonable qualification for pacemaker implantations and leaving the procedures in the hands of experienced operators will strengthen the "light side" and limit the "dark side" of this therapy in women. PMID:26455022

  6. Improved regional ventricular function after successful surgical revascularization

    SciTech Connect

    Brundage, B.H.; Massie, B.M.; Botvinick, E.H.

    1984-04-01

    Left ventricular segments with reversible asynergy at rest demonstrate reversible myocardial perfusion defects on exercise thallium-201 scintigrams. To determine if improved perfusion eliminates asynergy at rest, 23 patients with angina (stable in 21, unstable in 2) were studied before and after coronary artery bypass surgery. All patients underwent exercise myocardial perfusion scintigraphy, contrast ventriculography and coronary arteriography before and after surgery. Selective graft angiography was performed during the postoperative catheterization to determine graft patency. Segmental ventricular function was quantitated by a regional fraction method. The scintigrams were divided into five regions and compared with the corresponding regions of the ventriculogram. Seventy-one of a possible 142 ventricular segments exhibited exercise-induced perfusion deficits. Preoperative regional ejection fraction was normal in 42 of these segments and abnormal in 29. Postoperatively, in 19 of the abnormal segments, function improved or normalized. All these segments had improved perfusion during exercise after surgery and were supplied by a patent bypass graft. Nine of the 10 segments in which abnormal wall motion persisted postoperatively continued to have exercise-induced perfusion deficits, and 9 of the 10 segments were supplied by an occluded or stenotic graft or one with poor run off. Of the 42 segments with normal wall motion preoperatively, 30 had improved perfusion after surgery and 35 maintained normal function. This study indicates that asynergy at rest is permanently reversed after coronary bypass surgery if improved myocardial perfusion can be documented. These findings are consistent with but do not prove the concept that reversible rest asynergy may reflect chronic ischemia or a prolonged effect from previous ischemic episodes.

  7. Tools and Trends in Self-Paced Language Instruction

    ERIC Educational Resources Information Center

    Godwin-Jones, Robert

    2007-01-01

    Ever since the PLATO system of the 1960's, CALL (computer assisted language learning) has had a major focus on providing self-paced, auto-correcting exercises for language learners to practice their skills and improve their knowledge of discrete areas of language learning. The computer has been recognized from the beginning as a patient and…

  8. Algorithmic improvements to an exact region-filling technique

    NASA Astrophysics Data System (ADS)

    Elias Fabris, Antonio; Ramos Batista, Valério

    2015-09-01

    We present many algorithmic improvements in our early region filling technique, which in a previous publication was already proved to be correct for all connected digital pictures. Ours is an integer-only method that also finds all interior points of any given digital picture by displaying and storing them in a locating matrix. Our filling/locating program is applicable both in computer graphics and image processing.

  9. Innovative pacing: Recent advances, emerging technologies, and future directions in cardiac pacing.

    PubMed

    Austin, Christopher; Kusumoto, Fred

    2016-07-01

    The field of cardiovascular medicine is rapidly evolving as advancements in technology and engineering provide clinicians new and exciting ways to care for an aging population. Cardiac pacing, in particular, has seen a series of game-changing technologies emerge in the past several years spurred by low-power electronics, high density batteries, improved catheter delivery systems and innovative software design. We look at several of these emerging pacemaker technologies, discussing the rationale, current state and future directions of these pioneering developments in electrophysiology. PMID:27017442

  10. Thallium cardiac stressing by esophageal pacing

    SciTech Connect

    Allen, M.L.; Vacek, J.L.; Preston, D.F.; Robinson, R.G.; Feldkamp, M.J. )

    1989-09-01

    Forty-three patients were examined with the transesophageal pacing method of cardiac stressing and thallium imaging. Transesophageal cardiac pacing, using a pill electrode or a permanent pacemaker lead, is a safe alternative for patients who are physically unable to exercise. Prior studies suggest that transvenous right atrial pacing with thallium injection is equivalent to physical exercise thallium studies in the detection of coronary artery disease. The esophageal pacing bipolar electrode similarly increases heart rate without the necessity of transvenous pacing or fluoroscopy and without the adverse side effects often seen when using pharmacologic stressing agents (i.e., dipyridamole). The results compare well with cardiac catheterization, echocardiographic, and electrocardiographic results. Cardiac paced stress testing requires no sedation, is performed on an out-patient basis, and causes little if any discomfort for the patient.

  11. Improving regional universal newborn hearing screening programmes in Italy.

    PubMed

    Molini, E; Cristi, M C; Lapenna, R; Calzolaro, L; Muzzi, E; Ciciriello, E; Della Volpe, A; Orzan, E; Ricci, G

    2016-02-01

    The Universal Newborn Hearing Screening (UNHS) programme aims at achieving early detection of hearing impairment. Subsequent diagnosis and intervention should follow promptly. Within the framework of the Ministry of Health project CCM 2013 "Preventing Communication Disorders: a Regional Program for early Identification, Intervention and Care of Hearing Impaired Children", the limitations and strengths of current UNHS programs in Italy have been analysed by a group of professionals working in tertiary centres involved in regional UNHS programmes, using SWOT analysis and a subsequent TOWS matrix. Coverage and lost-to-follow up rates are issues related to UNHS programmes. Recommendations to improve the effectiveness of the UNHS programme have been identified. The need for homogeneous policies, high-quality information and dissemination of knowledge for operators and families of hearing-impaired children emerged from the discussion. PMID:27054385

  12. The effects of fluid ingestion on free-paced intermittent-sprint performance and pacing strategies in the heat.

    PubMed

    Skein, Melissa; Duffield, Rob

    2010-02-01

    The purpose of this study was to examine the effects of fluid ingestion on pacing strategies and performance during intermittent-sprint exercise in the heat. Nine male rugby players performed a habituation session and 2 x 50-min intermittent-sprint protocols at a temperature of 31 degrees C, either with or without fluid. Participants were informed of a third session (not performed) to ensure that they remained blind to all respective conditions. The protocol consisted of a 15-m sprint every minute separated by self-paced bouts of hard running, jogging, and walking for the remainder of the minute. Sprint time, distance covered during self-paced exercise, and vertical jump height before and after exercise were recorded. Heart rate, core temperature, nude mass, capillary blood haematocrit, pH, lactate concentration, perceptual ratings of perceived exertion, thermal stress, and thirst were also recorded. Sprint times (fluid vs. no-fluid: 2.82 +/- 0.11 vs. 2.82 +/- 0.14) and distance covered during self-paced exercise (fluid vs. no-fluid: 4168 +/- 419 vs. 3981 +/- 263 m) were not different between conditions (P = 0.10-0.98) but were progressively reduced to a greater extent in the no-fluid trial (7 +/- 13%) (d = 0.56-0.58). There were no differences (P = 0.22-1.00; d = <0.20-0.84) between conditions in any physiological measures. Perceptual ratings of perceived exertion and thermal stress did not differ between conditions (P = 0.34-0.91; d < or =0.20-0.48). Rating of thirst after exercise was lower in the fluid trial (P = 0.02; d = 0.62-0.73). The present results suggest that fluid availability did not improve intermittent-sprint performance, however did affect pacing strategies with a greater reduction in distance covered of self-paced exercise during the no-fluid trial. PMID:20077276

  13. Consistency of Students' Pace in Online Learning

    ERIC Educational Resources Information Center

    Hershkovitz, Arnon; Nachmias, Rafi

    2009-01-01

    The purpose of this study is to investigate the consistency of students' behavior regarding their pace of actions over sessions within an online course. Pace in a session is defined as the number of logged actions divided by session length (in minutes). Log files of 6,112 students were collected, and datasets were constructed for examining pace…

  14. 42 CFR 460.186 - PACE premiums.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false PACE premiums. 460.186 Section 460.186 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY...

  15. 42 CFR 460.186 - PACE premiums.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false PACE premiums. 460.186 Section 460.186 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY...

  16. 42 CFR 460.186 - PACE premiums.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false PACE premiums. 460.186 Section 460.186 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY...

  17. Web Tools: Keeping Learners on Pace

    ERIC Educational Resources Information Center

    Kosloski, Mickey

    2016-01-01

    One of the greatest challenges in teaching technology and engineering is pacing. Some students grasp new technological concepts quickly, while others need repetition and may struggle to keep pace. This poses an obstacle for the technology and engineering teacher, and is particularly true when teaching students to build a website. However, there…

  18. Satellite Sounder Data Assimilation for Improving Alaska Region Weather Forecast

    NASA Technical Reports Server (NTRS)

    Zhu, Jiang; Stevens, E.; Zhang, X.; Zavodsky, B. T.; Heinrichs, T.; Broderson, D.

    2014-01-01

    A case study and monthly statistical analysis using sounder data assimilation to improve the Alaska regional weather forecast model are presented. Weather forecast in Alaska faces challenges as well as opportunities. Alaska has a large land with multiple types of topography and coastal area. Weather forecast models must be finely tuned in order to accurately predict weather in Alaska. Being in the high-latitudes provides Alaska greater coverage of polar orbiting satellites for integration into forecasting models than the lower 48. Forecasting marine low stratus clouds is critical to the Alaska aviation and oil industry and is the current focus of the case study. NASA AIRS/CrIS sounder profiles data are used to do data assimilation for the Alaska regional weather forecast model to improve Arctic marine stratus clouds forecast. Choosing physical options for the WRF model is discussed. Preprocess of AIRS/CrIS sounder data for data assimilation is described. Local observation data, satellite data, and global data assimilation data are used to verify and/or evaluate the forecast results by the MET tools Model Evaluation Tools (MET).

  19. Effect of Right Ventricular versus Biventricular Pacing on Electrical Remodeling in the Normal Heart

    PubMed Central

    Saba, Samir; Mehdi, Haider; Mathier, Michael A.; Islam, M. Zahadul; Salama, Guy; London, Barry

    2010-01-01

    Background Biventricular (BIV) pacing can improve cardiac function in heart failure by altering the mechanical and electrical substrates. We investigated the effect of BIV versus right ventricular (RV) pacing on the normal heart. Methods and Results Male New Zealand White rabbits (n=33) were divided into 3 groups: sham-operated (control), RV pacing, and BIV pacing groups. Four weeks after surgery, the native QT (p=0.004) interval was significantly shorter in the BIV group compared to the RV or sham-operated groups. Also, compared to rabbits in the RV group, rabbits in the BIV group had shorter RV ventricular effective refractory period (VERP) at all cycle lengths, and shorter LV paced QT interval during the drive train of stimuli and close to refractoriness (p<0.001 for all comparisons). Protein expression of the KVLQT1 was significantly increased in the BIV group compared to the RV and control groups, while protein expression of SCN5A and connexin43 was significantly decreased in the RV compared to the other study groups. Erg protein expression was significantly increased in both pacing groups compared to the controls. Conclusions In this rabbit model, we demonstrate a direct effect of BIV but not RV pacing on shortening the native QT interval as well as the paced QT interval during burst pacing and close to the VERP. These findings underscore the fact that the effect of BIV pacing is partially mediated through direct electrical remodeling and may have implications as to the effect of BIV pacing on arrhythmia incidence and burden. PMID:20042767

  20. Right ventricular septal pacing: Safety and efficacy in a long term follow up

    PubMed Central

    Occhetta, Eraldo; Quirino, Gianluca; Baduena, Lara; Nappo, Rosaria; Cavallino, Chiara; Facchini, Emanuela; Pistelli, Paolo; Magnani, Andrea; Bortnik, Miriam; Francalacci, Gabriella; Dell’Era, Gabriele; Plebani, Laura; Marino, Paolo

    2015-01-01

    AIM: To evaluate the safety and efficacy of the permanent high interventricular septal pacing in a long term follow up, as alternative to right ventricular apical pacing. METHODS: We retrospectively evaluated: (1) 244 patients (74 ± 8 years; 169 men, 75 women) implanted with a single (132 pts) or dual chamber (112 pts) pacemaker (PM) with ventricular screw-in lead placed at the right ventricular high septal parahisian site (SEPTAL pacing); (2) 22 patients with permanent pacemaker and low percentage of pacing (< 20%) (NO pacing); (3) 33 patients with high percentage (> 80%) right ventricular apical pacing (RVA). All patients had a narrow spontaneous QRS (101 ± 14 ms). We evaluated New York Heart Association (NYHA) class, quality of life (QoL), 6 min walking test (6MWT) and left ventricular function (end-diastolic volume, LV-EDV; end-systolic volume, LV-ESV; ejection fraction, LV-EF) with 2D-echocardiography. RESULTS: Pacing parameters were stable during follow up (21 mo/patient). In SEPTAL pacing group we observed an improvement in NYHA class, QoL score and 6MWT. While LV-EDV didn’t significantly increase (104 ± 40 mL vs 100 ± 37 mL; P = 0.35), LV-ESV slightly increased (55 ± 31 mL vs 49 ± 27 mL; P = 0.05) and LV-EF slightly decreased (49% ± 11% vs 53% ± 11%; P = 0.001) but never falling < 45%. In the RVA pacing control group we observed a worsening of NYHA class and an important reduction of LV-EF (from 56% ± 6% to 43% ± 9%, P < 0.0001). CONCLUSION: Right ventricular permanent high septal pacing is safe and effective in a long term follow up evaluation; it could be a good alternative to the conventional RVA pacing in order to avoid its deleterious effects. PMID:26322189

  1. The Pace of Cultural Evolution

    PubMed Central

    Perreault, Charles

    2012-01-01

    Today, humans inhabit most of the world’s terrestrial habitats. This observation has been explained by the fact that we possess a secondary inheritance mechanism, culture, in addition to a genetic system. Because it is assumed that cultural evolution occurs faster than biological evolution, humans can adapt to new ecosystems more rapidly than other animals. This assumption, however, has never been tested empirically. Here, I compare rates of change in human technologies to rates of change in animal morphologies. I find that rates of cultural evolution are inversely correlated with the time interval over which they are measured, which is similar to what is known for biological rates. This correlation explains why the pace of cultural evolution appears faster when measured over recent time periods, where time intervals are often shorter. Controlling for the correlation between rates and time intervals, I show that (1) cultural evolution is faster than biological evolution; (2) this effect holds true even when the generation time of species is controlled for; and (3) culture allows us to evolve over short time scales, which are normally accessible only to short-lived species, while at the same time allowing for us to enjoy the benefits of having a long life history. PMID:23024804

  2. Can quantile mapping improve precipitation extremes from regional climate models?

    NASA Astrophysics Data System (ADS)

    Tani, Satyanarayana; Gobiet, Andreas

    2015-04-01

    The ability of quantile mapping to accurately bias correct regard to precipitation extremes is investigated in this study. We developed new methods by extending standard quantile mapping (QMα) to improve the quality of bias corrected extreme precipitation events as simulated by regional climate model (RCM) output. The new QM version (QMβ) was developed by combining parametric and nonparametric bias correction methods. The new nonparametric method is tested with and without a controlling shape parameter (Qmβ1 and Qmβ0, respectively). Bias corrections are applied on hindcast simulations for a small ensemble of RCMs at six different locations over Europe. We examined the quality of the extremes through split sample and cross validation approaches of these three bias correction methods. This split-sample approach mimics the application to future climate scenarios. A cross validation framework with particular focus on new extremes was developed. Error characteristics, q-q plots and Mean Absolute Error (MAEx) skill scores are used for evaluation. We demonstrate the unstable behaviour of correction function at higher quantiles with QMα, whereas the correction functions with for QMβ0 and QMβ1 are smoother, with QMβ1 providing the most reasonable correction values. The result from q-q plots demonstrates that, all bias correction methods are capable of producing new extremes but QMβ1 reproduces new extremes with low biases in all seasons compared to QMα, QMβ0. Our results clearly demonstrate the inherent limitations of empirical bias correction methods employed for extremes, particularly new extremes, and our findings reveals that the new bias correction method (Qmß1) produces more reliable climate scenarios for new extremes. These findings present a methodology that can better capture future extreme precipitation events, which is necessary to improve regional climate change impact studies.

  3. Heart rhythm during permanent cardiac pacing.

    PubMed Central

    Edhag, O; Rosenqvist, M

    1979-01-01

    Heart rhythm was analysed with regard to spontaneous or pacemaker-induced heart activity, in a consecutive series of 282 patients paced for at least 1 year. The mean duration of pacing was 59 (13 to 180) months. The mean age of the patients was 76 (39 to 93) years. Spontaneous heart activity at all routine examinations was found in 33 (12%) of the patients. Pacemaker-induced rhythm only was recorded in 42 per cent of the patients whereas the remaining 46 per cent had varying electrocardiographic patterns. Of the patients with spontaneous rhythm at each visit, 10 had had complete heart block before pacing. Regular sinus activity was recorded at every routine examination in 74 per cent of the patients paced for reasons other than the sick sinus syndrome. This indicated that a substantial number of paced patients might be candidates for atrial triggered pacing. Patients treated with digitalis more often had asystole at the time of replacement of the pacemaker (32%) than those not so treated (19). This suggests an increased risk of sudden death in paced patients on digitalis if the pacemaker fails. PMID:486279

  4. 42 CFR 460.180 - Medicare payment to PACE organizations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Payment § 460.180 Medicare payment to PACE organizations. (a) Principle...

  5. 42 CFR 460.170 - Reinstatement in PACE.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Participant Enrollment and Disenrollment § 460.170 Reinstatement in PACE. (a) A...

  6. 42 CFR 460.180 - Medicare payment to PACE organizations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Payment § 460.180 Medicare payment to PACE organizations. (a) Principle...

  7. 42 CFR 460.122 - PACE organization's appeals process.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Participant Rights § 460.122 PACE organization's appeals process. For...

  8. 42 CFR 460.122 - PACE organization's appeals process.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Participant Rights § 460.122 PACE organization's appeals process. For...

  9. 42 CFR 460.122 - PACE organization's appeals process.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Participant Rights § 460.122 PACE organization's appeals process. For...

  10. 42 CFR 460.170 - Reinstatement in PACE.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Participant Enrollment and Disenrollment § 460.170 Reinstatement in PACE. (a) A...

  11. 42 CFR 460.170 - Reinstatement in PACE.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Participant Enrollment and Disenrollment § 460.170 Reinstatement in PACE. (a) A...

  12. 42 CFR 460.122 - PACE organization's appeals process.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Participant Rights § 460.122 PACE organization's appeals process. For...

  13. 42 CFR 460.180 - Medicare payment to PACE organizations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Payment § 460.180 Medicare payment to PACE organizations. (a) Principle...

  14. 42 CFR 460.170 - Reinstatement in PACE.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Participant Enrollment and Disenrollment § 460.170 Reinstatement in PACE. (a) A...

  15. Improving efficiency of a regional stand alone bone bank.

    PubMed

    Warnock, Jonathan M; Rowan, Clare H; Davidson, Helen; Millar, Ciara; McAlinden, M Gavan

    2016-03-01

    The introduction of a stand-alone Bone Bank in our Regional Orthopaedic Hospital has improved the availability of femoral head allograft. Benninger et al. (Bone Joint J 96-B:1307-1311, 2014), demonstrated their institutions bank to be cost effective despite a 30 % discard rate for harvested allograft. We sought to audit our own discard rates and subsequent cost-effectiveness of our bone bank. Donor recruitment. Before approaching a potential donor, our establishment's nurse specialists review their clinical notes and biochemical laboratory results, available on a regional Electronic Care Records. They view femoral head architecture on radiographs against set criteria, Patient Archive and Communication system (SECTRA, Sweden). In total 1383 femoral heads were harvested, 247 were discarded giving an overall rate of 17.9 %. The most common reasons for discard of harvested graft was a positive microbiology/bacteriology result, n = 96 (38.9 %). After a rise in discard rates in 2007, we have steadily reduced our discard rates since 2006/2007 (28.2 %), 2008/2009 (17 %), 2010/2011 (14.8 %), and finally to 10.3 % in 2012/2013. In the current financial year, our cost to harvest, test, store and release a femoral head is £610. With a structured donor recruitment process and unique pre-operative radiographic analysis we have successfully reduced our discard rates bi-annually making our bone bank increasingly cost-effective. PMID:26138308

  16. Ventricular defibrillation combining DC electrical field and electrical pacing: an optical mapping study

    NASA Astrophysics Data System (ADS)

    Musunuri, Sai Shruthi; Tang, Liang; Joung, Boyoung; Berbari, Edward J.; Lin, Shien-Fong

    2009-02-01

    Although high voltage direct current (DC) shock is a standard technique to terminate ventricular fibrillation (VF), it can cause severe pain and tissue damage. The exact effect of the DC electric field, which can depolarize the heart during VF is still unknown. We hypothesized that low-energy DC field in combination with pacing (pacing+DC) could terminate VF by affecting the ventricular propagation pattern. In six Langendorff-perfused isolated rabbit hearts with the ablated sinoatrial (SA) node, the DC field was delivered to the left ventricle (cathode) and right ventricle (anode). We designed a timed protocol using LabVIEW programming that delivers pacing, DC and pacing+DC stimuli for two seconds time intervals each. The pacing pulse (with varying pacing cycle length: 300ms-30ms) was delivered to the apex. Transmembrane voltage was recorded with optical mapping technique for 16 seconds at a sampling rate of 2ms/frame. We crushed the sinoatrial node to reduce the heart rate. The baseline activation appeared to have endocardial origins with a mean escape ventricular rate of 60 +/- 5bpm at baseline. The DC field (30mA-60mA) alone increased the mean heart rate to 120+/-5bpm. Although DC alone terminated VF in a few cases, the rate of termination was very low (6.2%). However, when pacing+DC was applied, it was possible to terminate VF in 34 of 130 episodes in six rabbits. The rate of successful defibrillation of VF with pacing+DC was significantly higher than that with DC alone (20% vs 6.2%, p<0.01). Pacing alone never terminated the VF. In conclusion, DC field may affect the conduction velocity in normal condition. Pacing+DC intervention could lead to regularization of VF propagation and eventually to termination. Further improvement of this approach may offer a higher success rate of defibrillation with lower energy requirements.

  17. Lunar plasma measurement by MAP-PACE onboard KAGUYA (SELENE)

    NASA Astrophysics Data System (ADS)

    Saito, Yoshifumi

    Low energy charged particles around the Moon were vigorously observed by Moon orbiting satellites and plasma instrumentation placed on the lunar surface in 1960s and 1970s. Though there were some satellites that explored the Moon afterwards, most of them were dedicated to the global mapping of the lunar surface. KAGUYA(SELENE) is a Japanese lunar orbiter that studies the origin and evolution of the Moon by means of global mapping of element abundances, mineralogical composition, and surface geographical mapping from 100km altitude. KAGUYA was successfully launched on 14 September 2007 by HIIA launch vehicle from Tanegashima Space Center in Japan. KAGUYA was inserted into a circular lunar polar orbit of 100km altitude and started continuous observation in mid-December 2007. One of the fourteen science instruments MAP-PACE (MAgnetic field and Plasma experiment - Plasma energy Angle and Composition Experiment) was developed for the comprehensive three-dimensional plasma measurement around the Moon. MAP-PACE consists of 4 sensors: ESA (Electron Spectrum Analyzer)-S1, ESA-S2, IMA (Ion Mass Analyzer), and IEA (Ion Energy Analyzer). ESA-S1 and S2 measure the distribution function of low energy electrons below 15keV. IMA and IEA measure the distribution function of low energy ions below 28keV/q. IMA has an ability to discriminate the ion mass with high mass resolution. PACE sensors have been measuring solar wind, plasmas in the wake region of the Moon and plasmas in the Earth's magnetosphere. ESA sensors have discovered electron heating over magnetic anomalies on the lunar surface. ESA sensors have also observed electrons accelerated from the lunar surface in the wake region. PACE ion sensors have discovered new features of low energy ions around the Moon. IMA has discovered the existence of alkali ions that are originated from the lunar surface or lunar atmosphere and are picked up by the solar wind. IEA and IMA sensors discovered solar wind reflection by the Moon. PACE

  18. Self-Paced Instruction--New Directions

    ERIC Educational Resources Information Center

    Blum, Lester

    1976-01-01

    An argument that teaching introductory economic analysis can be made more effective with self-paced instruction using appropriately designed materials such as films, cassettes, and programmed learning units. (Author/AV)

  19. Conservation law for self-paced movements.

    PubMed

    Huh, Dongsung; Sejnowski, Terrence J

    2016-08-01

    Optimal control models of biological movements introduce external task factors to specify the pace of movements. Here, we present the dual to the principle of optimality based on a conserved quantity, called "drive," that represents the influence of internal motivation level on movement pace. Optimal control and drive conservation provide equivalent descriptions for the regularities observed within individual movements. For regularities across movements, drive conservation predicts a previously unidentified scaling law between the overall size and speed of various self-paced hand movements in the absence of any external tasks, which we confirmed with psychophysical experiments. Drive can be interpreted as a high-level control variable that sets the overall pace of movements and may be represented in the brain as the tonic levels of neuromodulators that control the level of internal motivation, thus providing insights into how internal states affect biological motor control. PMID:27418602

  20. Effect of Adaptive Paced Cardiolocomotor Synchronization During Running: A Preliminary Study

    PubMed Central

    Phillips, Bill; Jin, Yi

    2013-01-01

    Cardiolocomotor synchronization (CLS) has been well established for individuals engaged in rhythmic activity, such as walking, running, or cycling. When frequency of the activity is at or near the heart rate, entrainment occurs. CLS has been shown in many cases to improve the efficiency of locomotor activity, improving stroke volume, reducing blood pressure variability, and lowering the oxygen uptake (VO2). Instead of a 1:1 frequency ratio of activity to heart rate, an investigation was performed to determine if different harmonic coupling at other simple integer ratios (e.g. 1:2, 2:3, 3:2) could achieve any performance benefits. CLS was ensured by pacing the stride rate according to the measured heartbeat (i.e., adaptive paced CLS, or forced CLS). An algorithm was designed that determined the simplest ratio (lowest denominator) that, when multiplied by the heart rate will fall within an individualized, predetermined comfortable pacing range for the user. The algorithm was implemented on an iPhone 4, which generated a ‘tick-tock’ sound through the iPhone’s headphones. A sham-controlled crossover study was performed with 15 volunteers of various fitness levels. Subjects ran a 3 mile (4.83 km) simulated training run at their normal pace on two consecutive days (randomized one adaptive pacing, one sham). Adaptive pacing resulted in faster runs run times, with subjects running an average of 26:03 ± 3:23 for adaptive pacing and 26:38 ± 3:31 for sham (F = 5.46, p < 0.05). The increase in heart rate from the start of the race as estimated by an exponential time constant was significantly longer during adaptive pacing, τ = 0.99 ± 0.30, compared to sham, τ = 1.53 ± 0.34 (t = -6.62, p < 0.01). Eighty-seven percent of runners found it easy to adjust their stride length to match the pacing signal with seventy-nine percent reporting that pacing helped their performance. These results suggest that adaptive paced CLS may have a beneficial effect on running performance

  1. Improvement of snowpack simulations in a regional climate model

    SciTech Connect

    Jin, J.; Miller, N.L.

    2011-01-10

    To improve simulations of regional-scale snow processes and related cold-season hydroclimate, the Community Land Model version 3 (CLM3), developed by the National Center for Atmospheric Research (NCAR), was coupled with the Pennsylvania State University/NCAR fifth-generation Mesoscale Model (MM5). CLM3 physically describes the mass and heat transfer within the snowpack using five snow layers that include liquid water and solid ice. The coupled MM5–CLM3 model performance was evaluated for the snowmelt season in the Columbia River Basin in the Pacific Northwestern United States using gridded temperature and precipitation observations, along with station observations. The results from MM5–CLM3 show a significant improvement in the SWE simulation, which has been underestimated in the original version of MM5 coupled with the Noah land-surface model. One important cause for the underestimated SWE in Noah is its unrealistic land-surface structure configuration where vegetation, snow and the topsoil layer are blended when snow is present. This study demonstrates the importance of the sheltering effects of the forest canopy on snow surface energy budgets, which is included in CLM3. Such effects are further seen in the simulations of surface air temperature and precipitation in regional weather and climate models such as MM5. In addition, the snow-season surface albedo overestimated by MM5–Noah is now more accurately predicted by MM5–CLM3 using a more realistic albedo algorithm that intensifies the solar radiation absorption on the land surface, reducing the strong near-surface cold bias in MM5–Noah. The cold bias is further alleviated due to a slower snowmelt rate in MM5–CLM3 during the early snowmelt stage, which is closer to observations than the comparable components of MM5–Noah. In addition, the over-predicted precipitation in the Pacific Northwest as shown in MM5–Noah is significantly decreased in MM5 CLM3 due to the lower evaporation resulting from the

  2. Optogenetic pacing in Drosophila melanogaster (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Alex, Aneesh; Li, Airong; Men, Jing; Jerwick, Jason; Tanzi, Rudolph E.; Zhou, Chao

    2016-03-01

    A non-invasive, contact-less cardiac pacing technology can be a powerful tool in basic cardiac research and in clinics. Currently, electrical pacing is the gold standard for cardiac pacing. Although highly effective in controlling the cardiac function, the invasive nature, non-specificity to cardiac tissues and possible tissue damage limits its capabilities. Optical pacing of heart is a promising alternative, which is non-invasive and more specific, has high spatial and temporal precision, and avoids shortcomings in electrical stimulation. Optical coherence tomography has been proved to be an effective technique in non-invasive imaging in vivo with ultrahigh resolution and imaging speed. In the last several years, non-invasive specific optical pacing in animal hearts has been reported in quail, zebrafish, and rabbit models. However, Drosophila Melanogaster, which is a significant model with orthologs of 75% of human disease genes, has rarely been studied concerning their optical pacing in heart. Here, we combined optogenetic control of Drosophila heartbeat with optical coherence microscopy (OCM) technique for the first time. The light-gated cation channel, channelrhodopsin-2 (ChR2) was specifically expressed by transgene as a pacemaker in drosophila heart. By stimulating the pacemaker with 472 nm pulsed laser light at different frequencies, we achieved non-invasive and more specific optical control of the Drosophila heart rhythm, which demonstrates the wide potential of optical pacing for studying cardiac dynamics and development. Imaging capability of our customized OCM system was also involved to observe the pacing effect visually. No tissue damage was found after long exposure to laser pulses, which proved the safety of optogenetic control of Drosophila heart.

  3. Scanning linear estimation: improvements over region of interest (ROI) methods

    NASA Astrophysics Data System (ADS)

    Kupinski, Meredith K.; Clarkson, Eric W.; Barrett, Harrison H.

    2013-03-01

    In tomographic medical imaging, a signal activity is typically estimated by summing voxels from a reconstructed image. We introduce an alternative estimation scheme that operates on the raw projection data and offers a substantial improvement, as measured by the ensemble mean-square error (EMSE), when compared to using voxel values from a maximum-likelihood expectation-maximization (MLEM) reconstruction. The scanning-linear (SL) estimator operates on the raw projection data and is derived as a special case of maximum-likelihood estimation with a series of approximations to make the calculation tractable. The approximated likelihood accounts for background randomness, measurement noise and variability in the parameters to be estimated. When signal size and location are known, the SL estimate of signal activity is unbiased, i.e. the average estimate equals the true value. By contrast, unpredictable bias arising from the null functions of the imaging system affect standard algorithms that operate on reconstructed data. The SL method is demonstrated for two different tasks: (1) simultaneously estimating a signal’s size, location and activity; (2) for a fixed signal size and location, estimating activity. Noisy projection data are realistically simulated using measured calibration data from the multi-module multi-resolution small-animal SPECT imaging system. For both tasks, the same set of images is reconstructed using the MLEM algorithm (80 iterations), and the average and maximum values within the region of interest (ROI) are calculated for comparison. This comparison shows dramatic improvements in EMSE for the SL estimates. To show that the bias in ROI estimates affects not only absolute values but also relative differences, such as those used to monitor the response to therapy, the activity estimation task is repeated for three different signal sizes.

  4. High-resolution entrainment mapping of gastric pacing: a new analytical tool.

    PubMed

    O'Grady, Gregory; Du, Peng; Lammers, Wim J E P; Egbuji, John U; Mithraratne, Pulasthi; Chen, Jiande D Z; Cheng, Leo K; Windsor, John A; Pullan, Andrew J

    2010-02-01

    Gastric pacing has been investigated as a potential treatment for gastroparesis. New pacing protocols are required to improve symptom and motility outcomes; however, research progress has been constrained by a limited understanding of the effects of electrical stimulation on slow-wave activity. This study introduces high-resolution (HR) "entrainment mapping" for the analysis of gastric pacing and presents four demonstrations. Gastric pacing was initiated in a porcine model (typical amplitude 4 mA, pulse width 400 ms, period 17 s). Entrainment mapping was performed using flexible multielectrode arrays (paced propagation was found to be anisotropic (longitudinal 2.6 +/- 1.7 vs. circumferential 4.5 +/- 0.6 mm/s; P < 0.001). In the third demonstration, a dysrhythmic episode that occurred during pacing was mapped in HR, revealing an ectopic slow-wave focus and uncoupled propagations. In the fourth demonstration, differences were observed between paced and native slow-wave amplitudes (0.24 +/- 0.08 vs. 0.38 +/- 0.14 mV; P < 0.001), velocities (6.2 +/- 2.8 vs. 11.5 +/- 4.7 mm/s; P < 0.001), and activated areas (20.6 +/- 1.9 vs. 32.8 +/- 2.6 cm(2); P < 0.001). Entrainment mapping enables an accurate quantification of the effects of gastric pacing on slow-wave activity, offering an improved method to assess whether pacing protocols are likely to achieve physiologically and clinically useful outcomes. PMID:19926815

  5. Temporary leadless pacing in a patient with severe device infection.

    PubMed

    Kypta, Alexander; Blessberger, Hermann; Lichtenauer, Michael; Steinwender, Clemens

    2016-01-01

    A 64-year-old patient underwent implantation of a transcatheter pacing systems (TPS) for severe lead endocarditis. The patient experienced fever after a dental procedure. On the transoesophageal echocardiogram (TEE), vegetations were attached to the leads. Because the patient was pacemaker dependent, a temporary pacing lead had to be placed. After removal, however, he did not improve. A second TEE showed new vegetations. Ventricular fibrillation occurred spontaneously; so isoprenalin had to be stopped and a new lead was implanted. Vegetations appeared soon after the new temporary lead was placed. We used a TPS as a bridging device, followed by implantation of a resynchronisation system, and explantation of the TPS. After the Micra TPS was implanted, the patient recovered noticeably. All inflammation parameters were negative and an additional (18)F-fluorodeoxyglucose-positron emission tomography/CT imaging also proved to be negative. So a CRT-D device was then implanted, and the TCP was removed. PMID:27190123

  6. The pace of vocabulary growth helps predict later vocabulary skill

    PubMed Central

    Rowe, Meredith L.; Raudenbush, Stephen W.; Goldin-Meadow, Susan

    2011-01-01

    Children vary widely in the rate at which they acquire words—some start slow and speed up, others start fast and continue at a steady pace. Do early developmental variations of this sort help predict vocabulary skill just prior to kindergarten entry? This longitudinal study starts by examining important predictors (SES, parent input, child gesture) of vocabulary growth between 14 and 46 months (n=62), and then uses growth estimates to predict children's vocabulary at 54 months. Velocity and acceleration in vocabulary development at 30 months predicted later vocabulary, particularly for children from low socioeconomic backgrounds. Understanding the pace of early vocabulary growth thus improves our ability to predict school readiness, and may help identify children at risk for starting behind. PMID:22235920

  7. The roles of pacing interval and pacing strength in ventricular fibrillation induced by rapid pacing with 1 : 1 capture

    PubMed Central

    Zhao, Dongdong; Liu, Ban; Wei, Yidong; Tang, Kai; Yu, Xuejing

    2015-01-01

    Introduction The roles of pacing interval (PI) and pacing strength (PS) in ventricular fibrillation (VF) induced by rapid pacing with 1 : 1 capture remain unclear. Material and methods Epicardial unipolar electrograms (UEs) were simultaneously recorded using contact mapping in 11 swine. Activation-recovery interval (ARI) restitution was constructed at 4 sites, i.e. the apex and base of the left and right ventricles, respectively. A steady state pacing (SSP) protocol was performed to induce VF. The longest PI and the lowest PS for inducing VF were recorded. Statistical correlation analysis was performed to determine the relationship between local ARI restitution properties and PI and PS for VF induction. Results Forty restitution curves were constructed from 11 SSP procedures. The maximal slope (Smax) of the ARI restitution curve of the right ventricular apex was positively correlated with the PI for VF induction (r = 0.761, p < 0.05). Spatial dispersions of ARI and Smax were negatively correlated with the PS for VF induction (r = –0.626 and r = –0.722, respectively, both p < 0.05). Conclusions Ventricular fibrillation can be induced by rapid ventricular pacing with 1 : 1 capture. The PI for VF induction was related to the Smax of the ARI restitution curve of the right ventricular apex, while PS for VF induction was associated with the spatial dispersions of ARI and its restitution property. PMID:26528357

  8. 42 CFR 460.180 - Medicare payment to PACE organizations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... payment. Under a PACE program agreement, CMS makes a prospective monthly payment to the PACE organization... Medicare Advantage organization. (b) Determination of rate. (1) The PACE program agreement specifies the methodology used to calculate the monthly capitation amount applicable to a PACE organization. (2) Except...

  9. 42 CFR 460.180 - Medicare payment to PACE organizations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... payment. Under a PACE program agreement, CMS makes a prospective monthly payment to the PACE organization... Medicare Advantage organization. (b) Determination of rate. (1) The PACE program agreement specifies the methodology used to calculate the monthly capitation amount applicable to a PACE organization. (2) Except...

  10. Neurophysiological determinants of theoretical concepts and mechanisms involved in pacing.

    PubMed

    Roelands, Bart; de Koning, Jos; Foster, Carl; Hettinga, Floor; Meeusen, Romain

    2013-05-01

    improve performance. The distribution of the power output reveals that after dopamine reuptake inhibition, subjects are able to maintain a higher power output compared with placebo. Manipulations of serotonin and, especially, noradrenaline, have the opposite effect and force subjects to decrease power output early in the time trial. Interestingly, after manipulation of brain serotonin, subjects are often unable to perform an end sprint, indicating an absence of a reserve capacity or motivation to increase power output. Taken together, it appears that many factors, such as ambient conditions and manipulation of brain neurotransmitters, have the potential to influence power output during exercise, and might thus be involved as regulatory mechanisms in the complex skill of pacing. PMID:23456493

  11. Applying Multimodel Ensemble from Regional Climate Models for Improving Runoff Projections on Semiarid Regions of Spain

    NASA Astrophysics Data System (ADS)

    Garcia Galiano, S. G.; Olmos, P.; Giraldo Osorio, J. D.

    2015-12-01

    In the Mediterranean area, significant changes on temperature and precipitation are expected throughout the century. These trends could exacerbate the existing conditions in regions already vulnerable to climatic variability, reducing the water availability. Improving knowledge about plausible impacts of climate change on water cycle processes at basin scale, is an important step for building adaptive capacity to the impacts in this region, where severe water shortages are expected for the next decades. RCMs ensemble in combination with distributed hydrological models with few parameters, constitutes a valid and robust methodology to increase the reliability of climate and hydrological projections. For reaching this objective, a novel methodology for building Regional Climate Models (RCMs) ensembles of meteorological variables (rainfall an temperatures), was applied. RCMs ensembles are justified for increasing the reliability of climate and hydrological projections. The evaluation of RCMs goodness-of-fit to build the ensemble is based on empirical probability density functions (PDF) extracted from both RCMs dataset and a highly resolution gridded observational dataset, for the time period 1961-1990. The applied method is considering the seasonal and annual variability of the rainfall and temperatures. The RCMs ensembles constitute the input to a distributed hydrological model at basin scale, for assessing the runoff projections. The selected hydrological model is presenting few parameters in order to reduce the uncertainties involved. The study basin corresponds to a head basin of Segura River Basin, located in the South East of Spain. The impacts on runoff and its trend from observational dataset and climate projections, were assessed. Considering the control period 1961-1990, plausible significant decreases in runoff for the time period 2021-2050, were identified.

  12. Can Regional Climate Models Improve Warm Season Forecasts in the North American Monsoon Region?

    NASA Astrophysics Data System (ADS)

    Dominguez, F.; Castro, C. L.

    2009-12-01

    The goal of this work is to improve warm season forecasts in the North American Monsoon Region. To do this, we are dynamically downscaling warm season CFS (Climate Forecast System) reforecasts from 1982-2005 for the contiguous U.S. using the Weather Research and Forecasting (WRF) regional climate model. CFS is the global coupled ocean-atmosphere model used by the Climate Prediction Center (CPC), a branch of the National Center for Environmental Prediction (NCEP), to provide official U.S. seasonal climate forecasts. Recently, NCEP has produced a comprehensive long-term retrospective ensemble CFS reforecasts for the years 1980-2005. These reforecasts show that CFS model 1) has an ability to forecast tropical Pacific SSTs and large-scale teleconnection patterns, at least as evaluated for the winter season; 2) has greater skill in forecasting winter than summer climate; and 3) demonstrates an increase in skill when a greater number of ensembles members are used. The decrease in CFS skill during the warm season is due to the fact that the physical mechanisms of rainfall at this time are more related to mesoscale processes, such as the diurnal cycle of convection, low-level moisture transport, propagation and organization of convection, and surface moisture recycling. In general, these are poorly represented in global atmospheric models. Preliminary simulations for years with extreme summer climate conditions in the western and central U.S. (specifically 1988 and 1993) show that CFS-WRF simulations can provide a more realistic representation of convective rainfall processes. Thus a RCM can potentially add significant value in climate forecasting of the warm season provided the downscaling methodology incorporates the following: 1) spectral nudging to preserve the variability in the large scale circulation while still permitting the development of smaller-scale variability in the RCM; and 2) use of realistic soil moisture initial condition, in this case provided by the

  13. A Simulation Study of Paced TCP

    NASA Technical Reports Server (NTRS)

    Kulik, Joanna; Coulter, Robert; Rockwell, Dennis; Partridge, Craig

    2000-01-01

    In this paper, we study the performance of paced TCP, a modified version of TCP designed especially for high delay- bandwidth networks. In typical networks, TCP optimizes its send-rate by transmitting increasingly large bursts, or windows, of packets, one burst per round-trip time, until it reaches a maximum window-size, which corresponds to the full capacity of the network. In a network with a high delay-bandwidth product, however, Transmission Control Protocol's (TCPs) maximum window-size may be larger than the queue size of the intermediate routers, and routers will begin to drop packets as soon as the windows become too large for the router queues. The TCP sender then concludes that the bottleneck capacity of the network has been reached, and it limits its send-rate accordingly. Partridge proposed paced TCP as a means of solving the problem of queueing bottlenecks. A sender using paced TCP would release packets in multiple, small bursts during a round-trip time in which ordinary TCP would release a single, large burst of packets. This approach allows the sender to increase its send-rate to the maximum window size without encountering queueing bottlenecks. This paper describes the performance of paced TCP in a simulated network and discusses implementation details that can affect the performance of paced TCP.

  14. Assessment of a Regional Transportation Education Alliance To Improve Mobility.

    ERIC Educational Resources Information Center

    Kuhn, Beverly T.

    This report examines issues related to transportation education, with the objective of developing and packaging transportation-related materials for use in college and university transportation education programs. The study was conducted by the Southwest Region University Transportation Center (SWUTC) region, but it is expected that the results…

  15. REGIONAL APPROACH TO ESTIMATING RECREATION BENEFITS OF IMPROVED WATER QUALITY

    EPA Science Inventory

    Recreation demand and value are estimated with the travel-cost method for fishing, camping, boating, and swimming on a site-specific regional basis. The model is regional in that 197 sites are defined for the Pacific Northwest. A gravity model is employed to estimate the number o...

  16. Pacing hazards in helicopter aeromedical transport.

    PubMed

    Sumchai, A; Sternbach, G; Eliastam, M; Liem, L B

    1988-05-01

    A 62-year-old man with third-degree atrioventricular block and hemodynamically unstable ventricular tachycardia had a cardiac arrest during helicopter transport to a specialized cardiac care unit. Before transport, his ventricular tachycardia had been successfully terminated by a rapid overdrive pacing technique. The failure of "burst suppression" and the absence of pacer spike artifact on the electrocardiographic monitor raise questions about the potential hazards of using various pacing techniques during helicopter transports. Most significantly, this case points to the possibility of interference by exogenous electromagnetic signals in the medical compartment of the helicopter. PMID:3370099

  17. Evaluation of Long Term Effect of RV Apical Pacing on Global LV Function by Echocardiography

    PubMed Central

    Tilkar, Mahendra; Jain, Siddhant; Mondal, Subrata; Sarkar, Piyabi; Modi, Nitin

    2016-01-01

    Introduction We very often face pacemaker implanted patients during follow-up with shortness of breath and effort intolerance inspite of normal clinical parameters. Aim The aim of our study is to evaluate the cause of effort intolerance and probable cause of sub-clinical Congestive Cardiac Failure (CCF) in a case of long term Right Ventricular (RV) apical pacing on global Left Ventricular (LV) function non- invasively by echocardiography. Materials and Methods We studied 54 patients (Male 42, Female 12) of complete heart block (CHB) with RV apical pacing (40 VVI and 14 DCP). Mean duration of pacing was 58+4 months. All patients underwent 24 hours Holter monitoring to determine the percentage of ventricular pacing beats. 2-D Echocardiography was done to assess the regional wall motion of abnormality and global LV ejection fraction by modified Simpson’s rule. These methods were coupled with the Doppler derived Myocardial Performance Index (MPI), tissue Doppler imaging, and mechanical regional dyssynchrony with 3-D Echocardiography. Data were analysed from 54 RV- apical paced patients and compared with age and body surface area of 60 controlled subjects (Male 46, Female 14). Results Evaluation of LV function in 54 patients demonstrated regional wall motion abnormality and Doppler study revealed both LV systolic and diastolic dysfunction compare with control subjects (regional wall motion abnormality 80±6% vs 30±3% with p-value<0.0001) which is proportional to the percentage of ventricular pacing beats (mean paced beat 78%). Global LVEF 50±4% vs 60±2% (p-valve <0.0001) and MPI 0.46 ±0.12 v/s 0.36±0.09 (p-value <0.0001). Conclusion RV–apical pacing induces iatrogenic electrical dyssynchrony which leads to remodeling of LV and produces mechanical dyssynchrony which is responsible for LV dysfunction. Alternate site of RV pacing and/or biventricular pacing should be done to maintain biventricular electrical synchrony which will preserve the LV function. PMID

  18. PACES Participation in Educational Outreach Programs at the University of Texas at El Paso

    NASA Technical Reports Server (NTRS)

    Dodge, Rebecca L.

    1997-01-01

    The University of Texas at El Paso (UTEP) is involved in several initiatives to improve science education within the El Paso area public schools. These include outreach efforts into the K- 12 classrooms; training programs for in-service teachers; and the introduction of a strong science core curricula within the College of Education. The Pan American Center for Earth and Environmental Studies (PACES), a NASA-funded University Research Center, will leverage off the goals of these existing initiatives to provide curriculum support materials at all levels. We will use currently available Mission to Planet Earth (MTPE) materials as well as new materials developed specifically for this region, in an effort to introduce the Earth System Science perspective into these programs. In addition, we are developing curriculum support materials and classes within the Geology and Computer Departments, to provide education in the area of remote sensing and GIS applications at the undergraduate and graduate levels.

  19. Regional anesthesia for the trauma patient: improving patient outcomes.

    PubMed

    Gadsden, Jeff; Warlick, Alicia

    2015-01-01

    Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional analgesia confers excellent site-specific pain relief that is free from major side effects, reduces opioid requirement in trauma patients, and is safe and easy to perform. Specific populations that have shown benefits (including morbidity and mortality advantages) with regional analgesic techniques include those with fractured ribs, femur and hip fractures, and patients undergoing digital replantation. Acute compartment syndrome is a potentially devastating sequela of soft-tissue injury that complicates high-energy injuries such as proximal tibia fractures. The use of regional anesthesia in patients at risk for compartment syndrome is controversial; although the data is sparse, there is no evidence that peripheral nerve blocks delay the diagnosis, and these techniques may in fact facilitate the recognition of pathologic breakthrough pain. The benefits of regional analgesia are likely most influential when it is initiated as early as possible, and the performance of nerve blocks both in the emergency room and in the field has been shown to provide quality pain relief with an excellent safety profile. PMID:26316813

  20. Regional anesthesia for the trauma patient: improving patient outcomes

    PubMed Central

    Gadsden, Jeff; Warlick, Alicia

    2015-01-01

    Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional analgesia confers excellent site-specific pain relief that is free from major side effects, reduces opioid requirement in trauma patients, and is safe and easy to perform. Specific populations that have shown benefits (including morbidity and mortality advantages) with regional analgesic techniques include those with fractured ribs, femur and hip fractures, and patients undergoing digital replantation. Acute compartment syndrome is a potentially devastating sequela of soft-tissue injury that complicates high-energy injuries such as proximal tibia fractures. The use of regional anesthesia in patients at risk for compartment syndrome is controversial; although the data is sparse, there is no evidence that peripheral nerve blocks delay the diagnosis, and these techniques may in fact facilitate the recognition of pathologic breakthrough pain. The benefits of regional analgesia are likely most influential when it is initiated as early as possible, and the performance of nerve blocks both in the emergency room and in the field has been shown to provide quality pain relief with an excellent safety profile. PMID:26316813

  1. Self-Paced Graphics with Track Options.

    ERIC Educational Resources Information Center

    Hilliard, Garland K.

    An engineering graphics course offered at North Carolina State University for freshman engineering students is described. The course is divided into 14 units and the students are allowed to proceed at their own pace. The first 11 units comprise the required core; the remaining 3 units may be chosen from other areas such as computer graphics,…

  2. Developmental Math, Flipped and Self-Paced

    ERIC Educational Resources Information Center

    Weng, Pangyen

    2015-01-01

    This article describes a developmental math course design that uses flipped instruction and self-paced learning. The design was created and taught at Metropolitan State University, where most students are returning adult students with little preparation in mathematics. The author argues that this design suits the students well: the learning…

  3. Internship: A Pacing Guide for Student Teachers.

    ERIC Educational Resources Information Center

    Berrones, Elma; And Others

    This pacing guide is a detailed outline that provides trainees with a building-block approach to the aquisition of teaching skills. In addition, it provides clarity to the roles and responsibilities of the intern, the cooperating teacher, and the supervisor, and coordinates the classroom experience for the third semester of a four-semester…

  4. Program for Alternative Careers in Education (PACE).

    ERIC Educational Resources Information Center

    Flicker, Bernard

    The overall objective of the Program for Alternative Careers in Education (PACE) is to develop an alternative model of teacher preparation that prepares individuals to function as educators in the widest possible variety of educational institutions including public and private human service institutions, social welfare agencies, communication…

  5. An Integrated Preprofessional Individually Paced Instruction Curriculum.

    ERIC Educational Resources Information Center

    McCollom, Kenneth A.; Kurtz, Edwin B.

    The individually-paced instruction program carried out by the engineering faculty at Oklahoma State University is described in this article to illustrate its goals, principles, characteristics, developments, and present status. The instructional model is discussed in connection with behavioral objectives, criteria for performance, and student…

  6. Self-Paced Physics, Instructor Manual.

    ERIC Educational Resources Information Center

    New York Inst. of Tech., Old Westbury.

    As a part of the U. S. Naval Academy Self-Paced Physics Course materials, orientation is presented in this manual to assist an instructor in developing his individual class policies. Descriptions are given of objectives, class atmosphere, student progress, counseling activities, and remedial work. Under the heading of the management sequence,…

  7. Toward a More Efficient Implementation of Antifibrillation Pacing

    PubMed Central

    Wilson, Dan; Moehlis, Jeff

    2016-01-01

    We devise a methodology to determine an optimal pattern of inputs to synchronize firing patterns of cardiac cells which only requires the ability to measure action potential durations in individual cells. In numerical bidomain simulations, the resulting synchronizing inputs are shown to terminate spiral waves with a higher probability than comparable inputs that do not synchronize the cells as strongly. These results suggest that designing stimuli which promote synchronization in cardiac tissue could improve the success rate of defibrillation, and point towards novel strategies for optimizing antifibrillation pacing. PMID:27391010

  8. A New Regional 3-D Velocity Model of the India-Pakistan Region for Improved Event Location Accuracy

    NASA Astrophysics Data System (ADS)

    Reiter, D.; Vincent, C.; Johnson, M.

    2001-05-01

    A 3-D velocity model for the crust and upper mantle (WINPAK3D) has been developed to improve regional event location in the India-Pakistan region. Results of extensive testing demonstrate that the model improves location accuracy for this region, specifically for the case of small regionally recorded events, for which teleseismic data may not be available. The model was developed by integrating the results of more than sixty previous studies related to crustal velocity structure in the region. We evaluated the validity of the 3-D model using the following methods: (1) cross validation analysis for a variety of events, (2) comparison of model determined hypocenters with known event location, and (3) comparison of model-derived and empirically-derived source-specific station corrections (SSSC) generated for the International Monitoring System (IMS) auxiliary seismic station located at Nilore. The 3-D model provides significant improvement in regional location compared to both global and regional 1-D models in this area of complex structural variability. For example, the epicenter mislocation for an event with a well known location was only 6.4 km using the 3-D model, compared with a mislocation of 13.0 km using an average regional 1-D model and 15.1 km for the IASPEI91 model. We will present these and other results to demonstrate that 3-D velocity models are essential to improving event location accuracy in regions with complicated crustal geology and structures. Such 3-D models will be a prerequisite for achieving improved location accuracies for regions of high monitoring interest.

  9. Multichip imager with improved optical performance near the butt region

    NASA Technical Reports Server (NTRS)

    Kinnard, Kenneth P. (Inventor); Strong, Jr., Richard T. (Inventor); Goldfarb, Samuel (Inventor); Tower, John R. (Inventor)

    1991-01-01

    A compound imager consists of two or more individual chips, each with at least one line array of sensors thereupon. Each chip has a glass support plate attached to the side from which light reaches the line arrays. The chips are butted together end-to-end to make large line arrays of sensors. Because of imperfections in cutting, the butted surfaces define a gap. Light entering in the region of the gap is either lost or falls on an individual imager other than the one for which it is intended. This results in vignetting and/or crosstalk near the butted region. The gap is filled with an epoxy resin or other similar material which, when hardened, has an index of referaction near that of the glass support plate.

  10. Pacing-induced ST segment deviation in patients with unstable angina: clinical, angiographic, and hemodynamic correlation.

    PubMed

    Hussain, K M; Gould, L; Pomerantsev, E V; Angirekula, M; Bharathan, T

    1995-07-01

    To assess the clinical, coronary arteriographic, and hemodynamic differences between the unstable angina patients manifesting ST segment depression and those showing ST segment elevation as well as those demonstrating chest pain only without ST segment deviation during pacing, low-dose digital subtraction ventriculography was performed in 33 patients before and after abrupt cessation of atrial pacing during selective coronary arteriography. Transient ST segment depression during pacing was observed in 17 patients (52%), whereas 6 patients (18%) showed ST segment elevation; however, 10 patients (30%) did not manifest any ST segment deviation in spite of typical chest pain. Hypertension and a history of myocardial infarction were observed in a significantly higher (P < 0.05) proportion of patients with ST segment depression than in those with ST elevation. Patients who manifested ST segment depression during pacing had a higher incidence of triple-vessel disease (65 vs 17%; P < .05) as compared with the patients with ST segment elevation. Indirect evidence of intracoronary thrombi (complicated lesion, abrupt occlusion, and intraluminal filling defect) was noticed in a higher frequency (P < 0.05) in the group of patients with ST elevation during pacing. In patients with ST segment depression, no significant changes of global left ventricular (LV) functional parameters were observed. However, the length of the LV severe hypokinetic region was increased significantly (6.2 +/- 3.1 vs 23.5 +/- 6.2%; P < 0.005) during pacing in this group of patients. The shortening of the affected segments of the left ventricle was decreased significantly (52.3 +/- 3.6 vs 38.3 +/- 4.9%; P < 0.05) in these patients during pacing. In the group of patients with ST segment elevation during pacing, decrease in ejection fraction was associated with significant (P < 0.01) increase in midwall equatorial diastolic stress as compared with the patients with pacing-induced ST segment depression as

  11. Improving SLCF Science in the Himalayan Region: ICIMOD's Atmosphere Initiative

    NASA Astrophysics Data System (ADS)

    Panday, A. K.; Pradhan, B. B.; Surapipith, V.

    2013-12-01

    What fraction of the black carbon arriving on Yala Glacier in Langtang, Nepal, is from cooking fires in the houses in the valley below? What fraction is from elsewhere in rural Nepal? What fraction is from industrial and transport sources in Kathmandu? What fraction is from northern India and beyond? What fraction is from the high altitude forest fires that take place during March or April? Effectively mitigating the impacts of black carbon and other short-lived climate forcers requires detailed understanding not just of emissions and impacts, but also of the atmospheric transport pathways that connect the two. In mountainous areas of the Hindu-Kush Himalaya detailed quantitative knowledge about emissions, atmospheric processes, and impacts is still largely missing. The International Centre for Integrated Mountain Development (ICIMOD) is an intergovernmental organization covering Afghanistan, Pakistan, India, Nepal, China, Bhutan, Bangladesh, and Myanmar. ICIMOD's recently established Atmosphere Initiative not only assesses mitigation options and contributes to policy and capacity building in the region, but also works actively to promote collaboration among researchers in the region, while building up an in-house team whose research will address key questions about SLCF. In Spring 2013 ICIMOD's Atmosphere Initiative, in collaboration with the Institute for Advanced Sustainability Studies (IASS) in Potsdam, Germany, carried out the largest field campaign to date in Nepal, hosting instruments belonging to dozens of institutions around the world, at nine field site within and upwind of the Kathmandu Valley, Nepal. The dataset that has been collected gives unprecedented insights into the emissions and atmospheric processes taking place downwind of and within the largest urban agglomeration in the Himalaya region. Meanwhile, in collaboration with national partner institutions, ICIMOD is in the process of setting up one atmospheric observatory each in Bhutan and in

  12. Improving a regional model using reduced complexity and parameter estimation

    USGS Publications Warehouse

    Kelson, Victor A.; Hunt, Randall J.; Haitjema, Henk M.

    2002-01-01

    The availability of powerful desktop computers and graphical user interfaces for ground water flow models makes possible the construction of ever more complex models. A proposed copper-zinc sulfide mine in northern Wisconsin offers a unique case in which the same hydrologic system has been modeled using a variety of techniques covering a wide range of sophistication and complexity. Early in the permitting process, simple numerical models were used to evaluate the necessary amount of water to be pumped from the mine, reductions in streamflow, and the drawdowns in the regional aquifer. More complex models have subsequently been used in an attempt to refine the predictions. Even after so much modeling effort, questions regarding the accuracy and reliability of the predictions remain. We have performed a new analysis of the proposed mine using the two-dimensional analytic element code GFLOW coupled with the nonlinear parameter estimation code UCODE. The new model is parsimonious, containing fewer than 10 parameters, and covers a region several times larger in areal extent than any of the previous models. The model demonstrates the suitability of analytic element codes for use with parameter estimation codes. The simplified model results are similar to the more complex models; predicted mine inflows and UCODE-derived 95% confidence intervals are consistent with the previous predictions. More important, the large areal extent of the model allowed us to examine hydrological features not included in the previous models, resulting in new insights about the effects that far-field boundary conditions can have on near-field model calibration and parameterization. In this case, the addition of surface water runoff into a lake in the headwaters of a stream while holding recharge constant moved a regional ground watershed divide and resulted in some of the added water being captured by the adjoining basin. Finally, a simple analytical solution was used to clarify the GFLOW model

  13. The Pace of Perceivable Extreme Climate Change

    NASA Astrophysics Data System (ADS)

    Tan, X.; Gan, T. Y.

    2015-12-01

    When will the signal of obvious changes in extreme climate emerge over climate variability (Time of Emergence, ToE) is a key question for planning and implementing measures to mitigate the potential impact of climate change to natural and human systems that are generally adapted to potential changes from current variability. We estimated ToEs for the magnitude, duration and frequency of global extreme climate represented by 24 extreme climate indices (16 for temperature and 8 for precipitation) with different thresholds of the signal-to-noise (S/N) ratio based on projections of CMIP5 global climate models under RCP8.5 and RCP4.5 for the 21st century. The uncertainty of ToE is assessed by using 3 different methods to calculate S/N for each extreme index. Results show that ToEs of the projected extreme climate indices based on the RCP4.5 climate scenarios are generally projected to happen about 20 years later than that for the RCP8.5 climate scenarios. Under RCP8.5, the projected magnitude, duration and frequency of extreme temperature on Earth will all exceed 2 standard deviations by 2100, and the empirical 50th percentile of the global ToE for the frequency and magnitude of hot (cold) extreme are about 2040 and 2054 (2064 and 2054) for S/N > 2, respectively. The 50th percentile of global ToE for the intensity of extreme precipitation is about 2030 and 2058 for S/N >0.5 and S/N >1, respectively. We further evaluated the exposure of ecosystems and human societies to the pace of extreme climate change by determining the year of ToE for various extreme climate indices projected to occur over terrestrial biomes, marine realms and major urban areas with large populations. This was done by overlaying terrestrial, ecoregions and population maps with maps of ToE derived, to extract ToEs for these regions. Possible relationships between GDP per person and ToE are also investigated by relating the mean ToE for each country and its average value of GDP per person.

  14. Improvement of the Valencia region ultraviolet index (UVI) forecasting system

    NASA Astrophysics Data System (ADS)

    Gómez, I.; Marín, M. J.; Pastor, F.; Estrela, M. J.

    2012-04-01

    The CEAM Foundation (Valencia, Spain) has developed an operational ultraviolet index (UVI) forecasting system based on the Santa Barbara DISORT Atmospheric Radiative Transfer (SBDART) model. The main objective of this system is to provide the general public with a tool to minimize the impact of ultraviolet (UV) radiation, which can cause important human health problems. The system presented in this paper has been developed in collaboration with the Environment Department of the Regional Government of Valencia, and it replaces the one running until 2007. The new system substitutes the previously used Ozone Monitoring Instrument (OMI) observed data with the total ozone column data forecasted from the Global Forecasting System (GFS) model. This has allowed the forecasting period to be increased from only 1 day in the original system to 3 days, with daily updates. The UVI forecast presented herein uses maps to show the hourly daytime evolution of the UV index on selected locations as well as the maximum UVI expected in the area of interest for the following 3 days (D, D+1, and D+2). The locations selected correspond to measurement stations equipped with erythemal radiation instruments. The UVI forecast information, the erythemal radiation experimental data, and other outreach information are supplied to the public through both the CEAM Meteorology and Climatology Program Web page and the Environment Department of the Regional Government of Valencia Web page.

  15. 42 CFR 460.50 - Termination of PACE program agreement.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Sanctions, Enforcement Actions, and Termination § 460.50 Termination of...

  16. Temporary epicardial pacing wire placement in totally endoscopic cardiac surgery.

    PubMed

    Yu, Tao; Zhang, Xiaoshen; Huang, Keli

    2016-07-01

    Temporary epicardial pacing wire placement is a common procedure in cardiac surgery. However, it is difficult to perform in totally endoscopic cardiac surgery. We describe a simple new technique to place temporary epicardial pacing wires quickly and safely. PMID:27130494

  17. Improved Bayesian Infrasonic Source Localization for regional infrasound

    NASA Astrophysics Data System (ADS)

    Blom, Philip S.; Marcillo, Omar; Arrowsmith, Stephen J.

    2015-12-01

    The mathematical framework used in the Bayesian Infrasonic Source Localization (BISL) methodology is examined and simplified providing a generalized method of estimating the source location and time for an infrasonic event. The likelihood function describing an infrasonic detection used in BISL has been redefined to include the von Mises distribution developed in directional statistics and propagation-based, physically derived celerity-range and azimuth deviation models. Frameworks for constructing propagation-based celerity-range and azimuth deviation statistics are presented to demonstrate how stochastic propagation modelling methods can be used to improve the precision and accuracy of the posterior probability density function describing the source localization. Infrasonic signals recorded at a number of arrays in the western United States produced by rocket motor detonations at the Utah Test and Training Range are used to demonstrate the application of the new mathematical framework and to quantify the improvement obtained by using the stochastic propagation modelling methods. Using propagation-based priors, the spatial and temporal confidence bounds of the source decreased by more than 40 per cent in all cases and by as much as 80 per cent in one case. Further, the accuracy of the estimates remained high, keeping the ground truth within the 99 per cent confidence bounds for all cases.

  18. Improved Bayesian Infrasonic Source Localization for regional infrasound

    SciTech Connect

    Blom, Philip S.; Marcillo, Omar; Arrowsmith, Stephen J.

    2015-10-20

    The Bayesian Infrasonic Source Localization (BISL) methodology is examined and simplified providing a generalized method of estimating the source location and time for an infrasonic event and the mathematical framework is used therein. The likelihood function describing an infrasonic detection used in BISL has been redefined to include the von Mises distribution developed in directional statistics and propagation-based, physically derived celerity-range and azimuth deviation models. Frameworks for constructing propagation-based celerity-range and azimuth deviation statistics are presented to demonstrate how stochastic propagation modelling methods can be used to improve the precision and accuracy of the posterior probability density function describing the source localization. Infrasonic signals recorded at a number of arrays in the western United States produced by rocket motor detonations at the Utah Test and Training Range are used to demonstrate the application of the new mathematical framework and to quantify the improvement obtained by using the stochastic propagation modelling methods. Moreover, using propagation-based priors, the spatial and temporal confidence bounds of the source decreased by more than 40 per cent in all cases and by as much as 80 per cent in one case. Further, the accuracy of the estimates remained high, keeping the ground truth within the 99 per cent confidence bounds for all cases.

  19. Improved Bayesian Infrasonic Source Localization for regional infrasound

    DOE PAGESBeta

    Blom, Philip S.; Marcillo, Omar; Arrowsmith, Stephen J.

    2015-10-20

    The Bayesian Infrasonic Source Localization (BISL) methodology is examined and simplified providing a generalized method of estimating the source location and time for an infrasonic event and the mathematical framework is used therein. The likelihood function describing an infrasonic detection used in BISL has been redefined to include the von Mises distribution developed in directional statistics and propagation-based, physically derived celerity-range and azimuth deviation models. Frameworks for constructing propagation-based celerity-range and azimuth deviation statistics are presented to demonstrate how stochastic propagation modelling methods can be used to improve the precision and accuracy of the posterior probability density function describing themore » source localization. Infrasonic signals recorded at a number of arrays in the western United States produced by rocket motor detonations at the Utah Test and Training Range are used to demonstrate the application of the new mathematical framework and to quantify the improvement obtained by using the stochastic propagation modelling methods. Moreover, using propagation-based priors, the spatial and temporal confidence bounds of the source decreased by more than 40 per cent in all cases and by as much as 80 per cent in one case. Further, the accuracy of the estimates remained high, keeping the ground truth within the 99 per cent confidence bounds for all cases.« less

  20. Applying 20/20 Hindsight to Self-Pacing.

    ERIC Educational Resources Information Center

    Dunkleberger, Gary E.

    1980-01-01

    Discussed are several suggestions for the maintenance of a science self-paced classroom. Topics include the use of computers for student self-assessment, teachers and students roles in the self-paced classroom, and laboratory setup and packaging in the self-paced science laboratory. (Author/DS)

  1. His bundle pacing: Initial experience and lessons learned.

    PubMed

    Deshmukh, Amrish; Deshmukh, Pramod

    2016-01-01

    Direct His bundle pacing provides the most physiologic means of artificial pacing of the ventricles with a preserved His-Purkinje system and may play a role in patients with a diseased intrinsic conduction system. We describe our initial motivations and experience with permanent direct His bundle pacing and important lessons learned since that time. PMID:27591359

  2. State of the art of leadless pacing.

    PubMed

    Sperzel, Johannes; Burri, Haran; Gras, Daniel; Tjong, Fleur V Y; Knops, Reinoud E; Hindricks, Gerhard; Steinwender, Clemens; Defaye, Pascal

    2015-10-01

    Despite undisputable benefits, conventional pacemaker therapy is associated with specific complications related to the subcutaneous device and the transvenous leads. Recently, two miniaturized leadless pacemakers, Nanostim™ (St. Jude Medical) and Micra™ (Medtronic), which can be completely implanted inside the right ventricle using steerable delivery systems, entered clinical application. The WiCS™-cardiac resynchronisation therapy (CRT) system (wireless cardiac stimulation for CRT, EBR Systems) delivers leadless left ventricular endocardial stimulation for cardiac resynchronization. In addition to obvious cosmetic benefits, leadless pacing systems may have the potential to overcome some complications of conventional pacing. However, acute and long-term complications still remains to be determined, as well as the feasibility of device explantation years after device placement. PMID:26024918

  3. Visual aided pacing in respiratory maneuvers

    NASA Astrophysics Data System (ADS)

    Rambaudi, L. R.; Rossi, E.; Mántaras, M. C.; Perrone, M. S.; Siri, L. Nicola

    2007-11-01

    A visual aid to pace self-controlled respiratory cycles in humans is presented. Respiratory manoeuvres need to be accomplished in several clinic and research procedures, among others, the studies on Heart Rate Variability. Free running respiration turns to be difficult to correlate with other physiologic variables. Because of this fact, voluntary self-control is asked from the individuals under study. Currently, an acoustic metronome is used to pace respiratory frequency, its main limitation being the impossibility to induce predetermined timing in the stages within the respiratory cycle. In the present work, visual driven self-control was provided, with separate timing for the four stages of a normal respiratory cycle. This visual metronome (ViMet) was based on a microcontroller which power-ON and -OFF an eight-LED bar, in a four-stage respiratory cycle time series handset by the operator. The precise timing is also exhibited on an alphanumeric display.

  4. State of the art of leadless pacing

    PubMed Central

    Sperzel, Johannes; Burri, Haran; Gras, Daniel; Tjong, Fleur V.Y.; Knops, Reinoud E.; Hindricks, Gerhard; Steinwender, Clemens; Defaye, Pascal

    2015-01-01

    Despite undisputable benefits, conventional pacemaker therapy is associated with specific complications related to the subcutaneous device and the transvenous leads. Recently, two miniaturized leadless pacemakers, Nanostim™ (St. Jude Medical) and Micra™ (Medtronic), which can be completely implanted inside the right ventricle using steerable delivery systems, entered clinical application. The WiCS™-cardiac resynchronisation therapy (CRT) system (wireless cardiac stimulation for CRT, EBR Systems) delivers leadless left ventricular endocardial stimulation for cardiac resynchronization. In addition to obvious cosmetic benefits, leadless pacing systems may have the potential to overcome some complications of conventional pacing. However, acute and long-term complications still remains to be determined, as well as the feasibility of device explantation years after device placement. PMID:26024918

  5. Endogenous angiotensin-(1-7)/Mas receptor/NO pathway mediates the cardioprotective effects of pacing postconditioning.

    PubMed

    Abwainy, Ala'a; Babiker, Fawzi; Akhtar, Saghir; Benter, Ibrahim F

    2016-01-01

    The aim of the present study was to investigate the role of the ANG-(1-7) receptor (Mas) and nitric oxide (NO) in pacing postconditiong (PPC)-mediated cardioprotection against ischemia-reperfusion injury. Cardiac contractility and hemodynamics were assessed using a modified Langendorff system, cardiac damage was assessed by measuring infarct size and creatinine kinase levels, and levels of phosphorylated and total endothelial NO synthase (eNOS) were determined by Western blot analysis. Isolated hearts were subjected to 30 min of regional ischemia, produced by fixed position ligation of the left anterior descending coronary artery, followed by 30 min of reperfusion (n = 6). Hearts were also subjected to PPC (three cycles of 30 s of left ventricular pacing alternated with 30 s of right atrial pacing) and/or treated during reperfusion with ANG-(1-7), N(G)-nitro-l-arginine methyl ester, or the Mas antagonist (d-Ala7)-ANG I/II (1-7). The PPC-mediated improvement in cardiac contractility and hemodyanamics, cardiac damage, and eNOS phosphorylation were significantly attenuated upon treatment with (d-Ala7)-ANG I/II (1-7) or N(G)-nitro-l-arginine methyl ester. Treatment with ANG-(1-7) improved cardiac function and reduced infarct size and creatinine kinase levels; however, the effects of ANG-(1-7) were not additive with PPC. In conclusion, these data provide novel insights into the cardioprotective mechanisms of PPC in that they involve the Mas receptor and eNOS and further suggest a potential therapeutic role for ANG-(1-7) in cardiac ischemic injury. PMID:26519026

  6. Cardiac resynchronisation therapy in 2015: keeping up with the pace.

    PubMed

    Voskoboinik, A; McGavigan, A D; Mariani, J A

    2016-03-01

    Despite improved understanding of the pathophysiology of heart failure (HF) and availability of better medical therapies, HF continues to grow as a cause of morbidity and mortality in Australia and worldwide. Over the past decade, cardiac resynchronisation therapy (CRT), or biventricular pacing, has been embraced as a powerful weapon against this growing epidemic. However, much has changed in our understanding of dyssynchrony in HF, and this has led to a change in guidelines to ensure more appropriate selection of CRT candidates to improve the 'non-response' rate. More data have also emerged about the use of CRT in atrial fibrillation and in pacemaker-dependent patients. There has also been a growing focus on multimodality imaging to guide patient selection and lead positioning. Exciting new lead technologies are also emerging, with the potential to improve CRT outcomes further. PMID:25851588

  7. Gait Alterations During Constant Pace Treadmill Racewalking.

    PubMed

    Hanley, Brian

    2015-08-01

    Racewalking is an Olympic event requiring great endurance, and racewalkers often use treadmills in training because of the benefits of having a flat unchanging surface where pace judgment can be learned and because inclement weather can be avoided. The effects of fatigue associated with racewalking on a treadmill have not been studied and could be informative with regard to the maintenance of legal technique. The aim of this study was to measure key gait variables during a physically demanding treadmill racewalk. Fourteen international racewalkers completed 10 km on an instrumented treadmill at a pace equivalent to 103% of their recent best time. Spatiotemporal and ground reaction force data were recorded at 4 distances. High-speed videography data were simultaneously recorded to analyze changes in knee angle between the early and late stages. Increases in step length and corresponding decreases in cadence were found, although the small changes were not considered meaningful. There was also a small increase in flight time and a small decrease in push-off force. There were no other significant changes for any other variables (including knee angles). The increase in flight time might be important given that racewalkers are not permitted a visible loss of contact and suggests that fatiguing sessions on a treadmill can lead to the adoption of nonlegal technique. However, this disadvantage of treadmill training can be negated if the coach scrutinizes athletes throughout the session, and overall the consistent technique used is of benefit with regard to learning correct form and pacing ability. PMID:25647657

  8. Improved construction materials for polar regions using microcellular thermoplastic foams

    NASA Technical Reports Server (NTRS)

    Cunningham, Daniel J.

    1994-01-01

    Microcellular polymer foams (MCF) are thermoplastic foams with very small cell diameters, less than 10 microns, and very large cell densities, 10(exp 9) to 10(exp 15) cells per cubic centimeter of unfoamed material. The concept of foaming polymers with microcellular voids was conceived to reduce the amount of material used for mass-produced items without compromising the mechanical properties. The reasoning behind this concept was that if voids smaller than the critical flaw size pre-existing in polymers were introduced into the matrix, they would not affect the overall strength of the product. MCF polycarbonate (PC), polystyrene (PS), and polyvinyl chloride (PVC) were examined to determine the effects of the microstructure towards the mechanical properties of the materials at room and arctic temperatures. Batch process parameters were discovered for these materials and foamed samples of three densities were produced for each material. To quantify the toughness and strength of these polymers, the tensile yield strength, tensile toughness, and impact resistance were measured at room and arctic temperatures. The feasibility of MCF polymers has been demonstrated by the consistent and repeatable MCF microstructures formed, but the improvements in the mechanical properties were not conclusive. Therefore the usefulness of the MCF polymers to replace other materials in arctic environments is questionable.

  9. An Exploratory Study of Student-Paced versus Teacher-Paced Accommodations for Large-Scale Math Tests.

    ERIC Educational Resources Information Center

    Hollenbeck, Keith; Rozek-Tedesco, Marick A.; Tindal, Gerald; Glasgow, Aaron

    2000-01-01

    This study examined whether a teacher-paced video (TPV) accommodation or a student-paced computer (SPC) accommodation provided differential access for student with disabilities versus their general education peers on a large-scale math test. It found that although both pacing accommodations significantly influenced mean scores, the SPC…

  10. Optical stimulation enables paced electrophysiological studies in embryonic hearts

    PubMed Central

    Wang, Yves T.; Gu, Shi; Ma, Pei; Watanabe, Michiko; Rollins, Andrew M.; Jenkins, Michael W.

    2014-01-01

    Cardiac electrophysiology plays a critical role in the development and function of the heart. Studies of early embryonic electrical activity have lacked a viable point stimulation technique to pace in vitro samples. Here, optical pacing by high-precision infrared stimulation is used to pace excised embryonic hearts, allowing electrophysiological parameters to be quantified during pacing at varying rates with optical mapping. Combined optical pacing and optical mapping enables electrophysiological studies in embryos under more physiological conditions and at varying heart rates, allowing detection of abnormal conduction and comparisons between normal and pathological electrical activity during development in various models. PMID:24761284

  11. European clinical experience with a dual chamber single pass sensing and pacing defibrillation lead.

    PubMed

    Gradaus, Rainer; Gonska, Bernd D; Stellbrink, Christoph; Cron, Thomas; Tebbenjohanns, Jürgen; Blomström-Lundqvist, Carina; Himmrich, Ewald; Salerno, Jorge A; Osswald, Stefan; Gommer, Erik D; Van Veen, Benno K; Böcker, Dirk

    2002-07-01

    Dual chamber ICDs are increasingly implanted nowadays, mainly to improve discrimination between supraventricular and ventricular arrhythmias but also to maintain AV synchrony in patients with bradycardia. The aim of this study was to investigate a new single pass right ventricular defibrillation lead capable of true bipolar sensing and pacing in the right atrium and integrated bipolar sensing and pacing in the right ventricle. The performance of the lead was evaluated in 57 patients (age 61 +/- 12 years; New York Heart Association 1.9 +/- 0.6, left ventricular ejection fraction 0.38 +/- 0.15) at implant, at prehospital discharge, and during a 1-year follow-up. Sensing and pacing behavior of the lead was evaluated in six different body positions. In four patients, no stable position of the atrial electrode could intraoperatively be found. The intraoperative atrial sensing was 2.3 +/- 1.6 mV and the atrial pacing threshold 0.8 +/- 0.5 V at 0.5 ms. At follow-up, the atrial sensing ranged from 1.5 mV to 2.2 mV and the atrial pacing threshold product from 0.8 to 1.7 V/ms. In 11 patients, an intermittent atrial sensing problem and in 24 patients an atrial pacing dysfunction were observed in at least one body position. In 565 episodes, a sensitivity of 100% and a specificity of 96.5% were found for ventricular arrhythmias. In conclusion, this single pass defibrillation lead performed well as a VDD lead and for dual chamber arrhythmia discrimination. However, loss of atrial capture in 45% of patients preclude its use in patients depending on atrial pacing. PMID:12164450

  12. Single pass lead VDD pacing in children and adolescents.

    PubMed

    Rosenheck, S; Elami, A; Amikam, S; Erdman, S; Ovsyshcher, I E

    1997-08-01

    Implantation of permanent pacemakers in children and adolescents is possible but usually is limited to single chamber generators. The natural growth of these patients may require physiological pacing, but until recently two leads were required for this type of pacing. The single pass lead VDD pacing mode makes possible physiological pacing by using only one lead, for both atrial sensing and ventricular sensing and pacing. The feasibility of VDD pacing using endocardial lead was evaluated in 16 children and adolescents with congenital or postsurgical atrioventricular block. Their mean age was 7.9 +/- 4.9 years (range 1-16 years) and the smallest patient's weight was 8.2 kg. In all the patients, a single pass pacing lead with atrial sensing rings and bipolar ventricular pacing and sensing capability was implanted through the left or right subclavian vein. The pacemaker generator was implanted in a rectopectoral position. The mean atrial electrogram during the implantation was 4.2 +/- 2.1 mV and 2.6 +/- 1.9 mV after a mean of 1 week. The ventricular pacing threshold was 0.5 +/- 0.2 V; the ventricular pacing impedance was 560 +/- 95 omega; and the ventricular electrogram amplitude was 9.9 +/- 2.1 mV. This is a first report to demonstrate the feasibility of atrial synchronous ventricular endocardial pacing using a single pass lead in a relatively large group of children and adolescents. PMID:9272534

  13. 42 CFR 460.90 - PACE benefits under Medicare and Medicaid.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Services § 460.90 PACE benefits under Medicare and Medicaid. If a...

  14. 42 CFR 460.90 - PACE benefits under Medicare and Medicaid.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Services § 460.90 PACE benefits under Medicare and Medicaid. If a...

  15. 42 CFR 460.32 - Content and terms of PACE program agreement.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Program Agreement § 460.32 Content and terms of PACE program agreement....

  16. 42 CFR 460.90 - PACE benefits under Medicare and Medicaid.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Services § 460.90 PACE benefits under Medicare and Medicaid. If a...

  17. 42 CFR 460.32 - Content and terms of PACE program agreement.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Program Agreement § 460.32 Content and terms of PACE program agreement....

  18. 42 CFR 460.32 - Content and terms of PACE program agreement.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Program Agreement § 460.32 Content and terms of PACE program agreement....

  19. 42 CFR 460.32 - Content and terms of PACE program agreement.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Program Agreement § 460.32 Content and terms of PACE program agreement....

  20. 42 CFR 460.90 - PACE benefits under Medicare and Medicaid.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Services § 460.90 PACE benefits under Medicare and Medicaid. If a...

  1. 42 CFR 460.32 - Content and terms of PACE program agreement.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Program Agreement § 460.32 Content and terms of PACE program agreement....

  2. Right ventricle bipolar pacing may prevent appropriate biventricular pacing from two pacemakers. Case report.

    PubMed

    Kranidis, Athanasios I; Andrikopoulos, George K; Kappos, Kostas G; Bouki, Tania P; Dedehlias, Panos N

    2004-10-01

    This article reports on practical problems and possible solutions that may occur in case of upgrading a dual-chamber pacemaker by implanting a second left ventricular ventricular pacing, ventricular sensing, ventricular triggering (VVT) pacemaker. This therapeutic strategy was considered appropriate in the case of a 73-year-old patient with severe heart failure, who was scheduled to undergo coronary artery bypass surgery. A right-sided, dual-chamber pacemaker had been already implanted to the patient. The duration of the paced QRS complex was 220 ms and inter- and intraventricular dyssynchrony was documented in the echocardiographic study. We describe the methodological problems and possible solutions related to biventricular pacing following the abovementioned strategy. PMID:15484162

  3. Comparison of effectiveness of right ventricular septal pacing versus right ventricular apical pacing.

    PubMed

    Cano, Oscar; Osca, Joaquín; Sancho-Tello, María-José; Sánchez, Juan M; Ortiz, Víctor; Castro, José E; Salvador, Antonio; Olagüe, José

    2010-05-15

    Chronic right ventricular apical pacing (RVAP) has been associated with negative hemodynamic and clinical effects. The aim of the present study was to compare RVAP with right ventricular septal pacing (RVSP) in terms of echocardiographic features and clinical outcomes. A total of 93 patients without structural heart disease and with an indication for a permanent pacemaker were randomly assigned to receive a screw-in lead either in the RV apex (n = 46) or in the RV mid-septum (n = 47). The patients were divided into 3 subgroups according to the percentage of ventricular pacing: control group (n = 21, percentage of ventricular pacing < or =10%), RVAP group (n = 28), or RVSP group (n = 32; both latter groups had a percentage of ventricular pacing >10%). The RVAP group had more intraventricular dyssynchrony and a trend toward a worse left ventricular ejection fraction compared to the RVSP and control groups at 12 months of follow-up (maximal delay to peak systolic velocity between any of the 6 left ventricular basal segments was 57.8 +/- 38.2, 35.5 +/- 20.6, and 36.5 +/- 17.8 ms for RVAP, RVSP, and control group, respectively; p = 0.006; mean left ventricular ejection fraction 62.9 +/- 7.9%, 66.5 +/- 7.2%, and 66.6 +/- 7.2%, respectively, p = 0.14). Up to 48.1% of the RVAP patients showed significant intraventricular dyssynchrony compared to 19.4% of the RVSP patients and 23.8% of the controls (p = 0.04). However, no overt clinical benefits from RVSP were found. In conclusion, RVAP was associated with increased dyssynchrony compared to the RVSP and control patients. RVSP could represent an alternative pacing site in selected patients to reduce the harmful effects of traditional RVAP. PMID:20451689

  4. Benefit of single setting rate responsive ventricular pacing compared with fixed rate demand pacing in elderly patients.

    PubMed

    Gammage, M; Schofield, S; Rankin, I; Bennett, M; Coles, P; Pentecost, B

    1991-02-01

    In order to assess the value of a simple, single setting rate response option to VVI pacing, 12 patients (mean age 75.1 +/- 6.2, range 62-83 years, seven males, five females) with symptomatic complete heart block were entered into a double-blind, randomized crossover trial of VVI versus VVIR (single setting rate responsive) pacing using Medtronic Activitrax pacemakers. Assessment was by time taken in seconds (sec) and Borg scale symptom score (6-20) for simple activities (standing from chair x 30; walking 800 meters; 52 steps on stairs [slow and fast pace], and incremental, noninclined maximal treadmill exercise), performed after a 4-week period with the patient in each pacing mode. Times were significantly improved in VVIR mode for standing from chair [mean +/- SD] (78.7 +/- 22.5 vs 70.7 +/- 19.5 sec; P less than 0.05), for 800 m walk (1032 +/- 80 vs 885 +/- 59 sec; P less than 0.05), fast ascent of stairs (29.5 +/- 7.7 vs 26.5 +/- 5.6 sec; P less than 0.02), and treadmill exercise (626.7 +/- 189.5 vs 741.0 +/- 170.2 sec, P less than 0.005) although no difference in time for slow stair ascent was demonstrated. Symptom scores were significantly less in VVIR for standing from chair (12.7 +/- 2.8 vs 10.3 +/- 1.8; P less than 0.01), 800 m walk (10.9 +/- 2.7 vs 9.0 +/- 2.4; P less than 0.01), slow ascent of stairs (11.6 +/- 2.1 vs 10.0 +/- 2.0; P less than 0.01), and fast ascent of stairs (13.0 +/- 2.0 vs 11.7 +/- 1.9; P less than 0.02) but unchanged for treadmill exercise.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1706502

  5. Aliskiren protecting atrial structural remodeling from rapid atrial pacing in a canine model.

    PubMed

    Zhao, Zhiqiang; Chen, Yan; Li, Weimin; Wang, Xinghua; Li, Jian; Yang, Wansong; Cheng, Lijun; Liu, Tong; Liu, Enzhao; Li, Guangping

    2016-08-01

    Atrial fibrillation (AF) contributing to the increasing mortality risk is the most common disease in clinical practice. Owing to the side effects and relative inefficacy of current antiarrhythmic drugs, some research focuses on renin-angiotensin-aldosterone system (RAS) for finding out the new treatment of AF. The purpose of this study is to confirm whether aliskiren as a proximal inhibitor of renin, which completely inhibits RAS, has beneficial effects on atrial structural remodeling in AF. In this study, rapid atrial pacing was induced at 500 beats per minute for 2 weeks in a canine model. A different dose of aliskiren was given orally for 2 weeks before rapid atrial pacing. HE staining and Masson's staining were used for analysis of myocardial fibrosis. TGF-β1, signal pathways, and pro-inflammatory cytokines were shown for the mechanism of structural remodeling after the treatment of aliskiren. Serious atrial fibrosis was induced by rapid atrial pacing, followed by the elevated TGF-β1, upregulated MEK and ERK1/2, and increased inflammatory factors. Aliskiren could apparently improve myocardial fibrosis by reducing the expression of TGF-β1, inhibiting MEK and ERK1/2 signal pathways, and decreasing IL-18 and TLR4 in both serum and atrial tissue. In conclusion, aliskiren could prevent atrial structural remodeling from rapid atrial pacing for 2 weeks. Aliskiren may play a potential beneficial role in the treatment of AF induced by rapid atrial pacing. PMID:27118660

  6. Application of PACE Principles for Population Health Management of Frail Older Adults.

    PubMed

    Stefanacci, Richard G; Reich, Shelley; Casiano, Alex

    2015-10-01

    To determine which practices would have the most impact on reducing hospital and emergency department admissions and nursing home placement among older adults with multiple comorbid conditions, a literature search and survey were conducted to identify and prioritize comprehensive care principles as practiced in the Program of All-inclusive Care for the Elderly (PACE). PACE medical directors and members of the PACE interdisciplinary team (IDT) were surveyed to gain their insights on the most impactful practices, which were identified as: End-of-Life Management, Caregiver Support, Management of Red Flags, Medication Management, Participant and Caregiver Health Care System Literacy, and Care Coordination. In addition, this research evaluated measures that could be used to assess an organization's level of success with regard to each of the 6 PACE practices identified. The results reported in this article, found through a survey with PACE medical directors and IDT members concerning effective interventions, can be viewed as strategies to improve care for older adults, enabling them to maintain their independence in the community, avoid the expense of facility-based care, and enhance their quality of life. PMID:25647691

  7. A biophysically based finite-state machine model for analyzing gastric experimental entrainment and pacing recordings.

    PubMed

    Sathar, Shameer; Trew, Mark L; Du, Peng; O'Grady, Greg; Cheng, Leo K

    2014-04-01

    Gastrointestinal motility is coordinated by slow waves (SWs) generated by the interstitial cells of Cajal (ICC). Experimental studies have shown that SWs spontaneously activate at different intrinsic frequencies in isolated tissue, whereas in intact tissues they are entrained to a single frequency. Gastric pacing has been used in an attempt to improve motility in disorders such as gastroparesis by modulating entrainment, but the optimal methods of pacing are currently unknown. Computational models can aid in the interpretation of complex in vivo recordings and help to determine optimal pacing strategies. However, previous computational models of SW entrainment are limited to the intrinsic pacing frequency as the primary determinant of the conduction velocity, and are not able to accurately represent the effects of external stimuli and electrical anisotropies. In this paper, we present a novel computationally efficient method for modeling SW propagation through the ICC network while accounting for conductivity parameters and fiber orientations. The method successfully reproduced experimental recordings of entrainment following gastric transection and the effects of gastric pacing on SW activity. It provides a reliable new tool for investigating gastric electrophysiology in normal and diseased states, and to guide and focus future experimental studies. PMID:24276722

  8. Maine PACE Program Final Technical Report

    SciTech Connect

    Fischer, Dana; Adamson, Joy M

    2015-01-30

    The ARRA EECBG BetterBuilding helped augment the existing Home Energy Savings Programs (HESP) and incentives with financing through a subordinate lien PACE and HUD PowerSaver programs. The program was designed to document innovative techniques to dramatically increase the number of homes participating in weatherization programs in participating towns. Maine will support new energy efficiency retrofit pilots throughout the state, designed to motivate a large number of homeowners to invest in comprehensive home energy efficiency upgrades to bring real solutions to market.

  9. Influence of cinnamon and catnip on the stereotypical pacing of oncilla cats (Leopardus tigrinus) in captivity.

    PubMed

    Resende, Letícia de S; Pedretti Gomes, Karla C; Andriolo, Artur; Genaro, Gelson; Remy, Gabriella L; Almeida Ramos, Valdir de

    2011-01-01

    Nonhuman animals in captivity can experience environmental privation that results in their exhibiting abnormal behaviors. Environmental enrichment techniques can help improve their welfare. This study investigated the behavior of 8 zoo-housed oncilla cats (Leopardus tigrinus) in response to 2 odors (catnip and cinnamon) introduced individually into the animals' enclosures for 3 consecutive days. Proportion of scans spent engaging in stereotypical pacing were compared before, during, and after treatments. The addition of cinnamon reduced the proportion of pacing during and after enrichment (Wilcoxon: Z = 3.16, p < .001; Z = 3.16, p < .001, respectively), indicating a prolonged effect of the enrichment on the animals' behavior. Catnip appears to have elicited no significant difference in the stereotypic pacing before, during, or after the enrichment (Friedman: X(2) = 2.69; p = .260). The results highlight the potential use of cinnamon as a method of environmental enrichment for small captive-housed cats. PMID:22044295

  10. A gastroesophageal electrode for atrial and ventricular pacing.

    PubMed

    McEneaney, D J; Cochrane, D J; Anderson, J A; Adgey, A A

    1997-07-01

    Temporary transvenous cardiac pacing requires technical expertise and access to fluoroscopy. We have developed a gastroesophageal electrode capable of atrial and ventricular pacing. The flexible polythene gastroesophageal electrode is passed into the stomach under light sedation. Five ring electrodes, now positioned in the lower esophagus, are used for atrial pacing. A point source (cathode) on the distal tip of the electrode, now positioned in the gastric fundus, is used for ventricular pacing. Two configurations of atrial and ventricular pacing were compared: unipolar and bipolar. During unipolar ventricular pacing the indifferent electrode (anode) was a high impedance chest pad. For bipolar ventricular pacing the indifferent electrode was a ring electrodes placed 2 cm proximal to the tip. Unipolar atrial pacing was performed with 1 of 5 proximal ring electrodes acting as cathode ("cathodic") or as anode ("anodic") in conjunction with a chest pad. Bipolar atrial pacing was performed using combinations of 2 of 5 ring electrodes. Atrial capture was obtained in all 55 subjects attempted. When all electrode combinations were compared, atrial capture was significantly more frequent using the bipolar approach (153/210 bipolar, 65/210 unipolar; t = 7.37, P < 0.001). For unipolar atrial pacing, cathodic stimulation (from esophagus) was more successful than anodic stimulation (cathodic 62/105, anodic 20/105; t = 5.81, P < 0.001). In 43 subjects attempted unipolar ventricular pacing resulted in a higher frequency of capture than the bipolar approach (unipolar 41/43 (95.3%), bipolar 19/43 (44.2%); P < 0.001). In conclusion, atrial pacing was optimal using pairs of ring electrodes ("bipolar") while ventricular pacing was optimal using the distal electrode tip (cathode) in conjunction with a chest pad electrode ("unipolar"). This gastroesophageal electrode may be useful in the emergency management of acute bradyarrhythmias and for elective electrophysiological studies. PMID

  11. Vocalization and pauses in fast-paced reading.

    PubMed

    Breznitz, Z

    1990-04-01

    Previous research (Breznitz, 1987a) indicated that prompting first-graders to read faster than usual increases their comprehension. The present study was conducted to clarify which of the speech elements that comprise reading time is affected when reading pace is accelerated. First-graders (N = 76) read aloud three parallel forms of a comprehension test, at self- and fast-paced rates consecutively, followed by a second self-paced reading. Vocalization time, pause time, pause frequency, and the average length of vocalizations and pauses were determined with an automatic vocal transaction analyzer. During fast-paced reading, children made fewer and shorter pauses, vocalized at a faster rate, and tended to speak in longer units. The speech characteristics indicative of fast-paced reading were significantly correlated with reading comprehension, even during self-paced reading, and can serve as indicators of effective reading. PMID:2366048

  12. Characteristics of Midwest Region School Districts Identified for Improvement. Summary. Issues & Answers. REL 2012-No. 121

    ERIC Educational Resources Information Center

    van der Ploeg, Arie; Wan, Yinmei; Garcia, Alicia N.; Wraight, Sara; Burke, Matthew; Norbury, Heather; Gerdeman, R. Dean

    2012-01-01

    This report presents statistical profiles for the Midwest Region states of school districts designated as "in improvement" for school year 2009/10 under accountability provisions of the No Child Left Behind Act of 2001 and compares the prevalence and characteristics of these districts and those of districts not in improvement. It also reports the…

  13. Let's Go! School Nutrition Workgroups: Regional Partnerships for Improving School Meals.

    PubMed

    Kessler, Heidi L; Vine, Jackie; Rogers, Victoria W

    2015-01-01

    This report describes a regional approach for improving the nutritional quality of school meals and increasing the selection of healthier foods. Let's Go! is a childhood obesity prevention program that establishes regional workgroups to develop innovative solutions to improve school meal programs. Let's Go! fosters collaborative decision making, specifically addressing the feasibility of proposed strategies, differences in school environments, and level of readiness for change. This approach led to 77 schools achieving the HealthierUS School Challenge and 130 schools implementing Smarter Lunchrooms techniques in school year 2011-2012. Communities nationwide could use a similar approach to improve school meals. PMID:25656712

  14. Austin chalk maintains brisk drilling pace

    SciTech Connect

    Not Available

    1991-04-01

    Horizontal drilling in the Cretaceous Austin chalk trend of South Texas continues to set a fast pace. The Texas Railroad Commission has issued nearly 900 permits to drill horizontal wells in the Pearsall field area alone from 1984 through February 1991. TRC issued 1,485 permits for horizontal wells statewide during that period, including 1,285 since Jan. 1, 1990. Statewide, operators have reported completion of 685 horizontal wells. That includes 472 in Pearsall field, where TRC has issued 882 permits, and 121 in Giddings field, where 305 permits have been issued. Frio County, site of Pearsall field, led Texas counties with 494 permits and 278 horizontal completions. Oil drilling and reentry work is under way in many areas, and horizontal Austin chalk gas/condensate completions have been reported in Dimmit and Burleson counties.

  15. Microcomputer Applications for Health Care Professionals. Volume II. Curriculum Improvement Project. Region II.

    ERIC Educational Resources Information Center

    Bruce, Lucy

    This volume is one of three in a self-paced computer literacy course that gives allied health students a firm base of knowledge concerning computer usage in the hospital environment. It also develops skill in several applications software packages. Volume II contains materials for three one-hour courses on word processing applications, spreadsheet…

  16. Rural Policy Development: An NRHA and PACE Association Collaborative Model

    ERIC Educational Resources Information Center

    Fitzgerald, Peter; Morgan, Alan; Morris, Tom

    2004-01-01

    The Program of All-Inclusive Care for the Elderly (PACE) offers a unique model of comprehensive care for frail, elderly people. To date, all of the PACE programs have been located in urban areas. Rural advocates and policymakers, however, believe the program may hold great promise for use in rural areas, which have higher percentages of elderly…

  17. Less Is More: Pacing in the ESL Class.

    ERIC Educational Resources Information Center

    Shaunnessey, Maryann S.

    Pacing in the teaching of English as a second language (ESL) is considered. It is suggested that the problem of pacing is almost entirely a matter of teachers covering material so rapidly that the student frequently does not have the opportunity to integrate it. Since the recognition of sounds, symbols, and sentences is not mastery of them, it is…

  18. Prediction of Procrastination in a Self-Pacing Instructional System.

    ERIC Educational Resources Information Center

    Ely, Donald D.; Hampton, John D.

    The objective of the study was to predict potential procrastinators in a self-pacing instructional system. Seventy-five entering college freshmen were randomly selected to participate in a large scale individually-paced program. Those students (25) who procrastinated were classified as "no-start-procrastinators" (NSP); the remainder (52) were…

  19. Is Self-Paced Instruction Really Worth It?

    ERIC Educational Resources Information Center

    Roberson, J. A.; Crowe, C. T.

    1975-01-01

    Describes a self-paced, learning-for-mastery course in undergraduate fluid mechanics. Includes the method of course assessment, method of student evaluation, and a description of the instructor's role and work load. Summarizes aspects of self-paced instruction considered favorable and unfavorable. (GS)

  20. Accelerating the "Pace" against Illiteracy: Parent and Child Education.

    ERIC Educational Resources Information Center

    Noe, Roger

    1989-01-01

    In 1980, Kentucky reported the nation's lowest percentage of adults, aged 25 and older, who had graduated from high school. Legislators were inundated with recommendations for reform. The result was the enactment of the Parent and Child Education (PACE) pilot program (1986). In the PACE program, parents without high school diplomas attend classes…

  1. Social Interaction in Self-Paced Distance Education

    ERIC Educational Resources Information Center

    Anderson, Terry; Upton, Lorne; Dron, Jon; Malone, Judi; Poelhuber, Bruno

    2015-01-01

    In this paper we present a case study of a self-paced university course that was originally designed to support independent, self-paced study at distance. We developed a social media intervention, in design-based research terms, that allows these independent students to contribute archived content to enhance the course, to engage in discussions…

  2. Achievement Monitoring of Individually Paced Instruction. Final Report.

    ERIC Educational Resources Information Center

    Pinsky, Paul D.

    A study was made to monitor achievement of individually paced instruction. The project concentrated on designing testing procedures in group paced instructional programs to provide information to student, teachers, parents and administrators which could be used in both a formative and summative evaluation. The three objectives of the project were:…

  3. Right Bundle Branch Block-Like Pattern During Uncomplicated Right Ventricular Pacing and the Effect of Pacing Site.

    PubMed

    Tzeis, Stylianos; Andrikopoulos, George; Weigand, Severin; Grebmer, Christian; Semmler, Verena; Brkic, Amir; Asbach, Stefan; Kloppe, Axel; Lennerz, Carsten; Bourier, Felix; Pastromas, Sokratis; Kolb, Christof

    2016-03-15

    Right bundle branch block (RBBB) configuration is an unexpected finding during right ventricular (RV) pacing that raises the suspicion of inadvertent left ventricular lead positioning. The aim of this study was to evaluate the prevalence of paced RBBB pattern in relation to RV lead location. This is a secondary analysis of a prospective, multicenter study, which randomized implantable cardioverter defibrillator recipients to an apical versus midseptal defibrillator lead positioning. A 12-lead electrocardiogram was recorded during intrinsic rhythm and RV pacing. Paced RBBB-like pattern was defined as positive (>0.05 mV) net amplitude of QRS complex in leads V1 and/or V2. In total, 226 patients (65.6 ± 12.0 years, 20.8% women, 53.1% apical site) were included in the study. The prevalence of paced RBBB pattern in the total population was 15.5%. A significantly lower percentage of patients in the midseptal group demonstrated RBBB-type configuration during RV pacing compared with the apical group (1.9% vs 27.5%, p <0.001). Baseline RBBB, prolonged QRS duration during intrinsic rhythm, and reduced ejection fraction were not associated with increased likelihood of paced RBBB. In the subgroup of patients with RBBB type during pacing, 91.4% of patients had a paced QRS axis from -30° to -90°, whereas 100% of patients displayed a negative QRS vector at lead V3. In conclusion, RBBB configuration is encountered in a considerable percentage of device recipients during uncomplicated RV pacing. Midseptal lead positioning is associated with significantly lower likelihood of paced RBBB pattern compared with apical location. PMID:26796192

  4. Computer-Paced versus Experimenter-Paced Working Memory Span Tasks: Are They Equally Reliable and Valid?

    ERIC Educational Resources Information Center

    Bailey, Heather

    2012-01-01

    Working memory span tasks are popular measures, in part, because performance on these tasks predicts performance on other measures of cognitive ability. The traditional method of span-task administration is the experimenter-paced version, whose reliability and validity have been repeatedly demonstrated. However, computer-paced span tasks are…

  5. Improving Smallholder Farmer Biosecurity in the Mekong Region Through Change Management.

    PubMed

    Young, J R; Evans-Kocinski, S; Bush, R D; Windsor, P A

    2015-10-01

    Transboundary animal diseases including foot-and-mouth disease and haemorrhagic septicaemia remain a major constraint for improving smallholder large ruminant productivity in the Mekong region, producing negative impacts on rural livelihoods and compromising efforts to reduce poverty and food insecurity. The traditional husbandry practices of smallholders largely exclude preventive health measures, increasing risks of disease transmission. Although significant efforts have been made to understand the social aspects of change development in agricultural production, attention to improving the adoption of biosecurity has been limited. This study reviews smallholder biosecurity risk factors identified in the peer-reviewed literature and from field research observations conducted in Cambodia and Laos during 2006-2013, considering these in the context of a change management perspective aimed at improving adoption of biosecurity measures. Motivation for change, resistance to change, knowledge management, cultural dimensions, systems theory and leadership are discussed. Due to geographical, physical and resource variability, the implementation of biosecurity interventions suitable for smallholders is not a 'one size fits all'. Smallholders should be educated in biosecurity principles and empowered to make personal decisions rather than adopt prescribed pre-defined interventions. Biosecurity interventions should be aligned with smallholder farmer motivations, preferably offering clear short-term risk management benefits that elicit interest from smallholders. Linking biosecurity and disease control with improved livestock productivity provides opportunities for sustainable improvements in livelihoods. Participatory research and extension that improves farmer knowledge and practices offers a pathway to elicit sustainable broad-scale social change. However, examples of successes need to be communicated both at the 'evidence-based level' to influence regional policy

  6. An improvement of extremality regions for Gibbs measures of the Potts model on a Cayley tree

    NASA Astrophysics Data System (ADS)

    Haydarov, Farhod; Khakimov, Rustam

    2016-03-01

    We give a condition of extemelity for translation-invariant Gibbs measures of q—state Potts model on a Cayley tree. We'll improve the regions of extremality for some measures considered in [14]. Moreover, some results in [14] are generalized.

  7. Determining the profitability of improving water quality on farms in the southeastern Piedmont region of Georgia

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The Southeastern Piedmont (SEP) region of Georgia is a high nutrient status area for phosphorus (P) and nitrogen (N). Previous research indicates certain farm practices utilize more P and N from the soil and/or decrease P and N runoff. With the objective to improve water quality, six farm fields in...

  8. Remediation/Restoration of Degraded Soil to Improve Productivity In The Central Great Plains Region

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The quality and productivity of some farmlands in the central Great Plains Region (CGPR) have been lost through wind and water erosion induced by tillage and poor soil management. Productivity of degraded/eroded soils can be restored using organic amendments such as manure and improved crop and soil...

  9. Electrical Pacing of Cardiac Tissue Including Potassium Inward Rectification

    PubMed Central

    Galappaththige, Suran; Roth, Bradley J.

    2015-01-01

    In this study cardiac tissue is stimulated electrically through a small unipolar electrode. Numerical simulations predict that around an electrode are adjacent regions of depolarization and hyperpolarization. Experiments have shown that during pacing of resting cardiac tissue the hyperpolarization is often inhibited. Our goal is to determine if the inward rectifying potassium current (IK1) causes the inhibition of hyperpolarization. Numerical simulations were carried out using the bidomain model with potassium dynamics specified to be inward rectifying. In the simulations, adjacent regions of depolarization and hyperpolarization were observed surrounding the electrode. For cathodal currents the virtual anode produces a hyperpolarization that decreases over time. For long duration pulses the current-voltage curve is non-linear, with very small hyperpolarization compared to depolarization. For short pulses, the hyperpolarization is more prominent. Without the inward potassium rectification, the current voltage curve is linear and the hyperpolarization is evident for both long and short pulses. In conclusion, the inward rectification of the potassium current explains the inhibition of hyperpolarization for long duration stimulus pulses, but not for short duration pulses. PMID:26057242

  10. Pushing the pace of tree species migration.

    PubMed

    Lazarus, Eli D; McGill, Brian J

    2014-01-01

    Plants and animals have responded to past climate changes by migrating with habitable environments, sometimes shifting the boundaries of their geographic ranges by tens of kilometers per year or more. Species migrating in response to present climate conditions, however, must contend with landscapes fragmented by anthropogenic disturbance. We consider this problem in the context of wind-dispersed tree species. Mechanisms of long-distance seed dispersal make these species capable of rapid migration rates. Models of species-front migration suggest that even tree species with the capacity for long-distance dispersal will be unable to keep pace with future spatial changes in temperature gradients, exclusive of habitat fragmentation effects. Here we present a numerical model that captures the salient dynamics of migration by long-distance dispersal for a generic tree species. We then use the model to explore the possible effects of assisted colonization within a fragmented landscape under a simulated tree-planting scheme. Our results suggest that an assisted-colonization program could accelerate species-front migration rates enough to match the speed of climate change, but such a program would involve an environmental-sustainability intervention at a massive scale. PMID:25162663

  11. Pushing the Pace of Tree Species Migration

    PubMed Central

    Lazarus, Eli D.; McGill, Brian J.

    2014-01-01

    Plants and animals have responded to past climate changes by migrating with habitable environments, sometimes shifting the boundaries of their geographic ranges by tens of kilometers per year or more. Species migrating in response to present climate conditions, however, must contend with landscapes fragmented by anthropogenic disturbance. We consider this problem in the context of wind-dispersed tree species. Mechanisms of long-distance seed dispersal make these species capable of rapid migration rates. Models of species-front migration suggest that even tree species with the capacity for long-distance dispersal will be unable to keep pace with future spatial changes in temperature gradients, exclusive of habitat fragmentation effects. Here we present a numerical model that captures the salient dynamics of migration by long-distance dispersal for a generic tree species. We then use the model to explore the possible effects of assisted colonization within a fragmented landscape under a simulated tree-planting scheme. Our results suggest that an assisted-colonization program could accelerate species-front migration rates enough to match the speed of climate change, but such a program would involve an environmental-sustainability intervention at a massive scale. PMID:25162663

  12. Are Global and Regional Improvements in Life Expectancy and in Child, Adult and Senior Survival Slowing?

    PubMed Central

    Hum, Ryan J.; Verguet, Stéphane; Cheng, Yu-Ling; McGahan, Anita M.; Jha, Prabhat

    2015-01-01

    Improvements in life expectancy have been considerable over the past hundred years. Forecasters have taken to applying historical trends under an assumption of continuing improvements in life expectancy in the future. A linear mixed effects model was used to estimate the trends in global and regional rates of improvements in life expectancy, child, adult, and senior survival, in 166 countries between 1950 and 2010. Global improvements in life expectancy, including both child and adult survival rates, decelerated significantly over the study period. Overall life expectancy gains were estimated to have declined from 5.9 to 4.0 months per year for a mean deceleration of -0.07 months/year2; annual child survival gains declined from 4.4 to 1.6 deaths averted per 1000 for a mean deceleration of -0.06 deaths/1000/year2; adult survival gains were estimated to decline from 4.8 to 3.7 deaths averted per 1000 per year for a mean deceleration of -0.08 deaths/1000/year2. Senior survival gains however increased from 2.4 to 4.2 deaths averted per 1000 per year for an acceleration of 0.03 deaths/1000/year2. Regional variation in the four measures was substantial. The rates of global improvements in life expectancy, child survival, and adult survival have declined since 1950 despite an increase in the rate of improvements among seniors. We postulate that low-cost innovation, related to the last half-century progress in health–primarily devoted to children and middle age, is reaping diminishing returns on its investments. Trends are uneven across regions and measures, which may be due in part to the state of epidemiological transition between countries and regions and disparities in the diffusion of innovation, accessible only in high-income countries where life expectancy is already highest. PMID:25992949

  13. 42 CFR 460.24 - Limit on number of PACE program agreements.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Organization Application and Waiver Process § 460.24 Limit on number...

  14. 42 CFR 460.24 - Limit on number of PACE program agreements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Organization Application and Waiver Process § 460.24 Limit on number...

  15. 42 CFR 460.24 - Limit on number of PACE program agreements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Organization Application and Waiver Process § 460.24 Limit on number...

  16. 42 CFR 460.24 - Limit on number of PACE program agreements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Organization Application and Waiver Process § 460.24 Limit on number...

  17. 42 CFR 460.24 - Limit on number of PACE program agreements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Organization Application and Waiver Process § 460.24 Limit on number...

  18. Current State of Economic Returns from Education in China's Ethnic Regions and Explorations into Ways of Improvement

    ERIC Educational Resources Information Center

    Lijun, Zhang; Fei, Wang

    2010-01-01

    Economic development and social progress in China's ethnic minority regions depend on improvements in population attributes brought about by education. Developing education in China's ethnic regions is a project of fundamental significance for realizing sustainable economic and social development in the ethnic regions. Improving the economic…

  19. Self-Paced Timing Detects and Tracks Change in Prodromal Huntington Disease

    PubMed Central

    Rowe, Kelly C.; Paulsen, Jane S.; Langbehn, Douglas R.; Duff, Kevin; Beglinger, Leigh J.; Wang, Chiachi; O’Rourke, Justin J.F.; Stout, Julie C.; Moser, David J.

    2010-01-01

    Objective This study compares self-paced timing performance (cross-sectionally and longitudinally) between participants with prodromal Huntington disease (pr-HD) and a comparison group of gene non-expanded participants from affected families (NC). Methods At baseline, participants in two groups (747 pr-HD: 188 NC) listened to tones presented at 550ms intervals, matched that pace by tapping response keys and continued the rhythm (self-paced) after the tone had stopped. Standardized cross-sectional and longitudinal linear models examined the relationships between self-paced timing precision and estimated proximity to diagnosis, and various other demographic factors. Results Pr-HD participants showed significantly less timing precision than NC. Cross-sectional comparison of pr-HD and NC participants showed a significant performance difference on two administration conditions of the task (dominant hand: p<.0001; alternating thumbs: p<.0001). Additionally, estimated proximity to diagnosis was related to timing precision in both conditions, (dominant hand: t=−11.14,df=920, p<.0001; alternating thumbs: t=−11.32, df=918, p<.0001), even considering demographic and experience variables. Longitudinal modeling showed that pr-HD participants worsen more quickly at the task than the NC group, and that decline rate increases with estimated proximity to diagnosis in both conditions (dominant hand: t=−2.85,df=417, p=.0045; alternating thumbs: t=−3.56, df= 445, p=.0004). Effect sizes based on adjusted mean annual change ranged from −0.34 to 0.25 in the longitudinal model. Conclusions The self-paced timing paradigm has potential for use as a screening tool and outcome measure in pr-HD clinical trials to gauge therapeutically-mediated improvement or maintenance of function. PMID:20604618

  20. Remote Sensing Ocean Color Observations from NASA's PACE Mission: Applications and Societal Benefits

    NASA Astrophysics Data System (ADS)

    Tzortziou, M.; Omar, A. H.; Turner, W.

    2014-12-01

    The PACE (Pre- Aerosol, Clouds and ocean Ecosystems) mission is a strategic Climate Continuity mission, included in NASA's 2010 plan: "Responding to the Challenge of Climate and Environmental Change: NASA's Plan for a Climate-Centric Architecture for Earth Observations and Applications from Space". On a polar orbit, PACE will make climate-quality global measurements that are essential for understanding ocean biology, biogeochemistry and ecology, and determining how the ocean's role in global biogeochemical cycling and ocean ecology both affects and is affected by climate change. With advanced global remote sensing capabilities that include high spectral-resolution imaging, extended spectral coverage to the UV and SWIR, improved spatial resolution in inland, estuarine and coastal waters, enhanced atmospheric correction and higher signal-to-noise, PACE is expected to provide high quality observations that, over the long-term, will contribute to an extended time series of records on inland, coastal, and ocean ecosystems—all of which have substantial value beyond basic science and research. The combination of climate-quality, global atmospheric and oceanic observations provided by the PACE mission will provide a unique capability to help understand changes that affect our ecosystem services, implement science-based management strategies of coastal, marine and inland aquatic resources, and support assessments, policy analyses, and design approaches to plan adaptation and responses to impacts of climate change. Here we discuss the PACE applications program, the new capabilities afforded by this future satellite mission, and how they could potentially advance applications across a range of areas, including Oceans, Climate, Water Resources, Ecological Forecasting, Disasters, Human Health and Air Quality.

  1. Improving GHG inventories by regional information exchange: a report from Asia

    PubMed Central

    Umemiya, Chisa

    2006-01-01

    Background The Parties to the United Nations Framework Convention on Climate Change (UNFCCC) are required to develop and report a national inventory of greenhouse gases not controlled by the Montreal Protocol. In the Asia region, "Workshops on Greenhouse Gas Inventories in Asia (WGIA)" have been organised annually since 2003 under the support of the government of Japan. WGIAs promote information exchange in the region to support countries' efforts to improve the quality of greenhouse gas inventories. This paper reports the major outcomes of the WGIAs and discusses the key aspects of information exchange in the region for the improvement of inventories. Results The major outcomes of WGIAs intended to help countries improve GHG inventories, can be summarised as follows: (1) identification of common issues and possible solutions by sector, (2) reporting country inventory practices, and (3) verification of the UNFCCC reporting requirements. Conclusion The workshops provided the opportunity for countries to share common issues and constraints pertinent to GHG inventories and to exchange information regarding possible solutions for those issues based on their own experience. The relevance of information exchange is determined due to emission sources, emitting mechanisms from sources, and technologies used. Information exchange about emission sources that are unique to Asia, like those of the agriculture sector, contributes significantly to the accumulation of knowledge at the regional and global levels. Enabling countries to verify their national circumstances with the reporting requirements under UNFCCC is also an essential part of the WGIA information exchange activities. PMID:16930465

  2. An improved method for oriT-directed cloning and functionalization of large bacterial genomic regions.

    PubMed

    Kvitko, Brian H; McMillan, Ian A; Schweizer, Herbert P

    2013-08-01

    We have made significant improvements to a broad-host-range system for the cloning and manipulation of large bacterial genomic regions based on site-specific recombination between directly repeated oriT sites during conjugation. Using two suicide capture vectors carrying flanking homology regions, oriT sites are recombined on either side of the target region. Using a broad-host-range conjugation helper plasmid, the region between the oriT sites is conjugated into an Escherichia coli recipient strain, where it is circularized and maintained as a chimeric mini-F vector. The cloned target region is functionalized in multiple ways to accommodate downstream manipulation. The target region is flanked with Gateway attB sites for recombination into other vectors and by rare 18-bp I-SceI restriction sites for subcloning. The Tn7-functionalized target can also be inserted at a naturally occurring chromosomal attTn7 site(s) or maintained as a broad-host-range plasmid for complementation or heterologous expression studies. We have used the oriTn7 capture technique to clone and complement Burkholderia pseudomallei genomic regions up to 140 kb in size and have created isogenic Burkholderia strains with various combinations of genomic islands. We believe this system will greatly aid the cloning and genetic analysis of genomic islands, biosynthetic gene clusters, and large open reading frames. PMID:23747708

  3. An Improved Method for oriT-Directed Cloning and Functionalization of Large Bacterial Genomic Regions

    PubMed Central

    Kvitko, Brian H.; McMillan, Ian A.

    2013-01-01

    We have made significant improvements to a broad-host-range system for the cloning and manipulation of large bacterial genomic regions based on site-specific recombination between directly repeated oriT sites during conjugation. Using two suicide capture vectors carrying flanking homology regions, oriT sites are recombined on either side of the target region. Using a broad-host-range conjugation helper plasmid, the region between the oriT sites is conjugated into an Escherichia coli recipient strain, where it is circularized and maintained as a chimeric mini-F vector. The cloned target region is functionalized in multiple ways to accommodate downstream manipulation. The target region is flanked with Gateway attB sites for recombination into other vectors and by rare 18-bp I-SceI restriction sites for subcloning. The Tn7-functionalized target can also be inserted at a naturally occurring chromosomal attTn7 site(s) or maintained as a broad-host-range plasmid for complementation or heterologous expression studies. We have used the oriTn7 capture technique to clone and complement Burkholderia pseudomallei genomic regions up to 140 kb in size and have created isogenic Burkholderia strains with various combinations of genomic islands. We believe this system will greatly aid the cloning and genetic analysis of genomic islands, biosynthetic gene clusters, and large open reading frames. PMID:23747708

  4. Parent Involvement Activities in School Improvement Plans in the Northwest Region. Summary. Issues & Answers. REL 2008-No. 064

    ERIC Educational Resources Information Center

    Speth, Timothy; Saifer, Steffen; Forehand, Gregory

    2008-01-01

    This document presents a summary of the larger report, "Parent Involvement Activities in School Improvement Plans in the Northwest Region." Although the No Child Left Behind Act of 2001 (NCLB) spells out parent involvement requirements for schools in need of improvement, the majority of the Northwest Region school improvement plans reviewed failed…

  5. Reshaping Rural Schools in the Northwest Region: Lessons from Federal School Improvement Grant Implementation. REL 2016-107

    ERIC Educational Resources Information Center

    Scott, Caitlin; Ostler, Nora

    2016-01-01

    The five states in the Regional Educational Laboratory (REL) Northwest Region have many rural schools that have been designated as in need of improvement. And all five states had rural schools in the first cohort of federal School Improvement Grant (SIG) recipients. To address school improvement, the majority of those schools implemented the…

  6. Fast Paced, Low Cost Projects at MSFC

    NASA Technical Reports Server (NTRS)

    Watson-Morgan, Lisa; Clinton, Raymond

    2012-01-01

    What does an orbiting microsatellite, a robotic lander and a ruggedized camera and telescope have in common? They are all fast paced, low cost projects managed by Marshall Space Flight Center (MSFC) teamed with successful industry partners. MSFC has long been synonymous with human space flight large propulsion programs, engineering acumen and risk intolerance. However, there is a growing portfolio/product line within MSFC that focuses on these smaller, fast paced projects. While launching anything into space is expensive, using a managed risk posture, holding to schedule and keeping costs low by stopping at egood enough f were key elements to their success. Risk is defined as the possibility of loss or failure per Merriam Webster. The National Aeronautics and Space Administration (NASA) defines risk using procedural requirement 8705.4 and establishes eclasses f to discern the acceptable risk per a project. It states a Class D risk has a medium to significant risk of not achieving mission success. MSFC, along with industry partners, has created a niche in Class D efforts. How did the big, cautious MSFC succeed on these projects that embodied the antithesis of its heritage in human space flight? A key factor toward these successful projects was innovative industry partners such as Dynetics Corporation, University of Alabama in Huntsville (UAHuntsville), Johns Hopkins Applied Physics Laboratory (JHU APL), Teledyne Brown Engineering (TBE), Von Braun Center for Science and Innovation (VCSI), SAIC, and Jacobs. Fast Affordable Satellite Technology (FastSat HSV01) is a low earth orbit microsatellite that houses six instruments with the primary scientific objective of earth observation and technology demonstration. The team was comprised of Dynetics, UAHuntsvile, SAIC, Goddard Space Flight Center (GSFC) and VCSI with the United States Air Force Space Test Program as the customer. The team completed design, development, manufacturing, environmental test and integration in

  7. International Collaboration to Improve The Regional Seismic Travel Time (RSTT) Model

    NASA Astrophysics Data System (ADS)

    Myers, S. C.; Begnaud, M. L.; Ballard, S.; Bondar, I.; Storchak, D. A.; Given, J. W.; Guendel, F.

    2013-12-01

    The Regional Seismic Travel Time (RSTT) method (Myers et al., 2010) was developed to facilitate the use of regional data in routine seismic monitoring. RSTT improves prediction accuracy for Pn, Pg, Sn, and Lg travel times using a 3-dimensional model of the Earth's crust and laterally varying seismic wave speed in the upper mantle. Upper mantle velocity is parameterization as a linear function of depth, so that travel times can be computed accurately and in real time. Real-time computation on readily available computers is key to the usefulness of the method by seismic centers that utilize today's flexible networks. In areas where the RSTT model is well constrained by tomography (Eurasia and North America) we have demonstrated improvement in event location accuracy. Extension of RSTT tomographic datasets to new regions is being pursued through international outreach efforts that are coordinated between the Comprehensive Nuclear-Test-Ban Treaty Organization (CTBTO) and the International Seismological Centre (ISC). Our efforts to date have expanded the collection of regionally recorded events with well-constrained hypocenters in South America, Australia, and Africa. We have also incorporated recently published models of crust and upper mantle structure into the RSTT model. Tests in regions sampled by newly compiled data suggest that the RSTT model improves travel time predictions with respect to the ak135 model (Kennett et al., 1995), which is the global standard for travel time prediction. We are continuing to collect and freely distribute ground-truth data in new regions as well as updates to the RSTT model. This work performed in part under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344.

  8. Improving Ramsey spectroscopy in the extreme-ultraviolet region with a random-sampling approach

    SciTech Connect

    Eramo, R.; Bellini, M.; Corsi, C.; Liontos, I.; Cavalieri, S.

    2011-04-15

    Ramsey-like techniques, based on the coherent excitation of a sample by delayed and phase-correlated pulses, are promising tools for high-precision spectroscopic tests of QED in the extreme-ultraviolet (xuv) spectral region, but currently suffer experimental limitations related to long acquisition times and critical stability issues. Here we propose a random subsampling approach to Ramsey spectroscopy that, by allowing experimentalists to reach a given spectral resolution goal in a fraction of the usual acquisition time, leads to substantial improvements in high-resolution spectroscopy and may open the way to a widespread application of Ramsey-like techniques to precision measurements in the xuv spectral region.

  9. An improved regional ionospheric delay model based on the Nanning CORS network

    NASA Astrophysics Data System (ADS)

    Liu, Lilong; Cai, Chenghui; Chen, Jun; Li, Junyu; Huang, Liangke

    2015-12-01

    Klobuchar model can reflect the spatial and temporal variations of ionospheric feature, but model fixed initial phase and night-time delay will introduce a large number of errors. Aiming at the shortcomings of the models, take least-squares surface fitting model as the background, using CORS network in Nanning region to measure the data correctly, the Klobuchar model's initial phase, amplitude, and night-time delay values are steadily corrected, so as to establish regional ionospheric model in Nanning, the results show that the accuracy of Klobuchar model is improved significantly.

  10. Critical role of inhomogeneities in pacing termination of cardiac reentry

    NASA Astrophysics Data System (ADS)

    Sinha, Sitabhra; Stein, Kenneth M.; Christini, David J.

    2002-09-01

    Reentry around nonconducting ventricular scar tissue, a cause of lethal arrhythmias, is typically treated by rapid electrical stimulation from an implantable cardioverter defibrillator. However, the dynamical mechanisms of termination (success and failure) are poorly understood. To elucidate such mechanisms, we study the dynamics of pacing in one- and two-dimensional models of anatomical reentry. In a crucial realistic difference from previous studies of such systems, we have placed the pacing site away from the reentry circuit. Our model-independent results suggest that with such off-circuit pacing, the existence of inhomogeneity in the reentry circuit is essential for successful termination of tachycardia under certain conditions. Considering the critical role of such inhomogeneities may lead to more effective pacing algorithms.

  11. Positive emotion reduces dyspnea during slow paced breathing.

    PubMed

    Allen, Ben; Friedman, Bruce H

    2012-05-01

    Slow breathing is used to induce cardiovascular resonance, a state associated with health benefits, but it can also increase tidal volume and associated dyspnea (respiratory discomfort). Dyspnea may be decreased by induced positive affect. In this study, 71 subjects (36 men, M = 20 years) breathed at 6 breaths per min. In condition one, subjects paced their breathing by inhaling and exhaling as a vertical bar moved up and down. In condition two, breathing was paced by a timed slideshow of positive images; subjects inhaled during a black screen and exhaled as the image appeared. Cardiac, respiratory, and self-reported dyspnea and emotional indices were recorded. Tidal volume and the intensity and unpleasantness of dyspnea were reduced when paced breathing was combined with pleasant images. These results show that positive affect can reduce dyspnea during slow paced breathing, and may have applications for induced cardiovascular resonance. PMID:22292794

  12. Regional Seismic Travel-Time Prediction, Uncertainty, and Location Improvement in Western Eurasia

    NASA Astrophysics Data System (ADS)

    Flanagan, M. P.; Myers, S. C.

    2004-12-01

    We investigate our ability to improve regional travel-time prediction and seismic event location using an a priori, three-dimensional velocity model of Western Eurasia and North Africa: WENA1.0 [Pasyanos et al., 2004]. Our objective is to improve the accuracy of seismic location estimates and calculate representative location uncertainty estimates. As we focus on the geographic region of Western Eurasia, the Middle East, and North Africa, we develop, test, and validate 3D model-based travel-time prediction models for 30 stations in the study region. Three principal results are presented. First, the 3D WENA1.0 velocity model improves travel-time prediction over the iasp91 model, as measured by variance reduction, for regional Pg, Pn, and P phases recorded at the 30 stations. Second, a distance-dependent uncertainty model is developed and tested for the WENA1.0 model. Third, an end-to-end validation test based on 500 event relocations demonstrates improved location performance over the 1-dimensional iasp91 model. Validation of the 3D model is based on a comparison of approximately 11,000 Pg, Pn, and P travel-time predictions and empirical observations from ground truth (GT) events. Ray coverage for the validation dataset is chosen to provide representative, regional-distance sampling across Eurasia and North Africa. The WENA1.0 model markedly improves travel-time predictions for most stations with an average variance reduction of 25% for all ray paths. We find that improvement is station dependent, with some stations benefiting greatly from WENA1.0 predictions (52% at APA, 33% at BKR, and 32% at NIL), some stations showing moderate improvement (12% at KEV, 14% at BOM, and 12% at TAM), some benefiting only slightly (6% at MOX, and 4% at SVE), and some are degraded (-6% at MLR and -18% at QUE). We further test WENA1.0 by comparing location accuracy with results obtained using the iasp91 model. Again, relocation of these events is dependent on ray paths that evenly

  13. An Improved Anchor Shot Detection Method Using Fitness of Face Location and Dissimilarity of Icon Region

    NASA Astrophysics Data System (ADS)

    Keum, Ji-Soo; Lee, Hyon-Soo; Hagiwara, Masafumi

    In this letter, we propose an improved anchor shot detection (ASD) method in order to effectively retrieve anchor shots from news video. The face location and dissimilarity of icon region are used to reduce false alarms in the proposed method. According to the results of the experiment on several types of news video, the proposed method obtained high anchor detection results compared with previous methods.

  14. The Efficacy of Self-Paced Study in Multitrial Learning

    ERIC Educational Resources Information Center

    de Jonge, Mario; Tabbers, Huib K.; Pecher, Diane; Jang, Yoonhee; Zeelenberg, René

    2015-01-01

    In 2 experiments we investigated the efficacy of self-paced study in multitrial learning. In Experiment 1, native speakers of English studied lists of Dutch-English word pairs under 1 of 4 imposed fixed presentation rate conditions (24 × 1 s, 12 × 2 s, 6 × 4 s, or 3 × 8 s) and a self-paced study condition. Total study time per list was equated for…

  15. Pacing: A concept analysis of a chronic pain intervention

    PubMed Central

    Jamieson-Lega, Kathryn; Berry, Robyn; Brown, Cary A

    2013-01-01

    BACKGROUND: The intervention of pacing is regularly recommended for chronic pain patients. However, pacing is poorly defined and appears to be interpreted in varying, potentially contradictory manners within the field of chronic pain. This conceptual lack of clarity has implications for effective service delivery and for researchers’ ability to conduct rigorous study. An examination of the background literature demonstrates that while pacing is often one part of a multidisciplinary pain management program, outcome research is hindered by a lack of a clear and shared definition of this currently ill-defined construct. OBJECTIVES: To conduct a formal concept analysis of the term ‘pacing’. METHODS: A standardized concept analysis process (including literature scoping to identify all uses of the concept, analysis to determine defining attributes of the concept and identification of model, borderline and contrary cases) was used to determine what the concept of pacing does and does not represent within the current evidence base. RESULTS: A conceptual model including the core attributes of action, time, balance, learning and self-management emerged. From these attributes, an evidence-based definition for pacing was composed and distributed to stakeholders for review. After consideration of stakeholder feedback, the emergent definition of pacing was finalized as follows: “Pacing is an active self-management strategy whereby individuals learn to balance time spent on activity and rest for the purpose of achieving increased function and participation in meaningful activities”. CONCLUSION: The findings of the present concept analysis will help to standardize the use and definition of the term pacing across disciplines for the purposes of both pain management and research. PMID:23717825

  16. Improving Regional Forecast by Assimilating Atmospheric InfraRed Sounder (AIRS) Profiles into WRF Model

    NASA Technical Reports Server (NTRS)

    Chou, Shih-Hung; Zavodsky, Brad; Jedlovec, Gary J.

    2009-01-01

    In data sparse regions, remotely-sensed observations can be used to improve analyses and produce improved forecasts. One such source comes from the Atmospheric InfraRed Sounder (AIRS), which together with the Advanced Microwave Sounding Unit (AMSU), represents one of the most advanced space-based atmospheric sounding systems. The purpose of this paper is to describe a procedure to optimally assimilate high resolution AIRS profile data into a regional configuration of the Advanced Research WRF (ARW) version 2.2 using WRF-Var. The paper focuses on development of background error covariances for the regional domain and background type, and an optimal methodology for ingesting AIRS temperature and moisture profiles as separate overland and overwater retrievals with different error characteristics. The AIRS thermodynamic profiles are derived from the version 5.0 Earth Observing System (EOS) science team retrieval algorithm and contain information about the quality of each temperature layer. The quality indicators were used to select the highest quality temperature and moisture data for each profile location and pressure level. The analyses were then used to conduct a month-long series of regional forecasts over the continental U.S. The long-term impacts of AIRS profiles on forecast were assessed against verifying NAM analyses and stage IV precipitation data.

  17. The use of propagation path corrections to improve regional seismic event location in western China

    SciTech Connect

    Steck, L.K.; Cogbill, A.H.; Velasco, A.A.

    1999-03-01

    In an effort to improve the ability to locate seismic events in western China using only regional data, the authors have developed empirical propagation path corrections (PPCs) and applied such corrections using both traditional location routines as well as a nonlinear grid search method. Thus far, the authors have concentrated on corrections to observed P arrival times for shallow events using travel-time observations available from the USGS EDRs, the ISC catalogs, their own travel-tim picks from regional data, and data from other catalogs. They relocate events with the algorithm of Bratt and Bache (1988) from a region encompassing China. For individual stations having sufficient data, they produce a map of the regional travel-time residuals from all well-located teleseismic events. From these maps, interpolated PPC surfaces have been constructed using both surface fitting under tension and modified Bayesian kriging. The latter method offers the advantage of providing well-behaved interpolants, but requires that the authors have adequate error estimates associated with the travel-time residuals. To improve error estimates for kriging and event location, they separate measurement error from modeling error. The modeling error is defined as the travel-time variance of a particular model as a function of distance, while the measurement error is defined as the picking error associated with each phase. They estimate measurement errors for arrivals from the EDRs based on roundoff or truncation, and use signal-to-noise for the travel-time picks from the waveform data set.

  18. Feasibility of Leadless Cardiac Pacing Using Injectable Magnetic Microparticles

    PubMed Central

    Rotenberg, Menahem Y.; Gabay, Hovav; Etzion, Yoram; Cohen, Smadar

    2016-01-01

    A noninvasive, effective approach for immediate and painless heart pacing would have invaluable implications in several clinical scenarios. Here we present a novel strategy that utilizes the well-known mechano-electric feedback of the heart to evoke cardiac pacing, while relying on magnetic microparticles as leadless mechanical stimulators. We demonstrate that after localizing intravenously-injected magnetic microparticles in the right ventricular cavity using an external electromagnet, the application of magnetic pulses generates mechanical stimulation that provokes ventricular overdrive pacing in the rat heart. This temporary pacing consistently managed to revert drug-induced bradycardia, but could only last up to several seconds in the rat model, most likely due to escape of the particles between the applied pulses using our current experimental setting. In a pig model with open chest, MEF-based pacing was induced by banging magnetic particles and has lasted for a longer time. Due to overheating of the electromagnet, we intentionally terminated the experiments after 2 min. Our results demonstrate for the first time the feasibility of external leadless temporary pacing, using injectable magnetic microparticles that are manipulated by an external electromagnet. This new approach can have important utilities in clinical settings in which immediate and painless control of cardiac rhythm is required. PMID:27091192

  19. Feasibility of Leadless Cardiac Pacing Using Injectable Magnetic Microparticles.

    PubMed

    Rotenberg, Menahem Y; Gabay, Hovav; Etzion, Yoram; Cohen, Smadar

    2016-01-01

    A noninvasive, effective approach for immediate and painless heart pacing would have invaluable implications in several clinical scenarios. Here we present a novel strategy that utilizes the well-known mechano-electric feedback of the heart to evoke cardiac pacing, while relying on magnetic microparticles as leadless mechanical stimulators. We demonstrate that after localizing intravenously-injected magnetic microparticles in the right ventricular cavity using an external electromagnet, the application of magnetic pulses generates mechanical stimulation that provokes ventricular overdrive pacing in the rat heart. This temporary pacing consistently managed to revert drug-induced bradycardia, but could only last up to several seconds in the rat model, most likely due to escape of the particles between the applied pulses using our current experimental setting. In a pig model with open chest, MEF-based pacing was induced by banging magnetic particles and has lasted for a longer time. Due to overheating of the electromagnet, we intentionally terminated the experiments after 2 min. Our results demonstrate for the first time the feasibility of external leadless temporary pacing, using injectable magnetic microparticles that are manipulated by an external electromagnet. This new approach can have important utilities in clinical settings in which immediate and painless control of cardiac rhythm is required. PMID:27091192

  20. Optimum pacing mode for patients with angina pectoris.

    PubMed Central

    Kenny, R A; Ingram, A; Mitsuoka, T; Walsh, K; Sutton, R

    1986-01-01

    A within patient double blind prospective study of symptoms and exercise tolerance was designed to determine the preferred pacing mode in 10 patients with programmable dual chamber pacemakers who also had angina pectoris. Patients were randomly allocated to one month in each of the following modes: ventricular pacing at 70 beats/min (VVI) or atrioventricular synchronous upper rate 150 beats/min (DDD 150) or 100 beats/min (DDD 100). Medications were unchanged throughout the study; none was taking beta blockers. At the end of each month patients underwent an exercise test. During each month patients recorded symptoms and their preferred pacing mode. DDD 100 was the preferred mode (seven patients). There was significantly less chest pain with this mode than with either of the other modes. There were significantly more episodes of dizziness in VVI, and two patients who developed pacemaker syndrome were unable to complete the pacing period. Three patients developed angina during exercise testing in DDD 150. Atrial synchronous ventricular pacing is better than ventricular pacing for the control of symptoms in patients with angina pectoris provided that the upper atrial tracking rate is limited. PMID:3790382

  1. PACE and the Federal Housing Finance Agency (FHFA)

    SciTech Connect

    Zimring, Mark; Fuller, Merrian

    2010-03-17

    The FHFA regulates Fannie Mae, Freddie Mac, and the 12 Federal Home Loan Banks (the government-sponsored enterprises - GSEs). On June 18, 2009, James B. Lockhart III, then Director of FHFA, released a letter expressing concern about the negative impact of energy loan tax assessment programs (ELTAPs) - also known as Property Assessed Clean Energy (PACE) programs - on both the housing finance system and homeowner program participants. Subsequently, a number of PACE proponents responded to the concerns laid out in the FHFA letter. In early Fall 2009, word circulated that FHFA was planning to follow its June letter with guidance to other agencies, possibly including Fannie Mae and Freddie Mac, discouraging them from buying loans on properties subject to PACE-type assessment liens. This triggered a second round of stakeholder letters, several of which were addressed to President Obama. On October 18, 2009, the White House, in what some believe was an attempt to obviate the need for FHFA guidance, released a Policy Framework for PACE Financing Programs that outlined best practices guidance for homeowner and lender protection. As of February 2010, FHFA and the GSEs have agreed to monitor PACE programs and work with stakeholders and the Administration to consider additional guidance beyond the Policy Framework and to collect more information on PACE program efficacy and risks. A summary of the communications timeline and highlights of the communications are provided.

  2. Combining GOSAT XCO2 observations over land and ocean to improve regional CO2 flux estimates

    NASA Astrophysics Data System (ADS)

    Deng, Feng; Jones, Dylan B. A.; O'Dell, Christopher W.; Nassar, Ray; Parazoo, Nicholas C.

    2016-02-01

    We used the GEOS-Chem data assimilation system to examine the impact of combining Greenhouse Gases Observing Satellite (GOSAT) XCO2 data over land and ocean on regional CO2 flux estimates for 2010-2012. We found that compared to assimilating only land data, combining land and ocean data produced an a posteriori CO2 distribution that is in better agreement with independent data and fluxes that are in closer agreement with existing top-down and bottom-up estimates. Adding XCO2 data over oceans changed the tropical land regions from a source of 0.64 Pg C/yr to a sink of -0.60 Pg C/yr and produced a corresponding reduction in the estimated sink in northern and southern land regions by 0.49 Pg C/yr and 0.80 Pg C/yr, respectively. This highlights the importance of improved observational coverage in the tropics to better quantify the latitudinal distribution of the terrestrial fluxes. Based only on land XCO2 data, we estimated a strong source in northern tropical South America, which experienced wet conditions in 2010-2012. In contrast, with the land and ocean data, we estimated a sink for this wet region in the north, and a source for the seasonally dry regions in the south and east, which is consistent with our understanding of the impact of moisture availability on the carbon balance of the region. Our results suggest that using satellite data with a more zonally balanced observational coverage could help mitigate discrepancies in CO2 flux estimates; further improvement could be expected with the greater observational coverage provided by the Orbiting Carbon Observatory-2.

  3. Specific Intensity for Peaking: Is Race Pace the Best Option?

    PubMed Central

    Munoz, Iker; Seiler, Stephen; Alcocer, Alberto; Carr, Natasha; Esteve-Lanao, Jonathan

    2015-01-01

    Background: The peaking period for endurance competition is characterized for a relative increase of the intensity of training, after a longer period of training relatively dominated by lower intensity and higher volume Objectives: The present study was designed to compare physiological and 10 km performance effects of high intensity training (HIT) versus race pace interval training (RP) during peaking for competition in well-trained runners. Patients and Methods: 13 athletes took part in the study, they were divided into two groups: HIT and RP. HIT performed short intervals at ~105% of the maximal aerobic velocity (MAV), while RP trained longer intervals at a speed of ~90% of the MAV (a speed approximating 10 km race pace). After 12 weeks of baseline training, the athletes trained for 6 weeks under one of the two peaking regimes. Subjects performed 10 km prior to and after the intervention period. The total load of training was matched between groups during the treatment phase. Subjects completed a graded treadmill running test until volitional exhaustion prior to each 10 km race. MAV was determined as the minimal velocity eliciting maximal oxygen consumption (VO2max). Results: Both groups significantly improved their 10 km time (35 minutes 29 seconds ± 1 minutes 41 seconds vs 34 minutes 53 seconds ± 1 minutes 55 seconds, P < 0.01 for HIT; 35 minutes 27 seconds ± 1 minutes 40 seconds vs 34 minutes 53 seconds ± 1 minutes 18 seconds P < 0.01 for RP). VO2max increased after HIT (69 ± 3.6 vs 71.5 ± 4.2 ml.Kg-1.min-1, P < 0.05); while it didn’t for RP (68.4 ± 6 vs 69.8 ± 3 ml.Kg-1.min-1, p>0.05). In contrast, running economy decreased significantly after HIT (210 ± 6 ml.Kg-1.km-1 vs 218 ± 9, P < 0.05). Conclusions: A 6 week period of training at either 105% of MAV or 90% of MAV yielded similar performance gains in a 10km race performed at ~90% MAV. Therefore, the physiological impact of HIT training seems to be positive for VO2max but negative for running

  4. A hybrid approach to improving the skills of seasonal climate outlook at the regional scale

    NASA Astrophysics Data System (ADS)

    Liu, Shuyan; Wang, Julian X. L.; Liang, Xin-Zhong; Morris, Vernon

    2016-01-01

    A hybrid seasonal forecasting approach was generated by the National Centers for Environmental Prediction operational Climate Forecast System (CFS) and its nesting Climate extension of Weather Research and Forecasting (CWRF) model to improve forecasting skill over the United States. Skills for the three summers of 2011-2013 were evaluated regarding location, timing, magnitude, and frequency. Higher spatial pattern correlation coefficients showed that the hybrid approach substantially improved summer mean precipitation and 2-m temperature geographical distributions compared with the results of the CFS and CWRF models. The area mean temporal correlation coefficients demonstrated that the hybrid approach also consistently improved the timing prediction skills for both variables. In general, the smaller root mean square errors indicated that the hybrid approach reduced the magnitude of the biases for both precipitation and temperature. The greatest improvements were achieved when the individual models had similar skills. The comparison with a North American multi-model ensemble further proved the feasibility of improving real-time seasonal forecast skill by using the hybrid approach, especially for heavy rain forecasting. Based on the complementary advantages of CFS the global model and CWRF the nesting regional model, the hybrid approach showed a substantial enhancement over CFS real-time forecasts during the summer. Future works are needed for further improving the quality of the hybrid approach through CWRF's optimized physics ensemble, which has been proven to be feasible and reliable.

  5. Improving sensitivity of piezoresistive microcantilever biosensors using stress concentration region designs

    NASA Astrophysics Data System (ADS)

    Ansari, M. Z.; Cho, C.; Choi, W.; Lee, M.; Lee, S.; Kim, J.

    2013-12-01

    To improve the surface-stress sensitivity of piezoresistive microcantilever biosensors, this study presents cantilever designs with circular, square and triangular stress concentration regions (SCRs). The cantilever substrates are made of silicon and silicon dioxide and the piezoresistor is p-doped silicon. The cantilevers are characterized using FEM software for their surface-stress sensitivity and thermal vulnerability by applying surface stress, temperature and bias voltage loads. A relation for the surface-stress sensitivity of a silicon cantilever is also presented. Results show that use of SCRs in a silicon cantilever can improve its sensitivity by up to 55% and that a square SCR is the most suitable design to improve the overall sensitivity.

  6. Semirational Directed Evolution of Loop Regions in Aspergillus japonicus β-Fructofuranosidase for Improved Fructooligosaccharide Production

    PubMed Central

    Trollope, K. M.; Görgens, J. F.

    2015-01-01

    The Aspergillus japonicus β-fructofuranosidase catalyzes the industrially important biotransformation of sucrose to fructooligosaccharides. Operating at high substrate loading and temperatures between 50 and 60°C, the enzyme activity is negatively influenced by glucose product inhibition and thermal instability. To address these limitations, the solvent-exposed loop regions of the β-fructofuranosidase were engineered using a combined crystal structure- and evolutionary-guided approach. This semirational approach yielded a functionally enriched first-round library of 36 single-amino-acid-substitution variants with 58% retaining activity, and of these, 71% displayed improved activities compared to the parent. The substitutions yielding the five most improved variants subsequently were exhaustively combined and evaluated. A four-substitution combination variant was identified as the most improved and reduced the time to completion of an efficient industrial-like reaction by 22%. Characterization of the top five combination variants by isothermal denaturation assays indicated that these variants displayed improved thermostability, with the most thermostable variant displaying a 5.7°C increased melting temperature. The variants displayed uniquely altered, concentration-dependent substrate and product binding as determined by differential scanning fluorimetry. The altered catalytic activity was evidenced by increased specific activities of all five variants, with the most improved variant doubling that of the parent. Variant homology modeling and computational analyses were used to rationalize the effects of amino acid changes lacking direct interaction with substrates. Data indicated that targeting substitutions to loop regions resulted in improved enzyme thermostability, specific activity, and relief from product inhibition. PMID:26253664

  7. Semirational Directed Evolution of Loop Regions in Aspergillus japonicus β-Fructofuranosidase for Improved Fructooligosaccharide Production.

    PubMed

    Trollope, K M; Görgens, J F; Volschenk, H

    2015-10-01

    The Aspergillus japonicus β-fructofuranosidase catalyzes the industrially important biotransformation of sucrose to fructooligosaccharides. Operating at high substrate loading and temperatures between 50 and 60°C, the enzyme activity is negatively influenced by glucose product inhibition and thermal instability. To address these limitations, the solvent-exposed loop regions of the β-fructofuranosidase were engineered using a combined crystal structure- and evolutionary-guided approach. This semirational approach yielded a functionally enriched first-round library of 36 single-amino-acid-substitution variants with 58% retaining activity, and of these, 71% displayed improved activities compared to the parent. The substitutions yielding the five most improved variants subsequently were exhaustively combined and evaluated. A four-substitution combination variant was identified as the most improved and reduced the time to completion of an efficient industrial-like reaction by 22%. Characterization of the top five combination variants by isothermal denaturation assays indicated that these variants displayed improved thermostability, with the most thermostable variant displaying a 5.7°C increased melting temperature. The variants displayed uniquely altered, concentration-dependent substrate and product binding as determined by differential scanning fluorimetry. The altered catalytic activity was evidenced by increased specific activities of all five variants, with the most improved variant doubling that of the parent. Variant homology modeling and computational analyses were used to rationalize the effects of amino acid changes lacking direct interaction with substrates. Data indicated that targeting substitutions to loop regions resulted in improved enzyme thermostability, specific activity, and relief from product inhibition. PMID:26253664

  8. The impact of SLMTA in improving laboratory quality systems in the Caribbean Region

    PubMed Central

    Guevara, Giselle; Gordon, Floris; Irving, Yvette; Whyms, Ismae; Parris, Keith; Beckles, Songee; Maruta, Talkmore; Ndlovu, Nqobile; Albalak, Rachel; Alemnji, George

    2016-01-01

    Background Past efforts to improve laboratory quality systems and to achieve accreditation for better patient care in the Caribbean Region have been slow. Objective To describe the impact of the Strengthening of Laboratory Management Toward Accreditation (SLMTA) training programme and mentorship amongst five clinical laboratories in the Caribbean after 18 months. Method Five national reference laboratories from four countries participated in the SLMTA programme that incorporated classroom teaching and implementation of improvement projects. Mentors were assigned to the laboratories to guide trainees on their improvement projects and to assist in the development of Quality Management Systems (QMS). Audits were conducted at baseline, six months, exit (at 12 months) and post-SLMTA (at 18 months) using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist to measure changes in implementation of the QMS during the period. At the end of each audit, a comprehensive implementation plan was developed in order to address gaps. Results Baseline audit scores ranged from 19% to 52%, corresponding to 0 stars on the SLIPTA five-star scale. After 18 months, one laboratory reached four stars, two reached three stars and two reached two stars. There was a corresponding decrease in nonconformities and development of over 100 management and technical standard operating procedures in each of the five laboratories. Conclusion The tremendous improvement in these five Caribbean laboratories shows that SLMTA coupled with mentorship is an effective, user-friendly, flexible and customisable approach to the implementation of laboratory QMS. It is recommended that other laboratories in the region consider using the SLMTA training programme as they engage in quality systems improvement and preparation for accreditation. PMID:27066396

  9. Spontaneous Velocity Effect of Musical Expression on Self-Paced Walking.

    PubMed

    Buhmann, Jeska; Desmet, Frank; Moens, Bart; Van Dyck, Edith; Leman, Marc

    2016-01-01

    The expressive features of music can influence the velocity of walking. So far, studies used instructed (and intended) synchronization. But is this velocity effect still present with non-instructed (spontaneous) synchronization? To figure that out, participants were instructed to walk in their own comfort tempo on an indoor track, first in silence and then with tempo-matched music. We compared velocities of silence and music conditions. The results show that some music has an activating influence, increasing velocity and motivation, while other music has a relaxing influence, decreasing velocity and motivation. The influence of musical expression on the velocity of self-paced walking can be predicted with a regression model using only three sonic features explaining 56% of the variance. Phase-coherence between footfall and beat did not contribute to the velocity effect, due to its implied fixed pacing. The findings suggest that the velocity effect depends on vigor entrainment that influences both stride length and pacing. Our findings are relevant for preventing injuries, for gait improvement in walking rehabilitation, and for improving performance in sports activities. PMID:27167064

  10. Spontaneous Velocity Effect of Musical Expression on Self-Paced Walking

    PubMed Central

    Buhmann, Jeska; Desmet, Frank; Moens, Bart; Van Dyck, Edith; Leman, Marc

    2016-01-01

    The expressive features of music can influence the velocity of walking. So far, studies used instructed (and intended) synchronization. But is this velocity effect still present with non-instructed (spontaneous) synchronization? To figure that out, participants were instructed to walk in their own comfort tempo on an indoor track, first in silence and then with tempo-matched music. We compared velocities of silence and music conditions. The results show that some music has an activating influence, increasing velocity and motivation, while other music has a relaxing influence, decreasing velocity and motivation. The influence of musical expression on the velocity of self-paced walking can be predicted with a regression model using only three sonic features explaining 56% of the variance. Phase-coherence between footfall and beat did not contribute to the velocity effect, due to its implied fixed pacing. The findings suggest that the velocity effect depends on vigor entrainment that influences both stride length and pacing. Our findings are relevant for preventing injuries, for gait improvement in walking rehabilitation, and for improving performance in sports activities. PMID:27167064