Improved vascularization of planar membrane diffusion devices following continuous infusion of vascular endothelial growth factor.

PubMed

Trivedi, N; Steil, G M; Colton, C K; Bonner-Weir, S; Weir, G C

2000-01-01

Improving blood vessel formation around an immunobarrier device should improve the survival of the encapsulated tissue. In the present study we investigated the formation of new blood vessels around a planar membrane diffusion device (the Baxter Theracyte System) undergoing a continuous infusion of vascular endothelial growth factor through the membranes and into the surrounding tissue. Each device (20 microl) had both an inner immunoisolation membrane and an outer vascularizing membrane. Human recombinant vascular endothelial growth factor-165 was infused at 100 ng/day (low dose: n = 6) and 500 ng/day (high dose: n = 7) for 10 days into devices implanted s.c. in Sprague-Dawley rats; noninfused devices transplanted for an identical period were used as controls (n = 5). Two days following the termination of VEGF infusion, devices were loaded with 20 microl of Lispro insulin (1 U/kg) and the kinetics of insulin release from the lumen of the device was assessed. Devices were then explanted and the number of blood vessels (capillary and noncapillary) was quantified using morphometry. High-dose vascular endothelial growth factor infusion resulted in two- to threefold more blood vessels around the device than that obtained with the noninfused devices and devices infused with low-dose vascular endothelial growth factor. This increase in the number of blood vessels was accompanied by a modest increase in insulin diffusion from the device in the high-dose vascular endothelial growth factor infusion group. We conclude that vascular endothelial growth factor can be used to improve blood vessel formation adjacent to planar membrane diffusion devices.

A multicolor imaging pyrometer

NASA Technical Reports Server (NTRS)

Frish, Michael B.; Frank, Jonathan H.

1989-01-01

A multicolor imaging pyrometer was designed for accurately and precisely measuring the temperature distribution histories of small moving samples. The device projects six different color images of the sample onto a single charge coupled device array that provides an RS-170 video signal to a computerized frame grabber. The computer automatically selects which one of the six images provides useful data, and converts that information to a temperature map. By measuring the temperature of molten aluminum heated in a kiln, a breadboard version of the device was shown to provide high accuracy in difficult measurement situations. It is expected that this pyrometer will ultimately find application in measuring the temperature of materials undergoing radiant heating in a microgravity acoustic levitation furnace.

A multicolor imaging pyrometer

NASA Astrophysics Data System (ADS)

Frish, Michael B.; Frank, Jonathan H.

1989-06-01

A multicolor imaging pyrometer was designed for accurately and precisely measuring the temperature distribution histories of small moving samples. The device projects six different color images of the sample onto a single charge coupled device array that provides an RS-170 video signal to a computerized frame grabber. The computer automatically selects which one of the six images provides useful data, and converts that information to a temperature map. By measuring the temperature of molten aluminum heated in a kiln, a breadboard version of the device was shown to provide high accuracy in difficult measurement situations. It is expected that this pyrometer will ultimately find application in measuring the temperature of materials undergoing radiant heating in a microgravity acoustic levitation furnace.

Shape memory polymer network with thermally distinct elasticity and plasticity.

PubMed

Zhao, Qian; Zou, Weike; Luo, Yingwu; Xie, Tao

2016-01-01

Stimuli-responsive materials with sophisticated yet controllable shape-changing behaviors are highly desirable for real-world device applications. Among various shape-changing materials, the elastic nature of shape memory polymers allows fixation of temporary shapes that can recover on demand, whereas polymers with exchangeable bonds can undergo permanent shape change via plasticity. We integrate the elasticity and plasticity into a single polymer network. Rational molecular design allows these two opposite behaviors to be realized at different temperature ranges without any overlap. By exploring the cumulative nature of the plasticity, we demonstrate easy manipulation of highly complex shapes that is otherwise extremely challenging. The dynamic shape-changing behavior paves a new way for fabricating geometrically complex multifunctional devices.

Thrombosis prevention in lower extremity arthroplasty: mobile compression device or pharmacological therapy.

PubMed

Colwell, Clifford W

2014-11-01

Venous thromboembolic (VTE) events, either deep vein thromboses (DVT) or pulmonary emboli (PE), are important complications in patients undergoing knee or hip arthroplasty. Symptomatic VTE rates observed in total joint arthroplasty patients using the mobile compression device with home use capability were non-inferior to rates reported for pharmacological prophylaxis, including warfarin, enoxaparin, rivaroxaban, and dabigatran. Major bleeding in total hip arthroplasty was less using the mobile compression device than using low molecular weight heparin. A cost analysis demonstrated a cost savings based on decreased major bleeding. Use of a mobile compression device with or without aspirin for patients undergoing total joint arthroplasty provides a non-inferior risk for developing VTE compared with current pharmacological protocols.

[Risks associated with unrestricted consumption of alkaline-reduced water].

PubMed

Henry, Marc; Chambron, Jacques

2014-01-01

Consumption of alkaline reduced water produced by domestic electrolysis devices was approved in Japan in 1965 by the Minister of Health, Work and Wellbeing, for the treatment of gastrointestinal disorders. Today, these devices are also freely available in France. The commercial information provided with the devices recommends the consumption of 1 to 1.5 liters per day, not only for gastrointestinal disorders but also for numerous other illnesses such as diabetes, cancer and inflammation. Academic research on this subject has been undergoing in Japan since 1990, and has established that the active ingredient is dissolved dihydrogen, which eliminates the free radical HO· in vivo. It has also been shown that electrode degradation during use of the devices releases highly reactive platinum nanoparticles, the toxicity of which is unknown. The authors of this report recommend alerting the French health authorities to the uncontrolled availability of these devices that generate drug substances and should therefore be subject to regulatory requirements.

Broadband working-waveband-tunable polarization converter based on anisotropic metasurface

NASA Astrophysics Data System (ADS)

Lin, Yu; Wang, Lei; Gao, Jun; Lu, Yichao; Jiang, Suhua; Zeng, Wei

2017-03-01

We experimentally and theoretically demonstrate an ultrathin, broadband, and highly efficient metamaterial-based polarization converter with a metasurface/insulator/metal (MIM) configuration. In such a system, the resonance undergoes a transition from a vertical Fabry-Pérot type to a transverse type as the spacer thickness decreases. By changing the spacer thickness from 1 to 15 mm, the working waveband of this device could be tuned from 10.9-12.9 to 6-8 GHz without compromising the polarization conversion efficiency. Equivalent circuit theory and the transfer matrix method are used for demonstrating the physical mechanism of our device.

76 FR 58019 - Circulatory System Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-19

... Ablation System to be used for the treatment of atrial fibrillation in patients who are undergoing open... catheter-based device developed for the treatment of atrial fibrillation. The system consists of the...

Quick-release medical tape

PubMed Central

Laulicht, Bryan; Langer, Robert; Karp, Jeffrey M.

2012-01-01

Medical tape that provides secure fixation of life-sustaining and -monitoring devices with quick, easy, damage-free removal represents a longstanding unmet medical need in neonatal care. During removal of current medical tapes, crack propagation occurs at the adhesive–skin interface, which is also the interface responsible for device fixation. By designing quick-release medical tape to undergo crack propagation between the backing and adhesive layers, we decouple removal and device fixation, enabling dual functionality. We created an ordered adhesive/antiadhesive composite intermediary layer between the medical tape backing and adhesive for which we achieve tunable peel removal force, while maintaining high shear adhesion to secure medical devices. We elucidate the relationship between the spatial ordering of adhesive and antiadhesive regions to create a fully tunable system that achieves strong device fixation and quick, easy, damage-free device removal. We also described ways of neutralizing the residual adhesive on the skin and have observed that thick continuous films of adhesive are easier to remove than the thin islands associated with residual adhesive left by current medical tapes. PMID:23112196

Prospective study of tricuspid valve regurgitation associated with permanent leads in patients undergoing cardiac rhythm device implantation: Background, rationale, and design

PubMed Central

Dokainish, Hisham; Elbarasi, Esam; Masiero, Simona; Van de Heyning, Caroline; Brambatti, Michela; Ghazal, Sami; AL-Maashani, Said; Capucci, Alessandro; Buikema, Lisanne; Leong, Darryl; Shivalkar, Bharati; Saenen, Johan; Miljoen, Hielko; Morillo, Carlos; Divarakarmenon, Syam; Amit, Guy; Ribas, Sebastian; Brautigam, Aaron; Baiocco, Erika; Maolo, Alessandro; Romandini, Andrea; Maffei, Simone; Connolly, Stuart; Healey, Jeff

2015-01-01

Given the increasing numbers of cardiac device implantations worldwide, it is important to determine whether permanent endocardial leads across the tricuspid valve can promote tricuspid regurgitation (TR). Virtually all current data is retrospective, and indicates a signal of TR being increased after permanent lead implantation. However, the precise incidence of moderate or greater TR post-procedure, the exact mechanisms (mechanical, traumatic, functional), and the hemodynamic burden and clinical effects of this putative increase in TR, remain uncertain. We have therefore designed a multicenter, international, prospective study of 300 consecutive patients (recruitment completed, baseline data presented) who will undergo echocardiography and clinical assessment prior to, and at 1-year post device insertion. This prospective study will help determine whether cardiac device-associated TR is real, what are its potential mechanisms, and whether it has an important clinical impact on cardiac device patients. PMID:26779517

Shape memory polymer network with thermally distinct elasticity and plasticity

PubMed Central

Zhao, Qian; Zou, Weike; Luo, Yingwu; Xie, Tao

2016-01-01

Stimuli-responsive materials with sophisticated yet controllable shape-changing behaviors are highly desirable for real-world device applications. Among various shape-changing materials, the elastic nature of shape memory polymers allows fixation of temporary shapes that can recover on demand, whereas polymers with exchangeable bonds can undergo permanent shape change via plasticity. We integrate the elasticity and plasticity into a single polymer network. Rational molecular design allows these two opposite behaviors to be realized at different temperature ranges without any overlap. By exploring the cumulative nature of the plasticity, we demonstrate easy manipulation of highly complex shapes that is otherwise extremely challenging. The dynamic shape-changing behavior paves a new way for fabricating geometrically complex multifunctional devices. PMID:26824077

Surgical treatment of tricuspid valve insufficiency promotes early reverse remodeling in patients with axial-flow left ventricular assist devices.

PubMed

Maltais, Simon; Topilsky, Yan; Tchantchaleishvili, Vakhtang; McKellar, Stephen H; Durham, Lucian A; Joyce, Lyle D; Daly, Richard C; Park, Soon J

2012-06-01

The HeartMate II (Thoratec Corp, Pleasanton, Calif) continuous-flow left ventricular assist device has emerged as the standard of care for patients with advanced heart failure. The objective of this study was to assess the safety and early effectiveness of concomitant tricuspid valve procedures in patients undergoing implantation of a HeartMate II device. From February 2007 to April 2010, 83 patients underwent HeartMate II left ventricular assist device implantation. Of these, 37 patients had concomitant tricuspid valve procedures (32 repairs, 5 replacements) for severe tricuspid regurgitation. The effects of a tricuspid valve procedure on tricuspid regurgitation and right ventricular remodeling were assessed comparing echocardiographic findings at baseline and 30 days after left ventricular assist device implantation. Overall survival was also compared. Patients undergoing a concomitant tricuspid valve procedure had more tricuspid regurgitation (vena contracta, 5.6 ± 2.1 mm vs 2.9 ± 2.0 mm; P < .001), worse right ventricular dysfunction (right ventricular end-diastolic area, 33.6 ± 6.2 mm vs 31.6 ± 8.5 mm; P = .05), higher mean right atrial pressure (17.4 ± 7.1 mm Hg vs 14.9 ± 5.1 mm Hg; P = .03), and a higher Kormos score (2.6 ± 2.1 vs 1.2 ± 1.4; P = .0008) preoperatively. One month after surgery, tricuspid regurgitation was worse in patients who underwent left ventricular assist device implantation alone (+18.6%), whereas it improved significantly in patients undergoing a concomitant tricuspid valve procedure (-50.2%) (P = .005). A corresponding significant reduction in right ventricular end-diastolic area (33.6% ± 6.2% vs 30.1% ± 9.7%; P = .03) and a trend toward better right ventricular function (55.5% ± 79.7% vs 35.7% ± 60.5%; P = .28) were noted in patients undergoing a concomitant tricuspid valve procedure. Survival was comparable between the 2 groups. In patients with severe tricuspid regurgitation undergoing left ventricular assist device implantation, a concomitant tricuspid valve procedure effectively reduces tricuspid regurgitation and promotes reverse remodeling of the right ventricle. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Use of a pocket compression device for the prevention and treatment of pocket hematoma after pacemaker and defibrillator implantation (STOP-HEMATOMA-I).

PubMed

Turagam, Mohit K; Nagarajan, Darbhamulla V; Bartus, Krzysztof; Makkar, Akash; Swarup, Vijay

2017-08-01

Pocket hematoma is a recognized complication after placement of cardiac implantable electronic devices and is associated with increased device infection, length of hospitalization, and morbidity especially with uninterrupted antiplatelet agents and anticoagulants. We assessed the use of a post-surgical vest to decrease the incidence of pocket hematoma in patients undergoing device implantation with uninterrupted antiplatelet and anticoagulants. In this observational study, a vest was used by 20 consecutive patients who were compared to 20 age-, gender-, procedure-matched patients who received standard care. All patients were continued on antiplatelet and anticoagulants in the perioperative period. The pocket was assessed at post procedure day 0, 2, and 7, respectively. There were no significant differences in the baseline characteristics between both groups. Baseline mean international normalized ratio (INR) was significantly higher in the vest group when compared with the control group (2.7 ± 0.4 vs. 2.2 ± 0.3 = <0.001). The incidence of pocket hematoma was significantly lower in the vest group than the control group (0 vs 30%, p = 0.02) at the end of 7 days. Control group had a total of six hematomas with one patient requiring evacuation and blood transfusion. The vest group had three hematomas on day 2 that resolved by day 7. The risk of moderate or large pocket hematoma is significantly reduced with the use of this vest in high-risk patients undergoing implantable devices on uninterrupted antiplatelet and anticoagulants.

76 FR 28787 - Agency Forms Undergoing Paperwork Reduction Act Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-18

.... Proposed Project Respiratory Protective Devices--42 CFR part 84--Regulation 0920- 0109- Extension--National...). Background and Brief Description This data collection was formerly named Respiratory Protective Devices 30... respiratory protective devices is found in the Mine Safety and Health Amendments Act of 1977 (30 U.S.C. 577a...

Metasurfaces Based on Phase-Change Material as a Reconfigurable Platform for Multifunctional Devices

PubMed Central

Raeis-Hosseini, Niloufar; Rho, Junsuk

2017-01-01

Integration of phase-change materials (PCMs) into electrical/optical circuits has initiated extensive innovation for applications of metamaterials (MMs) including rewritable optical data storage, metasurfaces, and optoelectronic devices. PCMs have been studied deeply due to their reversible phase transition, high endurance, switching speed, and data retention. Germanium-antimony-tellurium (GST) is a PCM that has amorphous and crystalline phases with distinct properties, is bistable and nonvolatile, and undergoes a reliable and reproducible phase transition in response to an optical or electrical stimulus; GST may therefore have applications in tunable photonic devices and optoelectronic circuits. In this progress article, we outline recent studies of GST and discuss its advantages and possible applications in reconfigurable metadevices. We also discuss outlooks for integration of GST in active nanophotonic metadevices. PMID:28878196

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

PubMed

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

2018-05-20

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

Management of antithrombotic therapy in patients undergoing electrophysiological device surgery.

PubMed

Zacà, Valerio; Marcucci, Rossella; Parodi, Guido; Limbruno, Ugo; Notarstefano, Pasquale; Pieragnoli, Paolo; Di Cori, Andrea; Bongiorni, Maria Grazia; Casolo, Giancarlo

2015-06-01

The aim of this review is to formulate practical recommendations for the management of antithrombotic therapy in patients undergoing cardiac implantable electronic device (CIED) surgery by providing indications for a systematic approach to the problem integrating general technical considerations with patient-specific elements based on a careful evaluation of the balance between haemorrhagic and thromboembolic risk. Hundreds of thousands patients undergo implantation or replacement of CIEDs annually in Europe, and up to 50% of these subjects receive antiplatelet agents or oral anticoagulants. The rate of CIED-related complications, mainly infective, has also significantly increased so that transvenous lead extraction procedures are, consequently, often required. Cardiac implantable electronic device surgery is peculiar and portends specific intrinsic risks of developing potentially fatal haemorrhagic complications; on the other hand, the periprocedural suspension of antithrombotic therapy in patients with high thromboembolic risk cardiac conditions may have catastrophic consequences. Accordingly, the management of the candidate to CIED surgery receiving concomitant antithrombotic therapy is a topic of great clinical relevance yet controversial and only partially, if at all, adequately addressed in evidence-based current guidelines. In spite of the fact that in many procedures it seems reasonably safe to proceed with aspirin only or without interruption of anticoagulants, restricting to selected cases the use of bridging therapy with parenteral heparins, there are lots of variables that may make the therapeutic choices challenging. The decision-making process applied in this document relies on the development of a stratification of the procedural haemorrhagic risk and of the risk deriving from the suspension of antiplatelet or anticoagulant therapy combined to generate different clinical scenarios with specific indications for optimal management of periprocedural antithrombotic therapy. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

A pneumatic device for rapid loading of DNA sequencing gels.

PubMed

Panussis, D A; Cook, M W; Rifkin, L L; Snider, J E; Strong, J T; McGrane, R M; Wilson, R K; Mardis, E R

1998-05-01

This work describes the design and construction of a device that facilitates the loading of DNA samples onto polyacrylamide gels for detection in the Perkin Elmer/Applied Biosystems (PE/ABI) 373 and 377 DNA sequencing instruments. The device is mounted onto the existing gel cassettes and makes the process of loading high-density gels less cumbersome while the associated time and errors are reduced. The principle of operation includes the simultaneous transfer of the entire batch of samples, in which a spring-loaded air cylinder generates positive pressure and flexible silica capillaries transfer the samples. A retractable capillary array carrier allows the delivery ends of the capillaries to be held up clear of the gel during loader attachment on the gel plates, while enabling their insertion in the gel wells once the device is securely mounted. Gel-loading devices capable of simultaneously transferring 72 samples onto the PE/ABI 373 and 377 are currently being used in our production sequencing groups while a 96-sample transfer prototype undergoes testing.

Unipolar resistive switching behaviors and mechanisms in an annealed Ni/ZrO2/TaN memory device

NASA Astrophysics Data System (ADS)

Tsai, Tsung-Ling; Ho, Tsung-Han; Tseng, Tseung-Yuen

2015-01-01

The effects of Ni/ZrO2/TaN resistive switching memory devices without and with a 400 °C annealing process on switching properties are investigated. The devices exhibit unipolar resistive switching behaviors with low set and reset voltages because of a large amount of Ni diffusion with no reaction with ZrO2 after the annealing process, which is confirmed by ToF-SIMS and XPS analyses. A physical model based on a Ni filament is constructed to explain such phenomena. The device that undergoes the 400 °C annealing process exhibits an excellent endurance of more than 1.5  ×  104 cycles. The improvement can be attributed to the enhancement of oxygen ion migration along grain boundaries, which result in less oxygen ion consumption during the reset process. The device also performs good retention up to 105 s at 150 °C. Therefore, it has great potential for high-density nonvolatile memory applications.

Interfacial thermal degradation in inverted organic solar cells

DOE Office of Scientific and Technical Information (OSTI.GOV)

Greenbank, William; Hirsch, Lionel; Wantz, Guillaume

2015-12-28

The efficiency of organic photovoltaic (OPV) solar cells is constantly improving; however, the lifetime of the devices still requires significant improvement if the potential of OPV is to be realised. In this study, several series of inverted OPV were fabricated and thermally aged in the dark in an inert atmosphere. It was demonstrated that all of the devices undergo short circuit current-driven degradation, which is assigned to morphology changes in the active layer. In addition, a previously unreported, open circuit voltage-driven degradation mechanism was observed that is highly material specific and interfacial in origin. This mechanism was specifically observed inmore » devices containing MoO{sub 3} and silver as hole transporting layers and electrode materials, respectively. Devices with this combination were among the worst performing devices with respect to thermal ageing. The physical origins of this mechanism were explored by Rutherford backscattering spectrometry and atomic force microscopy and an increase in roughness with thermal ageing was observed that may be partially responsible for the ageing mechanism.« less

Robots on the Battlefield. Contemporary Perspectives and Implications for the Future

DTIC Science & Technology

2014-01-01

is irreplaceable. This may, for example, involve the robot exploring an inaccessible environment or one presenting a significant risk ( contaminated ... contamination , etc.), and the high rate of attrition that it is logically ex- pected to undergo must not cause any problems in terms of cost.19 This quick...surveillance, the identification and designation of targets, neutralizing explosive devices, and reconnaissance in contaminated , polluted or booby

Cangrelor use prior to left ventricular assist device surgery: a case series.

PubMed

Washam, Jeffrey B; Yerokun, Babatunde; Patel, Chetan B; Welsby, Ian J; Milano, Carmelo A; DeVore, Adam D

2018-06-02

Bleeding frequently occurs in patients undergoing placement of a left ventricular assist device (LVAD). Clinical factors that have been identified as contributing to peri-procedural bleeding include LVAD implantation after an acute myocardial infarction and preoperative use of antiplatelet agents. In this report, we describe the use of cangrelor for preoperative antiplatelet bridging to LVAD in five post myocardial infarction patients with cardiogenic shock that had recently undergone percutaneous coronary intervention. During the cangrelor bridging period, no cases of thrombotic or major bleeding events occurred. During the first week following LVAD implantation, two patients experienced a major bleeding (each case required chest exploration for suspected hemorrhage). To our knowledge, this is the first series describing cangrelor use for antiplatelet bridging in patients undergoing LVAD implantation. While this series suggest cangrelor could possibly be a safe and effective antiplatelet bridging strategy, further research is needed to identify the optimal antithrombotic strategy in cardiogenic shock patients undergoing LVAD implantation who have recently undergoing percutaneous coronary intervention.

Physical Organic Approach to Persistent, Cyclable, Low-Potential Electrolytes for Flow Battery Applications.

PubMed

Sevov, Christo S; Hickey, David P; Cook, Monique E; Robinson, Sophia G; Barnett, Shoshanna; Minteer, Shelley D; Sigman, Matthew S; Sanford, Melanie S

2017-03-01

The deployment of nonaqueous redox flow batteries for grid-scale energy storage has been impeded by a lack of electrolytes that undergo redox events at as low (anolyte) or high (catholyte) potentials as possible while exhibiting the stability and cycling lifetimes necessary for a battery device. Herein, we report a new approach to electrolyte design that uses physical organic tools for the predictive targeting of electrolytes that possess this combination of properties. We apply this approach to the identification of a new pyridinium-based anolyte that undergoes 1e - electrochemical charge-discharge cycling at low potential (-1.21 V vs Fc/Fc + ) to a 95% state-of-charge without detectable capacity loss after 200 cycles.

An audit of pressure sores caused by intermittent compression devices used to prevent venous thromboembolism.

PubMed

Skillman, Joanna; Thomas, Sunil

2011-12-01

When intermittent compression devices (ICDs) are used to prevent venous thromboembolism (VTE) they can cause pressure sores in a selected group of women, undergoing long operations. A prospective audit pre and post intervention showed a reduced risk with an alternative device, without increasing the risk of VTE.

Tungsten as a Chemically-Stable Electrode Material on Ga-Containing Piezoelectric Substrates Langasite and Catangasite for High-Temperature SAW Devices

PubMed Central

Rane, Gayatri K.; Seifert, Marietta; Menzel, Siegfried; Gemming, Thomas; Eckert, Jürgen

2016-01-01

Thin films of tungsten on piezoelectric substrates La3Ga5SiO14 (LGS) and Ca3TaGa3Si2O14 (CTGS) have been investigated as a potential new electrode material for interdigital transducers for surface acoustic wave-based sensor devices operating at high temperatures up to 800 °C under vacuum conditions. Although LGS is considered to be suitable for high-temperature applications, it undergoes chemical and structural transformation upon vacuum annealing due to diffusion of gallium and oxygen. This can alter the device properties depending on the electrode nature, the annealing temperature, and the duration of the application. Our studies present evidence for the chemical stability of W on these substrates against the diffusion of Ga/O from the substrate into the film, even upon annealing up to 800 °C under vacuum conditions using Auger electron spectroscopy and energy-dispersive X-ray spectroscopy, along with local studies using transmission electron microscopy. Additionally, the use of CTGS as a more stable substrate for such applications is indicated. PMID:28787898

Radial Shock Wave Devices Generate Cavitation

PubMed Central

Császár, Nikolaus B. M.; Angstman, Nicholas B.; Milz, Stefan; Sprecher, Christoph M.; Kobel, Philippe; Farhat, Mohamed; Furia, John P.; Schmitz, Christoph

2015-01-01

Background Conflicting reports in the literature have raised the question whether radial extracorporeal shock wave therapy (rESWT) devices and vibrating massage devices have similar energy signatures and, hence, cause similar bioeffects in treated tissues. Methods and Findings We used laser fiber optic probe hydrophone (FOPH) measurements, high-speed imaging and x-ray film analysis to compare fundamental elements of the energy signatures of two rESWT devices (Swiss DolorClast; Electro Medical Systems, Nyon, Switzerland; D-Actor 200; Storz Medical, Tägerwillen, Switzerland) and a vibrating massage device (Vibracare; G5/General Physiotherapy, Inc., Earth City, MO, USA). To assert potential bioeffects of these treatment modalities we investigated the influence of rESWT and vibrating massage devices on locomotion ability of Caenorhabditis elegans (C. elegans) worms. Results FOPH measurements demonstrated that both rESWT devices generated acoustic waves with comparable pressure and energy flux density. Furthermore, both rESWT devices generated cavitation as evidenced by high-speed imaging and caused mechanical damage on the surface of x-ray film. The vibrating massage device did not show any of these characteristics. Moreover, locomotion ability of C. elegans was statistically significantly impaired after exposure to radial extracorporeal shock waves but was unaffected after exposure of worms to the vibrating massage device. Conclusions The results of the present study indicate that both energy signature and bioeffects of rESWT devices are fundamentally different from those of vibrating massage devices. Clinical Relevance Prior ESWT studies have shown that tissues treated with sufficient quantities of acoustic sound waves undergo cavitation build-up, mechanotransduction, and ultimately, a biological alteration that “kick-starts” the healing response. Due to their different treatment indications and contra-indications rESWT devices cannot be equated to vibrating massage devices and should be used with due caution in clinical practice. PMID:26509573

Radial Shock Wave Devices Generate Cavitation.

PubMed

Császár, Nikolaus B M; Angstman, Nicholas B; Milz, Stefan; Sprecher, Christoph M; Kobel, Philippe; Farhat, Mohamed; Furia, John P; Schmitz, Christoph

2015-01-01

Conflicting reports in the literature have raised the question whether radial extracorporeal shock wave therapy (rESWT) devices and vibrating massage devices have similar energy signatures and, hence, cause similar bioeffects in treated tissues. We used laser fiber optic probe hydrophone (FOPH) measurements, high-speed imaging and x-ray film analysis to compare fundamental elements of the energy signatures of two rESWT devices (Swiss DolorClast; Electro Medical Systems, Nyon, Switzerland; D-Actor 200; Storz Medical, Tägerwillen, Switzerland) and a vibrating massage device (Vibracare; G5/General Physiotherapy, Inc., Earth City, MO, USA). To assert potential bioeffects of these treatment modalities we investigated the influence of rESWT and vibrating massage devices on locomotion ability of Caenorhabditis elegans (C. elegans) worms. FOPH measurements demonstrated that both rESWT devices generated acoustic waves with comparable pressure and energy flux density. Furthermore, both rESWT devices generated cavitation as evidenced by high-speed imaging and caused mechanical damage on the surface of x-ray film. The vibrating massage device did not show any of these characteristics. Moreover, locomotion ability of C. elegans was statistically significantly impaired after exposure to radial extracorporeal shock waves but was unaffected after exposure of worms to the vibrating massage device. The results of the present study indicate that both energy signature and bioeffects of rESWT devices are fundamentally different from those of vibrating massage devices. Prior ESWT studies have shown that tissues treated with sufficient quantities of acoustic sound waves undergo cavitation build-up, mechanotransduction, and ultimately, a biological alteration that "kick-starts" the healing response. Due to their different treatment indications and contra-indications rESWT devices cannot be equated to vibrating massage devices and should be used with due caution in clinical practice.

Environmental impact of the use of radiofrequency electromagnetic fields in physiotherapeutic treatment.

PubMed

Gryz, Krzysztof; Karpowicz, Jolanta

2014-01-01

Electromagnetic fields used in physiotherapeutic treatment affect not only patients, but also physiotherapists, patients not undergoing treatment and electronic medical equipment. The aim of the work was to study the parameters of the electromagnetic fields of physiotherapeutic devices with respect to requirements regarding the protection of electronic devices, including medical implants, against electromagnetic intererence, and the protection of the general public (patients not undergoing treatment and bystanders), as well as medical personnel, against the health hazards caused by electromagnetic exposure. The spatial distribution of electric and magnetic field strength was investigated near 3 capacitive short-wave and 3 long-wave diathermies and 3 ultrasound therapy units, as along with the capacitive electric currents caused by electromagnetic field interaction in the upper limbs of the physiotherapists operating these devices. The physiotherapists' exposure to electromagnetic fields depends on the spatial organisation of the workspace and their location during treatment. Electric fields able to interfere with the function of electronic medical implants and in whic anyone not undergoing treatment should not be present were measured up to 150-200 cm away from active applicators of short-wave diathermy, and up to 40-45 cm away from long-wave diathermy ones. Electric fields in which workers should not be present were measured up to 30-40 cm away from the applicators and cables of active short-wave diathermy devices. A capacitive electric current with a strength exceeding many times the international recommendations regarding workers protection was measured in the wrist while touching applicators and cables of active short-wave diathermy devices. The strongest environmental electromagnetic hazards occur near short-wave diathermy devices, and to a lesser degree near long-wave diathermy devices, but were not found near ultrasound therapy units.

Scalp cooling successfully prevents alopecia in breast cancer patients undergoing anthracycline/taxane-based chemotherapy.

PubMed

Vasconcelos, Ines; Wiesske, Alexandra; Schoenegg, Winfried

2018-04-13

Chemotherapy for breast cancer induces alopecia, representing a major source of patient distress. This study assesses whether a scalp-cooling device is effective in reducing chemotherapy-induced alopecia, and assesses adverse treatment effects. A prospective observational study including women with breast cancer undergoing chemotherapy and scalp cooling using a Paxman device. The primary efficacy end points were: successful hair preservation (no hair loss; <30% hair loss not requiring a wig; or <50% hair loss not requiring a wig) at the completion of chemotherapy. Secondary end points included adverse effects such as headache, pain, nausea or dizziness. The study enrolled 131 participants. Mean patient age was 49.8 years; 74% received anthracycline/taxane-based chemotherapy and 26% received taxane-monotherapy based chemotherapy. Hair preservation was successful in 102 women who underwent scalp cooling (71.0%; 95% CI = 63-79%). Only adverse events related to device use were collected, representing 7% (95% CI = 3-11%) of cases. Scalp cooling is effective in preventing hair loss among breast cancer patients undergoing standard chemotherapy treatment, and has minimal adverse effects. Copyright © 2018. Published by Elsevier Ltd.

Usefulness of vessel-sealing devices for peripartum hysterectomy: a retrospective cohort study.

PubMed

Rossetti, Diego; Vitale, Salvatore Giovanni; Bogani, Giorgio; Rapisarda, Agnese Maria Chiara; Gulino, Ferdinando Antonio; Frigerio, Luigi

2015-09-01

To evaluate the feasibility to perform peripartum hysterectomy (PH) with the introduction of LigaSure™ vessels-sealing device (LVSD) and how it influenced the surgical outcomes. We retrospectively evaluated procedures and outcome of women undergoing PH during the period between January 2001 and October 2013. Perioperative surgical results of patients undergoing PH using LVSD were compared to patients undergoing PH without LVSD. Forty-nine subjects had PH during the study period. Twenty (41%) hysterectomies were performed for placenta accreta, 8 (16%) for placenta previa, 21 (43%) for atony. Twenty-three subjects had PH using LVSD and 26 subjects had hysterectomy without the use of this device. We observe significant differences in estimated blood loss (p = 0.001), massive blood transfusions (>10 units RBC) (p = 0.025), operative time (p = 0.06). No difference in term of hospital stay and complications were observed (p = 0.78 and p = 0.35). One patient for each group had intraoperative complication (p = 0.9). The use of LVSD during PH does not increase operative complications, blood loss, and operative time in comparison to standard procedure.

New reaction tester accurate within 56 microseconds

NASA Technical Reports Server (NTRS)

Brown, H.

1972-01-01

Testing device measures simple and disjunctive reaction time of human subject to light stimuli. Tester consists of reaction key, logic card, panel mounted neon indicators, and interconnecting wiring. Device is used for determining reaction times of patients undergoing postoperative neurological therapy.

2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care (Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention).

PubMed

Rihal, Charanjit S; Naidu, Srihari S; Givertz, Michael M; Szeto, Wilson Y; Burke, James A; Kapur, Navin K; Kern, Morton; Garratt, Kirk N; Goldstein, James A; Dimas, Vivian; Tu, Thomas

2015-06-01

Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella(®); left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for right-sided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines. Copyright © 2015. Published by Elsevier Inc.

Pacemakers and implantable cardioverter defibrillators: device longevity is more important than smaller size: the patient's viewpoint.

PubMed

Wild, David M; Fisher, John D; Kim, Soo G; Ferrick, Kevin J; Gross, Jay N; Palma, Eugen C

2004-11-01

The size of pacemakers and implantable cardioverter defibrillators (ICDs) has been diminishing progressively. If two devices are otherwise identical in components, features and technology, the one with a larger battery should have a longer service life. Therefore, patients who receive smaller devices may require more frequent surgery to replace the devices. It is uncertain whether this tradeoff for smaller size is desired by patients. We surveyed 156 patients to determine whether patients prefer a larger, longer-lasting device, or a smaller device that is less noticeable but requires more frequent surgery. The effects of subgroups were evaluated; these included body habitus, age, gender, and patients seen at time of pulse generator replacement (PGR), initial implant, or follow-up. Among 156 patients surveyed, 151 expressed a preference. Of these, 90.1% preferred the larger device and 9.9% the smaller device (P <0.0001). Among thin patients, 79.5% preferred a larger device. Ninety percent of males and 89.2% of females selected the larger device. Among younger patients (< or =72 years), 89.6% preferred the larger device, as did 90.5% of older patients (>72 years). Of patients undergoing PGR or initial implants, 95% favored the larger device, as did 86% of patients presenting for follow-up. The vast majority of patients prefer a larger device to reduce the number of potential replacement operations. This preference crosses the spectrum of those with a previously implanted device, those undergoing initial implants, those returning for routine follow-up, and patients of various ages, gender, and habitus.

Controlling motion sickness and spatial disorientation and enhancing vestibular rehabilitation with a user-worn see-through display.

PubMed

Krueger, Wesley W O

2011-01-01

An eyewear mounted visual display ("User-worn see-through display") projecting an artificial horizon aligned with the user's head and body position in space can prevent or lessen motion sickness in susceptible individuals when in a motion provocative environment as well as aid patients undergoing vestibular rehabilitation. In this project, a wearable display device, including software technology and hardware, was developed and a phase I feasibility study and phase II clinical trial for safety and efficacy were performed. Both phase I and phase II were prospective studies funded by the NIH. The phase II study used repeated measures for motion intolerant subjects and a randomized control group (display device/no display device) pre-posttest design for patients in vestibular rehabilitation. Following technology and display device development, 75 patients were evaluated by test and rating scales in the phase II study; 25 subjects with motion intolerance used the technology in the display device in provocative environments and completed subjective rating scales, whereas 50 patients were evaluated before and after vestibular rehabilitation (25 using the display device and 25 in a control group) using established test measures. All patients with motion intolerance rated the technology as helpful for nine symptoms assessed, and 96% rated the display device as simple and easy to use. Duration of symptoms significantly decreased with use of the technology displayed. In patients undergoing vestibular rehabilitation, there were no significant differences in amount of change from pre- to posttherapy on objective balance tests between display device users and controls. However, those using the technology required significantly fewer rehabilitation sessions to achieve those outcomes than the control group. A user-worn see-through display, utilizing a visual fixation target coupled with a stable artificial horizon and aligned with user movement, has demonstrated substantial benefit for individuals susceptible to motion intolerance and spatial disorientation and those undergoing vestibular rehabilitation. The technology developed has applications in any environment where motion sensitivity affects human performance.

Advances in Retinal Prosthetic Research: A Systematic Review of Engineering and Clinical Characteristics of Current Prosthetic Initiatives.

PubMed

Cheng, Derrick L; Greenberg, Paul B; Borton, David A

2017-03-01

To date, reviews of retinal prostheses have focused primarily on devices undergoing human trials in the Western Hemisphere and fail to capture significant advances in materials and engineering research in countries such as Japan and Korea, as well as projects in early stages of development. To address these gaps, this systematic review examines worldwide advances in retinal prosthetic research, evaluates engineering characteristics and clinical progress of contemporary device initiatives, and identifies potential directions for future research in the field of retinal prosthetics. A literature search using PubMed, Google Scholar, and IEEExplore was conducted following the PRISMA Guidelines for Systematic Review. Inclusion criteria were peer-reviewed papers demonstrating progress in human or animal trials and papers discussing the prosthetic engineering design. For each initiative, a description of the device, its engineering considerations, and recent clinical results were provided. Ten prosthetic initiatives met our inclusion criteria and were organized by stimulation location. Of these initiatives, four have recently completed human trials, three are undergoing multi- or single-center human trials, and three are undergoing preclinical animal testing. Only the Argus II (FDA 2013, CE 2011) has obtained FDA approval for use in the United States; the Alpha-IMS (CE 2013) has achieved the highest visual acuity using a Landolt-C test to date and is the only device presently undergoing a multicenter clinical trial. Several distinct approaches to retinal stimulation have been successful in eliciting visual precepts in animals and/or humans. However, many clinical needs are still not met and engineering challenges must be addressed before a retinal prosthesis with the capability to fully and safely restore functional vision can be realized.

A Prospective, Multicenter, Single-Blind Study Assessing Indices of SNAP II Versus BIS VISTA on Surgical Patients Undergoing General Anesthesia.

PubMed

Bergese, Sergio D; Uribe, Alberto A; Puente, Erika G; Marcus, R-Jay L; Krohn, Randall J; Docsa, Steven; Soto, Roy G; Candiotti, Keith A

2017-02-03

Traditionally, anesthesiologists have relied on nonspecific subjective and objective physical signs to assess patients' comfort level and depth of anesthesia. Commercial development of electrical monitors, which use low- and high-frequency electroencephalogram (EEG) signals, have been developed to enhance the assessment of patients' level of consciousness. Multiple studies have shown that monitoring patients' consciousness levels can help in reducing drug consumption, anesthesia-related adverse events, and recovery time. This clinical study will provide information by simultaneously comparing the performance of the SNAP II (a single-channel EEG device) and the bispectral index (BIS) VISTA (a dual-channel EEG device) by assessing their efficacy in monitoring different anesthetic states in patients undergoing general anesthesia. The primary objective of this study is to establish the range of index values for the SNAP II corresponding to each anesthetic state (preinduction, loss of response, maintenance, first purposeful response, and extubation). The secondary objectives will assess the range of index values for BIS VISTA corresponding to each anesthetic state compared to published BIS VISTA range information, and estimate the area under the curve, sensitivity, and specificity for both devices. This is a multicenter, prospective, double-arm, parallel assignment, single-blind study involving patients undergoing elective surgery that requires general anesthesia. The study will include 40 patients and will be conducted at the following sites: The Ohio State University Medical Center (Columbus, OH); Northwestern University Prentice Women's Hospital (Chicago, IL); and University of Miami Jackson Memorial Hospital (Miami, FL). The study will assess the predictive value of SNAP II versus BIS VISTA indices at various anesthetic states in patients undergoing general anesthesia (preinduction, loss of response, maintenance, first purposeful response, and extubation). The SNAP II and BIS VISTA electrode arrays will be placed on the patient's forehead on opposite sides. The hemisphere location for both devices' electrodes will be equally alternated among the patient population. The index values for both devices will be recorded and correlated with the scorings received by performing the Modified Observer's Assessment of Alertness and Sedation and the American Society of Anesthesiologists Continuum of Depth of Sedation, at different stages of anesthesia. Enrollment for this study has been completed and statistical data analyses are currently underway. The results of this trial will provide information that will simultaneously compare the performance of SNAP II and BIS VISTA devices, with regards to monitoring different anesthesia states among patients. Clinicaltrials.gov NCT00829803; https://clinicaltrials.gov/ct2/show/NCT00829803 (Archived by WebCite at http://www.webcitation.org/6nmyi8YKO). ©Sergio D Bergese, Alberto A Uribe, Erika G Puente, R-Jay L Marcus, Randall J Krohn, Steven Docsa, Roy G Soto, Keith A Candiotti. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 03.02.2017.

A new device for the inflation of the antigravity suit.

PubMed

Brodrick, P M

1986-02-01

The 'Schuco' orthopaedic tourniquet inflator can be simply converted into a suitable device for inflating an antigravity suit (G-suit). The antigravity suit may be used on neurosurgical patients undergoing procedures in the sitting position to help prevent hypotension and air embolism. The availability of this device may encourage the more widespread use of an antigravity suit in neuro-anaesthetic practice.

A Prospective, Multicenter, Single-Blind Study Assessing Indices of SNAP II Versus BIS VISTA on Surgical Patients Undergoing General Anesthesia

PubMed Central

Bergese, Sergio D; Puente, Erika G; Marcus, R-Jay L; Krohn, Randall J; Docsa, Steven; Soto, Roy G; Candiotti, Keith A

2017-01-01

Background Traditionally, anesthesiologists have relied on nonspecific subjective and objective physical signs to assess patients’ comfort level and depth of anesthesia. Commercial development of electrical monitors, which use low- and high-frequency electroencephalogram (EEG) signals, have been developed to enhance the assessment of patients’ level of consciousness. Multiple studies have shown that monitoring patients’ consciousness levels can help in reducing drug consumption, anesthesia-related adverse events, and recovery time. This clinical study will provide information by simultaneously comparing the performance of the SNAP II (a single-channel EEG device) and the bispectral index (BIS) VISTA (a dual-channel EEG device) by assessing their efficacy in monitoring different anesthetic states in patients undergoing general anesthesia. Objective The primary objective of this study is to establish the range of index values for the SNAP II corresponding to each anesthetic state (preinduction, loss of response, maintenance, first purposeful response, and extubation). The secondary objectives will assess the range of index values for BIS VISTA corresponding to each anesthetic state compared to published BIS VISTA range information, and estimate the area under the curve, sensitivity, and specificity for both devices. Methods This is a multicenter, prospective, double-arm, parallel assignment, single-blind study involving patients undergoing elective surgery that requires general anesthesia. The study will include 40 patients and will be conducted at the following sites: The Ohio State University Medical Center (Columbus, OH); Northwestern University Prentice Women's Hospital (Chicago, IL); and University of Miami Jackson Memorial Hospital (Miami, FL). The study will assess the predictive value of SNAP II versus BIS VISTA indices at various anesthetic states in patients undergoing general anesthesia (preinduction, loss of response, maintenance, first purposeful response, and extubation). The SNAP II and BIS VISTA electrode arrays will be placed on the patient’s forehead on opposite sides. The hemisphere location for both devices’ electrodes will be equally alternated among the patient population. The index values for both devices will be recorded and correlated with the scorings received by performing the Modified Observer’s Assessment of Alertness and Sedation and the American Society of Anesthesiologists Continuum of Depth of Sedation, at different stages of anesthesia. Results Enrollment for this study has been completed and statistical data analyses are currently underway. Conclusions The results of this trial will provide information that will simultaneously compare the performance of SNAP II and BIS VISTA devices, with regards to monitoring different anesthesia states among patients. ClinicalTrial Clinicaltrials.gov NCT00829803; https://clinicaltrials.gov/ct2/show/NCT00829803 (Archived by WebCite at http://www.webcitation.org/6nmyi8YKO) PMID:28159731

Theater of Operations Construction in the Desert: A Handbook of Lessons Learned in the Middle East

DTIC Science & Technology

1981-01-01

dehydrates the desert environment. In addition, the wind always carries fine soil particles which abrade building elements, clog mechar:ical devices, and...lower salt rejection, and increased likelihood of scaling and membrane hydrolysis . Manufacturers recommend that feed stream flows not be lower than...undergo accelerated decomposition /aging when stored in high desert heat. This is complicated by the fa~t that many of the tests were designed to be

Rehabilitation of the olfactory sense after laryngectomy: long-term use of the larynx bypass.

PubMed

Göktas, Onder; Fleiner, Franca; Paschen, Christian; Lammert, Ingeborg; Schrom, Thomas

2008-09-01

Patients who undergo laryngectomy typically lose their sense of smell. One device that has been used to rehabilitate olfactory function in these patients is the larynx bypass. We conducted a long-term study of the larynx bypass in 16 laryngectomized patients. After undergoing objective and subjective baseline evaluations, patients were asked to use the device at home for at least 30 minutes each day for 3 months. They were also asked to record in a diary subjective ratings of their sense of smell and the practicability of using the device every day. At study's end, patients experienced a statistically significant improvement (p < 0.001) in olfactory function on objective measurement (Sniffin' Sticks testing). Subjective improvement was seen after 1 week (p < 0.001) and maintained throughout the study. Practicability scores improved statistically (p = 0.003), but the device remained difficult to use. The long-term use of the larynx bypass has not been studied previously, and we hope that our findings will serve as a basis for further investigation.

Safety and efficacy of hysteroscopic sterilization compared with laparoscopic sterilization: an observational cohort study.

PubMed

Mao, Jialin; Pfeifer, Samantha; Schlegel, Peter; Sedrakyan, Art

2015-10-13

To compare the safety and efficacy of hysteroscopic sterilization with the "Essure" device with laparoscopic sterilization in a large, all-inclusive, state cohort. Population based cohort study. Outpatient interventional setting in New York State. Women undergoing interval sterilization procedure, including hysteroscopic sterilization with Essure device and laparoscopic surgery, between 2005 and 2013. Safety events within 30 days of procedures; unintended pregnancies and reoperations within one year of procedures. Mixed model accounting for hospital clustering was used to compare 30 day and 1 year outcomes, adjusting for patient characteristics and other confounders. Time to reoperation was evaluated using frailty model for time to event analysis. We identified 8048 patients undergoing hysteroscopic sterilization and 44,278 undergoing laparoscopic sterilization between 2005 and 2013 in New York State. There was a significant increase in the use of hysteroscopic procedures during this period, while use of laparoscopic sterilization decreased. Patients undergoing hysteroscopic sterilization were older than those undergoing laparoscopic sterilization and were more likely to have a history of pelvic inflammatory disease (10.3% v 7.2%, P<0.01), major abdominal surgery (9.4% v 7.9%, P<0.01), and cesarean section (23.2% v 15.4%, P<0.01). At one year after surgery, hysteroscopic sterilization was not associated with a higher risk of unintended pregnancy (odds ratio 0.84 (95% CI 0.63 to 1.12)) but was associated with a substantially increased risk of reoperation (odds ratio 10.16 (7.47 to 13.81)) compared with laparoscopic sterilization. Patients undergoing hysteroscopic sterilization have a similar risk of unintended pregnancy but a more than 10-fold higher risk of undergoing reoperation compared with patients undergoing laparoscopic sterilization. Benefits and risks of both procedures should be discussed with patients for informed decisions making. © Mao et al 2015.

Direct hospital costs of total laparoscopic hysterectomy compared with fast-track open hysterectomy at a tertiary hospital: a retrospective case-controlled study.

PubMed

Rhou, Yoon J J; Pather, Selvan; Loadsman, John A; Campbell, Neil; Philp, Shannon; Carter, Jonathan

2015-12-01

To assess the direct intraoperative and postoperative costs in women undergoing total laparoscopic hysterectomy and fast-track open hysterectomy. A retrospective review of the direct hospital-related costs in a matched cohort of women undergoing total laparoscopic hysterectomy (TLH) and fast-track open hysterectomy (FTOH) at a tertiary hospital. All costs were calculated, including the cost of advanced high-energy laparoscopic devices. The effect of the learning curve on cost in laparoscopic hysterectomy was also assessed, as was the hospital case-weighted cost, which was compared with the actual cost. Fifty women were included in each arm of the study. TLH had a higher intraoperative cost, but a lower postoperative cost than FTOH (AUD$3877 vs AUD$2776 P < 0.001, AUD$3965 vs AUD$6233 P < 0.001). The total cost of TLH was not different from FTOH (AUD$7842 vs AUD$9009 P = 0.068) and after a learning curve; TLH cost less than FTOH (AUD$6797 vs AUD$8647, P < 0.001). The use of high-energy devices did not impact on the cost benefit of TLH, and hospital case-weight-based funding correlated poorly with actual cost. Despite the use of fast-track recovery protocols, the cost of TLH is no different to FTOH and after a learning curve is cheaper than open hysterectomy. Judicious use of advanced energy devices does not impact on the cost, and hospital case-weight-based funding model in our hospital is inaccurate when compared to directly calculated hospital costs. © 2013 The Authors ANZJOG © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Symmetry-breaking charge transfer in a zinc chlorodipyrrin acceptor for high open circuit voltage organic photovoltaics.

PubMed

Bartynski, Andrew N; Gruber, Mark; Das, Saptaparna; Rangan, Sylvie; Mollinger, Sonya; Trinh, Cong; Bradforth, Stephen E; Vandewal, Koen; Salleo, Alberto; Bartynski, Robert A; Bruetting, Wolfgang; Thompson, Mark E

2015-04-29

Low open-circuit voltages significantly limit the power conversion efficiency of organic photovoltaic devices. Typical strategies to enhance the open-circuit voltage involve tuning the HOMO and LUMO positions of the donor (D) and acceptor (A), respectively, to increase the interfacial energy gap or to tailor the donor or acceptor structure at the D/A interface. Here, we present an alternative approach to improve the open-circuit voltage through the use of a zinc chlorodipyrrin, ZCl [bis(dodecachloro-5-mesityldipyrrinato)zinc], as an acceptor, which undergoes symmetry-breaking charge transfer (CT) at the donor/acceptor interface. DBP/ZCl cells exhibit open-circuit voltages of 1.33 V compared to 0.88 V for analogous tetraphenyldibenzoperyflanthrene (DBP)/C60-based devices. Charge transfer state energies measured by Fourier-transform photocurrent spectroscopy and electroluminescence show that C60 forms a CT state of 1.45 ± 0.05 eV in a DBP/C60-based organic photovoltaic device, while ZCl as acceptor gives a CT state energy of 1.70 ± 0.05 eV in the corresponding device structure. In the ZCl device this results in an energetic loss between E(CT) and qV(OC) of 0.37 eV, substantially less than the 0.6 eV typically observed for organic systems and equal to the recombination losses seen in high-efficiency Si and GaAs devices. The substantial increase in open-circuit voltage and reduction in recombination losses for devices utilizing ZCl demonstrate the great promise of symmetry-breaking charge transfer in organic photovoltaic devices.

Development of novel active transport membrande devices

DOE Office of Scientific and Technical Information (OSTI.GOV)

Laciak, D.V.

1994-11-01

Air Products has undertaken a research program to fabricate and evaluate gas separation membranes based upon promising ``active-transport`` (AT) materials recently developed in our laboratories. Active Transport materials are ionic polymers and molten salts which undergo reversible interaction or reaction with ammonia and carbon dioxide. The materials are useful for separating these gases from mixtures with hydrogen. Moreover, AT membranes have the unique property of possessing high permeability towards ammnonia and carbon dioxide but low permeability towards hydrogen and can thus be used to permeate these components from a gas stream while retaining hydrogen at high pressure.

21 CFR 880.5450 - Patient care reverse isolation chamber.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Therapeutic Devices § 880.5450 Patient care reverse isolation chamber. (a) Identification. A patient care... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Patient care reverse isolation chamber. 880.5450... harmful airborne material. This device protects a patient who is undergoing treatment for burns or is...

Dosimetric considerations for patients with HIP prostheses undergoing pelvic irradiation. Report of the AAPM Radiation Therapy Committee Task Group 63.

PubMed

Reft, Chester; Alecu, Rodica; Das, Indra J; Gerbi, Bruce J; Keall, Paul; Lief, Eugene; Mijnheer, Ben J; Papanikolaou, Nikos; Sibata, Claudio; Van Dyk, Jake

2003-06-01

This document is the report of a task group of the Radiation Therapy Committee of the AAPM and has been prepared primarily to advise hospital physicists involved in external beam treatment of patients with pelvic malignancies who have high atomic number (Z) hip prostheses. The purpose of the report is to make the radiation oncology community aware of the problems arising from the presence of these devices in the radiation beam, to quantify the dose perturbations they cause, and, finally, to provide recommendations for treatment planning and delivery. Some of the data and recommendations are also applicable to patients having implanted high-Z prosthetic devices such as pins, humeral head replacements. The scientific understanding and methodology of clinical dosimetry for these situations is still incomplete. This report is intended to reflect the current state of scientific understanding and technical methodology in clinical dosimetry for radiation oncology patients with high-Z hip prostheses.

Carbon-bridged oligo(p-phenylenevinylene)s for photostable and broadly tunable, solution-processable thin film organic lasers

PubMed Central

Morales-Vidal, Marta; Boj, Pedro G.; Villalvilla, José M.; Quintana, José A.; Yan, Qifan; Lin, Nai-Ti; Zhu, Xiaozhang; Ruangsupapichat, Nopporn; Casado, Juan; Tsuji, Hayato; Nakamura, Eiichi; Díaz-García, María A.

2015-01-01

Thin film organic lasers represent a new generation of inexpensive, mechanically flexible devices for spectroscopy, optical communications and sensing. For this purpose, it is desired to develop highly efficient, stable, wavelength-tunable and solution-processable organic laser materials. Here we report that carbon-bridged oligo(p-phenylenevinylene)s serve as optimal materials combining all these properties simultaneously at the level required for applications by demonstrating amplified spontaneous emission and distributed feedback laser devices. A series of six compounds, with the repeating unit from 1 to 6, doped into polystyrene films undergo amplified spontaneous emission from 385 to 585 nm with remarkably low threshold and high net gain coefficients, as well as high photostability. The fabricated lasers show narrow linewidth (<0.13 nm) single mode emission at very low thresholds (0.7 kW cm−2), long operational lifetimes (>105 pump pulses for oligomers with three to six repeating units) and wavelength tunability across the visible spectrum (408–591 nm). PMID:26416643

Soft Nanoimprint Lithography for Direct Printing of Crystalline Metal Oxide Nanostructures

NASA Astrophysics Data System (ADS)

Kothari, Rohit; Beaulieu, Michael; Watkins, James

2015-03-01

We demonstrate a solution-based soft nanoimprint lithography technique to directly print dimensionally-stable crystalline metal oxide nanostructures. A patterned PDMS stamp is used in combination with a UV/thermal cure step to imprint a resist containing high concentrations of crystalline nanoparticles in an inorganic/organic binder phase. The as-imprinted nanostructures are highly crystalline and therefore undergo little shrinkage (less than 5% in some cases) upon thermal annealing. High aspect ratio nanostructures and sub-100 nm features are easily realized. Residual layer free direct imprinting (no etching) was achieved by choosing the resist with the appropriate surface energy to ensure dewetting at stamp-substrate interface. The technique was further extended to stack the nanostructures by deploying a layer-by-layer imprint strategy. The method is scalable and can produce large area device quality nanostructures in a rapid fashion at a low cost. CeO2, ITO and TiO2 nanopatterns are illustrated for their potential use in fuel cell electrodes, solar cell electrodes and photonic devices, respectively.

Real-Time Deposition Monitor for Ultrathin Conductive Films

NASA Technical Reports Server (NTRS)

Hines, Jacqueline

2011-01-01

A device has been developed that can be used for the real-time monitoring of ultrathin (2 or more) conductive films. The device responds in less than two microseconds, and can be used to monitor film depositions up to about 60 thick. Actual thickness monitoring capability will vary based on properties of the film being deposited. This is a single-use device, which, due to the very low device cost, can be disposable. Conventional quartz/crystal microbalance devices have proven inadequate to monitor the thickness of Pd films during deposition of ultrathin films for hydrogen sensor devices. When the deposited film is less than 100 , the QCM measurements are inadequate to allow monitoring of the ultrathin films being developed. Thus, an improved, high-sensitivity, real-time deposition monitor was needed to continue Pd film deposition development. The new deposition monitor utilizes a surface acoustic wave (SAW) device in a differential delay-line configuration to produce both a reference response and a response for the portion of the device on which the film is being deposited. Both responses are monitored simultaneously during deposition. The reference response remains unchanged, while the attenuation of the sensing path (where the film is being deposited) varies as the film thickness increases. This device utilizes the fact that on high-coupling piezoelectric substrates, the attenuation of an SAW undergoes a transition from low to very high, and back to low as the conductivity of a film on the device surface goes from nonconductive to highly conductive. Thus, the sensing path response starts with a low insertion loss, and as a conductive film is deposited, the film conductivity increases, causing the device insertion loss to increase dramatically (by up to 80 dB or more), and then with continued film thickness increases (and the corresponding conductivity increases), the device insertion loss goes back down to the low level at which it started. This provides a continuous, real-time monitoring of film deposition. For use with different films, the device would need to be calibrated to provide an understanding of how film thickness is related to film conductivity, as the device is responding primarily to conductivity effects (and not to mass loading effects) in this ultrathin film regime.

Comparison between AMS 700™ CX and Coloplast™ Titan inflatable penile prosthesis for Peyronie's disease treatment and remodeling: clinical outcomes and patient satisfaction.

PubMed

Chung, Eric; Solomon, Matthew; DeYoung, Ling; Brock, Gerald B

2013-11-01

The implantation of inflatable penile prosthesis (IPP) with simultaneous manual penile remodeling allows for men to undergo a single procedure aimed at correcting both the penile deformity/curvature and erectile dysfunction (ED). To evaluate the clinical outcomes and patient satisfaction in men with Peyronie's disease (PD) and ED who underwent AMS 700™ CX and the newer Coloplast™ Titan inflatable penile prosthesis (IPP) implant. Patient demographics, type of IPP, clinical outcomes, post-implant sexual characteristics, and overall patient satisfaction. A single-center retrospective review of clinical database and prospective telephone survey were conducted in all men with PD who underwent IPP between January 2006 and November 2010. A total of 138 patients with an average age of 57.7 (32 to 80) underwent AMS 700 CX (88 patients) and Coloplast Titans (50 patients) IPP implantation during the 5-year period. The majority of patients (91%) had only one IPP implantation. The IPP clinical outcomes include eight (6%) revision surgery for device malfunction and three (2%) device explantation for prosthesis infection. While there was no statistically significance in device survival between the two devices, the trend favored AMS 700 CX over Titan (5-year Kaplan-Meier estimates of mechanical survival were 91% vs. 87%, P>0.05) and both IPPs provided similar penile straightening without the need for revision surgery. Most men (79%) reported great satisfaction following CX or Titan implants with greater than two thirds of men reported greater self-confidence and 82% of patients would undergo the same operation again. AMS 700™ CX and Coloplast™ Titan IPP implantation and penile remodeling appeared to provide permanent penile straightening and high patient satisfaction without an increase risk of revision surgery. © 2012 International Society for Sexual Medicine.

Metal-free, flexible triboelectric generator based on MWCNT mesh film and PDMS layers

NASA Astrophysics Data System (ADS)

Hwang, Hayoung; Lee, Kang Yeol; Shin, Dongjoon; Shin, Jungho; Kim, Sangtae; Choi, Wonjoon

2018-06-01

We demonstrate a metal-free triboelectric energy harvester consisted of MWCNT mesh film and PDMS layer. Upon touch from a finger, the single electrode-mode energy harvester generates up to 27.0 W/m2 output power at 10 MΩ matched impedance. The device generates stable power upon touch by bare fingers or gloved fingers. Using copper counter electrode results in decreased power output, due to the weaker tendency in triboelectrification. The power output also scales with the pressure applied by the finger. The intertwined, condensed MWCNT network acts as a flexible yet effective current collector, with resistance across the device less than 10 Ω. This current collector possesses strong corrosion resistance and stability against potential oxidation, while its metal counterpart may undergo oxidation over extended exposure to air or frequent fracture upon straining. The flexible device form may be applied to various curved or irregular surfaces that undergo frequent human touches.

In Situ Growth of Free-Standing All Metal Oxide Asymmetric Supercapacitor.

PubMed

Yin, Bo-Si; Wang, Zhen-Bo; Zhang, Si-Wen; Liu, Chang; Ren, Qing-Qing; Ke, Ke

2016-10-05

Metal oxides have attracted renewed interest in applications as energy storage and conversion devices. Here, a new design is reported to acquire an asymmetric supercapacitor assembled by all free-standing metal oxides. The positive electrode is made of 3D NiO open porous nanoribbons network on nickel foam and the negative electrode is composed of SnO 2 /MnO 2 nanoflakes grown on carbon cloth (CC) substrate. The combination of two metal oxide electrodes which replaced the traditional group of carbon materials together with metal oxide has achieved a higher energy density. The self-supported 3D NiO nanoribbons network demonstrates a high specific capacitance and better cycle performance without obvious mechanical deformation despite of undergoing harsh bulk redox reactions. The SnO 2 /MnO 2 nanoflakes as the pseudocapacitive electrode exhibit a wide range of voltage window (-1 to 1 V), which is conducive to electrochemical energy storage. The (CC/SnO 2 /MnO 2 )(-)//(NiO/Ni foam)(+) asymmetric supercapacitor device delivers an energy density of 64.4 Wh kg -1 (at a power density of 250 W kg -1 ) and two devices in series are applied to light up 24 red LEDs for about 60 s. The outstanding electrochemical properties of the device hold great promise for long-life, high-energy, and high-power energy storage/conversion applications.

Profound hearing loss associated with hydrocodone/acetaminophen abuse.

PubMed

Friedman, R A; House, J W; Luxford, W M; Gherini, S; Mills, D

2000-03-01

To describe profound hearing loss associated with hydrocodone overuse and the successful rehabilitation of these patients with cochlear implantation. Retrospective review. A tertiary otologic referral center. Twelve patients with rapidly progressive hearing loss and a concurrent history of hydrocodone overuse. Comprehensive medical histories, physical findings, audiometric tests, and, in those patients undergoing cochlear implantation, postimplantation performance data were reviewed. Clinical characteristics of hydrocodone-related hearing loss and open set word and sentence performance in those patients undergoing cochlear implantation. Hydrocodone overuse was associated with rapidly progressive sensorineural hearing loss in 12 patients. In four patients the initial presentation was unilateral, and two of the patients experienced vestibular symptoms. None of the 12 patients experienced improved thresholds after high-dose prednisone. Seven of the eight patients undergoing cochlear implantation have demonstrated early success with their devices. Hydrocodone is frequently prescribed in combination with acetaminophen for the relief of pain and has a side effects profile similar to other medications in its class. Although not described previously, overuse or abuse can be associated with a rapidly progressive sensorineural hearing loss. These patients can be successfully rehabilitated with cochlear implantation.

Controlling Motion Sickness and Spatial Disorientation and Enhancing Vestibular Rehabilitation with a User-Worn See-Through Display

PubMed Central

Krueger, Wesley W.O.

2010-01-01

Objectives/Hypotheses An eyewear mounted visual display (“User-worn see-through display”) projecting an artificial horizon aligned with the user's head and body position in space can prevent or lessen motion sickness in susceptible individuals when in a motion provocative environment as well as aid patients undergoing vestibular rehabilitation. In this project, a wearable display device, including software technology and hardware, was developed and a phase I feasibility study and phase II clinical trial for safety and efficacy were performed. Study Design Both phase I and phase II were prospective studies funded by the NIH. The phase II study used repeated measures for motion intolerant subjects and a randomized control group (display device/no display device) pre-post test design for patients in vestibular rehabilitation. Methods Following technology and display device development, 75 patients were evaluated by test and rating scales in the phase II study; 25 subjects with motion intolerance used the technology in the display device in provocative environments and completed subjective rating scales while 50 patients were evaluated before and after vestibular rehabilitation (25 using the display device and 25 in a control group) using established test measures. Results All patients with motion intolerance rated the technology as helpful for nine symptoms assessed, and 96% rated the display device as simple and easy to use. Duration of symptoms significantly decreased with use of the technology displayed. In patients undergoing vestibular rehabilitation, there were no significant differences in amount of change from pre- to post-therapy on objective balance tests between display device users and controls. However, those using the technology required significantly fewer rehabilitation sessions to achieve those outcomes than the control group. Conclusions A user-worn see-through display, utilizing a visual fixation target coupled with a stable artificial horizon and aligned with user movement, has demonstrated substantial benefit for individuals susceptible to motion intolerance and spatial disorientation and those undergoing vestibular rehabilitation. The technology developed has applications in any environment where motion sensitivity affects human performance. PMID:21181963

Safety and performance of a novel embolic deflection device in patients undergoing transcatheter aortic valve replacement: results from the DEFLECT I study.

PubMed

Baumbach, Andreas; Mullen, Michael; Brickman, Adam M; Aggarwal, Suneil K; Pietras, Cody G; Forrest, John K; Hildick-Smith, David; Meller, Stephanie M; Gambone, Louise; den Heijer, Peter; Margolis, Pauliina; Voros, Szilard; Lansky, Alexandra J

2015-05-01

This study aimed to evaluate the safety and performance of the TriGuard™ Embolic Deflection Device (EDD), a nitinol mesh filter positioned in the aortic arch across all three major cerebral artery take-offs to deflect emboli away from the cerebral circulation, in patients undergoing transcatheter aortic valve replacement (TAVR). The prospective, multicentre DEFLECT I study (NCT01448421) enrolled 37 consecutive subjects undergoing TAVR with the TriGuard EDD. Subjects underwent clinical and cognitive follow-up to 30 days; cerebral diffusion-weighted magnetic resonance imaging (DW-MRI) was performed pre-procedure and at 4±2 days post procedure. The device performed as intended with successful cerebral coverage in 80% (28/35) of cases. The primary safety endpoint (in-hospital EDD device- or EDD procedure-related cardiovascular mortality, major stroke disability, life-threatening bleeding, distal embolisation, major vascular complications, or need for acute cardiac surgery) occurred in 8.1% of subjects (VARC-defined two life-threatening bleeds and one vascular complication). The presence of new cerebral ischaemic lesions on post-procedure DW-MRI (n=28) was similar to historical controls (82% vs. 76%, p=NS). However, an exploratory analysis found that per-patient total lesion volume was 34% lower than reported historical data (0.2 vs. 0.3 cm3), and 89% lower in patients with complete (n=17) versus incomplete (n=10) cerebral vessel coverage (0.05 vs. 0.45 cm3, p=0.016). Use of the first-generation TriGuard EDD during TAVR is safe, and device performance was successful in 80% of cases during the highest embolic-risk portions of the TAVR procedure. The potential of the TriGuard EDD to reduce total cerebral ischaemic burden merits further randomised investigation.

Oral anticoagulation management in patients with atrial fibrillation undergoing cardiac implantable electronic device implantation.

PubMed

Black-Maier, Eric; Kim, Sunghee; Steinberg, Benjamin A; Fonarow, Gregg C; Freeman, James V; Kowey, Peter R; Ansell, Jack; Gersh, Bernard J; Mahaffey, Kenneth W; Naccarelli, Gerald; Hylek, Elaine M; Go, Alan S; Peterson, Eric D; Piccini, Jonathan P

2017-09-01

Oral anticoagulation (OAC) therapy is associated with increased periprocedural risks after cardiac implantable electronic device (CIED) implantation. Patterns of anticoagulation management involving non-vitamin K antagonist oral anticoagulants (NOACs) have not been characterized. Anticoagulation strategies and outcomes differ by anticoagulant type in patients undergoing CIED implantation. Using the nationwide Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we assessed how atrial fibrillation (AF) patients undergoing CIED implantation were cared for and their subsequent outcomes. Outcomes were compared by oral anticoagulant therapy (none, warfarin, or NOAC) as well as by anticoagulation interruption status. Among 9129 AF patients, 416 (5%) underwent CIED implantation during a median follow-up of 30 months (interquartile range, 24-36). Of these, 60 (14%) had implantation on a NOAC. Relative to warfarin therapy, those on a NOAC were younger (70.5 years [range, 65-77.5 years] vs 77 years [range, 70-82 years]), had less valvular heart disease (15.0% vs 31.3%), higher creatinine clearance (67.3 [range, 59.7-99.0] vs 65.8 [range, 50.0-91.6]), were more likely to have persistent AF (26.7% vs 22.9%), and use concomitant aspirin (51.7% vs 35.2%). OAC therapy was commonly interrupted for CIED in 64% (n = 183 of 284) of warfarin patients and 65% (n = 39 of 60) of NOAC patients. Many interrupted patients received intravenous bridging anticoagulation: 33/183 (18%) interrupted warfarin and 4/39 (10%) interrupted NOAC patients. Thirty-day periprocedure bleeding and stroke adverse events were infrequent. Management of anticoagulation among AF patients undergoing CIED implantation is highly variable, with OAC being interrupted in more than half of both warfarin- and NOAC-treated patients. Bleeding and stroke events were infrequent in both warfarin and NOAC-treated patients. © 2017 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.

Safety evaluation of a leadless transcatheter pacemaker for magnetic resonance imaging use.

PubMed

Soejima, Kyoko; Edmonson, Jonathan; Ellingson, Michael L; Herberg, Ben; Wiklund, Craig; Zhao, Jing

2016-10-01

Increased magnetic resonance imaging (MRI) adoption and demand are driving the need for device patients to have safe access to MRI. The aim of this study was to address the interactions of MRI with the Micra transcatheter pacemaker system. A strategy was developed to evaluate potential MRI risks including device heating, unintended cardiac stimulation, force, torque, vibration, and device malfunction. Assessment of MRI-induced device heating was conducted using a phantom containing gelled saline, and Monte Carlo simulations incorporating these results were conducted to simulate numerous combinations of human body models, position locations in the MRI scanner bore, and a variety of coil designs. Lastly, a patient with a Micra pacemaker who underwent a clinically indicated MRI scan is presented. Compared to traditional MRI conditional pacemakers, the overall risk with Micra was greatly reduced because of the small size of the device and the absence of a lead. The modeling results predicted that the nonperfused temperature rise of the device would be less than 0.4°C at 1.5 T and 0.5°C at 3 T and that the risk of device heating with multiple device implants was not increased as compared with a single device. The clinical case study revealed no MRI-related complications. The MRI safety assessment tests conducted for the Micra pacemaker demonstrate that patients with a single device or multiple devices can safely undergo MRI scans in both 1.5- and 3-T MRI scanners. No MRI-related complications were observed in a patient implanted with a Micra pacemaker undergoing a clinically indicated scan. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

A device for automatically measuring and supervising the critical care patient's urine output.

PubMed

Otero, Abraham; Palacios, Francisco; Akinfiev, Teodor; Fernández, Roemi

2010-01-01

Critical care units are equipped with commercial monitoring devices capable of sensing patients' physiological parameters and supervising the achievement of the established therapeutic goals. This avoids human errors in this task and considerably decreases the workload of the healthcare staff. However, at present there still is a very relevant physiological parameter that is measured and supervised manually by the critical care units' healthcare staff: urine output. This paper presents a patent-pending device capable of automatically recording and supervising the urine output of a critical care patient. A high precision scale is used to measure the weight of a commercial urine meter. On the scale's pan there is a support frame made up of Bosch profiles that isolates the scale from force transmission from the patient's bed, and guarantees that the urine flows properly through the urine meter input tube. The scale's readings are sent to a PC via Bluetooth where an application supervises the achievement of the therapeutic goals. The device is currently undergoing tests at a research unit associated with the University Hospital of Getafe in Spain.

A mobile compression device for thrombosis prevention in hip and knee arthroplasty.

PubMed

Colwell, Clifford W; Froimson, Mark I; Anseth, Scott D; Giori, Nicholas J; Hamilton, William G; Barrack, Robert L; Buehler, Knute C; Mont, Michael A; Padgett, Douglas E; Pulido, Pamela A; Barnes, C Lowery

2014-02-05

Venous thromboembolic events, either deep venous thrombosis or pulmonary embolism, are important complications in patients undergoing knee or hip arthroplasty. The purpose of this study was to evaluate the effectiveness of a mobile compression device (ActiveCare+S.F.T.) with or without aspirin compared with current pharmacological protocols for prophylaxis against venous thromboembolism in patients undergoing elective primary unilateral arthroplasty of a lower-extremity joint. A multicenter registry was established to capture the rate of symptomatic venous thromboembolic events following primary knee arthroplasty (1551 patients) or hip arthroplasty (1509 patients) from ten sites. All patients were eighteen years of age or older with no known history of venous thromboembolism, coagulation disorder, or solid tumor. Use of the compression device began perioperatively and continued for a minimum of ten days. Patients with symptoms of deep venous thrombosis or pulmonary embolism underwent duplex ultrasonography and/or spiral computed tomography. All patients were evaluated at three months postoperatively to document any evidence of deep venous thrombosis or pulmonary embolism. Of 3060 patients, twenty-eight (0.92%) had venous thromboembolism (twenty distal deep venous thrombi, three proximal deep venous thrombi, and five pulmonary emboli). One death occurred, with no autopsy performed. Symptomatic venous thromboembolic rates observed in patients who had an arthroplasty of a lower-extremity joint using the mobile compression device were noninferior (not worse than), at a margin of 1.0%, to the rates reported for pharmacological prophylaxis, including warfarin, enoxaparin, rivaroxaban, and dabigatran, except in the knee arthroplasty group, in which the mobile compression device fell short of the rate reported for rivaroxaban by 0.06%. Use of the mobile compression device with or without aspirin for patients undergoing arthroplasty of a lower-extremity joint provides a noninferior risk for the development of venous thromboembolism compared with current pharmacological protocols.

Enhanced organic memory devices (OMEM) with a photochromic perhydro DTE as a transduction layer (Conference Presentation)

NASA Astrophysics Data System (ADS)

Cordes, Sandra; Kranz, Darius; Maibach, Eduard; Kempf, Maxim; Meerholz, Klaus

2016-09-01

In modern electronic systems memory elements are of fundamental importance for data storage. Especially solution-processable nonvolatile organic memories, which are inexpensive and can be manufactured on flexible substrates, are a promising alternative to brittle inorganic devices. Organic photochromic switchable compounds, mostly dithienylethenes (DTEs), are thermally stable, fatigue resistant and can undergo an electrically- or/and photo-induced ring-opening and -closing reaction which results in a change of energy levels. Due to the energetic difference in the highest occupied molecular orbital (HOMO) between the open and closed isomer, the DTE layer can be exploited as a switchable hole injection barrier that controls the electrical current in the diode. We demonstrated that a light-emitting organic memory (LE-OMEM) device with a perfluoro DTE transduction layer can be switched electrically via high current densities pulses and optically by irradiated light, with impressive current ON/OFF Ratios (OOR) of 10Λ2, 10Λ4 respectively. Currently we aim to minimize the barrier of the ON state and maximize the barrier of the OFF state by designing DTE molecules with larger differences in the HOMO energies of the two isomers yielding improved OOR values. By synthesizing perhydro derivates of DTE we achieved molecules with high HOMO levels and large ΔHOMO energies providing OMEM devices with excellent physical properties (OOR 1.4 x higher than perfluoro DTE). Due to the high HOMO level of the perhydro DTE utilization of hole transport layers (HTLs) is not necessary and thus manufacturing of OMEM devices is simplified.

Safety and efficacy of hysteroscopic sterilization compared with laparoscopic sterilization: an observational cohort study

PubMed Central

Mao, Jialin; Pfeifer, Samantha; Schlegel, Peter

2015-01-01

Objective To compare the safety and efficacy of hysteroscopic sterilization with the “Essure” device with laparoscopic sterilization in a large, all-inclusive, state cohort. Design Population based cohort study. Settings Outpatient interventional setting in New York State. Participants Women undergoing interval sterilization procedure, including hysteroscopic sterilization with Essure device and laparoscopic surgery, between 2005 and 2013. Main outcomes measures Safety events within 30 days of procedures; unintended pregnancies and reoperations within one year of procedures. Mixed model accounting for hospital clustering was used to compare 30 day and 1 year outcomes, adjusting for patient characteristics and other confounders. Time to reoperation was evaluated using frailty model for time to event analysis. Results We identified 8048 patients undergoing hysteroscopic sterilization and 44 278 undergoing laparoscopic sterilization between 2005 and 2013 in New York State. There was a significant increase in the use of hysteroscopic procedures during this period, while use of laparoscopic sterilization decreased. Patients undergoing hysteroscopic sterilization were older than those undergoing laparoscopic sterilization and were more likely to have a history of pelvic inflammatory disease (10.3% v 7.2%, P<0.01), major abdominal surgery (9.4% v 7.9%, P<0.01), and cesarean section (23.2% v 15.4%, P<0.01). At one year after surgery, hysteroscopic sterilization was not associated with a higher risk of unintended pregnancy (odds ratio 0.84 (95% CI 0.63 to 1.12)) but was associated with a substantially increased risk of reoperation (odds ratio 10.16 (7.47 to 13.81)) compared with laparoscopic sterilization. Conclusions Patients undergoing hysteroscopic sterilization have a similar risk of unintended pregnancy but a more than 10-fold higher risk of undergoing reoperation compared with patients undergoing laparoscopic sterilization. Benefits and risks of both procedures should be discussed with patients for informed decisions making. PMID:26462857

Emerging Transcatheter Options for Tricuspid Regurgitation

PubMed Central

Kalra, Ankur; Uberoi, Angad S.; Latib, Azeem; Khera, Sahil; Little, Stephen H.; Bhatt, Deepak L.; Reardon, Michael J.; Kleiman, Neal S.; Barker, Colin M.

2017-01-01

Tricuspid regurgitation (TR) presents as either primary valve pathology or secondary to pulmonary or left-sided heart disease. Severe TR portends a worse prognosis independent of age, right ventricular size and function, severe left ventricular dysfunction, and increased pulmonary arterial pressures. Surgical treatment for TR has mostly been limited to patients undergoing mitral valve repair since those at high surgical risk are not candidates for traditional TR surgery. For these patients, minimally invasive techniques could be of great benefit, yet these techniques have been slow to develop because of the various anatomic and physiological aspects of the tricuspid valve apparatus. Several promising new techniques are currently undergoing clinical investigation, including caval valve implantation, percutaneous tricuspid annuloplasty techniques (Trialign, TriCinch, Cardioband), edge-to-edge repair with the MitraClip system, the FORMA device, and the GATE tricuspid Atrioventricular Valved Stent. Further evaluation of their safety and long-term efficacy is warranted prior to commercial approval and widespread adoption. PMID:29743996

RESONATOR PARTICLE SEPARATOR

DOEpatents

Blewett, J.P.

1962-01-01

A wave guide resonator structure is described for use in separating particles of equal momentum but differing in mass and having energies exceeding one billion electron volts. The particles are those of sub-atomic size and are generally produced as a result of the bombardment of a target by a beam such as protons produced in a high-energy accelerator. In this wave guide construction, the particles undergo preferential deflection as a result of the presence of an electric field. The boundary conditions established in the resonator are such as to eliminate an interfering magnetic component, and to otherwise phase the electric field to obtain a traveling wave such as one which moves at the same speed as the unwanted particle. The latter undergoes continuous deflection over the whole length of the device and is, therefore, eliminated while the wanted particle is deflected in opposite directions over the length of the resonator and is thus able to enter an exit aperture. (AEC)

APPARATUS FOR THE DENSIFICATION AND ENERGIZATION OF CHARGED PARTICLES

DOEpatents

Post, R.F.; Coensgen, F.H.

1962-12-18

This patent relates to a device for materially increasing the energy and density of a plasma to produce conditions commensurate with the establishment and promotion of controlled thermonuclear reactions. To this end the device employs three successive stages of magnetic compression, each stage having magnetic mirrors to compress a plasma, the mirrors being moveable to transfer the plasma to successive stages for further compression. Accordingly, a plasma introduced to the first stage is increased in density and energy in stepwide fashion by virtue of the magnetic compression in the successive stages such that the plasma upon reaching the last stage is of extremely high energy and density commensurate the plasma particles undergoing thermonuclear reactions. The principal novelty of the device resides in the provision of a unidirectional magnetic field which increases in stepwise fashion in coaxially communicating compression chambers of progressively decreasing lengths and diameters. Pulsed magnetic fields are superimposed upon the undirectional field and are manipulated to establish resultant magnetic compression fields which increase in intensity and progressively move, with respect to time, through the compression chambers in the direction of the smallest one thereof. The resultant field in the last compression chamber is hence of relatively high intensity, and the density and energy of the plasma confined therein are correspondingly high. (AEC)

JESD57 Test Standard, Procedures for the Measurement of Single-Event Effects in Semiconductor Devices from Heavy-Ion Irradiation Revision Update

NASA Technical Reports Server (NTRS)

Lauenstein, Jean-Marie

2016-01-01

The JEDEC JESD57 test standard, Procedures for the Measurement of Single-Event Effects in Semiconductor Devices from Heavy-Ion Irradiation, is undergoing its first revision since 1996. This presentation will provide an overview of some of the key proposed updates to the document.

A Mechanomodulatory Device to Minimize Incisional Scar Formation

PubMed Central

Wong, Victor W.; Beasley, Bill; Zepeda, John; Dauskardt, Reinhold H.; Yock, Paul G.; Longaker, Michael T.; Gurtner, Geoffrey C.

2013-01-01

Objective To mechanically control the wound environment and prevent cutaneous scar formation. Approach We subjected various material substrates to biomechanical testing to investigate their ability to modulate skin behavior. Combinations of elastomeric materials, adhesives, and strain applicators were evaluated to develop topical stress-shielding devices. Noninvasive imaging modalities were utilized to characterize anatomic site-specific differences in skin biomechanical properties in humans. The devices were tested in a validated large animal model of hypertrophic scarring. Phase I within-patient controlled clinical trials were conducted to confirm their safety and efficacy in scar reduction in patients undergoing abdominoplasty surgery. Results Among the tested materials and device applicators, a polymer device was developed that effectively off-loaded high tension wounds and blocked pro-fibrotic pathways and excess scar formation in red Duroc swine. In humans, different anatomic sites exhibit unique biomechanical properties that may correlate with the propensity to form scars. In the clinical trial, utilization of this device significantly reduced incisional scar formation and improved scar appearance for up to 12 months compared with control incisions that underwent routine postoperative care. Innovation This is the first device that is able to precisely control the mechanical environment of incisional wounds and has been demonstrated in multiple clinical trials to significantly reduce scar formation after surgery. Conclusion Mechanomodulatory strategies to control the incisional wound environment can significantly reduce pathologic scarring and fibrosis after surgery. PMID:24527342

2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care: Endorsed by the American Heart Assocation, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention.

PubMed

Rihal, Charanjit S; Naidu, Srihari S; Givertz, Michael M; Szeto, Wilson Y; Burke, James A; Kapur, Navin K; Kern, Morton; Garratt, Kirk N; Goldstein, James A; Dimas, Vivian; Tu, Thomas

2015-05-19

Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella(®); left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for right-sided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines. Copyright © 2015 The Society for Cardiovascular Angiography and Interventions, The American College of Cardiology Foundation, The Heart Failure Society of America, and The Society for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care (Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie D'intervention).

PubMed

Rihal, Charanjit S; Naidu, Srihari S; Givertz, Michael M; Szeto, Wilson Y; Burke, James A; Kapur, Navin K; Kern, Morton; Garratt, Kirk N; Goldstein, James A; Dimas, Vivian; Tu, Thomas

2015-06-01

Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella®; left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for right-sided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines. © 2015 by The Society for Cardiovascular Angiography and Interventions, The American College of Cardiology Foundation, The Heart Failure Society of America, and The Society for Thoracic Surgery.

The cochlear implant as a tinnitus treatment.

PubMed

Vallés-Varela, Héctor; Royo-López, Juan; Carmen-Sampériz, Luis; Sebastián-Cortés, José M; Alfonso-Collado, Ignacio

2013-01-01

Tinnitus is a symptom of high prevalence in patients with cochlear pathology. We studied the evolution of tinnitus in patients undergoing unilateral cochlear implantation for treatment of profound hearing loss. This was a longitudinal, retrospective study of patients that underwent unilateral cochlear implantation and who had bilateral tinnitus. Tinnitus was assessed quantitatively and qualitatively before surgery and at 6 and 12 months after surgery. We evaluated 20 patients that underwent unilateral cochlear implantation with a Nucleus(®) CI24RE Contour Advance™ electrode device. During the periods in which the device was in operation, improvement or disappearance of tinnitus was evidenced in the ipsilateral ear in 65% of patients, and in the contralateral ear, in 50%. In periods in which the device was disconnected, improvement or disappearance of tinnitus was found in the ipsilateral ear in 50% of patients, and in the ear contralateral to the implant in 45% of the patients. In 10% of the patients, a new tinnitus appeared in the ipsilateral ear. The patients with profound hearing loss and bilateral tinnitus treated with unilateral cochlear implantation improved in a high percentage of cases, in the ipsilateral ear and in the contralateral ear. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Eye-Safe Lidar

NASA Technical Reports Server (NTRS)

Byer, Robert L.

1989-01-01

Laser infrared radar (lidar) undergoing development harmless to human eyes, consists almost entirely of solid-state components, and offers high range resolution. Operates at wavelength of about 2 micrometers. If radiation from such device strikes eye, almost completely absorbed by cornea without causing damage, even if aimed directly at eye. Continuous-wave light from laser oscillator amplified and modulated for transmission from telescope. Small portion of output of oscillator fed to single-mode fiber coupler, where mixed with return pulses. Intended for remote Doppler measurements of winds and differential-absorption measurements of concentrations of gases in atmosphere.

Food and Drug Administration Regulation of in Vitro Diagnostic Devices

PubMed Central

Mansfield, Elizabeth; O’Leary, Timothy J.; Gutman, Steven I.

2005-01-01

The Food and Drug Administration regulates the sale and distribution of laboratory devices under a statutory and regulatory framework that is unfamiliar to most clinical laboratory scientists. In this article we briefly describe the criteria that are used to classify and review in vitro diagnostic devices. We discuss the similarities and differences between devices that are not subject to premarket review, and those that are required to undergo either a premarket application or premarket notification [510(k)] pathway. We then discuss the methods that the Food and Drug Administration uses to assess the performance of in vitro diagnostic devices in the marketplace as a component of the total life cycle approach to medical device regulation. PMID:15681468

Fenestrated endovascular aortic repair and clinical trial devices for complex abdominal aortic aneurysms.

PubMed

Brinster, Clayton J; Milner, Ross

2018-06-01

Endovascular aortic repair (EVAR) has revolutionized the treatment of infrarenal abdominal aortic aneurysm (AAA), with consistently low reported perioperative morbidity and mortality. Universal applicability of EVAR to treat AAA is hindered by several specific anatomic constraints, however, and many patients cannot be treated with commercially available stent-grafts within the device specific instructions for use. Treatment of these complex pararenal aneurysms is increasingly accomplished by extension of EVAR into the visceral segment of the abdominal aorta with branches or fenestrations that allow perfusion of the visceral and renal arteries. Fenestrated endovascular aneurysm repair (FEVAR) was initially developed to treat high-risk patients unfit for open surgery and anatomically ineligible for standard infrarenal EVAR, but this technique has evolved over the past decade into a mature treatment option for complex AAA. High-volume, single-center reports, multicenter series and clinical reviews have demonstrated that FEVAR is a safe and effective technique with favorable results at proficient centers. Generalizability of these outcomes to less advanced centers remains unproven, and reintervention rates following FEVAR in the mid- and long-term, even among the most experienced centers, remain a concern. Several off-the-shelf devices that are undergoing clinical trial seek to broaden the anatomic applicability and overall availability of FEVAR. A significant number of patients are not candidates for off-the-shelf or customized stent-grafts, however, stressing the need for continued refinement of existing devices, development of novel devices with broader indications for use, and maintenance of open surgical skills.

The perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery.

PubMed

Barbara, David W; Wetzel, David R; Pulido, Juan N; Pershing, Bryan S; Park, Soon J; Stulak, John M; Zietlow, Scott P; Morris, David S; Boilson, Barry A; Mauermann, William J

2013-07-01

To describe the perioperative management of patients with left ventricular assist devices (LVADs) who require general anesthesia while undergoing noncardiac surgery (NCS) at a single, large tertiary referral center. Electronic medical records from September 2, 2005, through May 31, 2012, were retrospectively reviewed to evaluate the perioperative management and outcomes in LVAD patients undergoing NCS. Patients were included only if they required a general anesthetic and had previously been discharged from the hospital after initial LVAD implantation. Thirty-three patients with LVADs underwent general anesthesia for 67 noncardiac operations. The mean ± SD time from LVAD implantation to NCS was 317 ± 349 days. All but 1 patient had axial flow LVADs. Anticoagulation or antiplatelet agents were present within 7 days before NCS in 49 procedures (73%) and reversed in 32 of 49 (65%). No perioperative thrombotic complications related to anticoagulation or antiplatelet reversal were noted. Red blood cell, fresh frozen plasma, and platelet transfusions were administered during 10, 6, and 4 operations, respectively. The only intraoperative complication was surgical bleeding. Postoperative complications were present in 12 patients after NCS and were mainly composed of bleeding. Three patients died within 30 days of NCS, with the causes of death not attributed to NCS. Patients with LVAD safely underwent NCS in a multidisciplinary setting that included preoperative optimization by cardiologists familiar with LVADs when feasible. Anticoagulation or antiplatelet agents were present preoperatively in most patients with LVADs and were safely reversed when necessary for NCS. The relatively high occurrence of postoperative bleeding is consistent with previous series. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Inverse mirror plasma experimental device (IMPED) - a magnetized linear plasma device for wave studies

NASA Astrophysics Data System (ADS)

Bose, Sayak; Chattopadhyay, P. K.; Ghosh, J.; Sengupta, S.; Saxena, Y. C.; Pal, R.

2015-04-01

In a quasineutral plasma, electrons undergo collective oscillations, known as plasma oscillations, when perturbed locally. The oscillations propagate due to finite temperature effects. However, the wave can lose the phase coherence between constituting oscillators in an inhomogeneous plasma (phase mixing) because of the dependence of plasma oscillation frequency on plasma density. The longitudinal electric field associated with the wave may be used to accelerate electrons to high energies by exciting large amplitude wave. However when the maximum amplitude of the wave is reached that plasma can sustain, the wave breaks. The phenomena of wave breaking and phase mixing have applications in plasma heating and particle acceleration. For detailed experimental investigation of these phenomena a new device, inverse mirror plasma experimental device (IMPED), has been designed and fabricated. The detailed considerations taken before designing the device, so that different aspects of these phenomena can be studied in a controlled manner, are described. Specifications of different components of the IMPED machine and their flexibility aspects in upgrading, if necessary, are discussed. Initial results meeting the prerequisite condition of the plasma for such study, such as a quiescent, collisionless and uniform plasma, are presented. The machine produces δnnoise/n <= 1%, Luniform ~ 120 cm at argon filling pressure of ~10-4 mbar and axial magnetic field of B = 1090 G.

Optical Coherence Tomography

MedlinePlus

... patients who undergo balloon angioplasty also receive a stent—a small mesh-like device placed inside the ... OCT images can help cardiologists see if a stent is holding an artery open and whether the ...

Preliminary findings on the safety of 1.5 and 3 Tesla magnetic resonance imaging in cardiac pacemaker patients.

PubMed

van Dijk, Vincent F; Delnoy, Peter Paul H M; Smit, Jaap Jan J; Ramdat Misier, R Anand; Elvan, Arif; van Es, H Wouter; Rensing, Benno J W M; Raciti, Giovanni; Boersma, Lucas V A

2017-07-01

Modern pacemakers are designed to allow patients to undergo magnetic resonance imaging (MRI) under a set of specific conditions. Aim of this study is to provide confirmatory evidence of safety and performance of a new pacing system (ImageReady™, Boston Scientific) in patients undergoing 1.5 and 3T MRI. Two prospective, nonrandomized, single-arm studies were designed to provide confirmatory data of no impact of MRI on device function, lead parameters, and patient conditions in subjects implanted with the system undergoing a clinically non-indicated 1.5T and 3T MRI, respectively. Device measurements were done within 1 hour before and after the scan and at 1 month follow-up. Thirty-two subjects underwent MRI visit (17 subjects with 1.5T MRI and 15 subjects with 3T MRI). There were no unanticipated adverse effects related to the pacemaker. Device measurements taken pre- and post-MRI scan did not show any clinical relevant change that could indicate an effect of the MRI on the device or at the lead-tissue interface (RV threshold change: 0.01 ± 0.13 V, P = 0.60; RA threshold change: 0.01 ± 0.11 V, P = 0.53; R wave change: -0.44 ± 1.73 mV, P = 0.36; R wave change: 0.12 ± 1.67 mV, P = 0.73), with data confirmed at 1-month follow-up visit. The study documented safety of the pacing system in the 1.5T and 3T MRI environment by showing no adverse events related to device or MRI scan. Additional data are required to cover the more complex scenarios involving different diagnostic needs, conditions of use, clinical conditions, and new emerging technologies. © 2017 Wiley Periodicals, Inc.

Bipolar sealer device reduces blood loss and transfusion requirements in posterior spinal fusion for adolescent idiopathic scoliosis.

PubMed

Gordon, Zachary L; Son-Hing, Jochen P; Poe-Kochert, Connie; Thompson, George H

2013-01-01

Reducing perioperative blood loss and transfusion requirements is important in the operative treatment of idiopathic scoliosis. This can be achieved with special frames, cell saver systems, pharmacologic aspects, and other techniques. Recently there has been interest in bipolar sealer devices as an adjunct to traditional monopolar electrocautery. However, there is limited information on this device in pediatric spinal deformity surgery. We reviewed our experience with this device in a setting of a standard institutional operative carepath. Perioperative blood loss and transfusion requirements of 50 consecutive patients with adolescent idiopathic scoliosis undergoing a posterior spinal fusion and segmental spinal instrumentation and who had a bipolar sealer device used during their surgery was compared with a control group of the 50 preceding consecutive patients who did not. Anesthesia, surgical technique, use of intraoperative epsilon aminocaproic acid (Amicar), postoperative protocol, and indications for transfusions (hemoglobin≤7.0 g/dL) were identical in both groups. The preoperative demographics for the patients in both groups were statistically the same. The bipolar sealer group demonstrated a significant reduction in intraoperative estimated blood loss, total perioperative blood loss, volume of blood products transfused, and overall transfusion rate when compared with the control group. When subgroups consisting of only hybrid or all-pedicle screw constructs were considered individually, these findings remained consistent. There were no complications associated with the use of this device. Using the bipolar sealer device is a significant adjunct in decreasing perioperative blood loss and transfusion requirements in patients undergoing surgery for adolescent idiopathic scoliosis. Level III-retrospective comparative study.

Relationship between Device Size and Body Weight in Dogs with Patent Ductus Arteriosus Undergoing Amplatz Canine Duct Occluder Deployment.

PubMed

Wesselowski, S; Saunders, A B; Gordon, S G

2017-09-01

Deployment of the Amplatz Canine Duct Occluder (ACDO) is the preferred method for minimally invasive occlusion of patent ductus arteriosus (PDA) in dogs, with appropriate device sizing crucial to successful closure. Dogs of any body weight can be affected by PDA. To describe the range of ACDO sizes deployed in dogs of various body weights for improved procedural planning and inventory selection and to investigate for correlation between minimal ductal diameter (MDD) and body weight. A total of 152 dogs undergoing ACDO deployment between 2008 and 2016. Body weight, age, breed, sex, and MDD obtained by angiography (MDD-A), MDD obtained by transesophageal echocardiography (MDD-TEE), and ACDO size deployed were retrospectively evaluated. Correlation between body weight and ACDO size, MDD-A and MDD-TEE was poor, with R-squared values of 0.4, 0.36, and 0.3, respectively. Femoral artery diameter in the smallest population of dogs placed inherent limitations on the use of larger device sizes, with no limitations on the wide range of device sizes required as patient size increased. The most commonly used ACDO devices were size 3 through 6, representing 57% of the devices deployed within the entire study population. Patent ductus arteriosus anatomy varies on an individual basis, with poor correlation between MDD and body weight. Weight-based assumptions about expected ACDO device size for a given patient are not recommended. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

Stretchable living materials and devices with hydrogel–elastomer hybrids hosting programmed cells

PubMed Central

Liu, Xinyue; Tang, Tzu-Chieh; Tham, Eléonore; Yuk, Hyunwoo; Lin, Shaoting; Lu, Timothy K.; Zhao, Xuanhe

2017-01-01

Living systems, such as bacteria, yeasts, and mammalian cells, can be genetically programmed with synthetic circuits that execute sensing, computing, memory, and response functions. Integrating these functional living components into materials and devices will provide powerful tools for scientific research and enable new technological applications. However, it has been a grand challenge to maintain the viability, functionality, and safety of living components in freestanding materials and devices, which frequently undergo deformations during applications. Here, we report the design of a set of living materials and devices based on stretchable, robust, and biocompatible hydrogel–elastomer hybrids that host various types of genetically engineered bacterial cells. The hydrogel provides sustainable supplies of water and nutrients, and the elastomer is air-permeable, maintaining long-term viability and functionality of the encapsulated cells. Communication between different bacterial strains and with the environment is achieved via diffusion of molecules in the hydrogel. The high stretchability and robustness of the hydrogel–elastomer hybrids prevent leakage of cells from the living materials and devices, even under large deformations. We show functions and applications of stretchable living sensors that are responsive to multiple chemicals in a variety of form factors, including skin patches and gloves-based sensors. We further develop a quantitative model that couples transportation of signaling molecules and cellular response to aid the design of future living materials and devices. PMID:28202725

The influence of deficient retro-aortic rim on technical success and early adverse events following device closure of secundum atrial septal defects: An Analysis of the IMPACT Registry®.

PubMed

O'Byrne, Michael L; Gillespie, Matthew J; Kennedy, Kevin F; Dori, Yoav; Rome, Jonathan J; Glatz, Andrew C

2017-01-01

Concern regarding aortic erosion has focused attention on the retro-aortic rim in patients undergoing device closure of atrial septal defects (ASD), but its effect on early outcomes is not well studied. A multicenter retrospective cohort study of patients undergoing device occlusion of ASD between 1/2011-10/2014 was performed, using data from the IMproving Pediatric and Adult Congenital Treatment Registry. Subjects were divided between those with retro-aortic rim <5 and ≥5 mm. Primary outcomes were technical failure and major early adverse events. Case times were measured as surrogates of technical complexity. The effect of deficient retro-aortic rim on primary outcomes was assessed using hierarchical logistic regression, adjusting for other suspected covariates and assessing whether they represent independent risk factors RESULTS: 1,564 subjects (from 77 centers) were included, with deficient retro-aortic rim present in 40%. Technical failure occurred in 91 subjects (5.8%) and a major early adverse event in 64 subjects (4.1%). Adjusting for known covariates, the presence of a deficient retro-aortic rim was not significantly associated with technical failure (OR: 1.3, 95% CI: 0.9-2.1) or major early adverse event (OR: 0.7, 95% CI: 0.4-1. 2). Total case (P = 0.01) and fluoroscopy time (P = 0.02) were greater in subjects with deficient rim, but sheath time was not significantly different (P = 0.07). Additional covariates independently associated with these outcomes were identified. Deficient retro-aortic rim was highly prevalent but not associated with increased risk of technical failure or early adverse events. Studies with longer follow-up are necessary to assess other outcomes, including device erosion. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Forced-Air Warmers and Surgical Site Infections in Patients Undergoing Knee or Hip Arthroplasty.

PubMed

Austin, Paul N

2017-01-01

The majority of the evidence indicates preventing inadvertent perioperative hypothermia reduces the incidence of many perioperative complications. Among the results of inadvertent perioperative hypothermia are increased bleeding, myocardial events, impaired wound healing, and diminished renal function. Most researchers agree there is an increased incidence of surgical site infections in patients who experience inadvertent perioperative hypothermia. Forced-air warming is effective in preventing inadvertent perioperative hypothermia. Paradoxically, forced-air warmers have been implicated in causing surgical site infections in patients undergoing total knee or hip arthroplasty. The results of investigations suggest these devices harbor pathogens and cause unwanted airflow disturbances. However, no significant increases in bacterial counts were found when forced-air warmers were used according to the manufacturer's directions. The results of one study suggested the incidence of surgical site infections in patients undergoing total joint arthroplasty was increased when using a forced-air warmer. However these researchers did not control for other factors affecting the incidence of surgical site infections in these patients. Current evidence does not support forced-air warmers causing surgical site infections in patients undergoing total knee or hip arthroplasty. Clinicians must use and maintain these devices as per the manufacturer's directions. They may consider using alternative warming methods. Well-conducted studies are needed to help determine the role of forced-air warmers in causing infections in these patients.

Emergence of Quantum Phase-Slip Behaviour in Superconducting NbN Nanowires: DC Electrical Transport and Fabrication Technologies.

PubMed

Constantino, Nicolas G N; Anwar, Muhammad Shahbaz; Kennedy, Oscar W; Dang, Manyu; Warburton, Paul A; Fenton, Jonathan C

2018-06-16

Superconducting nanowires undergoing quantum phase-slips have potential for impact in electronic devices, with a high-accuracy quantum current standard among a possible toolbox of novel components. A key element of developing such technologies is to understand the requirements for, and control the production of, superconducting nanowires that undergo coherent quantum phase-slips. We present three fabrication technologies, based on using electron-beam lithography or neon focussed ion-beam lithography, for defining narrow superconducting nanowires, and have used these to create nanowires in niobium nitride with widths in the range of 20⁻250 nm. We present characterisation of the nanowires using DC electrical transport at temperatures down to 300 mK. We demonstrate that a range of different behaviours may be obtained in different nanowires, including bulk-like superconducting properties with critical-current features, the observation of phase-slip centres and the observation of zero conductance below a critical voltage, characteristic of coherent quantum phase-slips. We observe critical voltages up to 5 mV, an order of magnitude larger than other reports to date. The different prominence of quantum phase-slip effects in the various nanowires may be understood as arising from the differing importance of quantum fluctuations. Control of the nanowire properties will pave the way for routine fabrication of coherent quantum phase-slip nanowire devices for technology applications.

Noncardiac Surgical Procedures After Left Ventricular Assist Device Implantation.

PubMed

Taghavi, Sharven; Jayarajan, Senthil N; Ambur, Vishnu; Mangi, Abeel A; Chan, Elaine; Dauer, Elizabeth; Sjoholm, Lars O; Pathak, Abhijit; Santora, Thomas A; Goldberg, Amy J; Rappold, Joseph F

2016-01-01

As left ventricular assist devices (LVADs) are increasingly used for patients with end-stage heart failure, the need for noncardiac surgical procedures (NCSs) in these patients will continue to rise. We examined the various types of NCS required and its outcomes in LVAD patients requiring NCS. The National Inpatient Sample Database was examined for all patients implanted with an LVAD from 2007 to 2010. Patients requiring NCS after LVAD implantation were compared to all other patients receiving an LVAD. There were 1,397 patients undergoing LVAD implantation. Of these, 298 (21.3%) required 459 NCS after LVAD implantation. There were 153 (33.3%) general surgery procedures, with abdominal/bowel procedures (n = 76, 16.6%) being most common. Thoracic (n = 141, 30.7%) and vascular (n = 140, 30.5%) procedures were also common. Patients requiring NCS developed more wound infections (9.1 vs. 4.6%, p = 0.004), greater bleeding complications (44.0 vs. 24.8%, p < 0.001) and were more likely to develop any complication (87.2 vs. 82.0%, p = 0.001). On multivariate analysis, the requirement of NCSs (odds ratio: 1.45, 95% confidence interval: 0.95-2.20, p = 0.08) was not associated with mortality. Noncardiac surgical procedures are commonly required after LVAD implantation, and the incidence of complications after NCS is high. This suggests that patients undergoing even low-risk NCS should be cared at centers with treating surgeons and LVAD specialists.

Sizing of patent ductus arteriosus in adults for transcatheter closure using the balloon pull-through technique.

PubMed

Shafi, Nabil A; Singh, Gagan D; Smith, Thomas W; Rogers, Jason H

2018-05-01

To describe a novel balloon sizing technique used during adult transcatheter patent ductus arteriosus (PDA) closure. In addition, to determine the clinical and procedural outcomes in six patients who underwent PDA balloon sizing with subsequent deployment of a PDA occluder device. Transcatheter PDA closure in adults has excellent safety and procedural outcomes. However, PDA sizing in adults can be challenging due to variable defect size, high flow state, or anatomical complexity. We describe a series of six cases where the balloon- pull through technique was successfully performed for PDA sizing prior to transcatheter closure. Consecutive adult patients undergoing adult PDA closure at our institution were studied retrospectively. A partially inflated sizing balloon was pulled through the defect from the aorta into the pulmonary artery and the balloon waist diameter was measured. Procedural success and clinical outcomes were obtained. Six adult patients underwent successful balloon pull-through technique for PDA sizing during transcatheter PDA closure, since conventional angiography often gave suboptimal opacification of the defect. All PDAs were treated with closure devices based on balloon PDA sizing with complete closure and no complications. In three patients that underwent preprocedure computed tomography, the balloon size matched the CT derived measurements. The balloon pull-through technique for PDA sizing is a safe and accurate sizing modality in adults undergoing transcatheter PDA closure. © 2017 Wiley Periodicals, Inc.

Prevention of hypothermia in patients undergoing orthotopic liver transplantation using the humigard® open surgery humidification system: a prospective randomized pilot and feasibility clinical trial.

PubMed

Weinberg, Laurence; Huang, Andrew; Alban, Daniel; Jones, Robert; Story, David; McNicol, Larry; Pearce, Brett

2017-01-23

Perioperative thermal disturbances during orthotopic liver transplantation (OLT) are common. We hypothesized that in patients undergoing OLT the use of a humidified high flow CO 2 warming system maintains higher intraoperative temperatures when compared to standardized multimodal strategies to maintain thermoregulatory homeostasis. We performed a randomized pilot study in adult patients undergoing primary OLT. Participants were randomized to receive either open wound humidification with a high flow CO 2 warming system in addition to standard care (Humidification group) or to standard care alone (Control group). The primary end point was nasopharyngeal core temperature measured 5 min immediately prior to reperfusion of the donor liver (Stage 3 - 5 min). Secondary endpoints included intraoperative PaCO 2 , minute ventilation and the use of vasoconstrictors. Eleven patients were randomized to each group. Both groups were similar for age, body mass index, MELD, SOFA and APACHE II scores, baseline temperature, and duration of surgery. Immediately prior to reperfusion (Stage 3 - 5 min) the mean (SD) core temperature was higher in the Humidification Group compared to the Control Group: 36.0 °C (0.13) vs. 35.4 °C (0.22), p = 0.028. Repeated measured ANOVA showed that core temperatures over time during the stages of the transplant were higher in the Humidification Group compared to the Control Group (p < 0.0001). There were no significant differences in the ETCO 2 , PaCO 2 , minute ventilation, or inotropic support. The humidified high flow CO 2 warming system was superior to standardized multimodal strategies in maintaining normothermia in patients undergoing OLT. Use of the device was feasible and did not interfere with any aspects of surgery. A larger study is needed to investigate if the improved thermoregulation observed is associated with improved patient outcomes. ACTRN12616001631493 . Retrospectively registered 25 November 2016.

Prognostic Value of Serum Lactate Levels in Patients Undergoing Urgent Heart Transplant: A Subanalysis of the ASIS-TC Spanish Multicenter Study.

PubMed

Couto-Mallón, David; González-Vílchez, Francisco; Almenar-Bonet, Luis; Díaz-Molina, Beatriz; Segovia-Cubero, Javier; González-Costello, José; Delgado-Jiménez, Juan; Castel-Lavilla, María A; Crespo-Leiro, María G; Rangel-Sousa, Diego; Martínez-Sellés, Manuel; Rábago-Juan-Aracil, Gregorio; De-la-Fuente-Galán, Luis; Blasco-Peiró, Teresa; Hervás-Sotomayor, Daniela; Garrido-Bravo, Iris P; Mirabet-Pérez, Sonia; Muñiz, Javier; Barge-Caballero, Eduardo

2018-05-30

To study the prognostic value of serum lactate in patients under temporary preoperative mechanical circulatory support who underwent urgent heart transplant. We conducted a subanalysis of a Spanish multicenter registry recording data on patients under temporary mechanical circulatory support listed for highly urgent heart transplant from 2010 to 2015. Participants selected for the present study were those who received a transplant and who had known preoperative serum lactate levels. The main study outcome was 1-year survival after transplant. A total of 177 heart transplant recipients were studied; preoperatively, 90 were supported on venoarterial extracorporeal membrane oxygenation, 51 on temporary left ventricular assist devices, and 36 on temporary biventricular assist devices. Preoperative hyperlactatemia (≥ 2 mmol/L) was present in 44 (25%) patients. On multivariable analysis, pretransplant serum lactate was identified as an independent predictor of 1-year posttransplant survival (adjusted HR per 0.1 mmol/L, 1.02; 95%CI, 1.01-1.03; P = .007). One-year posttransplant survival was 53.1% (95%CI, 45.3-60.9) in patients with preoperative hyperlactatemia and 75.6% (95%CI, 71.8-79.4) in those without preoperative hyperlactatemia (adjusted HR, 1.94; 95%CI, 1.04-3.63; P = .039). Preoperative hyperlactatemia correlated with adverse outcomes in patients supported with extracorporeal membrane oxygenation, but not in patients supported on ventricular assist devices. Preoperative serum lactate is a strong independent predictor of worse outcomes in patients undergoing urgent heart transplant on short-term mechanical circulatory support. Copyright © 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Characteristics of Clinical Studies Used for US Food and Drug Administration Approval of High-Risk Medical Device Supplements.

PubMed

Zheng, Sarah Y; Dhruva, Sanket S; Redberg, Rita F

2017-08-15

High-risk medical devices often undergo modifications, which are approved by the US Food and Drug Administration (FDA) through various kinds of premarket approval (PMA) supplements. There have been multiple high-profile recalls of devices approved as PMA supplements. To characterize the quality of the clinical studies and data (strength of evidence) used to support FDA approval of panel-track supplements (a type of PMA supplement pathway that is used for significant changes in a device or indication for use and always requires clinical data). Descriptive study of clinical studies supporting panel-track supplements approved by the FDA between April 19, 2006, and October 9, 2015. Panel-track supplement approval. Methodological quality of studies including randomization, blinding, type of controls, clinical vs surrogate primary end points, use of post hoc analyses, and reporting of age and sex. Eighty-three clinical studies supported the approval of 78 panel-track supplements, with 71 panel-track supplements (91%) supported by a single study. Of the 83 studies, 37 (45%) were randomized clinical trials and 25 (30%) were blinded. The median number of patients per study was 185 (interquartile range, 75-305), and the median follow-up duration was 180 days (interquartile range, 84-270 days). There were a total of 150 primary end points (mean [SD], 1.8 [1.2] per study), and 57 primary end points (38%) were compared with controls. Of primary end points with controls, 6 (11%) were retrospective controls and 51 (89%) were active controls. One hundred twenty-one primary end points (81%) were surrogate end points. Thirty-three studies (40%) did not report age and 25 (30%) did not report sex for all enrolled patients. The FDA required postapproval studies for 29 of 78 (37%) panel-track supplements. Among clinical studies used to support FDA approval of high-risk medical device modifications, fewer than half were randomized, blinded, or controlled, and most primary outcomes were based on surrogate end points. These findings suggest that the quality of studies and data evaluated to support approval by the FDA of modifications of high-risk devices should be improved.

Design and evaluation of a nondestructive fissile assay device for HTGR fuel samples

DOE Office of Scientific and Technical Information (OSTI.GOV)

McNeany, S. R.; Knoll, R. W.; Jenkins, J. D.

1979-02-01

Nondestructive assay of fissile material plays an important role in nuclear fuel processing facilities. Information for product quality control, plant criticality safety, and nuclear materials accountability can be obtained from assay devices. All of this is necessary for a safe, efficient, and orderly operation of a production plant. Presented here is a design description and an operational evaluation of a device developed to nondestructively assay small samples of High-Temperature Gas-Cooled Reactor (HTGR) fuel. The measurement technique employed consists in thermal-neutron irradiation of a sample followed by pneumatic transfer to a high-efficiency neutron detector where delayed neutrons are counted. In general,more » samples undergo several irradiation and count cycles during a measurement. The total number of delayed-neutron counts accumulated is translated into grams of fissile mass through comparison with the counts accumulated in an identical irradiation and count sequence of calibration standards. Successful operation of the device through many experiments over a one-year period indicates high operational reliability. Tests of assay precision show this to be better than 0.25% for measurements of 10 min. Assay biases may be encountered if calibration standards are not representative of unknown samples, but reasonable care in construction and control of standards should lead to no more than 0.2% bias in the measurements. Nondestructive fissile assay of HTGR fuel samples by thermal-neutron irradiation and delayed-neutron detection has been demonstrated to be a rapid and accurate analysis technique. However, careful attention and control must be given to calibration standards to see that they remain representative of unknown samples.« less

Thermochromic halide perovskite solar cells.

PubMed

Lin, Jia; Lai, Minliang; Dou, Letian; Kley, Christopher S; Chen, Hong; Peng, Fei; Sun, Junliang; Lu, Dylan; Hawks, Steven A; Xie, Chenlu; Cui, Fan; Alivisatos, A Paul; Limmer, David T; Yang, Peidong

2018-03-01

Smart photovoltaic windows represent a promising green technology featuring tunable transparency and electrical power generation under external stimuli to control the light transmission and manage the solar energy. Here, we demonstrate a thermochromic solar cell for smart photovoltaic window applications utilizing the structural phase transitions in inorganic halide perovskite caesium lead iodide/bromide. The solar cells undergo thermally-driven, moisture-mediated reversible transitions between a transparent non-perovskite phase (81.7% visible transparency) with low power output and a deeply coloured perovskite phase (35.4% visible transparency) with high power output. The inorganic perovskites exhibit tunable colours and transparencies, a peak device efficiency above 7%, and a phase transition temperature as low as 105 °C. We demonstrate excellent device stability over repeated phase transition cycles without colour fade or performance degradation. The photovoltaic windows showing both photoactivity and thermochromic features represent key stepping-stones for integration with buildings, automobiles, information displays, and potentially many other technologies.

Thermochromic halide perovskite solar cells

NASA Astrophysics Data System (ADS)

Lin, Jia; Lai, Minliang; Dou, Letian; Kley, Christopher S.; Chen, Hong; Peng, Fei; Sun, Junliang; Lu, Dylan; Hawks, Steven A.; Xie, Chenlu; Cui, Fan; Alivisatos, A. Paul; Limmer, David T.; Yang, Peidong

2018-03-01

Smart photovoltaic windows represent a promising green technology featuring tunable transparency and electrical power generation under external stimuli to control the light transmission and manage the solar energy. Here, we demonstrate a thermochromic solar cell for smart photovoltaic window applications utilizing the structural phase transitions in inorganic halide perovskite caesium lead iodide/bromide. The solar cells undergo thermally-driven, moisture-mediated reversible transitions between a transparent non-perovskite phase (81.7% visible transparency) with low power output and a deeply coloured perovskite phase (35.4% visible transparency) with high power output. The inorganic perovskites exhibit tunable colours and transparencies, a peak device efficiency above 7%, and a phase transition temperature as low as 105 °C. We demonstrate excellent device stability over repeated phase transition cycles without colour fade or performance degradation. The photovoltaic windows showing both photoactivity and thermochromic features represent key stepping-stones for integration with buildings, automobiles, information displays, and potentially many other technologies.

On artifacts in single-molecule force spectroscopy

PubMed Central

Cossio, Pilar; Hummer, Gerhard; Szabo, Attila

2015-01-01

In typical force spectroscopy experiments, a small biomolecule is attached to a soft polymer linker that is pulled with a relatively large bead or cantilever. At constant force, the total extension stochastically changes between two (or more) values, indicating that the biomolecule undergoes transitions between two (or several) conformational states. In this paper, we consider the influence of the dynamics of the linker and mesoscopic pulling device on the force-dependent rate of the conformational transition extracted from the time dependence of the total extension, and the distribution of rupture forces in force-clamp and force-ramp experiments, respectively. For these different experiments, we derive analytic expressions for the observables that account for the mechanical response and dynamics of the pulling device and linker. Possible artifacts arise when the characteristic times of the pulling device and linker become comparable to, or slower than, the lifetimes of the metastable conformational states, and when the highly anharmonic regime of stretched linkers is probed at high forces. We also revisit the problem of relating force-clamp and force-ramp experiments, and identify a linker and loading rate-dependent correction to the rates extracted from the latter. The theory provides a framework for both the design and the quantitative analysis of force spectroscopy experiments by highlighting, and correcting for, factors that complicate their interpretation. PMID:26540730

Plasmonic Structures for CMOS Photonics and Control of Spontaneous Emission

DTIC Science & Technology

2013-04-01

structures; v) developed CMOS Si photonic switching device based on the vanadium dioxide ( VO2 ) phase transition. vi) also engaged in a partnership with...CMOS Si photonic switching device based on the vanadium dioxide ( VO2 ) phase transition. vii. exploring approaches to enhance spontaneous emission in...size and bandwidth, we are exploring phase-change materials and, in particular, vanadium dioxide. VO2 undergoes an insulator-to-metal phase transition

A current-driven resistive instability and its nonlinear effects in simulations of coaxial helicity injection in a tokamak

DOE PAGES

Hooper, E. B.; Sovinec, C. R.

2016-10-06

An instability observed in whole-device, resistive magnetohydrodynamic simulations of the driven phase of coaxial helicity injection in the National Spherical Torus eXperiment is identified as a current-driven resistive mode in an unusual geometry that transiently generates a current sheet. The mode consists of plasma flow velocity and magnetic field eddies in a tube aligned with the magnetic field at the surface of the injected magnetic flux. At low plasma temperatures (~10–20 eV), the mode is benign, but at high temperatures (~100 eV) its amplitude undergoes relaxation oscillations, broadening the layer of injected current and flow at the surface of themore » injected toroidal flux and background plasma. The poloidal-field structure is affected and the magnetic surface closure is generally prevented while the mode undergoes relaxation oscillations during injection. Furthermore, this study describes the mode and uses linearized numerical computations and an analytic slab model to identify the unstable mode.« less

Beware of parotitis induced by iodine-containing contrast media.

PubMed

Kohat, A K; Jayantee, K; Phadke, R V; Muthu, R; Singh, V; Misra, U K

2014-01-01

Carotid stenting is being increasingly used for revascularization of the moderate to severe carotid stenosis and thus its complications are increasingly being recognized. We report a rare complication of induced by iodine contrast in a patient undergoing carotid stenting. s. A 51 year old man after the second stenting developed multiple small infarcts in spite of the distal device. He also had painful parotid swelling which improved within a week. One should be aware of iodine parotitis s in the patients undergoing iodinated contrast study.

Biredox ionic liquids with solid-like redox density in the liquid state for high-energy supercapacitors.

PubMed

Mourad, Eléonore; Coustan, Laura; Lannelongue, Pierre; Zigah, Dodzi; Mehdi, Ahmad; Vioux, André; Freunberger, Stefan A; Favier, Frédéric; Fontaine, Olivier

2017-04-01

Kinetics of electrochemical reactions are several orders of magnitude slower in solids than in liquids as a result of the much lower ion diffusivity. Yet, the solid state maximizes the density of redox species, which is at least two orders of magnitude lower in liquids because of solubility limitations. With regard to electrochemical energy storage devices, this leads to high-energy batteries with limited power and high-power supercapacitors with a well-known energy deficiency. For such devices the ideal system should endow the liquid state with a density of redox species close to the solid state. Here we report an approach based on biredox ionic liquids to achieve bulk-like redox density at liquid-like fast kinetics. The cation and anion of these biredox ionic liquids bear moieties that undergo very fast reversible redox reactions. As a first demonstration of their potential for high-capacity/high-rate charge storage, we used them in redox supercapacitors. These ionic liquids are able to decouple charge storage from an ion-accessible electrode surface, by storing significant charge in the pores of the electrodes, to minimize self-discharge and leakage current as a result of retaining the redox species in the pores, and to raise working voltage due to their wide electrochemical window.

Determining the risks of clinically indicated nonthoracic magnetic resonance imaging at 1.5 T for patients with pacemakers and implantable cardioverter-defibrillators: rationale and design of the MagnaSafe Registry.

PubMed

Russo, Robert J

2013-03-01

Until recently, the presence of a permanent pacemaker or an implantable cardioverter-defibrillator has been a relative contraindication for the performance of magnetic resonance imaging (MRI). A number of small studies have shown that MRI can be performed with minimal risk when patients are properly monitored and device programming is modified appropriately for the procedure. However, the risk of performing MRI for patients with implanted cardiac devices has not been sufficiently evaluated to advocate routine clinical use. The aim of the present protocol is to prospectively determine the rate of adverse clinical events and device parameter changes in patients with implanted non-MRI-conditional cardiac devices undergoing clinically indicated nonthoracic MRI at 1.5 T. The MagnaSafe Registry is a multicenter, prospective cohort study of up to 1500 MRI examinations in patients with pacemakers or implantable cardioverter-defibrillators implanted after 2001 who undergo clinically indicated nonthoracic MRI following a specific protocol to ensure that preventable potential adverse events are mitigated. Adverse events and changes in device parameter measurements that may be associated with the imaging procedure will be documented. Through August 2012, 701 MRI studies have been performed, representing 47% of the total target enrollment. The results of this registry will provide additional documentation of the risk of MRI and will further validate a clinical protocol for screening and the performance of clinically indicated MRI for patients with implanted cardiac devices. Copyright © 2013 Mosby, Inc. All rights reserved.

Anesthetic Management of Cardioband Implantation: Data From a Preliminary Experience and New Insights.

PubMed

Pieri, Marina; Belletti, Alessandro; Oriani, Alessandro; Landoni, Giovanni; Latib, Azeem; Mangieri, Antonio; Colombo, Antonio; Zangrillo, Alberto; Monaco, Fabrizio

2017-04-01

Percutaneous procedures for the treatment of mitral valve disease represent valuable therapeutic options for high-risk patients. The anesthetic management of these patients is complex, as they often suffer from cardiac failure and present multiple comorbidities. A recently developed device for transcatheter mitral valve annuloplasty (Cardioband - Valtech Cardio, Or Yehuda, Israel) is now available in clinical practice. The aim of this study was to present the authors' experience with Cardioband device implantation and to describe their anesthetic strategy. Retrospective study. Cardiac catheterization laboratory of a teaching hospital. Thirteen patients undergoing Cardioband implantation. All the procedures were performed under general anesthesia with continuous transesophageal echocardiographic monitoring. Three-dimensional echocardiography, inotropic therapy, cardiac pacing, and mechanical circulatory support always were available and performed as needed. Mean age was 73±7.1 years, and mean preoperative ejection fraction was 38±7.4%. No complications related to anesthetic management were recorded. The authors observed 1 episode of device malfunction and 1 case of accidental damage to the circumflex artery. Postoperative complications were observed in 3 patients, involving detachment of the anchors, anemia requiring transfusions, vascular injury, and new-onset atrial fibrillation. Six patients (46%) required ICU admission. All patients (100%) were discharged from the hospital. Cardioband device implantation under general anesthesia is a feasible approach when performed by skilled physicians with all the expertise and the resources of high-volume centers used to dealing with severely ill patients. Copyright © 2017 Elsevier Inc. All rights reserved.

First-in-man use of a novel embolic protection device for patients undergoing transcatheter aortic valve implantation.

PubMed

Naber, Christoph K; Ghanem, Alexander; Abizaid, Alexander A; Wolf, Alexander; Sinning, Jan-Malte; Werner, Nikos; Nickenig, Georg; Schmitz, Thomas; Grube, Eberhard

2012-05-15

We describe the first-in-human experience with a novel cerebral embolic protection device used during transcatheter aortic valve implantation (TAVI). One current challenge of TAVI is the reduction of procedural stroke. Procedural mobilisation of debris is a known source of cerebral embolisation. Mechanical protection by transient filtration of cerebral blood flow might reduce the embolic burden during TAVI. We aimed to evaluate the feasibility and safety of the Claret CE Pro™ cerebral protection device in patients undergoing TAVI. Patients scheduled for TAVI were prospectively enrolled at three centres. The Claret CE Pro™ (Claret Medical, Inc. Santa Rosa, CA, USA) cerebral protection device was placed via the right radial/brachial artery prior to TAVI and was removed after the procedure. The primary endpoint was technical success rate. Secondary endpoints encompassed procedural and 30-day stroke rates, as well as device-related complications. Deployment of the Claret CE Pro™ cerebral protection device was intended for use in 40 patients, 35 devices were implanted into the aortic arch. Technical success rate with delivery of the proximal and distal filter was 60% for the first generation device and 87% for the second-generation device. Delivery times for the first-generation device were 12.4±12.1 minutes and 4.4 ± 2.5 minutes for the second-generation device (p<0.05). The quantity of contrast used related to the Claret CE Pro System was 19.6 ± 3.8 ml. Captured debris was documented in at least 19 of 35 implanted devices (54.3%). No procedural transient ischaemic attacks, minor strokes or major strokes occurred. Thirty-day follow-up showed one minor stroke occurring 30 days after the procedure, and two major strokes both occurring well after the patient had completed TAVI. The use of the Claret CE Pro™ system is feasible and safe. Capture of debris in more than half of the patients provides evidence for the potential to reduce the procedural cerebral embolic burden utilising this dedicated filter system during TAVI.

Inelastic deformation of plasma polymerised thin films facilitated by transient dense plasma focus irradiation

NASA Astrophysics Data System (ADS)

Grant, Daniel S.; Rawat, Rajdeep S.; Bazaka, Kateryna; Jacob, Mohan V.

2017-09-01

The high degree of crosslinking present in plasma polymerised thin films, coupled with their high molecular weight, imbues these films with properties similar to those of thermosetting polymers. For instance, such films tend to be relatively hard, insoluble, and to date have not exhibited plasticity when subjected to elevated temperatures. In this paper it is demonstrated that plasma polymers can, in fact, undergo plastic deformation in response to the application of extremely short-lived thermal treatment delivered by a dense plasma focus device, as evidenced by the evolution of bubble-like structures from the thin film. This finding suggests new avenues for texturing plasma thin films, and synthesising cavities that may find utility as thermal insulators or domains for material encapsulation.

40 CFR 63.7195 - What definitions apply to this subpart?

Code of Federal Regulations, 2010 CFR

2010-07-01

... units used to manufacture p-type and n-type semiconductors or active solid state devices from a wafer... where wastewater undergoes treatment (such as pH adjustment) before discharge, and are not used to...

40 CFR 63.7195 - What definitions apply to this subpart?

Code of Federal Regulations, 2011 CFR

2011-07-01

... units used to manufacture p-type and n-type semiconductors or active solid state devices from a wafer... where wastewater undergoes treatment (such as pH adjustment) before discharge, and are not used to...

REACTOR CONTROL DEVICE

DOEpatents

Graham, R.H.

1962-09-01

A wholly mechanical compact control device is designed for automatically rendering the core of a fission reactor subcritical in response to core temperatures in excess of the design operating temperature limit. The control device comprises an expansible bellows interposed between the base of a channel in a reactor core and the inner end of a fuel cylinder therein which is normally resiliently urged inwardly. The bellows contains a working fluid which undergoes a liquid to vapor phase change at a temperature substantially equal to the design temperature limit. Hence, the bellows abruptiy expands at this limiting temperature to force the fuel cylinder outward and render the core subcritical. The control device is particularly applicable to aircraft propulsion reactor service. (AEC)

PCDTBT based solar cells: one year of operation under real-world conditions

PubMed Central

Zhang, Yiwei; Bovill, Edward; Kingsley, James; Buckley, Alastair R.; Yi, Hunan; Iraqi, Ahmed; Wang, Tao; Lidzey, David G.

2016-01-01

We present measurements of the outdoor stability of PCDTBT:PC71BM based bulk heterojunction organic solar cells for over the course of a year. We find that the devices undergo a burn-in process lasting 450 hours followed by a TS80 lifetime of up to 6200 hours. We conclude that in the most stable devices, the observed TS80 lifetime is limited by thermally-induced stress between the device layers, as well as materials degradation as a result of edge-ingress of water or moisture through the encapsulation. PMID:26857950

Initial Experience of an Anesthesiology-based Service for Perioperative Management of Pacemakers and Implantable Cardioverter Defibrillators.

PubMed

Rooke, G Alec; Lombaard, Stefan A; Van Norman, Gail A; Dziersk, Jörg; Natrajan, Krishna M; Larson, Lyle W; Poole, Jeanne E

2015-11-01

Management of cardiovascular implantable electronic devices (CIEDs), including pacemakers and implantable cardioverter defibrillators, for surgical procedures is challenging due to the increasing number of patients with CIEDs and limited availability of trained providers. At the authors' institution, a small group of anesthesiologists were trained to interrogate CIEDs, devise a management plan, and perform preoperative and postoperative programming and device testing whenever necessary. Patients undergoing surgery between October 1, 2009 and June 30, 2013 at the University of Washington Medical Center were included in a retrospective chart review to determine the number of devices actively managed by the Electrophysiology/Cardiology Service (EPCS) versus the Anesthesiology Device Service (ADS), changes in workload over time, surgical case delays due to device management, and errors and problems encountered in device programming. The EPCS managed 254 CIEDs, the ADS managed 548, and 227 by neither service. Over time, the ADS providers managed an increasing percentage of devices with decreasing supervision from the EPCS. Only two CIEDs managed by the ADS required immediate assistance from the EPCS. Patients who were unstable postoperatively were referred to the EPCS. Although numerous issues in programming were encountered, primarily when restoring demand pacing after programming asynchronous pacing for surgery, no patient harm resulted from ADS or EPCS management of CIEDs. An ADS can provide safe CIED management for surgery, but it requires specialized provider training and strong support from the EPCS. Due to the complexity of CIED management, an ADS will likely only be feasible in high-volume settings.

The Challenge of Producing Fiber-Based Organic Electronic Devices

PubMed Central

Könyves-Toth, Tobias; Gassmann, Andrea; von Seggern, Heinz

2014-01-01

The implementation of organic electronic devices on fibers is a challenging task, not yet investigated in detail. As was shown earlier, a direct transition from a flat device structure to a fiber substrate is in principle possible. However, a more detailed investigation of the process reveals additional complexities than just the transition in geometry. It will be shown, that the layer formation of evaporated materials behaves differently due to the multi-angled incidence on the fibers surface. In order to achieve homogenous layers the evaporation process has to be adapted. Additionally, the fiber geometry itself facilitates damaging of its surface due to mechanical impact and leads to a high surface roughness, thereby often hindering commercial fibers to be used as substrates. In this article, a treatment of commercial polymer-coated glass fibers will be demonstrated that allows for the fabrication of rather flexible organic light-emitting diodes (OLEDs) with cylindrical emission characteristics. Since OLEDs rely the most on a smooth substrate, fibers undergoing the proposed treatment are applicable for other organic electronic devices such as transistors and solar cells. Finally, the technique also supports the future fabrication of organic electronics not only in smart textiles and woven electronics but also in bent surfaces, which opens a wide range of applications. PMID:28788128

Analysis of surgeries performed after hysteroscopic sterilization as tabulated from 3,803 Essure patient experiences

PubMed Central

Li, Xiang; Wood, Samuel H; Jones, Christopher A

2017-01-01

Objective Although previous research has suggested that risk for reoperation among hysteroscopic sterilization (HS) patients is more than ten times higher than for patients undergoing standard laparoscopic tubal ligation, little has been reported about these subsequent procedures. Methods This descriptive cohort study used a confidential online questionnaire to gather data from women (n=3,803) who volunteered information on HS followed by device removal surgery performed due to new symptoms developing after Essure placement. Results In this sample, mean age was 35.6 years and women undergoing hysterectomy after HS comprised 64.9% (n=2,468). Median interval between HS and hysterectomy was 3.7 (interquartile range, 3.9) years and mean age at hysterectomy was 36.3 years. Some patients (n=1,035) sought removal of HS devices and fallopian tubes only, while other miscellaneous gynecological procedures were also occasionally performed for Essure-associated symptoms. When data from all patients who had any post-Essure surgery besides hysterectomy were aggregated (e.g., device removal + “other” cases, n=1,335) and compared to those cases undergoing hysterectomy, mean age was significantly lower than for the hysterectomy group (34.4 vs. 36.3 years, respectively; P<0.01); uterus-conserving surgeries were also typically performed significantly earlier than hysterectomy (P<0.01). Conclusion This investigation is the first to characterize specific gynecological operations after Essure, and suggests that the predominant surgical answer to HS complaints is hysterectomy for many women. Dissatisfaction with HS may represent an important indication for hysterectomy and additional study is needed to quantify this phenomenon. PMID:28534016

A Superconducting Dual-Channel Photonic Switch.

PubMed

Srivastava, Yogesh Kumar; Manjappa, Manukumara; Cong, Longqing; Krishnamoorthy, Harish N S; Savinov, Vassili; Pitchappa, Prakash; Singh, Ranjan

2018-06-05

The mechanism of Cooper pair formation and its underlying physics has long occupied the investigation into high temperature (high-T c ) cuprate superconductors. One of the ways to unravel this is to observe the ultrafast response present in the charge carrier dynamics of a photoexcited specimen. This results in an interesting approach to exploit the dissipation-less dynamic features of superconductors to be utilized for designing high-performance active subwavelength photonic devices with extremely low-loss operation. Here, dual-channel, ultrafast, all-optical switching and modulation between the resistive and the superconducting quantum mechanical phase is experimentally demonstrated. The ultrafast phase switching is demonstrated via modulation of sharp Fano resonance of a high-T c yttrium barium copper oxide (YBCO) superconducting metamaterial device. Upon photoexcitation by femtosecond light pulses, the ultrasensitive cuprate superconductor undergoes dual dissociation-relaxation dynamics, with restoration of superconductivity within a cycle, and thereby establishes the existence of dual switching windows within a timescale of 80 ps. Pathways are explored to engineer the secondary dissociation channel which provides unprecedented control over the switching speed. Most importantly, the results envision new ways to accomplish low-loss, ultrafast, and ultrasensitive dual-channel switching applications that are inaccessible through conventional metallic and dielectric based metamaterials. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Implantable cardioverter-defibrillator therapy in Brugada syndrome: a 20-year single-center experience.

PubMed

Conte, Giulio; Sieira, Juan; Ciconte, Giuseppe; de Asmundis, Carlo; Chierchia, Gian-Battista; Baltogiannis, Giannis; Di Giovanni, Giacomo; La Meir, Mark; Wellens, Francis; Czapla, Jens; Wauters, Kristel; Levinstein, Moises; Saitoh, Yukio; Irfan, Ghazala; Julià, Justo; Pappaert, Gudrun; Brugada, Pedro

2015-03-10

Patients with Brugada syndrome and aborted sudden cardiac death or syncope have higher risks for ventricular arrhythmias (VAs) and should undergo implantable cardioverter-defibrillator (ICD) placement. Device-based management of asymptomatic patients is controversial. ICD therapy is associated with high rates of inappropriate shocks and device-related complications. The objective of this study was to investigate clinical features, management, and long-term follow-up of ICD therapy in patients with Brugada syndrome. Patients presenting with spontaneous or drug-induced Brugada type 1 electrocardiographic findings, who underwent ICD implantation and continuous follow-up at a single institution, were eligible for this study. A total of 176 consecutive patients were included. During a mean follow-up period of 83.8 ± 57.3 months, spontaneous sustained VAs occurred in 30 patients (17%). Eight patients (4.5%) died. Appropriate ICD shocks occurred in 28 patients (15.9%), and 33 patients (18.7%) had inappropriate shocks. Electrical storm occurred in 4 subjects (2.3%). Twenty-eight patients (15.9%) experienced device-related complications. In multivariate Cox regression analysis, aborted sudden cardiac death and VA inducibility on electrophysiologic studies were independent predictors of appropriate shock occurrence. ICD therapy was an effective strategy in Brugada syndrome, treating potentially lethal arrhythmias in 17% of patients during long-term follow-up. Appropriate shocks were significantly associated with the presence of aborted sudden cardiac death but also occurred in 13% of asymptomatic patients. Risk stratification by electrophysiologic study may identify asymptomatic patients at risk for arrhythmic events and could be helpful in investigating syncope not related to VAs. ICD placement is frequently associated with device-related complications, and rates of inappropriate shocks remain high regardless of careful device programming. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Effect of Caregiver Driven Robot-Assisted In-Ward Training in Subacute Stroke Patients: A Case Series

PubMed Central

2018-01-01

Objective To evaluate the effect of caregiver driven robot-assisted in-ward training in subacute stroke patients. Methods A retrospective evaluation was performed for patients treated with caregiver driven robot-assisted in-ward training to retain gait function from June 2014 and December 2016. All patients received more than 2 weeks of caregiver driven robot-assisted in-ward training after undergoing conventional programs. The robot was used as a sitting device, a standing frame, or a high-walker depending on functional status of the patient. Patients were evaluated before and after robot training. Patient records were assessed by Korean version of Modified Barthel Index (K-MBI), Functional Independence Measure (FIM), and Functional Ambulation Category (FAC). Results Initially, patients used the robot as a sitting device (n=6), a standing frame (n=7), or a partial body-weight support high-walker (n=2). As patient functions were improved, usage level of the robot was changed to the next level. At the end of the treatment, the robot was used as a sitting device (n=1), a standing frame (n=6), or high-walker (n=8). Scores of K-MBI (Δ17.47±10.72) and FIM (Δ19.80±12.34) were improved in all patients. Conclusion Patients' usage level of the robot and functional scores were improved. Therefore, performing additional caregiver driven robot-assisted in-ward training is feasible and beneficial for subacute stroke patients. PMID:29765872

Effect of Caregiver Driven Robot-Assisted In-Ward Training in Subacute Stroke Patients: A Case Series.

PubMed

Kim, Sang Beom; Lee, Kyeong Woo; Lee, Jong Hwa; Lee, Sook Joung; Park, Jin Gee; Park, Joo Won

2018-04-01

To evaluate the effect of caregiver driven robot-assisted in-ward training in subacute stroke patients. A retrospective evaluation was performed for patients treated with caregiver driven robot-assisted in-ward training to retain gait function from June 2014 and December 2016. All patients received more than 2 weeks of caregiver driven robot-assisted in-ward training after undergoing conventional programs. The robot was used as a sitting device, a standing frame, or a high-walker depending on functional status of the patient. Patients were evaluated before and after robot training. Patient records were assessed by Korean version of Modified Barthel Index (K-MBI), Functional Independence Measure (FIM), and Functional Ambulation Category (FAC). Initially, patients used the robot as a sitting device (n=6), a standing frame (n=7), or a partial body-weight support high-walker (n=2). As patient functions were improved, usage level of the robot was changed to the next level. At the end of the treatment, the robot was used as a sitting device (n=1), a standing frame (n=6), or high-walker (n=8). Scores of K-MBI (Δ17.47±10.72) and FIM (Δ19.80±12.34) were improved in all patients. Patients' usage level of the robot and functional scores were improved. Therefore, performing additional caregiver driven robot-assisted in-ward training is feasible and beneficial for subacute stroke patients.

An app for patient education and self-audit within an enhanced recovery program for bowel surgery: a pilot study assessing validity and usability.

PubMed

Pecorelli, Nicolò; Fiore, Julio F; Kaneva, Pepa; Somasundram, Abarna; Charlebois, Patrick; Liberman, A Sender; Stein, Barry L; Carli, Franco; Feldman, Liane S

2018-05-01

While patient engagement and clinical audit are key components of successful enhanced recovery programs (ERPs), they require substantial resource allocation. The objective of this study was to assess the validity and usability of a novel mobile device application for education and self-reporting of adherence for patients undergoing bowel surgery within an established ERP. Prospectively recruited patients undergoing bowel surgery within an ERP used a novel app specifically designed to provide daily recovery milestones and record adherence to 15 different ERP processes and six patient-reported outcomes (PROs). Validity was measured by the agreement index (Cohen's kappa coefficient for categorical, and interclass correlation coefficient (ICC) for continuous variables) between patient-reported data through the app and data recorded by a clinical auditor. Acceptability and usability of the app were measured by the System Usability Scale (SUS). Forty-five patients participated in the study (mean age 61, 64% male). Overall, patients completed 159 of 179 (89%) of the available questionnaires through the app. Median time to complete a questionnaire was 2 min 49 s (i.q.r. 2'32″-4'36″). Substantial (kappa > 0.6) or almost perfect agreement (kappa > 0.8) and strong correlation (ICC > 0.7) between data collected through the app and by the clinical auditor was found for 14 ERP processes and four PROs. Patient-reported usability was high; mean SUS score was 87 (95% CI 83-91). Only 6 (13%) patients needed technical support to use the app. Forty (89%) patients found the app was helpful to achieve their daily goals, and 34 (76%) thought it increased their motivation to recover after surgery. This novel application provides a tool to record patient adherence to care processes and PROs, with high agreement with traditional clinical audit, high usability, and patient satisfaction. Future studies should investigate the use of mobile device apps as strategies to increase adherence to perioperative interventions.

Direct magnetocaloric characterization and simulation of thermomagnetic cycles

NASA Astrophysics Data System (ADS)

Porcari, G.; Buzzi, M.; Cugini, F.; Pellicelli, R.; Pernechele, C.; Caron, L.; Brück, E.; Solzi, M.

2013-07-01

An experimental setup for the direct measurement of the magnetocaloric effect capable of simulating high frequency magnetothermal cycles on laboratory-scale samples is described. The study of the magnetocaloric properties of working materials under operative conditions is fundamental for the development of innovative devices. Frequency and time dependent characterization can provide essential information on intrinsic features such as magnetic field induced fatigue in materials undergoing first order magnetic phase transitions. A full characterization of the adiabatic temperature change performed for a sample of Gadolinium across its Curie transition shows the good agreement between our results and literature data and in-field differential scanning calorimetry.

Melding a High-Risk Patient for Continuous Flow Left Ventricular Assist Device into a Low-Risk Patient.

PubMed

Amione-Guerra, Javier; Cruz-Solbes, Ana S; Gonzalez Bonilla, Hilda; Estep, Jerry D; Guha, Ashrith; Bhimaraj, Arvind; Suarez, Erik E; Bruckner, Brian A; Torre-Amione, Guillermo; Park, Myung H; Trachtenberg, Barry H

The model for end-stage liver disease (MELD) has been used as a predictor of mortality after left ventricular assist device (LVAD) placement. However, improvement or worsening of MELD and how those changes affect outcomes is unknown. We performed a retrospective analysis of 244 patients implanted with a continuous flow (CF) LVAD. Patients were dichotomized at admission into low- or high-risk categories using a cutoff of MELD ≥ 19, and they were reclassified at day of implant forming four groups: Group LL (low to low, remained low risk), LH (low to high, worsened to high risk), HH (high to high, remained high risk), and HL (high to low, improved to low risk). Patients who improved to a low risk (group HL) had the same 1 year survival as those that remained low risk (group LL; 80% vs. 77%; p = 0.6). However, patients who were initially classified as low risk and worsened to a high risk (group LH) had a survival that was worse than those that were consistently high risk (group HH; 55% vs. 10%; p = 0.01). Model for end-stage liver disease reclassification after adjusting for commonly attributed risk factors remained an independent predictor for mortality, including patients classified as Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) 1 and 2. In conclusion, our MELD score reclassification is an independent and powerful predictor of mortality in patients undergoing LVAD implantation.

Early Right Ventricular Assist Device Use in Patients Undergoing Continuous-Flow Left Ventricular Assist Device Implantation: Incidence and Risk Factors From the Interagency Registry for Mechanically Assisted Circulatory Support.

PubMed

Kiernan, Michael S; Grandin, E Wilson; Brinkley, Marshall; Kapur, Navin K; Pham, Duc Thinh; Ruthazer, Robin; Rame, J Eduardo; Atluri, Pavan; Birati, Edo Y; Oliveira, Guilherme H; Pagani, Francis D; Kirklin, James K; Naftel, David; Kormos, Robert L; Teuteberg, Jeffrey J; DeNofrio, David

2017-10-01

To investigate preimplant risk factors associated with early right ventricular assist device (RVAD) use in patients undergoing continuous-flow left ventricular assist device (LVAD) surgery. Patients in the Interagency Registry for Mechanically Assisted Circulatory Support who underwent primary continuous-flow-LVAD surgery were examined for concurrent or subsequent RVAD implantation within 14 days of LVAD. Risk factors for RVAD implantation and the combined end point of RVAD or death within 14 days of LVAD were assessed with stepwise logistic regression. We compared survival between patients with and without RVAD using Kaplan-Meier method and Cox proportional hazards modeling. Of 9976 patients undergoing continuous-flow-LVAD implantation, 386 patients (3.9%) required an RVAD within 14 days of LVAD surgery. Preimplant characteristics associated with RVAD use included interagency registry for mechanically assisted circulatory support patient profiles 1 and 2, the need for preoperative extracorporeal membrane oxygenation or renal replacement therapy, severe preimplant tricuspid regurgitation, history of cardiac surgery, and concomitant procedures other than tricuspid valve repair at the time of LVAD. Hemodynamic determinants included elevated right atrial pressure, reduced pulmonary artery pulse pressure, and reduced stroke volume. The final model demonstrated good performance for both RVAD implant (area under the curve, 0.78) and the combined end point of RVAD or death within 14 days (area under the curve, 0.73). Compared with patients receiving an isolated LVAD, patients requiring RVAD had decreased 1- and 6-month survival: 78.1% versus 95.8% and 63.6% versus 87.9%, respectively ( P <0.0001 for both). The need for RVAD implantation after LVAD is associated with indices of global illness severity, markers of end-organ dysfunction, and profiles of hemodynamic instability. © 2017 American Heart Association, Inc.

Engineering topological defect patterns of Bose condensates in shaken optical lattices

NASA Astrophysics Data System (ADS)

Feng, Lei; Clark, Logan W.; Gaj, Anita; Chin, Cheng

2017-04-01

Topological defects emerge and play an essential role in the dynamics of systems undergoing continuous, symmetry-breaking phase transitions. Here, we study the topological defects (domain walls) which form when a Bose condensate in a shaken optical lattice undergoes a quantum phase transition and separates into domains of superfluid with finite momentum. Here, we experimentally demonstrate the ability to control the pattern of domain walls using a digital micromirror device. We further explore implementations of this technique to study dynamics near the phase transition and the evolution of topological defects.

Implantation of a HeartMate II left ventricular assist device via left thoracotomy.

PubMed

Cho, Yang Hyun; Deo, Salil V; Schirger, John A; Pereira, Naveen L; Stulak, John M; Park, Soon J

2012-11-01

Left thoracotomy was used as an approach for the implantation of pulsatile ventricular assist devices. Avoiding the standard approach of median sternotomy is attractive in patients undergoing complicated redo cardiac surgery, especially with prior mediastinal radiation. We report a case of the use of left thoracotomy for the implantation of the HeartMate II axial-flow pump. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Systemic inflammatory response syndromes in the era of interventional cardiology.

PubMed

Gorla, Riccardo; Erbel, Raimund; Eagle, Kim A; Bossone, Eduardo

2018-04-12

Systemic inflammatory response syndrome (SIRS), initially reported after cardiovascular surgery, has been described after various interventional cardiology procedures, including endovascular/thoracic aortic repair (EVAR/TEVAR), implantation of heart rhythm devices, percutaneous coronary intervention (PCI), electrophysiology procedures (EP), and transcatheter aortic valve implantation (TAVI). In these settings, a comprehensive understanding of the triggers, pathogenesis as well as a common diagnostic/therapeutic algorithm is lacking and will be discussed in this review. SIRS occurs in about 40% and 50% of patients undergoing TEVAR/EVAR and TAVI respectively; it affects 0.1% of patients undergoing implantation of heart rhythm devices. Prevalence is unknown after PCI or EP. Clinical presentation includes fever, dyspnoea/tachypnoea, tachycardia, weakness, chest pain and pericardial/pleural effusion. Several triggers can be identified, related to implanted devices, biomaterial, and procedural aspects (prolonged hypotension, aneurysm thrombus manipulation, active fixation atrial leads, coronary microembolization, balloon dilatation/stent implantantation, contrast medium, coronary/myocardial microperforation). Nonetheless, these triggers share three main pathogenic pathways leading to SIRS clinical manifestations: leucocytes activation, endothelial injury/activation, and myocardial/pericardial injury. Therapy consists of non-steroidal agents, with corticosteroids as second-line treatment in non-responders. Although a benign evolution is reported after implantation of heart rhythm devices, PCI and EP, major adverse events may occur after EVAR/TEVAR and TAVI at short- and mid-term follow up. Copyright © 2018 Elsevier Inc. All rights reserved.

Assessing the Risk of Contrast-Induced Nephropathy Using a Finger Stick Analysis in Recalls from Breast Screening: The CINFIBS Explorative Study.

PubMed

Houben, I P L; van Berlo, C J L Y; Bekers, O; Nijssen, E C; Lobbes, M B I; Wildberger, J E

2017-01-01

To evaluate whether a handheld point-of-care (POC) device is able to predict and discriminate patients at potential risk of contrast-induced nephropathy (CIN) prior to iodine-based contrast media delivery. Between December 2014 and June 2016, women undergoing contrast-enhanced spectral mammography (CESM) with an iodine-based contrast agent were asked to have their risk of CIN assessed by a dedicated POC device (StatSensor CREAT) and a risk factor questionnaire based on national guidelines. Prior to contrast injection, a venous blood sample was drawn to compare the results of POC with regular laboratory testing. A total of 351 patients were included; 344 were finally categorized as low risk patients by blood creatinine evaluation. Seven patients had a eGFR below 60 ml/min/1.73 m 2 , necessitating additional preparation prior to contrast delivery. The POC device failed to categorize six out of seven patients (86%), leading to (at that stage) unwanted contrast administration. Two patients subsequently developed CIN after 2-5 days, which was self-limiting after 30 days. The POC device tested was not able to reliably assess impairment of renal function in our patient cohort undergoing CESM. Consequently, we still consider classic clinical laboratory testing preferable in patients at potential risk for developing CIN.

Long-term outcomes of children undergoing video-assisted gastrostomy.

PubMed

Salö, Martin; Santimano, Ana; Helmroth, Sofia; Stenström, Pernilla; Arnbjornsson, Einar Ólafur

2017-01-01

The aims of this study were to assess the short- and long-term complication rates after video-assisted gastrostomy (VAG), the effects of age and gender on long-term complications and the effect of duration of gastrostomy tube retention on the need for gastroraphy when the gastrostomy device was removed. This was a retrospective study of children undergoing VAG at a single institution. Children who died or moved from the area were excluded. The rates of short- and long-term complications developing at 3-6 months or 2 or more years, respectively, were compared. A total of 170 children were studied, out of a cohort of 303 children. The median age at surgery was 2 years. The median duration of postoperative long-term follow-up was 5 years (2-9 years). The complications at the respective short and long-term follow-ups were as follows: granulation tissue, leakage, infection and vomiting. There were no differences in the short- versus long-term complication rates for gender and age. Children needing gastroraphy had used a gastrostomy device significantly longer compared with children with spontaneous closure. Complications after VAG decrease over time. A longer duration of gastrostomy device retention leads to increased need for gastroraphy.

Increasing patient knowledge on the proper usage of a PCA machine with the use of a post-operative instructional card.

PubMed

Shovel, Louisa; Max, Bryan; Correll, Darin J

2016-01-01

The purpose of this study was to see if an instructional card, attached to the PCA machine following total hip arthroplasty describing proper use of the device, would positively affect subjects' understanding of device usage, pain scores, pain medication consumption and satisfaction. Eighty adults undergoing total hip replacements who had been prescribed PCA were randomized into two study groups. Forty participants received the standard post-operative instruction on PCA device usage at our institution. The other 40 participants received the standard of care in addition to being given a typed instructional card immediately post-operatively, describing proper PCA device use. This card was attached to the PCA device during their recovery period. On post-operative day one, each patient completed a questionnaire on PCA usage, pain scores and satisfaction scores. The pain scores in the Instructional Card group were significantly lower than the Control group (p = 0.024). Subjects' understanding of PCA usage was also improved in the Instructional Card group for six of the seven questions asked. The findings from this study strongly support that postoperative patient information on proper PCA use by means of an instructional card improves pain control and hence the overall recovery for patients undergoing surgery. In addition, through improved understanding it adds an important safety feature in that patients and potentially their family members and/or friends may refrain from PCA-by-proxy. This article demonstrates that the simple intervention of adding an instructional card to a PCA machine is an effective method to improve patients' knowledge as well as pain control and potentially increase the safety of the device use.

Cervical external immobilization devices: evaluation of magnetic resonance imaging issues at 3.0 Tesla.

PubMed

Diaz, Francis L; Tweardy, Lisa; Shellock, Frank G

2010-02-15

Laboratory investigation, ex vivo. Currently, no studies have addressed the magnetic resonance imaging (MRI) issues for cervical external immobilization devices at 3-Tesla. Under certain conditions significant heating may occur, resulting in patient burns. Furthermore, artifacts can be substantial and prevent the diagnostic use of MRI. Therefore, the objective of this investigation was to evaluate MRI issues for 4 different cervical external immobilization devices at 3-Tesla. Excessive heating and substantial artifacts are 2 potential complications associated with performing MRI at 3-Tesla in patients with cervical external immobilization devices. Using ex vivo testing techniques, MRI-related heating and artifacts were evaluated for 4 different cervical devices during MRI at 3-Tesla. Four cervical external immobilization devices (Generation 80, Resolve Ring and Superstructure, Resolve Ring and Jerome Vest/Jerome Superstructure, and the V1 Halo System; Ossur Americas, Aliso Viejo, CA) underwent MRI testing at 3-Tesla. All devices were made from nonmetallic or nonmagnetic materials. Heating was determined using a gelled-saline-filled skull phantom with fluoroptic thermometry probes attached to the skull pins. MRI was performed at 3-Tesla, using a high level of RF energy. Artifacts were assessed at 3-Tesla, using standard cervical imaging techniques. The Generation 80 and V1 Halo devices exhibited substantial temperature rises (11.6 degrees C and 8.5 degrees C, respectively), with "sparking" evident for the Generation 80 during the MRI procedure. Artifacts were problematic for these devices, as well. By comparison, the 2 Resolve Ring-based cervical external immobilization devices showed little or no heating (< or = 0.6 degrees C) and the artifacts were acceptable for diagnostic MRI examinations. The low degree of heating and minor artifacts associated with the Resolve-based cervical external immobilization devices indicated that these products are safe for patients undergoing MRI at 3-Tesla.

A systematic review of the effectiveness of warming interventions for women undergoing cesarean section.

PubMed

Munday, Judy; Hines, Sonia; Wallace, Karen; Chang, Anne M; Gibbons, Kristen; Yates, Patsy

2014-12-01

Women undergoing cesarean section are vulnerable to adverse effects associated with inadvertent perioperative hypothermia, but there has been a lack of synthesized evidence for temperature management in this population. This systematic review aimed to synthesize the best available evidence in relation to preventing hypothermia in mothers undergoing cesarean section surgery. Randomized controlled trials meeting the inclusion criteria (adult patients of any ethnic background, with or without comorbidities, undergoing any mode of anesthesia for any type of cesarean section) were eligible for consideration. Active or passive warming interventions versus usual care or placebo, aiming to limit or manage core heat loss in women undergoing cesarean section were considered. The primary outcome was maternal core temperature. A comprehensive search with no language restrictions was undertaken of multiple databases from their inception until May 2012. Two independent reviewers using the standardized critical appraisal instrument for randomized controlled trials from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instruments (JBI-MASTARI) assessed retrieved papers for methodological quality and conducted data collection. Where possible, results were combined in a fixed effects meta-analysis using the Cochrane Collaboration Review Manager software. Due to heterogeneity for one outcome, random effects meta-analysis was also used. A combined total of 719 participants from 12 studies were included. Intravenous fluid warming was found to be effective at maintaining maternal temperature and preventing shivering. Warming devices, including forced air warming and under-body carbon polymer mattresses, were effective at preventing hypothermia. However, effectiveness increased if the devices were applied preoperatively. Preoperative warming devices reduced shivering and improved neonatal temperatures at birth. Intravenous fluid warming did not improve neonatal temperature, and the effectiveness of warming interventions on umbilical pH remains unclear. Intravenous fluid warming by any method improves maternal temperature and reduces shivering during and after cesarean section, as does preoperative body warming. Preoperative warming strategies should be utilized where possible. Preoperative or intraoperative warmed IV fluids should be standard practice. Warming strategies are less effective when intrathecal opioids are administered. Further research is needed to investigate interventions in emergency cesarean section surgery. Larger scale studies using standardized, clinically meaningful temperature measurement time points are required. © 2014 Sigma Theta Tau International.

Tapered structure construction

DOE Office of Scientific and Technical Information (OSTI.GOV)

Smith, Eric D.; Takata, Rosalind K.; Slocum, Alexander H.

Feeding stock used to form a tapered structure into a curving device such that each point on the stock undergoes rotational motion about a peak location of the tapered structure; and the stock meets a predecessor portion of stock along one or more adjacent edges.

Endoscopic Devices for Obesity.

PubMed

Sampath, Kartik; Dinani, Amreen M; Rothstein, Richard I

2016-06-01

The obesity epidemic, recognized by the World Health Organization in 1997, refers to the rising incidence of obesity worldwide. Lifestyle modification and pharmacotherapy are often ineffective long-term solutions; bariatric surgery remains the gold standard for long-term obesity weight loss. Despite the reported benefits, it has been estimated that only 1% of obese patients will undergo surgery. Endoscopic treatment for obesity represents a potential cost-effective, accessible, minimally invasive procedure that can function as a bridge or alternative intervention to bariatric surgery. We review the current endoscopic bariatric devices including space occupying devices, endoscopic gastroplasty, aspiration technology, post-bariatric surgery endoscopic revision, and obesity-related NOTES procedures. Given the diverse devices already FDA approved and in development, we discuss the future directions of endoscopic therapies for obesity.

Accelerated Aging with Electrical Overstress and Prognostics for Power MOSFETs

NASA Technical Reports Server (NTRS)

Saha, Sankalita; Celaya, Jose Ramon; Vashchenko, Vladislav; Mahiuddin, Shompa; Goebel, Kai F.

2011-01-01

Power electronics play an increasingly important role in energy applications as part of their power converter circuits. Understanding the behavior of these devices, especially their failure modes as they age with nominal usage or sudden fault development is critical in ensuring efficiency. In this paper, a prognostics based health management of power MOSFETs undergoing accelerated aging through electrical overstress at the gate area is presented. Details of the accelerated aging methodology, modeling of the degradation process of the device and prognostics algorithm for prediction of the future state of health of the device are presented. Experiments with multiple devices demonstrate the performance of the model and the prognostics algorithm as well as the scope of application. Index Terms Power MOSFET, accelerated aging, prognostics

Intrinsically stretchable and healable semiconducting polymer for organic transistors

NASA Astrophysics Data System (ADS)

Oh, Jin Young; Rondeau-Gagné, Simon; Chiu, Yu-Cheng; Chortos, Alex; Lissel, Franziska; Wang, Ging-Ji Nathan; Schroeder, Bob C.; Kurosawa, Tadanori; Lopez, Jeffrey; Katsumata, Toru; Xu, Jie; Zhu, Chenxin; Gu, Xiaodan; Bae, Won-Gyu; Kim, Yeongin; Jin, Lihua; Chung, Jong Won; Tok, Jeffrey B.-H.; Bao, Zhenan

2016-11-01

Thin-film field-effect transistors are essential elements of stretchable electronic devices for wearable electronics. All of the materials and components of such transistors need to be stretchable and mechanically robust. Although there has been recent progress towards stretchable conductors, the realization of stretchable semiconductors has focused mainly on strain-accommodating engineering of materials, or blending of nanofibres or nanowires into elastomers. An alternative approach relies on using semiconductors that are intrinsically stretchable, so that they can be fabricated using standard processing methods. Molecular stretchability can be enhanced when conjugated polymers, containing modified side-chains and segmented backbones, are infused with more flexible molecular building blocks. Here we present a design concept for stretchable semiconducting polymers, which involves introducing chemical moieties to promote dynamic non-covalent crosslinking of the conjugated polymers. These non-covalent crosslinking moieties are able to undergo an energy dissipation mechanism through breakage of bonds when strain is applied, while retaining high charge transport abilities. As a result, our polymer is able to recover its high field-effect mobility performance (more than 1 square centimetre per volt per second) even after a hundred cycles at 100 per cent applied strain. Organic thin-film field-effect transistors fabricated from these materials exhibited mobility as high as 1.3 square centimetres per volt per second and a high on/off current ratio exceeding a million. The field-effect mobility remained as high as 1.12 square centimetres per volt per second at 100 per cent strain along the direction perpendicular to the strain. The field-effect mobility of damaged devices can be almost fully recovered after a solvent and thermal healing treatment. Finally, we successfully fabricated a skin-inspired stretchable organic transistor operating under deformations that might be expected in a wearable device.

Intrinsically stretchable and healable semiconducting polymer for organic transistors.

PubMed

Oh, Jin Young; Rondeau-Gagné, Simon; Chiu, Yu-Cheng; Chortos, Alex; Lissel, Franziska; Wang, Ging-Ji Nathan; Schroeder, Bob C; Kurosawa, Tadanori; Lopez, Jeffrey; Katsumata, Toru; Xu, Jie; Zhu, Chenxin; Gu, Xiaodan; Bae, Won-Gyu; Kim, Yeongin; Jin, Lihua; Chung, Jong Won; Tok, Jeffrey B-H; Bao, Zhenan

2016-11-17

Thin-film field-effect transistors are essential elements of stretchable electronic devices for wearable electronics. All of the materials and components of such transistors need to be stretchable and mechanically robust. Although there has been recent progress towards stretchable conductors, the realization of stretchable semiconductors has focused mainly on strain-accommodating engineering of materials, or blending of nanofibres or nanowires into elastomers. An alternative approach relies on using semiconductors that are intrinsically stretchable, so that they can be fabricated using standard processing methods. Molecular stretchability can be enhanced when conjugated polymers, containing modified side-chains and segmented backbones, are infused with more flexible molecular building blocks. Here we present a design concept for stretchable semiconducting polymers, which involves introducing chemical moieties to promote dynamic non-covalent crosslinking of the conjugated polymers. These non-covalent crosslinking moieties are able to undergo an energy dissipation mechanism through breakage of bonds when strain is applied, while retaining high charge transport abilities. As a result, our polymer is able to recover its high field-effect mobility performance (more than 1 square centimetre per volt per second) even after a hundred cycles at 100 per cent applied strain. Organic thin-film field-effect transistors fabricated from these materials exhibited mobility as high as 1.3 square centimetres per volt per second and a high on/off current ratio exceeding a million. The field-effect mobility remained as high as 1.12 square centimetres per volt per second at 100 per cent strain along the direction perpendicular to the strain. The field-effect mobility of damaged devices can be almost fully recovered after a solvent and thermal healing treatment. Finally, we successfully fabricated a skin-inspired stretchable organic transistor operating under deformations that might be expected in a wearable device.

Integrated titanium dioxide (TiO2) nanoparticles on interdigitated device electrodes (IDEs) for pH analysis

NASA Astrophysics Data System (ADS)

Azizah, N.; Hashim, U.; Arshad, M. K. Md.; Gopinath, Subash C. B.; Nadzirah, Sh.; Farehanim, M. A.; Fatin, M. F.; Ruslinda, A. R.; Ayub, R. M.

2016-07-01

Titanium dioxide (TiO2) nanoparticles based Interdigitated Device Electrodes (IDEs) Nanobiosensor device was developed for intracellular biochemical detection. Fabrication and characterization of pH sensors using IDE nanocoated with TiO2 was studied in this paper. In this paper, a preliminary assessment of this intracellular sensor with electrical measurement under different pH levels. 3-aminopropyltriethoxysilane (APTES) was used to enhance the sensitivity of titanium dioxide layer as well as able to provide surface modification by undergoing protonation and deprotonation process. Different types of pH solution provide different resistivity and conductivity towards the surface. Base solution has the higher current compared to an acid solution. Amine and oxide functionalized TiO2 based IDE exhibit pH-dependent could be understood in terms of the change in surface charge during protonation and deprotonation. The simple fabrication process, high sensitivity, and fast response of the TiO2 based IDEs facilitate their applications in a wide range of areas. The small size of semiconductor TiO2 based IDE for sensitive, label-free, real time detection of a wide range of biological species could be explored in vivo diagnostics and array-based screening.

Rapid Transition of the Hole Rashba Effect from Strong Field Dependence to Saturation in Semiconductor Nanowires

NASA Astrophysics Data System (ADS)

Luo, Jun-Wei; Li, Shu-Shen; Zunger, Alex

2017-09-01

The electric field manipulation of the Rashba spin-orbit coupling effects provides a route to electrically control spins, constituting the foundation of the field of semiconductor spintronics. In general, the strength of the Rashba effects depends linearly on the applied electric field and is significant only for heavy-atom materials with large intrinsic spin-orbit interaction under high electric fields. Here, we illustrate in 1D semiconductor nanowires an anomalous field dependence of the hole (but not electron) Rashba effect (HRE). (i) At low fields, the strength of the HRE exhibits a steep increase with the field so that even low fields can be used for device switching. (ii) At higher fields, the HRE undergoes a rapid transition to saturation with a giant strength even for light-atom materials such as Si (exceeding 100 meV Å). (iii) The nanowire-size dependence of the saturation HRE is rather weak for light-atom Si, so size fluctuations would have a limited effect; this is a key requirement for scalability of Rashba-field-based spintronic devices. These three features offer Si nanowires as a promising platform for the realization of scalable complementary metal-oxide-semiconductor compatible spintronic devices.

Effects of transcatheter closure of Fontan fenestration on exercise tolerance. kidecho@yahoo.com.

PubMed

Momenah, Tarek S; Eltayb, Haifa; Oakley, Reida El; Qethamy, Howeida Al; Faraidi, Yahya Al

2008-05-01

Baffle fenestration is associated with a significantly better outcome in standard and high-risk patients undergoing completion of Fontan. We report the effects of subsequent transcatheter closure of fenestration on exercise capacity and oxygen saturation. Sixteen patients with a mean age of 10.3 years underwent Amplatzer septal occluder (ASO) device transcatheter closure of Fontan fenestration. All had a fenestrated Fontan operation 6 month to 8 years prior to the procedure. A stress test was performed before and after device closure of fenestration in 14 patients (2 patients did not tolerate stress test before the procedure). The fenestrations in all patients were successfully occluded with the use of the Amplatzer device occluder. No complications occurred during or after the procedure. O2 saturation increased from a mean 85.1 +/- 7.89% to 94.5 +/- 3.63% (p < 0.01) at rest and from 66.2 +/- 12.86% to 87.2 +/- 8.64% (p < 0.01) following exercise. Exercise duration has also increased from 8.22 +/- 2.74 min to 10.29 +/- 1.91 min (p < 0.05). Transcatheter closure of Fontan fenestration increases the duration of exercise capacity and increases O2 saturation at rest and after exercise.

Laser, light, and energy devices for cellulite and lipodystrophy.

PubMed

Peterson, Jennifer D; Goldman, Mitchel P

2011-07-01

Cellulite affects all races, and it is estimated that 85% of women older than 20 years have some degree of cellulite. Many currently accepted cellulite therapies target deficiencies in lymphatic drainage and microvascular circulation. Devices using radiofrequency, laser, and light-based energies, alone or in combination and coupled frequently with tissue manipulation, are available for improving cellulite. Laser assisted liposuction may improve cellulite appearance. Although improvement using these devices is temporary, it may last several months. Patients who want smoother skin with less visible cellulite can undergo a series of treatments and then return for additional treatments as necessary. Copyright © 2011 Elsevier Inc. All rights reserved.

Clinical characteristics and outcome of infective endocarditis involving implantable cardiac devices.

PubMed

Athan, Eugene; Chu, Vivian H; Tattevin, Pierre; Selton-Suty, Christine; Jones, Phillip; Naber, Christoph; Miró, José M; Ninot, Salvador; Fernández-Hidalgo, Nuria; Durante-Mangoni, Emanuele; Spelman, Denis; Hoen, Bruno; Lejko-Zupanc, Tatjana; Cecchi, Enrico; Thuny, Franck; Hannan, Margaret M; Pappas, Paul; Henry, Margaret; Fowler, Vance G; Crowley, Anna Lisa; Wang, Andrew

2012-04-25

Infection of implantable cardiac devices is an emerging disease with significant morbidity, mortality, and health care costs. To describe the clinical characteristics and outcome of cardiac device infective endocarditis (CDIE) with attention to its health care association and to evaluate the association between device removal during index hospitalization and outcome. Prospective cohort study using data from the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), conducted June 2000 through August 2006 in 61 centers in 28 countries. Patients were hospitalized adults with definite endocarditis as defined by modified Duke endocarditis criteria. In-hospital and 1-year mortality. CDIE was diagnosed in 177 (6.4% [95% CI, 5.5%-7.4%]) of a total cohort of 2760 patients with definite infective endocarditis. The clinical profile of CDIE included advanced patient age (median, 71.2 years [interquartile range, 59.8-77.6]); causation by staphylococci (62 [35.0% {95% CI, 28.0%-42.5%}] Staphylococcus aureus and 56 [31.6% {95% CI, 24.9%-39.0%}] coagulase-negative staphylococci); and a high prevalence of health care-associated infection (81 [45.8% {95% CI, 38.3%-53.4%}]). There was coexisting valve involvement in 66 (37.3% [95% CI, 30.2%-44.9%]) patients, predominantly tricuspid valve infection (43/177 [24.3%]), with associated higher mortality. In-hospital and 1-year mortality rates were 14.7% (26/177 [95% CI, 9.8%-20.8%]) and 23.2% (41/177 [95% CI, 17.2%-30.1%]), respectively. Proportional hazards regression analysis showed a survival benefit at 1 year for device removal during the initial hospitalization (28/141 patients [19.9%] who underwent device removal during the index hospitalization had died at 1 year, vs 13/34 [38.2%] who did not undergo device removal; hazard ratio, 0.42 [95% CI, 0.22-0.82]). Among patients with CDIE, the rate of concomitant valve infection is high, as is mortality, particularly if there is valve involvement. Early device removal is associated with improved survival at 1 year.

IMRT treatment of anal cancer with a scrotal shield

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hood, Rodney C., E-mail: Rodney.Hood@duke.edu; Wu, Q. Jackie; McMahon, Ryan

The risk of sterility in males undergoing radiotherapy in the pelvic region indicates the use of a shielding device, which offers protection to the testes for patients wishing to maintain fertility. The use of such devices in the realm of intensity-modulated radiotherapy (IMRT) in the pelvic region can pose many obstacles during simulation, treatment planning, and delivery of radiotherapy. This work focuses on the development and execution of an IMRT plan for the treatment of anal cancer using a scrotal shielding device on a clinical patient. An IMRT plan was developed using Eclipse treatment planning system (Varian Medical Systems, Palomore » Alto, CA), using a wide array of gantry angles as well as fixed jaw and fluence editing techniques. When possible, the entire target volume was encompassed by the treatment field. When the beam was incident on the scrotal shield, the jaw was fixed to avoid the device and the collimator rotation optimized to irradiate as much of the target as possible. This technique maximizes genital sparing and allows minimal irradiation of the gonads. When this fixed-jaw technique was found to compromise adequate coverage of the target, manual fluence editing techniques were used to avoid the shielding device. Special procedures for simulation, imaging, and treatment verification were also developed. In vivo dosimetry was used to verify and ensure acceptable dose to the gonads. The combination of these techniques resulted in a highly conformal plan that spares organs and risk and avoids the genitals as well as entrance of primary radiation onto the shielding device.« less

PLMA vs. I-gel: A Comparative Evaluation of Respiratory Mechanics in Laparoscopic Cholecystectomy

PubMed Central

Sharma, Bimla; Sehgal, Raminder; Sahai, Chand; Sood, Jayashree

2010-01-01

Background: Supraglottic airway devices (SADs), such as ProSealTM laryngeal mask airway (PLMA), which produce high oropharyngeal seal pressure (OSP) and have the facility for gastric decompression have been used in laparoscopic procedures. i-gel is a new SAD which shares these features with the PLMA. This study was designed to compare the respiratory mechanics of these two devices during positive pressure ventilation in anaesthetised adult patients undergoing laparoscopic cholecystectomy. Patients & Methods: The study included 60 ASA I-II adult patients scheduled for laparoscopic cholecystectomy. The patients were randomized to two groups of 30 each, with either PLMA or i-gel as their airway device. Anaesthesia and premedication were standardized for both the groups. In addition to routine monitoring, neuromuscular monitoring with TOF ratio, OSP and respiratory mechanics monitoring (dynamic compliance, resistance, work of breathing, measured minute ventilation and peak airway pressures) were employed. Fibreoptic evaluation of positioning of the devices and adverse events related to them were also compared. Results: The OSP (cm H2O) were higher for PLMA (38.9 vs. 35.6, P=0.007). The respiratory mechanics parameters using the two devices were comparable apart from the dynamic compliance, which was significantly higher with i-gel (P < 0.05). Malrotation was higher with i-gel than with PLMA (15 vs. 5, P = 0.006). Conclusion: The PLMA formed a better seal while the dynamic compliance was higher with the i-gel. Both devices provided optimal ventilation and oxygenation and the adverse events were also comparable. PMID:21547168

Evolution of oxygenated cadmium sulfide (CdS:O) during high-temperature CdTe solar cell fabrication

DOE Office of Scientific and Technical Information (OSTI.GOV)

Meysing, Daniel M.; Reese, Matthew O.; Warren, Charles W.

Oxygenated cadmium sulfide (CdS:O) produced by reactive sputtering has emerged as a promising alternative to conventional CdS for use as the n-type window layer in CdTe solar cells. Here, complementary techniques are used to expose the window layer (CdS or CdS:O) in completed superstrate devices and combined with a suite of materials characterization to elucidate its evolution during high temperature device processing. During device fabrication amorphous CdS:O undergoes significant interdiffusion with CdTe and recrystallization, forming CdS1-yTey nanocrystals whose Te fraction approaches solubility limits. Significant oxygen remains after processing, concentrated in sulfate clusters dispersed among the CdS1-yTey alloy phase, accounting formore » ~30% of the post-processed window layer based on cross-sectional microscopy. Interdiffusion and recrystallization are observed in devices with un-oxygenated CdS, but to a much lesser extent. Etching experiments suggest that the CdS thickness is minimally changed during processing, but the CdS:O window layer is reduced from 100 nm to 60-80 nm, which is confirmed by microscopy. Alloying reduces the band gap of the CdS:O window layer to 2.15 eV, but reductions in thickness and areal density improve its transmission spectrum, which is well matched to device quantum efficiency. The changes to the window layer in the reactive environments of device fabrication are profoundly different than what occurs by thermal annealing in an inert environment, which produced films with a band gap of 2.4 eV for both CdS and CdS:O. These results illustrate for the first time the significant changes that occur to the window layer during processing that are critical to the performance of CdTe solar cells.« less

The impact of use of an intraoperative margin assessment device on re-excision rates.

PubMed

Sebastian, Molly; Akbari, Stephanie; Anglin, Beth; Lin, Erin H; Police, Alice M

2015-01-01

Historically there has been a high rate of surgical interventions to obtain clear margins for breast cancer patients undergoing breast conserving local therapy. An intraoperative margin assessment tool (MarginProbe) has been approved for use in the US since 2013. This study is the first compilation of data from routine use of the device, to assess the impact of device utilization on re-excision rates. We present a retrospective, observational, review from groups of consecutive patients, before and after the implementation of intraoperative use of the device during lumpectomy procedures. Lesions were localized by standard methods. The intraoperative margin assessment device was used on all circumferential margins of the main specimen, but not on any additional shavings. A positive reading by the device led to an additional shaving of the corresponding cavity location. Specimens were also, when feasible, imaged intra-operatively by X-ray, and additional shavings were taken if needed based on clinical assessment. For each surgeon, historical re-excision rates were established based on a consecutive set of patients from a time period proximal to initiation of use of the device. From March 2013 to April 2014 the device was routinely used by 4 surgeons in 3 centers. In total, 165 cases lumpectomy cases were performed. Positive margins resulted in additional re-excision procedures in 9.7% (16/165) of the cases. The corresponding historical set from 2012 and 2013 consisted of 186 Lumpectomy cases, in which additional re-excision procedures were performed in 25.8% (48/186) of the cases. The reduction in the rate of re-excision procedures was significant 62% (P < 0.0001). Use of an intraoperative margin assessment device contributes to achieving clear margins and reducing re-excision procedures. As in some cases positive margins were found on shavings, future studies of interest may include an analysis of the effect of using the device on the shavings intra-operatively.

The fundamentals of extra-corporeal membrane oxygenation.

PubMed

Aghili, N; Kang, S; Kapur, N K

2015-02-01

During the past 50 years, pharmacologic advancements for cardiovascular risk factors and device innovation for the management of coronary disease, including acute myocardial infarction have radically changed the landscape of heart disease. At present, nearly 25% of individuals develop chronic heart failure after an acute myocardial infarction. It is estimated that nearly 2.6% of the American population suffers from heart failure. In the modern era, miniaturized continuous flow ventricular assist devices are now demonstrating nearly 75% 2-year survival rates with improved patient functionality. As a result, elderly patients with cardiogenic shock for whom medical treatment held minimal promise, may now be viable candidates for advanced mechanical therapies. Given this option, there is a need for more approaches to salvage patients from cardiogenic shock with percutaneously delivered mechanical circulatory support (pMCS) systems. The use of pMCS is growing and now includes patients with acute and chronic heart failure as well as patients undergoing high risk interventional and electrophysiology procedures. Each of these devices has a unique hemodynamic effect and therefore an in-depth understanding of device characteristics is required for optimal patient management. Extracorporeal membrane oxygenation (ECMO) is one of the earliest types of pMCS systems primarily used for cardiorespiratory failure. ECMO can be used in different configurations, which makes it a versatile hemodynamic support device for different patient scenarios. In this paper, the authors review different configurations, indications, and hemodynamic profile of ECMO in respiratory and cardiac failure patients.

Telemetric implantable pressure sensor for short- and long-term monitoring of intracranial pressure.

PubMed

Frischholz, M; Sarmento, L; Wenzel, M; Aquilina, K; Edwards, R; Coakham, H B

2007-01-01

Patients with hydrocephalus, idiopathic intracranial hypertension and head injury frequently require monitoring of intracranial pressure (ICP) and may need repeated episodes of monitoring months or years apart. The gold standard for measurement of ICP remains the external ventricular catheter. This is a fluid-filled catheter transducer system that allows regular recalibration and correction of zero drift by its position relative to a fixed anatomical reference. It also allows drainage of cerebrospinal fluid (CSF), providing a means of lowering the ICP. Several catheter tip transducer systems are currently in clinical use, including using strain gauges or fiber-optical pressure sensing techniques. In these devices, zero drift and calibration cannot be checked in vivo. All the ICP monitoring devices in current clinical use require a physical connection between the brain and the external environment. This is a source of infection and limits the duration of monitoring. A number of telemetric monitoring devices, in which data is in some way transmitted transcutaneously, have been developed over the last twenty years, but significant technical problems have precluded their use in routine clinical practice. All current ICP monitors are temporary percutaneous implanted devices. Placement of these devices carries significant morbidity, particularly infection. Patients undergoing repeated monitoring require multiple surgical procedures. Apart from decreasing the risk of infection in patients with severe head injury, the clinical value of an accurate telemetric ICP monitoring system which maintains its reliability over a long period of implantation is high.

Echocardiographic predictors of coil vs device closure in patients undergoing percutaneous patent ductus arteriosus closure.

PubMed

Roushdy, Alaa; Abd El Razek, Yasmeen; Mamdouh Tawfik, Ahmed

2018-01-01

To determine anatomic and hemodynamic echocardiographic predictors for patent ductus arteriosus (PDA) device vs coil closure. Seventy-six patients who were referred for elective transcatheter PDA closure were enrolled in the study. All patients underwent full echocardiogram including measurement of the PDA pulmonary end diameter, color flow width and extent, peak and end-diastolic Doppler gradients across the duct, diastolic flow reversal, left atrial dimensions and volume, left ventricular sphericity index, and volumes. The study group was subdivided into 2 subgroups based on the mode of PDA closure whether by coil (n = 42) or device (n = 34). Using univariate analysis there was a highly significant difference between the 2 groups as regard the pulmonary end diameter measured in both the suprasternal and parasternal short-axis views as well as the color flow width and color flow extent (P < .0001). The device closure group had statistically significant higher end-systolic and end-diastolic volumes indexed, left atrial volume, and diastolic flow reversal. Receiver operating characteristic curve analysis showed a pulmonary end diameter cutoff point from the suprasternal view > 2.5 mm and from parasternal short-axis view > 2.61 mm to have the highest balanced sensitivity and specificity to predict the likelihood for device closure (AUC 0.971 and 0.979 respectively). The pulmonary end diameter measured from the suprasternal view was the most independent predictor of device closure. The selection between PDA coil or device closure can be done on the basis of multiple anatomic and hemodynamic echocardiographic variables. © 2017 Wiley Periodicals, Inc.

Java Tool Framework for Automation of Hardware Commissioning and Maintenance Procedures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ho, J C; Fisher, J M; Gordon, J B

2007-10-02

The National Ignition Facility (NIF) is a 192-beam laser system designed to study high energy density physics. Each beam line contains a variety of line replaceable units (LRUs) that contain optics, stepping motors, sensors and other devices to control and diagnose the laser. During commissioning and subsequent maintenance of the laser, LRUs undergo a qualification process using the Integrated Computer Control System (ICCS) to verify and calibrate the equipment. The commissioning processes are both repetitive and tedious when we use remote manual computer controls, making them ideal candidates for software automation. Maintenance and Commissioning Tool (MCT) software was developed tomore » improve the efficiency of the qualification process. The tools are implemented in Java, leveraging ICCS services and CORBA to communicate with the control devices. The framework provides easy-to-use mechanisms for handling configuration data, task execution, task progress reporting, and generation of commissioning test reports. The tool framework design and application examples will be discussed.« less

A Josephson radiation comb generator.

PubMed

Solinas, P; Gasparinetti, S; Golubev, D; Giazotto, F

2015-07-20

We propose the implementation of a Josephson Radiation Comb Generator (JRCG) based on a dc superconducting quantum interference device (SQUID) driven by an external magnetic field. When the magnetic flux crosses a diffraction node of the critical current interference pattern, the superconducting phase undergoes a jump of π and a voltage pulse is generated at the extremes of the SQUID. Under periodic drive this allows one to generate a sequence of sharp, evenly spaced voltage pulses. In the frequency domain, this corresponds to a comb-like structure similar to the one exploited in optics and metrology. With this device it is possible to generate up to several hundreds of harmonics of the driving frequency. For example, a chain of 50 identical high-critical-temperature SQUIDs driven at 1 GHz can deliver up to a 0.5 nW at 200 GHz. The availability of a fully solid-state radiation comb generator such as the JRCG, easily integrable on chip, may pave the way to a number of technological applications, from metrology to sub-millimeter wave generation.

Guest concentration, bias current, and temperature-dependent sign inversion of magneto-electroluminescence in thermally activated delayed fluorescence devices

NASA Astrophysics Data System (ADS)

Deng, Junquan; Jia, Weiyao; Chen, Yingbing; Liu, Dongyu; Hu, Yeqian; Xiong, Zuhong

2017-03-01

Non-emissive triplet excited states in devices that undergo thermally activated delayed fluorescence (TADF) can be up-converted to singlet excited states via reverse intersystem crossing (RISC), which leads to an enhanced electroluminescence efficiency. Exciton-based fluorescence devices always exhibit a positive magneto-electroluminescence (MEL) because intersystem crossing (ISC) can be suppressed effectively by an external magnetic field. Conversely, TADF devices should exhibit a negative MEL because RISC is suppressed by the external magnetic field. Intriguingly, we observed a positive MEL in TADF devices. Moreover, the sign of the MEL was either positive or negative, and depended on experimental conditions, including doping concentration, current density and temperature. The MEL observed from our TADF devices demonstrated that ISC in the host material and RISC in the guest material coexisted. These competing processes were affected by the experimental conditions, which led to the sign change of the MEL. This work gives important insight into the energy transfer processes and the evolution of excited states in TADF devices.

Efficacy of Mobile Health Care Application and Wearable Device in Improvement of Physical Performance in Colorectal Cancer Patients Undergoing Chemotherapy.

PubMed

Cheong, In Yae; An, So Yeon; Cha, Won Chul; Rha, Mi Yong; Kim, Seung Tae; Chang, Dong Kyung; Hwang, Ji Hye

2018-06-01

The use of a mobile health care application, the delivery of health care or health care-related services through the use of portable devices, to manage functional loss, treatment-related toxicities, and impaired quality of life in cancer patients during chemotherapy through supervised self-management has been increasing. The aim of the present study was to evaluate the efficacy and feasibility of comprehensive mobile health care using a tailored rehabilitation program for colorectal cancer patients undergoing active chemotherapy. A total of 102 colorectal cancer patients undergoing chemotherapy underwent 12 weeks of smartphone aftercare through provision of a mobile application and wearable device that included a rehabilitation exercise program and information on their disease and treatment. The grip strength test, 30-second chair stand test, 2-minute walk test, amount of physical activity (International Physical Activity Questionnaire short-form), quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30), and nutritional status (Patient-generated Subjective Global Assessment) were assessed and measured at baseline, at mid-intervention (6 weeks), and at completion of the intervention (12 weeks). The rehabilitation exercise intensity was adjusted by the test results at every assessment and through real-time communication between the patients and clinicians. Of the 102 patients, 75 completed all 12 weeks of the smartphone aftercare rehabilitation program. The lower extremity strength (P < .001) and cardiorespiratory endurance (P < .001) was significantly improved. Fatigue (P < .007) and nausea/vomiting (P < .040) symptoms were significantly relieved after the program. A tailored rehabilitation exercise program provided through a comprehensive mobile health care application was effective in improving patients' physical capacity and treatment-related symptoms even during active chemotherapy. Copyright © 2018 Elsevier Inc. All rights reserved.

Mortality and Rates of Secondary Intervention After EVAR in an Unselected Population: Influence of Simple Clinical Categories and Implications for Surveillance

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hammond, Christopher J., E-mail: christopherhammond@nhs.net; Shah, Asim H.; Snoddon, Andrew

IntroductionPost-EVAR surveillance has a major impact upon patients, carers and healthcare resources. We hypothesised that elective indication, on-IFU anatomy, use of a modern device or normal first CTA, or a combination of these categories, might predict a rate of secondary intervention low enough to alter current surveillance protocols.MethodsPatients undergoing EVAR in our institution between 01.05.2007 and 28.02.2013 were assessed. Data on indication (elective, emergency), anatomy relative to IFU, device, first month CTA result, secondary intervention and mortality were obtained. Kaplan–Meier charts of mortality and freedom from secondary intervention were produced. Statistical analysis was by log-rank test and Cox proportional hazardmore » modelling.Results234 patients underwent EVAR (188 elective, 208 on-IFU). Most implants were Endurant (106) or Talent (98). 151 patients had a normal first CTA. By median follow-up of 38.6 months, 39 patients underwent secondary intervention. A normal first CTA and elective indication were significantly associated with reduced risk of secondary intervention (p < 0.001 and p = 0.042 respectively), but device type and placement on- or off-IFU were not. Elective placement with a normal first CTA was 93 % predictive of freedom from secondary intervention by 32 months post-EVAR. Of nine patients undergoing secondary intervention in this group, eight presented symptomatically.DiscussionIn optimal procedural circumstances with normal post-procedural imaging, only 7 % of patients undergoing EVAR require secondary intervention, a minority of which is driven by surveillance. These data support a change to surveillance more tailored to the individual patient, and highlight the need for further qualitative and quantitative research.« less

Comparison of the WarmCloud and Bair Hugger Warming Devices for the Prevention of Intraoperative Hypothermia in Patients Undergoing Orthotopic Liver Transplantation: A Randomized Clinical Trial

PubMed Central

Pearce, Brett; Mattheyse, Linda; Ellard, Louise; Desmond, Fiona; Pillai, Param; Weinberg, Laurence

2018-01-01

Background The avoidance of hypothermia is vital during prolonged and open surgery to improve patient outcomes. Hypothermia is particularly common during orthotopic liver transplantation (OLT) and associated with undesirable physiological effects that can adversely impact on perioperative morbidity. The KanMed WarmCloud (Bromma, Sweden) is a revolutionary, closed-loop, warm-air heating mattress developed to maintain normothermia and prevent pressure sores during major surgery. The clinical effectiveness of the WarmCloud device during OLT is unknown. Therefore, we conducted a randomized controlled trial to determine whether the WarmCloud device reduces hypothermia and prevents pressure injuries compared with the Bair Hugger underbody warming device. Methods Patients were randomly allocated to receive either the WarmCloud or Bair Hugger warming device. Both groups also received other routine standardized multimodal thermoregulatory strategies. Temperatures were recorded by nasopharyngeal temperature probe at set time points during surgery. The primary endpoint was nasopharyngeal temperature recorded 5 minutes before reperfusion. Secondary endpoints included changes in temperature over the predefined intraoperative time points, number of patients whose nadir temperature was below 35.5°C and the development of pressure injuries during surgery. Results Twenty-six patients were recruited with 13 patients randomized to each group. One patient from the WarmCloud group was excluded because of a protocol violation. Baseline characteristics were similar. The mean (standard deviation) temperature before reperfusion was 36.0°C (0.7) in the WarmCloud group versus 36.3°C (0.6) in the Bairhugger group (P = 0.25). There were no statistical differences between the groups for any of the secondary endpoints. Conclusions When combined with standardized multimodal thermoregulatory strategies, the WarmCloud device does not reduce hypothermia compared with the Bair Hugger device in patients undergoing OLT. PMID:29707629

Exceeding Conventional Photovoltaic Efficiency Limits Using Colloidal Quantum Dots

NASA Astrophysics Data System (ADS)

Pach, Gregory F.

Colloidal quantum dots (QDs) are a widely investigated field of research due to their highly tunable nature in which the optical and electronic properties of the nanocrystal can be manipulated by merely changing the nanocrystal's size. Specifically, colloidal quantum dot solar cells (QDSCs) have become a promising candidate for future generation photovoltaic technology. Quantum dots exhibit multiple exciton generation (MEG) in which multiple electron-hole pairs are generated from a single high-energy photon. This process is not observed in bulk-like semiconductors and allows for QDSCs to achieve theoretical efficiency limits above the standard single-junction Shockley-Queisser limit. However, the fast expanding field of QDSC research has lacked standardization of synthetic techniques and device design. Therefore, we sought to detail methodology for synthesizing PbS and PbSe QDs as well as photovoltaic device fabrication techniques as a fast track toward constructing high-performance solar cells. We show that these protocols lead toward consistently achieving efficiencies above 8% for PbS QDSCs. Using the same methodology for building single-junction photovoltaic devices, we incorporated PbS QDs as a bottom cell into a monolithic tandem architecture along with solution-processed CdTe nanocrystals. Modeling shows that near-peak tandem device efficiencies can be achieved across a wide range of bottom cell band gaps, and therefore the highly tunable band gap of lead-chalcogenide QDs lends well towards a bottom cell in a tandem architecture. A fully functioning monolithic tandem device is realized through the development of a ZnTe/ZnO recombination layer that appropriately combines the two subcells in series. Multiple recent reports have shown nanocrystalline heterostructures to undergo the MEG process more efficiency than several other nanostrucutres, namely lead-chalcogenide QDs. The final section of my thesis expands upon a recent publication by Zhang et. al., which details the synthesis of PbS/CdS heterostructures in which the PbS and CdS domains exist on opposite sides of the nanocrystal and are termed "Janus particles". Transient absorption spectroscopy shows MEG quantum yields above unity very the thermodynamic limit of 2Eg for PbS/CdS Janus particles. We further explain a mechanism for enhanced MEG using photoluminescence studies.

Procedural and longer-term outcomes of wire- versus device-based antegrade dissection and re-entry techniques for the percutaneous revascularization of coronary chronic total occlusions.

PubMed

Azzalini, Lorenzo; Dautov, Rustem; Brilakis, Emmanouil S; Ojeda, Soledad; Benincasa, Susanna; Bellini, Barbara; Karatasakis, Aris; Chavarría, Jorge; Rangan, Bavana V; Pan, Manuel; Carlino, Mauro; Colombo, Antonio; Rinfret, Stéphane

2017-03-15

There are few data regarding the procedural and follow-up outcomes of different antegrade dissection/re-entry (ADR) techniques for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We compiled a multicenter registry of consecutive patients undergoing ADR-based CTO PCI at four high-volume specialized institutions. Patients were divided according to the specific ADR technique used: subintimal tracking and re-entry (STAR), limited antegrade subintimal tracking (LAST), or device-based with the CrossBoss/Stingray system (Boston Scientific, Marlborough, MA). Major adverse cardiac events (MACE: cardiac death, target-vessel myocardial infarction and target-vessel revascularization) on follow-up were the main outcome of this study. Independent predictors of MACE were sought with Cox regression analysis. A total of 223 patients were included (STAR n=39, LAST n=68, CrossBoss/Stingray n=116). Baseline characteristics were similar across groups. Technical and procedural success was lower with STAR (59% and 59%), as compared with LAST (96% and 96%) and CrossBoss/Stingray (89% and 87%; p<0.001 for both). At 24-month follow-up, MACE rates were higher in STAR (15.4%) and LAST (17.5%), as compared with device-based ADR with CrossBoss/Stingray (4.3%, p=0.02), driven by TVR (7.7% vs. 15.5% vs. 3.1%, respectively; p=0.02). Multivariable Cox regression analysis identified wire-based ADR (STAR and LAST) and total stent length as independent predictors of MACE. In this multicenter cohort of patients undergoing CTO PCI with ADR techniques, STAR had lower success rates, as compared with the CrossBoss/Stingray system and LAST. The CrossBoss/Stingray system was independently associated with lower risk of MACE on follow-up, as compared with wire-based ADR techniques. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Device and method for imaging of non-linear and linear properties of formations surrounding a borehole

DOEpatents

Johnson, Paul A; Tencate, James A; Le Bas, Pierre-Yves; Guyer, Robert; Vu, Cung Khac; Skelt, Christopher

2013-11-05

In some aspects of the disclosure, a method and an apparatus is disclosed for investigating material surrounding the borehole. The method includes generating a first low frequency acoustic wave within the borehole, wherein the first low frequency acoustic wave induces a linear and a nonlinear response in one or more features in the material that are substantially perpendicular to a radius of the borehole; directing a first sequence of high frequency pulses in a direction perpendicularly with respect to the longitudinal axis of the borehole into the material contemporaneously with the first acoustic wave; and receiving one or more second high frequency pulses at one or more receivers positionable in the borehole produced by an interaction between the first sequence of high frequency pulses and the one or more features undergoing linear and nonlinear elastic distortion due to the first low frequency acoustic wave to investigate the material surrounding the borehole.

Conjecture: imines as unidirectional photodriven molecular motors-motional and constitutional dynamic devices.

PubMed

Lehn, Jean-Marie

2006-08-07

Compounds containing the C==N group, such as imines and their derivatives, may undergo syn-anti isomerization by two different routes: 1) photochemically, by out-of-plane rotation around the carbon-nitrogen double bond through a "perpendicular" form, and 2) thermally, by in-plane nitrogen inversion through a "linear" transition state. When the two interconversions occur in sequence, a full, closed process is accomplished, restoring the initial state of the system along two different steps. In a chiral imine-type compound, for example, with an asymmetric center next to the C==N function, photoinduced rotation may be expected to occur in one sense in preference to the opposite one. Thus, photoisomerization followed by thermal isomerization in a chiral imine compound generates unidirectional molecular motion. Generally, imine-type compounds represent unidirectional molecular photomotors converting light energy into mechanical motion. As they are also able to undergo exchange of the carbonyl and amine partners, they present constitutional dynamics. Thus, imine-type compounds are double dynamic, motional, and constitutional devices.

Ultrasound-guided trans-rectal high-intensity focused ultrasound (HIFU) for advanced cervical cancer ablation is feasible: a case report.

PubMed

Abel, M; Ahmed, H; Leen, E; Park, E; Chen, M; Wasan, H; Price, P; Monzon, L; Gedroyc, W; Abel, P

2015-01-01

High-intensity focused ultrasound (HIFU) is an ablative treatment undergoing assessment for the treatment of benign and malignant disease. We describe the first reported intracavitary HIFU ablation for recurrent, unresectable and symptomatic cervical cancer. A 38 year old woman receiving palliative chemotherapy for metastatic cervical adenocarcinoma was offered ablative treatment from an intracavitary trans-rectal HIFU device (Sonablate® 500). Pre-treatment symptoms included vaginal bleeding and discharge that were sufficient to impede her quality of life. No peri-procedural adverse events occurred. Symptoms resolved completely immediately post-procedure, reappeared at 7 days, increasing to pre-procedural levels by day 30. This first time experience of intracavitary cervical HIFU suggests that it is feasible for palliation of advanced cervical cancer, with no early evidence of unexpected toxicity. Ethical approval had also been granted for the use of per-vaginal access if appropriate. This route, alone or in combination with the rectal route, may provide increased accessibility in future patients with a redesigned device more suited to trans-vaginal ablations. Intracavitary HIFU is a potentially safe procedure for the treatment of cervical cancer and able to provide symptomatic improvement in the palliative setting.

Efficient green lasers for high-resolution scanning micro-projector displays

NASA Astrophysics Data System (ADS)

Bhatia, Vikram; Bauco, Anthony S.; Oubei, Hassan M.; Loeber, David A. S.

2010-02-01

Laser-based projectors are gaining increased acceptance in mobile device market due to their low power consumption, superior image quality and small size. The basic configuration of such micro-projectors is a miniature mirror that creates an image by raster scanning the collinear red, blue and green laser beams that are individually modulated on a pixel-bypixel basis. The image resolution of these displays can be limited by the modulation bandwidth of the laser sources, and the modulation speed of the green laser has been one of the key limitations in the development of these displays. We will discuss how this limitation is fundamental to the architecture of many laser designs and then present a green laser configuration which overcomes these difficulties. In this green laser architecture infra-red light from a distributed Bragg-reflector (DBR) laser diode undergoes conversion to green light in a waveguided second harmonic generator (SHG) crystal. The direct doubling in a single pass through the SHG crystal allows the device to operate at the large modulation bandwidth of the DBR laser. We demonstrate that the resultant product has a small footprint (<0.7 cc envelope volume), high efficiency (>9% electrical-to-optical conversion) and large modulation bandwidth (>100 MHz).

Prompt-gamma monitoring in hadrontherapy: A review

NASA Astrophysics Data System (ADS)

Krimmer, J.; Dauvergne, D.; Létang, J. M.; Testa, É.

2018-01-01

Secondary radiation emission induced by nuclear reactions is correlated to the path of ions in matter. Therefore, such penetrating radiation can be used for in vivo control of hadrontherapy treatments, for which the primary beam is absorbed inside the patient. Among secondary radiations, prompt-gamma rays were proposed for real-time verification of ion range. Such a verification is a desired condition to reduce uncertainties in treatment planning. For more than a decade, efforts have been undertaken worldwide to promote prompt-gamma-based devices to be used in clinical conditions. Dedicated cameras are necessary to overcome the challenges of a broad- and high-energy distribution, a large background, high instantaneous count rates, and compatibility constraints with patient irradiation. Several types of prompt-gamma imaging devices have been proposed, that are either physically-collimated or electronically collimated (Compton cameras). Clinical tests are now undergoing. Meanwhile, other methods than direct prompt-gamma imaging were proposed, that are based on specific counting using either time-of-flight or photon energy measurements. In the present article, we make a review and discuss the state of the art for all techniques using prompt-gamma detection to improve the quality assurance in hadrontherapy.

Interparticle spacing and structural ordering in superlattice PbS nanocrystal solids undergoing ligand exchange

DOE PAGES

Weidman, Mark C.; Yager, Kevin G.; Tisdale, William A.

2014-12-12

Controlling the interparticle spacing in quantum dot (QD) thin films is the most readily accessible way to control transport rates between neighboring QDs and a critical component of device optimization. Here, we use X-ray scattering measurements to accurately measure the interparticle spacing in films of highly monodisperse lead sulfide (PbS) QDs that have undergone a variety of device-relevant ligand exchanges. We tabulate these values for use in simulations and data analysis. We find that monothiol and dithiol ligand species typically result in interparticle spacing values that are equal to the length of a single monothiol or dithiol ligand. Additionally, wemore » find that spin-coating a thick film of QDs followed by a long-duration ligand exchange results in a more complete ligand exchange than spin-coating many thin layers with short-duration ligand exchanges in between. The former method also preserves a remarkable degree of the long-range ordering that was present in the film prior to ligand exchange. These results shed light on ways to produce highly-ordered QD solids with compact and functional ligands, which could lead to enhanced interdot coupling and transport phenomena.« less

A microfluidic-based lid device for conventional cell culture dishes to automatically control oxygen level.

PubMed

Lee, Seung Yeob; Yang, Sung

2018-04-25

Most conventional hypoxic cell culture systems undergo reoxygenation during experimental manipulations, resulting in undesirable effects including the reduction of cell viability. A lid device was developed herein for conventional cell culture dishes to resolve this limitation. The integration of multilayered microfluidic channels inside a thin membrane was designed to prevent the reoxygenation caused by reagent infusion and automatically control the oxygen level. The experimental data clearly show the reducibility of the dissolved oxygen in the infusing reagent and the controllability of the oxygen level inside the dish. The feasibility of the device for hypoxia studies was confirmed by HIF-1α experiments. Therefore, the device could be used as a compact and convenient hypoxic cell culture system to prevent reoxygenation-related issues.

A new method for overhead drilling.

PubMed

Rempel, David; Star, Demetra; Barr, Alan; Gibbons, Billy; Janowitz, Ira

2009-12-01

In the construction sector, overhead drilling into concrete or metal ceilings is a strenuous task associated with shoulder, neck and back musculoskeletal disorders due to the large applied forces and awkward arm postures. Two intervention devices, an inverted drill press and a foot lever design, were developed then compared to the usual method by construction workers performing their normal overhead drilling activities (n = 14). While the intervention devices were rated as less fatiguing than the usual method, their ratings on usability measures were worse than the usual method. The study demonstrates that the intervention devices can reduce fatigue; however, additional modifications are necessary in order to improve usability and productivity. Devices designed to improve workplace safety may need to undergo several rounds of field testing and modification prior to implementation.

A multi-responsive water-driven actuator with instant and powerful performance for versatile applications

NASA Astrophysics Data System (ADS)

Mu, Jiuke; Hou, Chengyi; Zhu, Bingjie; Wang, Hongzhi; Li, Yaogang; Zhang, Qinghong

2015-03-01

Mechanical actuators driven by water that respond to multiple stimuli, exhibit fast responses and large deformations, and generate high stress have potential in artificial muscles, motors, and generators. Meeting all these requirements in a single device remains a challenge. We report a graphene monolayer paper that undergoes reversible deformation. Its graphene oxide cells wrinkle and extend in response to water desorption and absorption, respectively. Its fast (~0.3 s), powerful (>100 MPa output stress, 7.5 × 105 N kg-1 unit mass force), and controllable actuation can be triggered by moisture, heat, and light. The graphene monolayer paper has potential in artificial muscles, robotic hands, and electromagnetic-free generators.

KSC-07pd1222

NASA Image and Video Library

2007-05-16

KENNEDY SPACE CENTER, FLA. -- In the Payload Hazardous Servicing Facility, the Phoenix spacecraft undergoes a heat shield deployment test, with a firing of ordnance associated with the separation device. Phoenix will land in icy soils near the north polar permanent ice cap of Mars and explore the history of the water in these soils and any associated rocks, while monitoring polar climate. Landing is planned in May 2008 on arctic ground where a mission currently in orbit, Mars Odyssey, has detected high concentrations of ice just beneath the top layer of soil. Launch of Phoenix aboard a Delta II rocket is targeted for Aug. 3 from Cape Canaveral Air Force Station in Florida. Photo credit: NASA/George Shelton

Design and construction of a tensile tester for the testing of simple composites

NASA Technical Reports Server (NTRS)

Borst, Mark A.; Spiegel, F. Xavier

1994-01-01

The following is a design for a tensile tester which will be used to test the tensile strength and anisotropic properties of simple composites. These simple composites are suspected to be anisotropic primarily in a single plane. When the composites undergo a tensile force, they will undergo deformation, causing movement either to the left or right. The composites are suspect due to their method of construction. Each sample has a single layer of unidirectional continuous fibers embedded in a rubbery resin. It has been well established that a serious limitation of unidirectional fiber composites is the very large in-plane anisotropy. The design presented here incorporates a single degree of freedom such that distortion (to the left or right) due to anisotropic tendencies may be measured. The device will spend the vast majority of its time in an undergraduate materials lab. As a result, ease of use and durability are valued more highly than research grade accuracy. Additional concerns focus on the fact that this machine will be built as a student project. Issues which are dealt with during this design include: specimen configuration or shape; a method of applying consistent, linear tension force; a method of gripping specimen without affecting its overall properties; a method of collecting data; repeatability of data; ease of use; ease of construction; and cost. After the device has been constructed, it will be used to test the simple composites which were fabricated in house. A comparison will be made between composites manufactured using aluminum screening as the strengthening fibers and those manufactured using fiberglass screening.

A study of medical device regulation management model in Asia.

PubMed

Wu, Yi-Hui; Li, Fong-An; Fan, Yin-Ting; Tu, Pei-Weng

2016-06-01

With the aging of the post-war baby boomer generation, the increasing demands for healthcare are driving the growth of medical industry and development of new products in order to meet the immense needs from the aging population. However, medical devices are designed to maintain the health and safety of people, therefore, medical devices are undergoing rigorous management by competent health authorities in all countries. In recent years, Asian countries have been reforming their regulations and standards for medical devices with substantial changes. The study is a summary of the framework of medical device regulations in Asian countries, including Asian Harmonization Working Party (AHWP), Japan, China, Taiwan, South Korea, India and Singapore. Expert commentary: Asian countries are constantly reforming their medical device regulations. The emergence of brand-new technology and quality management issues arose by global manufacturing have imposed difficulties in harmonizing and reaching consensus between countries. The third-party conformity assessment system for medical devices can reduce the costs for competent health authorities and shorten the review time, which could facilitate the feasibility of harmonization of medical device regulations.

Assessment of Safety and Interference Issues of Radio Frequency Identification Devices in 0.3 Tesla Magnetic Resonance Imaging and Computed Tomography

PubMed Central

Periyasamy, M.; Dhanasekaran, R.

2014-01-01

The objective of this study was to evaluate two issues regarding magnetic resonance imaging (MRI) including device functionality and image artifacts for the presence of radio frequency identification devices (RFID) in association with 0.3 Tesla at 12.7 MHz MRI and computed tomography (CT) scanning. Fifteen samples of RFID tags with two different sizes (wristband and ID card types) were tested. The tags were exposed to several MR-imaging conditions during MRI examination and X-rays of CT scan. Throughout the test, the tags were oriented in three different directions (axial, coronal, and sagittal) relative to MRI system in order to cover all possible situations with respect to the patient undergoing MRI and CT scanning, wearing a RFID tag on wrist. We observed that the tags did not sustain physical damage with their functionality remaining unaffected even after MRI and CT scanning, and there was no alternation in previously stored data as well. In addition, no evidence of either signal loss or artifact was seen in the acquired MR and CT images. Therefore, we can conclude that the use of this passive RFID tag is safe for a patient undergoing MRI at 0.3 T/12.7 MHz and CT Scanning. PMID:24701187

An electronic circuit for sensing malfunctions in test instrumentation

NASA Technical Reports Server (NTRS)

Miller, W. M., Jr.

1969-01-01

Monitoring device differentiates between malfunctions occurring in the system undergoing test and malfunctions within the test instrumentation itself. Electronic circuits in the monitor use transistors to commutate silicon controlled rectifiers by removing the drive voltage, display circuits are then used to monitor multiple discrete lines.

Agile patency system eliminates risk of capsule retention in patients with known intestinal strictures who undergo capsule endoscopy.

PubMed

Herrerias, Juan M; Leighton, Jonathan A; Costamagna, Guido; Infantolino, Anthony; Eliakim, Rami; Fischer, Doron; Rubin, David T; Manten, Howard D; Scapa, Eitan; Morgan, Douglas R; Bergwerk, Ari J; Koslowsky, Binyamin; Adler, Samuel N

2008-05-01

Capsule endoscopy (CE) of the small bowel has become a standard diagnostic tool, but there have been concerns regarding the risk of capsule retention in certain high-risk groups. The Agile patency system, an ingestible and dissolvable capsule with an external scanner, was developed to allow physicians to perform CE with greater confidence that the capsule will be safely excreted in patients at risk for capsule retention. Our purpose was to assess the ability of the device to help physicians identify which patients with known strictures may safely undergo CE. Patients with known strictures ingested the new patency capsule and underwent periodic scanning until it was excreted. The intestinal tract was considered to be sufficiently patent if the capsule was excreted intact or if the capsule was not detected by the scanner at 30 hours after ingestion. If patency was established, then standard CE was performed. International multicenter study. A total of 106 patients with known strictures. Agile patency system. Performance and safety of Agile patency system. A total of 106 patients ingested the patency capsule. Fifty-nine (56%) excreted it intact and subsequently underwent CE. There were no cases of capsule retention. Significant findings on CE were found in 24 (41%). There were 3 severe adverse events. These results suggest that the Agile patency system is a useful tool for physicians to use before CE in patients with strictures to avoid retention. This group of patients may have a high yield of clinically significant findings at CE. This capsule may determine whether patients who have a contraindication to CE may safely undergo CE and obtain useful diagnostic information.

Ubiquitous Nature of Distal Athero/Thromboembolic Events during Lower Extremity Atherectomy Procedures Involving the Superficial Femoral Artery

PubMed Central

Wasty, Najam; Khakwani, M. Z.; Kotev, Spas; Boiangiu, Catalin; Hasan, Omar; Anna, Manjusha; Tayal, Rajiv; Kaid, Khalil; Baker, Gail; Cohen, Marc

2016-01-01

This study aims to evaluate occurrence, size, composition, and clinical significance of embolized debris during superficial femoral artery atherectomy using all commercially available atherectomy devices. Distal athero/thromboembolic events (DATE) are a universal phenomenon in lower extremity atherectomy procedures (LEAPs) due to the sheer volume of atheroma and the thrombus burden in peripheral arterial disease. Some of these events can be clinically significant. We prospectively gathered clinical and histopathological data on all commercially available atherectomy devices by using embolic protection devices (EPD) in every case. After intervention, the contents of EPD were examined both microscopically and macroscopically. Data from 59 consecutive patients undergoing LEAP were analyzed. DATE occurred 100% of the time. The composition of particulate debris varied with the device used. Grossly visible agglomerated debris was captured by the filter in the majority of patients 54/59 (91.5%). Clinically significant debris, defined by the Preventing Lower Extremity Distal Embolization Using Embolic Filter Protection registry as particle diameter > 0.2 cm, was found in 33/59 (56%) patients. The size of captured debris particles ranged from 0.1 to 2.4 mm. While DATE occurred in all patients, clinically significant DATE occurred in 56% patients undergoing LEAP regardless of the atherectomy device. In spite of a large fraction of the clinically significant debris occurring on our routine dual antiplatelet regimen, no patient suffered an amputation. Although DATE was prevented by the use of EPD in all 59 cases, more data are needed to determine whether the use of EPD translates into a long-term clinical benefit. Use of EPD and optimal thromboprophylaxis should be considered in patients, especially in the setting of compromised distal runoff. PMID:27867291

What are estimated reimbursements for lower extremity prostheses capable of surgical and nonsurgical lengthening?

PubMed

Henderson, Eric R; Pepper, Andrew M; Letson, G Douglas

2012-04-01

Growing prostheses accommodate skeletally immature patients with bone tumors undergoing limb-preserving surgery. Early devices required surgical procedures for lengthening; recent devices lengthen without surgery. Expenses for newer expandable devices that lengthen without surgery are more than for their predecessors but overall reimbursement amounts are not known. We sought to determine reimbursement amounts associated with lengthening of growing prostheses requiring surgical and nonsurgical lengthening. We retrospectively reviewed 17 patients with growing prostheses requiring surgical expansion and eight patients with prostheses capable of nonsurgical expansion. Insurance documents were reviewed to determine the reimbursement for implantation, lengthening, and complications. Growth data were obtained from the literature. Mean reimbursement amounts of surgical and nonsurgical lengthenings were $9950 and $272, respectively. Estimated reimbursements associated with implantation of a growing prosthesis varied depending on age, sex, and location. The largest difference was found for 4-year-old boys with distal femoral replacement where reimbursement for expansion to maturity for surgical and nonsurgical lengthening prostheses would be $379,000 and $208,000, respectively. For children requiring more than one surgical expansion, net reimbursements were lower when a noninvasive lengthening device was used. Annual per-prosthesis maintenance reimbursements to address complications for surgical and nonsurgical lengthening prostheses were $3386 and $1856, respectively. This study showed that reimbursements for lengthening of growing endoprostheses capable of nonsurgical expansion may be less expensive in younger patients, particularly male patients undergoing distal femur replacement, than endoprostheses requiring surgical lengthening. Longer outcomes studies are required to see if reimbursements for complications differ between devices. Level III, economic and decision analysis. See the Guidelines for Authors for a complete description of levels of evidence.

Microdialysis Sampling Techniques Applied to Studies of the Foreign Body Reaction

PubMed Central

Sides, Cynthia R.; Stenken, Julie A.

2014-01-01

Implanted materials including drug delivery devices and chemical sensors undergo what is termed the foreign body reaction (FBR). Depending on the device and its intended application, the FBR can have differing consequences. An extensive scientific research effort has been devoted to elucidating the cellular and molecular mechanisms that drive the FBR. Important, yet relatively unexplored, research includes the localized tissue biochemistry and the chemical signaling events that occur throughout the FBR. This review provides an overview of the mechanisms of the FBR, describes how the FBR affects different implanted devices, and illustrates the role that microdialysis sampling can play in further elucidating the chemical communication processes that drive FBR outcomes. PMID:24269987

Simulation of photons from plasmas for the applications to display devices

NASA Astrophysics Data System (ADS)

Lee, Hae June; Yoon, Hyun Jin; Lee, Jae Koo

2007-07-01

Numerical modeling of the photon transport of the ultraviolet (UV) and the visible lights are presented for plasma based display devices. The transport of UV lights which undergo resonance trapping by ground state atoms is solved by using the Holstein equation. After the UV lights are transformed to visible lights at the phosphor surfaces, the visible lights experience complicated traces inside the cell and finally are emitted toward the viewing window after having some power loss within the cell. A three-dimensional ray trace of the visible lights is calculated with a radiosity model. These simulations for the photons strengthen plasma discharge modeling for the application to display devices.

Management of long-term and reversible hysteroscopic sterilization: a novel device with nickel-titanium shape memory alloy

PubMed Central

2014-01-01

Background Female sterilization is the second most commonly used method of contraception in the United States. Female sterilization can now be performed through laparoscopic, abdominal, or hysteroscopic approaches. The hysteroscopic sterilization may be a safer option than sterilization through laparoscopy or laparotomy because it avoids invading the abdominal cavity and undergoing general anaesthesia. Hysteroscopic sterilization mainly includes chemical agents and mechanical devices. Common issues related to the toxicity of the chemical agents used have raised concerns regarding this kind of contraception. The difficulty of the transcervical insertion of such mechanical devices into the fallopian tubes has increased the high incidence of device displacement or dislodgment. At present, Essure® is the only commercially available hysteroscopic sterilization device being used clinically. The system is irreversible and is not effective immediately. Presentation of the hypothesis Our new hysteroscopic sterility system consists of nickel-titanium (NiTi) shape memory alloy and a waterproof membrane. The NiTi alloy is covered with two coatings to avoid toxic Ni release and to prevent stimulation of epithelial tissue growth around the oviducts. Because of the shape memory effect of the NiTi alloy, the device works like an umbrella: it stays collapsed at low temperature before placement and opens by the force of shape memory activated by the body temperature after it is inserted hysteroscopically into the interstitial tubal lumen. The rim of the open device will incise into interstitial myometrium during the process of unfolding. Once the device is fixed, it blocks the tube completely. When the patient no longer wishes for sterilization, the device can be closed by perfusing liquid with low temperature into the uterine cavity, followed by prospective hysteroscopic removal. After the device removal, the fallopian tube will revert to its physiological functions. Testing the hypothesis Currently, experimental and clinical studies are needed to attest the safety, efficiency and reversibility of the novel sterilization device. Implications of the hypothesis If our hypothesis is confirmed, appropriate and reversible contraceptive can be achieved with the device we have designed, which may have significant repercussions for numerous women worldwide. PMID:24999021

Recent Advances in the Synthesis and Biomedical Applications of Nanocomposite Hydrogels

PubMed Central

Spizzirri, Umile Gianfranco; Curcio, Manuela; Cirillo, Giuseppe; Spataro, Tania; Vittorio, Orazio; Picci, Nevio; Hampel, Silke; Iemma, Francesca; Nicoletta, Fiore Pasquale

2015-01-01

Hydrogels sensitive to electric current are usually made of polyelectrolytes and undergo erosion, swelling, de-swelling or bending in the presence of an applied electric field. The electrical conductivity of many polymeric materials used for the fabrication of biomedical devices is not high enough to achieve an effective modulation of the functional properties, and thus, the incorporation of conducting materials (e.g., carbon nanotubes and nanographene oxide) was proposed as a valuable approach to overcome this limitation. By coupling the biological and chemical features of both natural and synthetic polymers with the favourable properties of carbon nanostructures (e.g., cellular uptake, electromagnetic and magnetic behaviour), it is possible to produce highly versatile and effective nanocomposite materials. In the present review, the recent advances in the synthesis and biomedical applications of electro-responsive nanocomposite hydrogels are discussed. PMID:26473915

Recent Advances in the Synthesis and Biomedical Applications of Nanocomposite Hydrogels.

PubMed

Spizzirri, Umile Gianfranco; Curcio, Manuela; Cirillo, Giuseppe; Spataro, Tania; Vittorio, Orazio; Picci, Nevio; Hampel, Silke; Iemma, Francesca; Nicoletta, Fiore Pasquale

2015-10-13

Hydrogels sensitive to electric current are usually made of polyelectrolytes and undergo erosion, swelling, de-swelling or bending in the presence of an applied electric field. The electrical conductivity of many polymeric materials used for the fabrication of biomedical devices is not high enough to achieve an effective modulation of the functional properties, and thus, the incorporation of conducting materials (e.g., carbon nanotubes and nanographene oxide) was proposed as a valuable approach to overcome this limitation. By coupling the biological and chemical features of both natural and synthetic polymers with the favourable properties of carbon nanostructures (e.g., cellular uptake, electromagnetic and magnetic behaviour), it is possible to produce highly versatile and effective nanocomposite materials. In the present review, the recent advances in the synthesis and biomedical applications of electro-responsive nanocomposite hydrogels are discussed.

First-in-man experience with the ReVive PV peripheral thrombectomy device for the revascularization of below-the-knee embolic occlusions.

PubMed

Landau, David; Moomey, Charles; Fiorella, David

2014-10-01

To report the initial use of a novel thrombectomy device for revascularization of below-the-knee thromboembolic occlusions encountered during proximal revascularization procedures. The ReVive PV Peripheral Thrombectomy Device is a non-detachable, self-expanding stent-like device recently approved for peripheral thrombectomy. Four patients (3 women; mean age 68.8 years) undergoing proximal revascularization procedures experienced embolic occlusions of all 3 trifurcation vessels in 1 patient, the tibioperoneal trunk alone in 2 cases, and the peroneal artery alone in the last patient. In all cases, the involved arteries represented the primary or sole vessel(s) providing outflow to the lower extremity. In each case, the ReVive PV device was used to successfully extract the thrombus and restore flow to the distal extremity. No complications were encountered during any of the procedures. The ReVive PV peripheral thrombectomy device may facilitate the safe and efficient revascularization of distal arterial embolic occlusions.

"Should We Make a Start Then?": A Strange Case of (Delayed) Client-Initiated Psychological Assessment.

ERIC Educational Resources Information Center

McHoul, Alec; Rapley, Mark

2002-01-01

Subjects Sack's (1992) conjecture about there being "omni-relevant devices" in specific kinds of conversation to empirical analysis. Examines a data fragment taken from a corpus of materials in which "resettled" mental patients are undergoing "quality of life assessments." (Author/VWL)

AN EXPERIMENTAL ASSESSMENT OF A GROUND PILOT TRAINER IN GENERAL AVIATION.

ERIC Educational Resources Information Center

PHILLIPS, C.R., JR.

EXPERIMENTAL FLIGHT TRAINING WAS CONDUCTED IN CONJUNCTION WITH A COMMERCIAL MODEL GROUND TRAINER TO DETERMINE ITS EFFECTIVENESS IN CONTRIBUTING TO THE PROFICIENCY LEVEL USUALLY OBTAINED BY STUDENTS UNDERGOING A RIGIDLY CONTROLLED FLIGHT SYLLABUS WITHOUT USE OF SYNTHETIC TRAINING DEVICES. DIFFERENTIAL LEVELS OF TRAINING WITH THE GROUND TRAINERS…

14 CFR 60.16 - Additional qualifications for a currently qualified FSTD.

Code of Federal Regulations, 2010 CFR

2010-01-01

... TRANSPORTATION (CONTINUED) AIRMEN FLIGHT SIMULATION TRAINING DEVICE INITIAL AND CONTINUING QUALIFICATION AND USE... required to undergo an additional qualification process if a user intends to use the FSTD for meeting... that FSTD. This process consists of the following: (1) The sponsor: (i) Must submit to the NSPM all...

40 CFR 60.57c - Monitoring requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 60.57c Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED... date, time, and duration. (d) The owner or operator of an affected facility using an air pollution... § 60.52c undergoes an initial air pollution control device inspection that is at least as protective as...

Efficacy of vibration on venipuncture pain scores in a pediatric emergency department.

PubMed

Secil, Aydinoz; Fatih, Celikel; Gokhan, Aydemir; Alpaslan, Genc Fatih; Gonul, Sezer Rabia

2014-10-01

Venipuncture is a frequent source of painful procedures for infants. It has been well documented that infants react to pain with a combination of physiologic and behavioral responses. Infants are unable to describe pain and at particularly high risk for inadequate pain management. The Vibration Anesthesia Device is a specifically designed device for management of pain from minor procedures. It has been shown to reduce venipuncture pain in older children but has not been studied in infants. The mechanism of its effects has been described by a gate control theory, which states that vibration stimulates the dorsal horn neurons where the pain signal is being modulated. The objective of this study was to investigate the efficacy of this device on pain during and after venipuncture procedures in infants. Study participants were 60 healthy infants undergoing venipuncture procedure for routine laboratory tests. Infants were divided into 2 groups as follows: group 1 (n = 30) was placed vibration anesthesia device 5 to 10 cm proximally through the site of venipuncture, and group 2 (n = 30) underwent venipuncture only. A single observer rated pain responses using the Face, Legs, Activity, Cry, and Consolability scale before, during, and after the procedure. The χ distribution and Student t test were used for statistical analysis. Groups did not differ by sex. Mean age of group 2 is less than group 1 and is statistically significant (P = 0.026). There were no differences between pain scores of groups assessed by Face, Legs, Activity, Cry, and Consolability scale before, during, and after venipuncture procedure (P = 0.359, P = 0.907, and P = 0.400 respectively). We assessed the efficacy of a vibration anesthesia device, and our results suggested that this device did not reduce pain scores in infants during and after venipuncture procedure.

Management of severe ischemic cardiomyopathy: left ventricular assist device as destination therapy versus conventional bypass and mitral valve surgery.

PubMed

Maltais, Simon; Tchantchaleishvili, Vahtang; Schaff, Hartzell V; Daly, Richard C; Suri, Rakesh M; Dearani, Joseph A; Topilsky, Yan; Stulak, John M; Joyce, Lyle D; Park, Soon J

2014-04-01

Patients with severe ischemic cardiomyopathy (left ventricular ejection fraction <25%) and severe ischemic mitral regurgitation have a poor survival with medical therapy alone. Left ventricular assist device as destination therapy is reserved for patients who are too high risk for conventional surgery. We evaluated our outcomes with conventional surgery within this population and the comparative effectiveness of these 2 therapies. We identified patients who underwent conventional surgery or left ventricular assist device as destination therapy for severe ischemic cardiomyopathy (left ventricular ejection fraction <25%) and severe mitral regurgitation. The era for conventional surgery spanned from 1993 to 2009 and from 2007 to 2011 for left ventricular assist device as destination therapy. We compared baseline patient characteristics and outcomes in terms of end-organ function and survival. A total of 88 patients were identified; 55 patients underwent conventional surgery (63%), and 33 patients (37%) received a left ventricular assist device as destination therapy. Patients who received left ventricular assist device as destination therapy had the increased prevalence of renal failure, inotrope dependency, and intra-aortic balloon support. Patients undergoing conventional surgery required longer ventilatory support, and patients receiving a left ventricular assist device required more reoperation for bleeding. Mortality rates were similar between the 2 groups at 30 days (7% in the conventional surgery group vs 3% in the left ventricular assist device as destination therapy group, P = .65) and at 1 year (22% in the conventional surgery group vs 15% in the left ventricular assist device as destination therapy group, P = .58). There was a trend toward improved survival in patients receiving a left ventricular assist device compared with the propensity-matched groups at 1 year (94% vs 71%, P = .171). The operative mortality and early survival after conventional surgery seem to be acceptable. For inoperable or prohibitive-risk patients, left ventricular assist device as destination therapy can be offered with similar outcomes. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Safety syringes and anti-needlestick devices in orthopaedic surgery.

PubMed

Sibbitt, Wilmer L; Band, Philip A; Kettwich, Lawrence G; Sibbitt, Cristina R; Sibbitt, Lori J; Bankhurst, Arthur D

2011-09-07

The American Academy of Orthopaedic Surgery (AAOS), The Joint Commission, the Occupational Safety and Health Administration (OSHA), and the Needlestick Safety and Prevention Act encourage the integration of safety-engineered devices to prevent needlestick injuries to health-care workers and patients. We hypothesized that safety syringes and needles could be used in outpatient orthopaedic injection and aspiration procedures. The study investigated the orthopaedic uses and procedural idiosyncrasies of safety-engineered devices, including (1) four safety needles (Eclipse, SafetyGlide, SurGuard, and Magellan), (2) a mechanical safety syringe (RPD), (3) two automatic retractable syringes (Integra, VanishPoint), (4) three manual retractable syringes (Procedur-SF, Baksnap, Invirosnap), and (5) three shielded syringes (Safety-Lok, Monoject, and Digitally Activated Shielded [DAS] Syringe). The devices were first tested ex vivo, and then 1300 devices were used for 425 subjects undergoing outpatient arthrocentesis, intra-articular injections, local anesthesia, aspiration biopsy, and ultrasound-guided procedures. During the clinical observation, there were no accidental needlesticks (0 needlesticks per 1300 devices). Safety needles could be successfully used on a Luer syringe but were limited to ≤1.5 in (≤3.81 cm) in length and the shield could interfere with sonography. The mechanical safety syringes functioned well in all orthopaedic procedures. Automatic retractable syringes were too small for arthrocentesis of the knee, and the plunger blew out and prematurely collapsed with high-pressure injections. The manual retractable syringes and shielded syringes could be used with conventional needles for most orthopaedic procedures. The most effective and reliable safety devices for orthopaedic syringe procedures are shielded safety needles, mechanical syringes, manual retractable syringes, and shielded syringes, but not automatic retractable syringes. Even when adopting safety-engineered devices for an orthopaedic clinic, conventional syringes larger than 20 mL and conventional needles longer than 1.5 in (3.8 cm) are necessary.

Molecular solar thermal energy storage in photoswitch oligomers increases energy densities and storage times.

PubMed

Mansø, Mads; Petersen, Anne Ugleholdt; Wang, Zhihang; Erhart, Paul; Nielsen, Mogens Brøndsted; Moth-Poulsen, Kasper

2018-05-16

Molecular photoswitches can be used for solar thermal energy storage by photoisomerization into high-energy, meta-stable isomers; we present a molecular design strategy leading to photoswitches with high energy densities and long storage times. High measured energy densities of up to 559 kJ kg -1 (155 Wh kg -1 ), long storage lifetimes up to 48.5 days, and high quantum yields of conversion of up to 94% per subunit are demonstrated in norbornadiene/quadricyclane (NBD/QC) photo-/thermoswitch couples incorporated into dimeric and trimeric structures. By changing the linker unit between the NBD units, we can at the same time fine-tune light-harvesting and energy densities of the dimers and trimers so that they exceed those of their monomeric analogs. These new oligomers thereby meet several of the criteria to be met for an optimum molecule to ultimately enter actual devices being able to undergo closed cycles of solar light-harvesting, energy storage, and heat release.

Electroconvulsive therapy for depression in a patient with an Inspire hypoglossal nerve stimulator device for obstructive sleep apnea: A case report.

PubMed

Mingo, Katie; Kominsky, Alan

2018-04-19

METHODS: This is a case report of a patient who underwent placement and initiation of a hypoglossal nerve stimulator device in the context of receiving electroconvulsive therapy for bipolar depression between February and September 2016. To our knowledge, this has not yet been reported in the literature. Outcome measurements included successful device activation and successful device use throughout electroconvulsive therapy. The patient underwent successful device implantation, activation, and use without disruption throughout electroconvulsive therapy sessions. No special device deactivation was required during electroconvulsive therapy sessions. Obstructive sleep apnea is a common disorder that causes significant reduction in quality of life and is an independent risk factor for multiple comorbidities. Electroconvulsive therapy is an established treatment for medication-refractory depression with minimal risk in most patient populations. This is the first report in the literature of a patient undergoing ECT for bipolar depression with recent activation of Inspire hypoglossal nerve stimulator who had no disruption in the function of his implanted device. Copyright © 2018. Published by Elsevier Inc.

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

PubMed Central

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

2018-01-01

Background Clinical guidelines recommend monitoring of blood pressure at home using an automatic blood pressure device for the management of hypertension. Devices are not often calibrated against direct blood pressure measures, leaving health care providers and patients with less reliable information than is possible with current technology. Rigorous assessments of medical devices are necessary for establishing clinical utility. Objective The purpose of our study was 2-fold: (1) to assess the validity and perform iterative calibration of indirect blood pressure measurements by a noninvasive wrist cuff blood pressure device in direct comparison with simultaneously recorded peripheral and central intra-arterial blood pressure measurements and (2) to assess the validity of the measurements thereafter of the noninvasive wrist cuff blood pressure device in comparison with measurements by a noninvasive upper arm blood pressure device to the Canadian hypertension guidelines. Methods The cloud-based blood pressure algorithms for an oscillometric wrist cuff device were iteratively calibrated to direct pressure measures in 20 consented patient participants. We then assessed measurement validity of the device, using Bland-Altman analysis during routine cardiovascular catheterization. Results The precalibrated absolute mean difference between direct intra-arterial to wrist cuff pressure measurements were 10.8 (SD 9.7) for systolic and 16.1 (SD 6.3) for diastolic. The postcalibrated absolute mean difference was 7.2 (SD 5.1) for systolic and 4.3 (SD 3.3) for diastolic pressures. This is an improvement in accuracy of 33% systolic and 73% diastolic with a 48% reduction in the variability for both measures. Furthermore, the wrist cuff device demonstrated similar sensitivity in measuring high blood pressure compared with the direct intra-arterial method. The device, when calibrated to direct aortic pressures, demonstrated the potential to reduce a treatment gap in high blood pressure measurements. Conclusions The systolic pressure measurements of the wrist cuff have been iteratively calibrated using gold standard central (ascending aortic) pressure. This improves the accuracy of the indirect measures and potentially reduces the treatment gap. Devices that undergo auscultatory (indirect) calibration for licensing can be greatly improved by additional iterative calibration via intra-arterial (direct) measures of blood pressure. Further clinical trials with repeated use of the device over time are needed to assess the reliability of the device in accordance with current and evolving guidelines for informed decision making in the management of hypertension. Trial Registration ClinicalTrials.gov NCT03015363; https://clinicaltrials.gov/ct2/show/NCT03015363 (Archived by WebCite at http://www.webcitation.org/6xPZgseYS) PMID:29695375

A novel non-imaging optics based Raman spectroscopy device for transdermal blood analyte measurement

PubMed Central

Kong, Chae-Ryon; Barman, Ishan; Dingari, Narahara Chari; Kang, Jeon Woong; Galindo, Luis; Dasari, Ramachandra R.; Feld, Michael S.

2011-01-01

Due to its high chemical specificity, Raman spectroscopy has been considered to be a promising technique for non-invasive disease diagnosis. However, during Raman excitation, less than one out of a million photons undergo spontaneous Raman scattering and such weakness in Raman scattered light often require highly efficient collection of Raman scattered light for the analysis of biological tissues. We present a novel non-imaging optics based portable Raman spectroscopy instrument designed for enhanced light collection. While the instrument was demonstrated on transdermal blood glucose measurement, it can also be used for detection of other clinically relevant blood analytes such as creatinine, urea and cholesterol, as well as other tissue diagnosis applications. For enhanced light collection, a non-imaging optical element called compound hyperbolic concentrator (CHC) converts the wide angular range of scattered photons (numerical aperture (NA) of 1.0) from the tissue into a limited range of angles accommodated by the acceptance angles of the collection system (e.g., an optical fiber with NA of 0.22). A CHC enables collimation of scattered light directions to within extremely narrow range of angles while also maintaining practical physical dimensions. Such a design allows for the development of a very efficient and compact spectroscopy system for analyzing highly scattering biological tissues. Using the CHC-based portable Raman instrument in a clinical research setting, we demonstrate successful transdermal blood glucose predictions in human subjects undergoing oral glucose tolerance tests. PMID:22125761

Comprehensive electrocardiogram-to-device time for primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: A report from the American Heart Association mission: Lifeline program.

PubMed

Shavadia, Jay S; French, William; Hellkamp, Anne S; Thomas, Laine; Bates, Eric R; Manoukian, Steven V; Kontos, Michael C; Suter, Robert; Henry, Timothy D; Dauerman, Harold L; Roe, Matthew T

2018-03-01

Assessing hospital-related network-level primary percutaneous coronary intervention (PCI) performance for ST-segment elevation myocardial infarction (STEMI) is challenging due to differential time-to-treatment metrics based on location of diagnostic electrocardiogram (ECG) for STEMI. STEMI patients undergoing primary PCI at 588 PCI-capable hospitals in AHA Mission: Lifeline (2008-2013) were categorized by initial STEMI identification location: PCI-capable hospitals (Group 1); pre-hospital setting (Group 2); and non-PCI-capable hospitals (Group 3). Patient-specific time-to-treatment categories were converted to minutes ahead of or behind their group-specific mean; average time-to-treatment difference for all patients at a given hospital was termed comprehensive ECG-to-device time. Hospitals were then stratified into tertiles based on their comprehensive ECG-to-device times with negative values below the mean representing shorter (faster) time intervals. Of 117,857 patients, the proportion in Groups 1, 2, and 3 were 42%, 33%, and 25%, respectively. Lower rates of heart failure and cardiac arrest at presentation are noted within patients presenting to high-performing hospitals. Median comprehensive ECG-to-device time was shortest at -9 minutes (25th, 75th percentiles: -13, -6) for the high-performing hospital tertile, 1 minute (-1, 3) for middle-performing, and 11 minutes (7, 16) for low-performing. Unadjusted rates of in-hospital mortality were 2.3%, 2.6%, and 2.7%, respectively, but the adjusted risk of in-hospital mortality was similar across tertiles. Comprehensive ECG-to-device time provides an integrated hospital-related network-level assessment of reperfusion timing metrics for primary PCI, regardless of the location for STEMI identification; further validation will delineate how this metric can be used to facilitate STEMI care improvements. Copyright © 2017 Elsevier Inc. All rights reserved.

Rapid Transition of the Hole Rashba Effect from Strong Field Dependence to Saturation in Semiconductor Nanowires.

PubMed

Luo, Jun-Wei; Li, Shu-Shen; Zunger, Alex

2017-09-22

The electric field manipulation of the Rashba spin-orbit coupling effects provides a route to electrically control spins, constituting the foundation of the field of semiconductor spintronics. In general, the strength of the Rashba effects depends linearly on the applied electric field and is significant only for heavy-atom materials with large intrinsic spin-orbit interaction under high electric fields. Here, we illustrate in 1D semiconductor nanowires an anomalous field dependence of the hole (but not electron) Rashba effect (HRE). (i) At low fields, the strength of the HRE exhibits a steep increase with the field so that even low fields can be used for device switching. (ii) At higher fields, the HRE undergoes a rapid transition to saturation with a giant strength even for light-atom materials such as Si (exceeding 100 meV Å). (iii) The nanowire-size dependence of the saturation HRE is rather weak for light-atom Si, so size fluctuations would have a limited effect; this is a key requirement for scalability of Rashba-field-based spintronic devices. These three features offer Si nanowires as a promising platform for the realization of scalable complementary metal-oxide-semiconductor compatible spintronic devices.

Gravity Effects in Microgap Flow Boiling

NASA Technical Reports Server (NTRS)

Robinson, Franklin; Bar-Cohen, Avram

2017-01-01

Increasing integration density of electronic components has exacerbated the thermal management challenges facing electronic system developers. The high power, heat flux, and volumetric heat generation of emerging devices are driving the transition from remote cooling, which relies on conduction and spreading, to embedded cooling, which facilitates direct contact between the heat-generating device and coolant flow. Microgap coolers employ the forced flow of dielectric fluids undergoing phase change in a heated channel between devices. While two phase microcoolers are used routinely in ground-based systems, the lack of acceptable models and correlations for microgravity operation has limited their use for spacecraft thermal management. Previous research has revealed that gravitational acceleration plays a diminishing role as the channel diameter shrinks, but there is considerable variation among the proposed gravity-insensitive channel dimensions and minimal research on rectangular ducts. Reliable criteria for achieving gravity-insensitive flow boiling performance would enable spaceflight systems to exploit this powerful thermal management technique and reduce development time and costs through reliance on ground-based testing. In the present effort, the authors have studied the effect of evaporator orientation on flow boiling performance of HFE7100 in a 218 m tall by 13.0 mm wide microgap cooler. Similar heat transfer coefficients and critical heat flux were achieved across five evaporator orientations, indicating that the effect of gravity was negligible.

Results of a randomized trial of HERMES-assisted versus non-HERMES-assisted laparoscopic antireflux surgery.

PubMed

Luketich, J D; Fernando, H C; Buenaventura, P O; Christie, N A; Grondin, S C; Schauer, P R

2002-09-01

Speech recognition technology is a recent development in minimally invasive surgery. This study was designed to assess the impact of HERMES on operating room efficiency and user satisfaction. Patients undergoing laparoscopic antireflux operations by surgeons experienced in minimally invasive surgery were randomized to HERMES-assisted or standard laparoscopic operations. The variables of interest were circulating nurse's time spent adjusting devices that are voice-controlled by HERMES, number of adjustments to devices requested, and surgeon and nurse satisfaction measured on a scale from 1 (dissatisfied) to 10 (satisfied). A total of 30 cases were studied. In the non-HERMES cases, nurses were interrupted to make device adjustments an average of 15.3 times per case versus 0.33 times per case in the with-HERMES cases (p < 0.01). The interruptions during the non-HERMES cases averaged 4.35 min per case versus 0.16 min per case in the with-HERMES cases (p = 0.03). Average satisfaction scores for HERMES operations as opposed to non-HERMES operations were 9.2 versus 5.3 for nurses (p < 0.01) and 9.0 versus 5.1 for surgeons (p < 0.01). Physician and nurse acceptance of HERMES was very high because of the smoother interruption-free environment.

[Restrictions for ICD patients in daily life].

PubMed

Köbe, Julia; Gradaus, Rainer; Zumhagen, Sven; Böcker, Dirk

2005-11-01

Patients with an implantable cardioverter defibrillator (ICD) may experience loss of consciousness. Electromagnetic interference (EMI) may trigger undesired or inhibit necessary therapy in patients with an ICD. Therefore, questions about personal or professional activities for ICD patients arise. Restricting driving or other personal activities has adverse effects on the patient's quality of life. The national Societies of Cardiology provide recommendations for ICD patients concerning driving of motor vehicles. Patients with an ICD that is implanted prophylactically do not have to refrain from driving after recovery from the implantation procedure. Patients with arrhythmias are classified into different groups depending on the risk of recurrence of tachycardias and symptoms. Commercial driving is not allowed for patients with an ICD in Germany except for those with a prophylactic indication without a history of arrhythmias. Those patients may drive small cars but no trucks or busses. Guidelines for medical fitness in commercial or military flying are regulated by the Joint Aviation Authorities (JAA) and ventricular tachycardias are a contraindication for both. Fortunately, loss of consciousness is not dangerous in most jobs. Strong sources of EMI can occur at special workplaces. Patients have to be advised and tested individually concerning their risk for EMI at their employment site before returning safely. Modern life exposes to an increasing amount of EMI. Intact household devices usually do not interfere with ICDs. Mobile phones may interfere with implanted devices. Interaction can be minimized by special precautions like maintaining a distance of minimum 10 cm between mobile phone and ICD. Electronic surveillance systems work differently and have the potential to interact with devices. Patients should be advised to pass those systems with avoiding longer exposure. The presence of an ICD is presently a contraindication for undergoing magnetic resonance imaging (MRI) because of a high risk of destruction of the system with even potential harm to the patient. High-frequency application for electrocautery devices or ablation is possible under certain precautions that have to be planned before. There is a high sensitivity of ICD systems to ionizing radiation with defect of the devices after a cumulative dose > 5 Gy.

Pulmonary function tests do not predict mortality in patients undergoing continuous-flow left ventricular assist device implantation.

PubMed

Bedzra, Edo K S; Dardas, Todd F; Cheng, Richard K; Pal, Jay D; Mahr, Claudius; Smith, Jason W; Shively, Kent; Masri, S Carolina; Levy, Wayne C; Mokadam, Nahush A

2017-12-01

To investigate the effect of pulmonary function testing on outcomes after continuous flow left ventricular assist device implantation. A total of 263 and 239 patients, respectively, had tests of forced expiratory volume in 1 second and diffusing capacity of the lungs for carbon monoxide preoperatively for left ventricular assist device implantations between July 2005 and September 2015. Kaplan-Meier analysis and multivariable Cox regressions were performed to evaluate mortality. Patients were analyzed in a single cohort and across 5 groups. Postoperative intensive care unit and hospital lengths of stay were evaluated with negative binomial regressions. There is no association of forced expiratory volume in 1 second and diffusing capacity of the lungs for carbon monoxide with survival and no difference in mortality at 1 and 3 years between the groups (log rank P = .841 and .713, respectively). Greater values in either parameter were associated with decreased hospital lengths of stay. Only diffusing capacity of the lungs for carbon monoxide was associated with increased intensive care unit length of stay in the group analysis (P = .001). Ventilator times, postoperative pneumonia, reintubation, and tracheostomy rates were similar across the groups. Forced expiratory volume in 1 second and diffusing capacity of the lungs for carbon monoxide are not associated with operative or long-term mortality in patients undergoing continuous flow left ventricular assist device implantation. These findings suggest that these abnormal pulmonary function tests alone should not preclude mechanical circulatory support candidacy. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Magnetic Resonance Imaging in Nondependent Pacemaker Patients with Pacemakers and Defibrillators with a Nearly Depleted Battery.

PubMed

Okamura, Hideo; Padmanabhan, Deepak; Watson, Robert E; Dalzell, Connie; Acker, Nancy; Jondal, Mary; Romme, Abby L; Cha, Yong-Mei; Asirvatham, Samuel J; Felmlee, Joel P; Friedman, Paul A

2017-05-01

Magnetic resonance imaging (MRI) in patients with non-MRI-conditional cardiac implantable electronic devices (CIEDs) has been shown to be safe when performed under closely monitored protocols. However, the safety of MRI in patients with devices with a nearly depleted battery has not been reported. Prospective data were collected between January 2008 and May 2015 in patients with non-MRI-conditional CIEDs undergoing clinically indicated MRI under institutional protocol. Patients who were pacemaker dependent were excluded. Patients whose devices were at elective replacement indicator (ERI) at the time of MRI or close to ERI (ERI or replacement for battery depletion within 3 months of scan) were identified through database review and analyzed for clinical events. MRI scans (n = 569) were performed in 442 patients. Of these, we identified 13 scans performed with a nearly depleted battery in nine patients. All scans with implantable cardioverter defibrillators (ICDs, n = 9) were uneventful. However, two scans with pacemakers close to ERI resulted in a power-on-reset (PoR) event. One scan with a pacemaker close to ERI that was programmed to DOO mode reached ERI during MRI and automatically changed to VVI mode. Additionally, one scan with a pacemaker at ERI did not allow programming. All pacemakers with events were implanted before 2005. Patients with pacemakers and ICDs with a nearly depleted battery can safely undergo MRI when patients are not pacemaker dependent. Attention should be paid because old devices can result in PoR or ERI during MRI, which may lead to oversensing and inhibition of pacing. © 2017 Wiley Periodicals, Inc.

Long-term central venous access device selection.

PubMed

Gabriel, Janice

Infusion therapy is often viewed as a means to an end - a way to administer medications and fluids. It is one of the few specialties that affect almost all areas of healthcare. Safe, effective and reliable vascular access should be the goal of every health professional who is starting a patient on a prescribed course of intravenous therapy, especially if that patient is undergoing a prolonged course. This article aims to refresh and update nurses' clinical knowledge of the detailed patient assessment required before choosing a central venous access device, as well as supporting a reduction in complications and earlier recognition of potential problems. It discusses clinical indications for devices, the range of long-term intravenous therapies that can be used, and patient assessment.

A Novel Nanoionics-Based Switch for Microwave Applications

NASA Technical Reports Server (NTRS)

Nessel, James A.; Lee, Richard Q.; Mueller, Carl H.; Kozicki, Michael N.; Ren, Minghan; Morse, Jacki

2008-01-01

This paper reports the development and characterization of a novel switching device for use in microwave systems. The device utilizes a switching mechanism based on nanoionics, in which mobile ions within a solid electrolyte undergo an electrochemical process to form and remove a conductive metallic "bridge" to define the change of state. The nanoionics-based switch has demonstrated an insertion loss of approx.0.5dB, isolation of >30dB, low voltage operation (1V), low power (approx. micro-W) and low energy (approx. nJ) consumption, and excellent linearity up to 6 GHz. The switch requires fewer bias operations (due to non-volatile nature) and has a simple planar geometry allowing for novel device structures and easy integration into microwave power distribution circuits.

Performance of a Water Recirculation Loop Maintenance Device and Process for the Advanced Spacesuit Water Membrane Evaporator

NASA Technical Reports Server (NTRS)

Steele, John W.; Rector, Tony; Bue, Grant C.; Campbell, Colin; Makinen, Janice

2013-01-01

A dual-bed device to maintain the water quality of the Advanced Spacesuit Water Membrane Evaporation (SWME) water recirculation loop has been designed and is undergoing testing. The SWME is a heat rejection device under development at the NASA Johnson Space Center to perform thermal control for advanced spacesuits. One advantage to this technology is the potential for a significantly greater degree of tolerance to contamination when compared to the existing Sublimator technology. The driver for the development of a water recirculation maintenance device is to further enhance this advantage through the leveraging of fluid loop management lessons-learned from the International Space Station (ISS). A bed design that was developed for a Hamilton Sundstrand military application, and considered for a potential ISS application with the Urine Processor Assembly, provides a low pressure drop means for water maintenance in a recirculation loop. The bed design is coupled with high capacity ion exchange resins, organic adsorbents, and a cyclic methodology developed for the Extravehicular Mobility Unit (EMU) Transport Water loop. The bed design further leverages a sorbent developed for ISS that introduces a biocide in a microgravity-compatible manner for the Internal Active Thermal Control System (IATCS). The leveraging of these water maintenance technologies to the SWME recirculation loop is a unique demonstration of applying the valuable lessons learned on the ISS to the next generation of manned spaceflight Environmental Control and Life Support System (ECLSS) hardware.

Design and Evaluation of a Water Recirculation Loop Maintenance Device for the Advanced Spacesuit Water Membrane Evaporator

NASA Technical Reports Server (NTRS)

Steele, John W.; Rector, Tony; Bue, Grant C.; Campbell, Colin; Makinen, Janice

2012-01-01

A dual-bed device to maintain the water quality of the Advanced Spacesuit Water Membrane Evaporation (SWME) water recirculation loop has been designed and is undergoing testing. The SWME is a heat rejection device under development at the NASA Johnson Space Center to perform thermal control for advanced spacesuits. One advantage to this technology is the potential for a significantly greater degree of tolerance to contamination when compared to the existing sublimator technology. The driver for the development of a water recirculation maintenance device is to further enhance this advantage through the leveraging of fluid loop management lessons learned from the International Space Station (ISS). A bed design that was developed for a Hamilton Sundstrand military application, and considered for a potential ISS application with the Urine Processor Assembly, provides a low pressure drop means for water maintenance in a recirculation loop. The bed design is coupled with high-capacity ion exchange resins, organic adsorbents, and a cyclic methodology developed for the Extravehicular Mobility Unit Transport Water Loop. The bed design further leverages a sorbent developed for the ISS that introduces a biocide in a microgravity-compatible manner for the Internal Active Thermal Control System. The leveraging of these water maintenance technologies to the SWME recirculation loop is a unique demonstration of applying the valuable lessons learned on the ISS to the next generation of crewed spaceflight Environmental Control and Life Support System hardware.

Stroke treatment academic industry roundtable: research priorities in the assessment of neurothrombectomy devices.

PubMed

Saver, Jeffrey L; Jovin, Tudor G; Smith, Wade S; Albers, Gregory W; Baron, Jean-Claude; Boltze, Johannes; Broderick, Joseph P; Davis, Lisa A; Demchuk, Andrew M; DeSena, Salvatore; Fiehler, Jens; Gorelick, Philip B; Hacke, Werner; Holt, Bill; Jahan, Reza; Jing, Hui; Khatri, Pooja; Kidwell, Chelsea S; Lees, Kennedy R; Lev, Michael H; Liebeskind, David S; Luby, Marie; Lyden, Patrick; Megerian, J Thomas; Mocco, J; Muir, Keith W; Rowley, Howard A; Ruedy, Richard M; Savitz, Sean I; Sipelis, Vitas J; Shimp, Samuel K; Wechsler, Lawrence R; Wintermark, Max; Wu, Ona; Yavagal, Dileep R; Yoo, Albert J

2013-12-01

The goal of the Stroke Treatment Academic Industry Roundtable (STAIR) meetings is to advance the development of stroke therapies. At STAIR VIII, consensus recommendations were developed for clinical trial strategies to demonstrate the benefit of endovascular reperfusion therapies for acute ischemic stroke. Prospects for success with forthcoming endovascular trials are robust, because new neurothrombectomy devices have superior reperfusion efficacy compared with earlier-generation interventions. Specific recommendations are provided for trial designs in 3 populations: (1) patients undergoing intravenous fibrinolysis, (2) early patients ineligible for or having failed intravenous fibrinolysis, and (3) wake-up and other late-presenting patients. Among intravenous fibrinolysis-eligible patients, key principles are that CT or MRI confirmation of target arterial occlusions should precede randomization; endovascular intervention should be pursued with the greatest rapidity possible; and combined intravenous and neurothrombectomy therapy is more promising than neurothrombectomy alone. Among patients ineligible for or having failed intravenous fibrinolysis, scientific equipoise was affirmed and the need to randomize all eligible patients emphasized. Vessel imaging to confirm occlusion is mandatory, and infarct core and penumbral imaging is desirable in later time windows. Additional STAIR VIII recommendations include approaches to test multiple devices in a single trial, utility weighting of disability end points, and adaptive designs to delineate time and tissue injury thresholds at which benefits from intervention no longer accrue. Endovascular research priorities in acute ischemic stroke are to perform trials testing new, highly effective neuro thrombectomy devices rapidly deployed in patients confirmed to have target vessel occlusions.

Design and Evaluation of a Water Recirculation Loop Maintenance Device for the Advanced Spacesuit Water Membrane Evaporator

NASA Technical Reports Server (NTRS)

Steele, John W.; Rector, Tony; Bue, Grant C.; Campbell, Colin; Makinen, Janice

2011-01-01

A dual-bed device to maintain the water quality of the Advanced Spacesuit Water Membrane Evaporation (SWME) water recirculation loop has been designed and is undergoing testing. The SWME is a heat rejection device under development at the NASA Johnson Space Center to perform thermal control for advanced spacesuits. One advantage to this technology is the potential for a significantly greater degree of tolerance to contamination when compared to the existing Sublimator technology. The driver for the development of a water recirculation maintenance device is to further enhance this advantage through the leveraging of fluid loop management lessons-learned from the International Space Station (ISS). A bed design that was developed for a Hamilton Sundstrand military application, and considered for a potential ISS application with the Urine Processor Assembly, provides a low pressure drop means for water maintenance in a recirculation loop. The bed design is coupled with high capacity ion exchange resins, organic adsorbents, and a cyclic methodology developed for the Extravehicular Mobility Unit (EMU) Transport Water loop. The bed design further leverages a sorbent developed for ISS that introduces a biocide in a microgravity-compatible manner for the Internal Active Thermal Control System (IATCS). The leveraging of these water maintenance technologies to the SWME recirculation loop is a clear demonstration of applying the valuable lessons learned on the ISS to the next generation of manned spaceflight Environmental Control and Life Support System (ECLSS) hardware.

Performance of a Water Recirculation Loop Maintenance Device and Process for the Advanced Spacesuit Water Membrane Evaporator

NASA Technical Reports Server (NTRS)

Rector, Tony; Steele, John W.; Bue, Grant C.; Campbell, Colin; Makinen, Janice

2012-01-01

A water loop maintenance device and process to maintain the water quality of the Advanced Spacesuit Water Membrane Evaporation (SWME) water recirculation loop has been undergoing a performance evaluation. The SWME is a heat rejection device under development at the NASA Johnson Space Center to perform thermal control for advanced spacesuits. One advantage to this technology is the potential for a significantly greater degree of tolerance to contamination when compared to the existing Sublimator technology. The driver for the water recirculation maintenance device and process is to further enhance this advantage through the leveraging of fluid loop management lessons-learned from the International Space Station (ISS). A bed design that was developed for a Hamilton Sundstrand military application, and considered for a potential ISS application with the Urine Processor Assembly, provides a low pressure drop means for water maintenance in a recirculation loop. The bed design is coupled with high capacity ion exchange resins, organic adsorbents, and a cyclic methodology developed for the Extravehicular Mobility Unit (EMU) Transport Water loop. The maintenance process further leverages a sorbent developed for ISS that introduces a biocide in a microgravity-compatible manner for the Internal Active Thermal Control System (IATCS). The leveraging of these water maintenance technologies to the SWME recirculation loop is a unique demonstration of applying the valuable lessons learned on the ISS to the next generation of manned spaceflight Environmental Control and Life Support System (ECLSS) hardware. This

Type I allergic hypersensitivity reactions due to ethylene oxide sterilised leucocyte filters in patients with thalassaemia: report of four cases.

PubMed

Belen, Burcu; Polat, Meltem

2015-02-27

Ethylene oxide (EO) is a highly reactive gas used in sterilisation of heat sensitive medical devices, such as infusion sets, cannulae, intubation materials, ventriculoperitoneal shunts, dialysis catheters and stents. Allergic reactions due to EO have been reported in haemodialysis patients, patients undergoing extracorporeal photopheresis and donors of plasmapheresis. Clinical manifestations vary considerably and generally do not allow differentiation between IgE-mediated anaphylaxis and anaphylactoid reactions. We report four patients with thalassaemia who experienced anaphylaxis during transfusion due to ethylene oxide sterilised leucocyte filters. The aim of this report is to highlight the fact that frequently transfused patients can have allergic reactions due to EO particles left in leucocyte filters. 2015 BMJ Publishing Group Ltd.

An X-Y Platform for Randsight-Type Instruments.

ERIC Educational Resources Information Center

Clewett, R. W.; And Others

A hand-operated mechanical device, called an X-Y Platform because of its ability to undergo orthogonal planar motions reminiscent of X and Y coordinates, permits design simplifications and lower costs when used with RANDSIGHT-type closed circuit television to enable the partially sighted to read and write. This paper presents a detailed discussion…

A Critical Review of 13 Years of Mobile Game-Based Learning

ERIC Educational Resources Information Center

Giannakas, Filippos; Kambourakis, Georgios; Papasalouros, Andreas; Gritzalis, Stefanos

2018-01-01

With the increasing popularity of smartphones and tablets, game-based learning (GBL) is undergoing a rapid shift to mobile platforms. This transformation is driven by mobility, wireless interfaces, and built-in sensors that these smart devices offer in order to enable blended and context-sensitive mobile learning (m-Learning) activities. Thus,…

Development of a Telehealth Intervention for Head and Neck Cancer Patients

PubMed Central

Studts, Jamie L.; Bumpous, Jeffrey M.; Gregg, Jennifer L.; Wilson, Liz; Keeney, Cynthia; Scharfenberger, Jennifer A.; Pfeifer, Mark P.

2009-01-01

Abstract Treatment for head and neck cancer precipitates a myriad of distressing symptoms. Patients may be isolated both physically and socially and may lack the self-efficacy to report problems and participate as partners in their care. The goal of this project was to design a telehealth intervention to address such isolation, develop patient self-efficacy, and improve symptom management during the treatment experience. Participatory action research and a review of the literature were used to develop electronically administered symptom management algorithms addressing all major symptoms experienced by patients undergoing treatment for head and neck cancers. Daily questions and related messages were then programmed into an easy-to-use telehealth messaging device, the Health Buddy®. Clinician and patient acceptance, feasibility, and technology issues were measured. Using participatory action research is an effective means for developing electronic algorithms acceptable to both clinicians and patients. The use of a simple tele-messaging device as an adjunct to symptom management is feasible, affordable, and acceptable to patients. This telehealth intervention provides support and education to patients undergoing treatment for head and neck cancers. PMID:19199847

Time-Resolved Small-Angle X-ray Scattering Reveals Millisecond Transitions of a DNA Origami Switch.

PubMed

Bruetzel, Linda K; Walker, Philipp U; Gerling, Thomas; Dietz, Hendrik; Lipfert, Jan

2018-04-11

Self-assembled DNA structures enable creation of specific shapes at the nanometer-micrometer scale with molecular resolution. The construction of functional DNA assemblies will likely require dynamic structures that can undergo controllable conformational changes. DNA devices based on shape complementary stacking interactions have been demonstrated to undergo reversible conformational changes triggered by changes in ionic environment or temperature. An experimentally unexplored aspect is how quickly conformational transitions of large synthetic DNA origami structures can actually occur. Here, we use time-resolved small-angle X-ray scattering to monitor large-scale conformational transitions of a two-state DNA origami switch in free solution. We show that the DNA device switches from its open to its closed conformation upon addition of MgCl 2 in milliseconds, which is close to the theoretical diffusive speed limit. In contrast, measurements of the dimerization of DNA origami bricks reveal much slower and concentration-dependent assembly kinetics. DNA brick dimerization occurs on a time scale of minutes to hours suggesting that the kinetics depend on local concentration and molecular alignment.

Development of a telehealth intervention for head and neck cancer patients.

PubMed

Head, Barbara A; Studts, Jamie L; Bumpous, Jeffrey M; Gregg, Jennifer L; Wilson, Liz; Keeney, Cynthia; Scharfenberger, Jennifer A; Pfeifer, Mark P

2009-01-01

Treatment for head and neck cancer precipitates a myriad of distressing symptoms. Patients may be isolated both physically and socially and may lack the self-efficacy to report problems and participate as partners in their care. The goal of this project was to design a telehealth intervention to address such isolation, develop patient self-efficacy, and improve symptom management during the treatment experience. Participatory action research and a review of the literature were used to develop electronically administered symptom management algorithms addressing all major symptoms experienced by patients undergoing treatment for head and neck cancers. Daily questions and related messages were then programmed into an easy-to-use telehealth messaging device, the Health Buddy(R). Clinician and patient acceptance, feasibility, and technology issues were measured. Using participatory action research is an effective means for developing electronic algorithms acceptable to both clinicians and patients. The use of a simple tele-messaging device as an adjunct to symptom management is feasible, affordable, and acceptable to patients. This telehealth intervention provides support and education to patients undergoing treatment for head and neck cancers.

Rationalizing the light-induced phase separation of mixed halide organic-inorganic perovskites.

PubMed

Draguta, Sergiu; Sharia, Onise; Yoon, Seog Joon; Brennan, Michael C; Morozov, Yurii V; Manser, Joseph S; Kamat, Prashant V; Schneider, William F; Kuno, Masaru

2017-08-04

Mixed halide hybrid perovskites, CH 3 NH 3 Pb(I 1-x Br x ) 3 , represent good candidates for low-cost, high efficiency photovoltaic, and light-emitting devices. Their band gaps can be tuned from 1.6 to 2.3 eV, by changing the halide anion identity. Unfortunately, mixed halide perovskites undergo phase separation under illumination. This leads to iodide- and bromide-rich domains along with corresponding changes to the material's optical/electrical response. Here, using combined spectroscopic measurements and theoretical modeling, we quantitatively rationalize all microscopic processes that occur during phase separation. Our model suggests that the driving force behind phase separation is the bandgap reduction of iodide-rich phases. It additionally explains observed non-linear intensity dependencies, as well as self-limited growth of iodide-rich domains. Most importantly, our model reveals that mixed halide perovskites can be stabilized against phase separation by deliberately engineering carrier diffusion lengths and injected carrier densities.Mixed halide hybrid perovskites possess tunable band gaps, however, under illumination they undergo phase separation. Using spectroscopic measurements and theoretical modelling, Draguta and Sharia et al. quantitatively rationalize the microscopic processes that occur during phase separation.

Large-scale and patternable graphene: direct transformation of amorphous carbon film into graphene/graphite on insulators via Cu mediation engineering and its application to all-carbon based devices

NASA Astrophysics Data System (ADS)

Chen, Yu-Ze; Medina, Henry; Lin, Hung-Chiao; Tsai, Hung-Wei; Su, Teng-Yu; Chueh, Yu-Lun

2015-01-01

Chemical vapour deposition of graphene was the preferred way to synthesize graphene for multiple applications. However, several problems related to transfer processes, such as wrinkles, cleanness and scratches, have limited its application at the industrial scale. Intense research was triggered into developing alternative synthesis methods to directly deposit graphene on insulators at low cost with high uniformity and large area. In this work, we demonstrate a new concept to directly achieve growth of graphene on non-metal substrates. By exposing an amorphous carbon (a-C) film in Cu gaseous molecules after annealing at 850 °C, the carbon (a-C) film surprisingly undergoes a noticeable transformation to crystalline graphene. Furthermore, the thickness of graphene could be controlled, depending on the thickness of the pre-deposited a-C film. The transformation mechanism was investigated and explained in detail. This approach enables development of a one-step process to fabricate electrical devices made of all carbon material, highlighting the uniqueness of the novel approach for developing graphene electronic devices. Interestingly, the carbon electrodes made directly on the graphene layer by our approach offer a good ohmic contact compared with the Schottky barriers usually observed on graphene devices using metals as electrodes.Chemical vapour deposition of graphene was the preferred way to synthesize graphene for multiple applications. However, several problems related to transfer processes, such as wrinkles, cleanness and scratches, have limited its application at the industrial scale. Intense research was triggered into developing alternative synthesis methods to directly deposit graphene on insulators at low cost with high uniformity and large area. In this work, we demonstrate a new concept to directly achieve growth of graphene on non-metal substrates. By exposing an amorphous carbon (a-C) film in Cu gaseous molecules after annealing at 850 °C, the carbon (a-C) film surprisingly undergoes a noticeable transformation to crystalline graphene. Furthermore, the thickness of graphene could be controlled, depending on the thickness of the pre-deposited a-C film. The transformation mechanism was investigated and explained in detail. This approach enables development of a one-step process to fabricate electrical devices made of all carbon material, highlighting the uniqueness of the novel approach for developing graphene electronic devices. Interestingly, the carbon electrodes made directly on the graphene layer by our approach offer a good ohmic contact compared with the Schottky barriers usually observed on graphene devices using metals as electrodes. Electronic supplementary information (ESI) available: Experimental methods; pictures of a new quartz tube and an aged quartz tube before and after annealing Cu foil at 1025 °C for 2 h; Raman spectrum of as-deposited a-C layer; XPS depth profiles of 25 nm-thick pre-deposited a-C film after annealing in the presence of Cu gaseous molecules and the corresponding transformation ratios; ICP-MS results of Cu gaseous molecules captured by the formation of the Ni-Cu alloy; SEM-EDS results of samples with different thicknesses of pre-deposited a-C films; UV-Vis spectrum of the graphene directly transformed from the 5 nm-thick pre-deposited a-C film on quartz substrate. See DOI: 10.1039/c4nr04627g

Additive Manufacturing: Unlocking the Evolution of Energy Materials

PubMed Central

Zhakeyev, Adilet; Wang, Panfeng; Shu, Wenmiao; Wang, Huizhi

2017-01-01

Abstract The global energy infrastructure is undergoing a drastic transformation towards renewable energy, posing huge challenges on the energy materials research, development and manufacturing. Additive manufacturing has shown its promise to change the way how future energy system can be designed and delivered. It offers capability in manufacturing complex 3D structures, with near‐complete design freedom and high sustainability due to minimal use of materials and toxic chemicals. Recent literatures have reported that additive manufacturing could unlock the evolution of energy materials and chemistries with unprecedented performance in the way that could never be achieved by conventional manufacturing techniques. This comprehensive review will fill the gap in communicating on recent breakthroughs in additive manufacturing for energy material and device applications. It will underpin the discoveries on what 3D functional energy structures can be created without design constraints, which bespoke energy materials could be additively manufactured with customised solutions, and how the additively manufactured devices could be integrated into energy systems. This review will also highlight emerging and important applications in energy additive manufacturing, including fuel cells, batteries, hydrogen, solar cell as well as carbon capture and storage. PMID:29051861

The role and application of ion beam analysis for studies of plasma-facing components in controlled fusion devices

NASA Astrophysics Data System (ADS)

Rubel, Marek; Petersson, Per; Alves, Eduardo; Brezinsek, Sebastijan; Coad, Joseph Paul; Heinola, Kalle; Mayer, Matej; Widdowson, Anna

2016-03-01

First wall materials in controlled fusion devices undergo serious modification by several physical and chemical processes arising from plasma-wall interactions. Detailed information is required for the assessment of material lifetime and accumulation of hydrogen isotopes in wall materials. The intention of this work is to give a concise overview of key issues in the characterization of plasma-facing materials and components in tokamaks, especially in JET with an ITER-Like Wall. IBA techniques play a particularly prominent role here because of their isotope selectivity in the low-Z range (1-10), high sensitivity and combination of several methods in a single run. The role of 3He-based NRA, RBS (standard and micro-size beam) and HIERDA in fuel retention and material migration studies is presented. The use of tracer techniques with rare isotopes (e.g. 15N) or marker layers on wall diagnostic components is described. Special instrumentation, development of equipment to enhance research capabilities and issues in handling of contaminated materials are addressed.

Additive Manufacturing: Unlocking the Evolution of Energy Materials.

PubMed

Zhakeyev, Adilet; Wang, Panfeng; Zhang, Li; Shu, Wenmiao; Wang, Huizhi; Xuan, Jin

2017-10-01

The global energy infrastructure is undergoing a drastic transformation towards renewable energy, posing huge challenges on the energy materials research, development and manufacturing. Additive manufacturing has shown its promise to change the way how future energy system can be designed and delivered. It offers capability in manufacturing complex 3D structures, with near-complete design freedom and high sustainability due to minimal use of materials and toxic chemicals. Recent literatures have reported that additive manufacturing could unlock the evolution of energy materials and chemistries with unprecedented performance in the way that could never be achieved by conventional manufacturing techniques. This comprehensive review will fill the gap in communicating on recent breakthroughs in additive manufacturing for energy material and device applications. It will underpin the discoveries on what 3D functional energy structures can be created without design constraints, which bespoke energy materials could be additively manufactured with customised solutions, and how the additively manufactured devices could be integrated into energy systems. This review will also highlight emerging and important applications in energy additive manufacturing, including fuel cells, batteries, hydrogen, solar cell as well as carbon capture and storage.

Dry immunochemical sensor for the detection of PETN vapor

NASA Astrophysics Data System (ADS)

Lukens, Herbert Richard

1992-05-01

Giaever (1973) showed that an indium semi-mirror coated with a monolayer of a substance would undergo reduced optical reflectance after incubation with a solution of the substance's antibody. He was able to see the effect with the naked eye. Lukens and Williams (1977) reversed the process by first attaching the target substance's antibody to the semi-mirror, after which the device would show a decline in optical density when exposed to a solution of the target substance. Lukens and Williams (1982) subsequently found that the device could also be used as an immunochemical film badge (IFB) to detect an airborne target substance. Early efforts to develop the IFB for the detection of airborne substances were plagued by such a high degree of performance variability that there were doubts in some quarters that an airborne target substance could bind to its antibody until Lukens (1990) demonstrated such binding in experiments with radiolabeled cocaine and morphine. Recently improved semi-mirrors and densitometry have been obtained and have led to improved performance of IFB's. As shown in this paper, IFB's can now be constructed that detect PETN vapor in a few seconds.

Continuation of a Levonorgestrel Intrauterine Device During Hematopoietic Stem Cell Transplant: A Case Report.

PubMed

Brady, Paula C; Soiffer, Robert J; Ginsburg, Elizabeth S

2017-04-01

During treatment of hematologic malignancies in premenopausal women, both menstrual suppression and contraception are crucial. Continuation of hormonal intrauterine devices (IUDs) - widely used and highly effective contraceptives that also decrease menstrual flow - is controversial during hematopoietic stem cell transplants (SCTs) due to infectious and vaginal bleeding concerns. A 23-year-old nulligravid female was diagnosed with acute myeloid leukemia (AML, positive for FLT3-ITD, DNMT3A and RUNX1, with normal cytogenetics). She elected to retain her existing levonorgestrel-containing IUD during chemotherapy and SCT. During and following treatment, she remained amenorrheic without infection, despite severe neutropenia and thrombocytopenia. Eight months later, she remains in remission without IUD-related complications. This is the first report of levonorgestrel IUD retention during hematopoietic SCT. Despite severe neutropenia and thrombocytopenia, the patient developed neither pelvic infection by retaining her IUD nor significant vaginal bleeding. Future studies are needed to confirm the safety of levonorgestrel IUDs in women undergoing SCT. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Observation of Nanoscale Morphological and Structural Degradation in Perovskite Solar Cells by In-Situ TEM

DOE PAGES

Yang, Bin; Dyck, Ondrej K.; Univ. of Tennessee, Knoxville, TN; ...

2016-11-04

The chemical stability of organometallic halide perovskites is a major barrier facing their application in the fast rising field of next generation photovoltaics. These materials were shown to undergo degradation due to the influence of heat or moisture, significantly limiting the lifetime of associated devices. To overcome this stability issue, a fundamental understanding of degradation mechanisms is of foremost importance. Here, high resolution in situ transmission electron microscopy and electron energy loss spectroscopy elemental mapping were applied to probe morphological and structural changes in perovskite films during controlled environmental exposure treatments. Both moisture and oxygen in ambient air are revealedmore » to facilitate degradation in CH 3NH 3PbI 3 perovskites through decomposition and oxidation pathways, respectively. In addition, even in moisture- and oxygen-free environment evident degradation could be induced by heating at the solar cell s real-field operating temperature and the degradation was found to originate from defect sites. These findings provide fundamental insight to prevent degradation of perovskite materials and associated devices for realistic applications.« less

Observation of Nanoscale Morphological and Structural Degradation in Perovskite Solar Cells by In-Situ TEM

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yang, Bin; Dyck, Ondrej K.; Univ. of Tennessee, Knoxville, TN

The chemical stability of organometallic halide perovskites is a major barrier facing their application in the fast rising field of next generation photovoltaics. These materials were shown to undergo degradation due to the influence of heat or moisture, significantly limiting the lifetime of associated devices. To overcome this stability issue, a fundamental understanding of degradation mechanisms is of foremost importance. Here, high resolution in situ transmission electron microscopy and electron energy loss spectroscopy elemental mapping were applied to probe morphological and structural changes in perovskite films during controlled environmental exposure treatments. Both moisture and oxygen in ambient air are revealedmore » to facilitate degradation in CH 3NH 3PbI 3 perovskites through decomposition and oxidation pathways, respectively. In addition, even in moisture- and oxygen-free environment evident degradation could be induced by heating at the solar cell s real-field operating temperature and the degradation was found to originate from defect sites. These findings provide fundamental insight to prevent degradation of perovskite materials and associated devices for realistic applications.« less

Lithium Niobate Whispering Gallery Resonators: Applications and Fundamental Studies

NASA Astrophysics Data System (ADS)

Maleki, L.; Matsko, A. B.

Optical whispering gallery modes (WGMs) are closed circulating electromagnetic waves undergoing total internal reflection inside an axio-symmetric body of a transparent dielectric that forms a resonator. Radiative losses are negligible in these modes if the radius of the resonator exceeds several tens of wavelengths, and surface scattering losses can be made small with surface conditioning techniques. Thus, the quality factor (Q) in crystalline WGM resonators is limited by material losses that are, nevertheless, extremely small in optical materials. WGM resonators made of LiNbO3 have been successfully used in optics and microwave photonics. The resonators are characterized by narrow bandwidth, in the hundred kilohertz to gigahertz range. A proper choice of highly transparent and/or nonlinear resonator material, like lithium niobate, allows for realization of a number of high performance devices: tunable and multi-pole filters, resonant electro-optic modulators, photonic microwave receivers, opto-electronic microwave oscillators, and parametric frequency converters, among others.

Integrated multispectral high-power laser platform for the defeat of heat-seeking missiles

NASA Astrophysics Data System (ADS)

Tadjikov, Boris; Tsekoun, Alexei; Lyakh, Arkadiy; Maulini, Richard; Barron, Rodolfo; Patel, C. Kumar N.

2011-06-01

Quantum cascade lasers are finding rapid acceptance in many defense and security applications. Our new multispectral laser platform providing watt-level outputs near 2.0 μm, 4.0 μm and 4.6 μm in continuous wave regime at room temperature. Individual lasers are spectrally beam combined into a single output beam with excellent quality. Our rugged, compact (11 × 10 × 6.5 inches), and highly reliable, air-cooled multispectral laser platform is already finding acceptance at system level. Our uncooled devices produce > 2W at 4.6 μm and >1.5W at 4.0 μm at room temperature, and maintain watt-level output at 67°C with real wallplug efficiencies >10%. Finally, all of our QCLs undergo 100-hour pre-delivery burn-in and pass shock, vibration, and temperature testing according to MIL-STD-810G.

AKIGUARD (Acute Kidney Injury GUARding Device) trial: in-hospital and one-year outcomes.

PubMed

Usmiani, Tullio; Andreis, Alessandro; Budano, Carlo; Sbarra, Pierluigi; Andriani, Monica; Garrone, Paolo; Fanelli, Anna Laura; Calcagnile, Chiara; Bergamasco, Laura; Biancone, Luigi; Marra, Sebastiano

2016-07-01

Contrast-induced acute kidney injury (CIAKI) in patients with chronic kidney disease undergoing coronary angiography or percutaneous coronary intervention is a common iatrogenic complication associated with increased morbidity and mortality. This study compares sodium bicarbonate/isotonic saline/N-acetylcysteine/vitamin C prophylaxis (BS-NAC) against high-volume forced diuresis with matched hydration in CIAKI prevention. One-hundred and thirty-three consecutive patients undergoing coronary angiography or percutaneous coronary intervention with estimated glomerular filtration rate less than 60 mL/min/1.73m were randomized to the study group receiving matched hydration (MHG) or to the control group receiving BS-NAC. MHG received in vein (i.v.) 250 mL isotonic saline bolus, followed by a 0.5 mg/kg furosemide i.v. bolus to forced diuresis. A dedicated device automatically matched the isotonic saline i.v. infusion rate to the urinary output for 1 h before, during and 4 h after the procedure. MHG had the lowest incidence of CIAKI (7 vs. 25%, P = 0.01), major adverse cardiac and cerebrovascular events at 1 year (7 vs. 32%, P < 0.01) and readmissions to cardiology/nephrology departments (8 vs. 25%, P = 0.03; hospitalization days 1.0 ± 3.8 vs. 4.9 ± 12.5, P = 0.01). Three months after the procedure the decrease in the estimated glomerular filtration rate was 0.02% for MHG versus 15% for the control group. Matched hydration was more effective than BS-NAC in CIAKI prevention. One-year follow-up showed that matched hydration was associated also with limited chronic kidney disease progression, major adverse cardiac and cerebrovascular events and hospitalizations.

The Use of the 'Preclosure' Technique for Antegrade Aspiration Thrombectomy with Large Catheters in Acute Limb Ischemia

DOE Office of Scientific and Technical Information (OSTI.GOV)

Funke, C., E-mail: claas_funke@hotmail.com; Pfiffner, R.; Husmann, M.

2013-04-15

This study was designed to assess retrospectively short- and mid-term outcomes of the use of a suture-mediated closure device to close the antegrade access in patients undergoing percutaneous aspiration thrombectomy with large catheters for acute leg ischemia. Between November 2005 and February 2010, a suture-mediated active closure system (ProGlide{sup Registered-Sign} 6F, Abbott) was placed before arterial sheath (mean 9 F, range 6-12 F) introduction in 101 patients (74 men, 73 %, mean age 70.1 {+-} 12.6 years standard deviation). Data regarding mortality, complications, and factors contributing to vascular complications at the access site was collected for 6 month after themore » intervention to detect device-related problems. As a coincidence, 77 patients had follow-up visits for a duplex ultrasound. There were a total of 19 vascular complications (19 %) at the puncture site, all of which were of hemorrhagic nature and none of which consisted of vessel occlusion. Two major outcome complications (2 %) occurred. A retroperitoneal hematoma and a serious inguinal bleeding required additive treatment and did not result in permanent sequelae. Nine cases involved death of which eight were not attributable to the closure and one remained unclear. Successful closure was achieved in 95 patients (94 %); additional manual compression was sufficient in the majority of the remaining patients. Numerous factors contributing to vascular complications were encountered. With acceptable short- and mid-term outcomes, the 'preclose' technique can be a reliable option for the closure of a large antegrade femoral access even for patients at a high risk of vascular complications, such as those undergoing aspiration thrombectomy.« less

Epicardial clip occlusion of the left atrial appendage during cardiac surgery provides optimal surgical results and long-term stability.

PubMed

Kurfirst, Vojtech; Mokrácek, Aleš; Canádyová, Júlia; Frána, Radim; Zeman, Petr

2017-07-01

Occlusion of the left atrial appendage (LAA) has become an integral and important part of the surgical treatment of atrial fibrillation. Different methods of surgical occlusion of the LAA have been associated with varying levels of short- and long-term success for closure. The purpose of this study was to evaluate long-term results of epicardial placement and endocardial occlusion in patients undergoing cardiac operative procedures. A total of 101 patients (average age 65.7 years) undergoing cardiac operative procedures with the epicardial AtriClip Exclusion System of the LAA were enrolled in the study. The AtriClip was placed via a sternotomy or a thoracotomy or from a thoracoscopic approach. Postoperative variables, such as thromboembolic events, clip stability and endocardial leakage around the device, were examined by transoesophageal echocardiography (TEE) and/or computed tomography. Perioperative clip implantation was achieved in 98% of patients. TEE and/or computed tomography conducted during the follow-up period, comprising 1873 patient-months with a mean duration of 18 ± 11 months, revealed no clip migration, no leakage around the device and no clot formation near the remnant cul-de-sac. During the follow-up period, 4 of the cardiac patients experienced transitory ischaemic attacks, whereas no patient experienced a cerebrovascular attack. The Epicardial AtriClip Exclusion System of the LAA appears to be a feasable and safe operative method with a high success rate. Long-term follow-up confirmed clip stability, complete occlussion of the LAA and absence of any atrial fibrilation-related thromboembolic events. These results need to be confirmed by a larger, multicentre study. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Long-term Results for the BacJac Interspinous Device in Lumbar Spine Degenerative Disease.

PubMed

Spallone, Aldo; Lavorato, Luigi; Belvisi, Daniele

2018-05-14

 To evaluate the long-term results of using the BacJac interspinous device (Pioneer Surgical Technology Inc.) in a series of patients with degenerative lumbar spine disease.  Forty-one patients undergoing lumbar surgery with implantation of a BacJac device from 2009 to 2012 were enrolled in the present study. Patients were evaluated using the Oswestry Disability Scale (ODI).  Although all patients showed a significant improvement of the ODI score immediately after surgery, only 41% of patients showed a satisfactory outcome. We observed worse results in the patients operated on at the L3-L4 level and in whom the device was implanted in a segment different from the one where surgical decompression had been performed. Weight gain in the months after surgery was also a poor outcome-influencing factor.  This study confirms what is already suggested in the relevant literature regarding the long-term inefficacy of the so-called dynamic stabilization devices. Georg Thieme Verlag KG Stuttgart · New York.

Medical devices and the Middle East: market, regulation, and reimbursement in Gulf Cooperation Council states.

PubMed

Howard, Jason J

2014-01-01

With some of the richest economies in the world, the Gulf Cooperation Council (GCC) is undergoing rapid growth not only in its population but also in health care expenditure. Despite the GCC's abundance of hydrocarbon-based wealth, the drivers of the medical device industry in the GCC are still in flux, with gains yet to be made in areas of infrastructure, regulation, and reimbursement. However, the regional disease burden, expanding health insurance penetration, increasing privatization, and a desire to attract skilled expatriate health care providers have led to favorable conditions for the medical device market in the GCC. The purpose of this article is to investigate the current state of the GCC medical device industry, with respect to market, regulation, and reimbursement, paying special attention to the three largest medical device markets: Saudi Arabia, the United Arab Emirates, and Qatar. The GCC would seem to represent fertile ground for the development of medical technologies, especially those in line with the regional health priorities of the respective member states.

Review of MRI positioning devices for guiding focused ultrasound systems.

PubMed

Yiallouras, C; Damianou, C

2015-06-01

This article contains a review of positioning devices that are currently used in the area of magnetic resonance imaging (MRI) guided focused ultrasound surgery (MRgFUS). The paper includes an extensive review of literature published since the first prototype system was invented in 1991. The technology has grown into a fast developing area with application to any organ accessible to ultrasound. The initial design operated using hydraulic principles, while the latest technology incorporates piezoelectric motors. Although, in the beginning there were fears regarding MRI safety, during recent years, the deployment of MR-safe positioning devices in FUS has become routine. Many of these positioning devices are now undergoing testing in clinical trials. Existing MRgFUS systems have been utilized mostly in oncology (fibroids, brain, liver, kidney, bone, pancreas, eye, thyroid, and prostate). It is anticipated that, in the near future, there will be a positioning device for every organ that is accessible by focused ultrasound. Copyright © 2014 John Wiley & Sons, Ltd.

Understanding the C-pulse device and its potential to treat heart failure.

PubMed

Sales, Virna L; McCarthy, Patrick M

2010-03-01

The Sunshine Heart C-Pulse (C-Pulse; Sunshine Heart Inc., Tustin, CA) device is an extra-aortic implantable counterpulsation pump designed as a non-blood contacting ambulatory heart assist device, which may provide relief from symptoms for class II-III congestive heart failure patients. It has a comparable hemodynamic augmentation to intra-aortic balloon counterpulsation devices. The C-Pulse cuff is implanted through a median sternotomy, secured around the ascending aorta, and pneumatically driven by an external system controller. Pre-clinical studies in the acute pig model, and initial temporary clinical studies in patients undergoing off-pump coronary bypass surgery have shown substantial increase in diastolic perfusion of the coronary vessels, which translated to a favorable improvement in ventricular function. A U.S. prospective multi-center trial to evaluate the safety and efficacy of the C-Pulse in class III patients with moderate heart failure is now in progress.

A design handbook for phase change thermal control and energy storage devices. [selected paraffins

NASA Technical Reports Server (NTRS)

Humphries, W. R.; Griggs, E. I.

1977-01-01

Comprehensive survey is given of the thermal aspects of phase change material devices. Fundamental mechanisms of heat transfer within the phase change device are discussed. Performance in zero-g and one-g fields are examined as it relates to such a device. Computer models for phase change materials, with metal fillers, undergoing conductive and convective processes are detailed. Using these models, extensive parametric data are presented for a hypothetical configuration with a rectangular phase change housing, using straight fins as the filler, and paraffin as the phase change material. These data are generated over a range of realistic sizes, material properties, and thermal boundary conditions. A number of illustrative examples are given to demonstrate use of the parametric data. Also, a complete listing of phase change material property data are reproduced herein as an aid to the reader.

Electromyographic evaluation in children orthodontically treated for skeletal Class II malocclusion: Comparison of two treatment techniques.

PubMed

Ortu, Eleonora; Pietropaoli, Davide; Adib, Fray; Masci, Chiara; Giannoni, Mario; Monaco, Annalisa

2017-11-16

Objective To compare the clinical efficacy of two techniques for fabricating a Bimler device by assessing the patient's surface electromyography (sEMG) activity at rest before treatment and six months after treatment. Methods Twenty-four patients undergoing orthodontic treatment were enrolled in the study; 12 formed the test group and wore a Bimler device fabricated with a Myoprint impression using neuromuscular orthodontic technique and 12 formed the control group and were treated by traditional orthodontic technique with a wax bite in protrusion. The "rest" sEMG of each patient was recorded prior to treatment and six months after treatment. Results The neuromuscular-designed Bimler device was more comfortable and provided better treatment results than the traditional Bimler device. Conclusion This study suggests that the patient group subjected to neuromuscular orthodontic treatment had a treatment outcome with more relaxed masticatory muscles and better function versus the traditional orthodontic treatment.

A new mild hyperthermia device to treat vascular involvement in cancer surgery.

PubMed

Ware, Matthew J; Nguyen, Lam P; Law, Justin J; Krzykawska-Serda, Martyna; Taylor, Kimberly M; Cao, Hop S Tran; Anderson, Andrew O; Pulikkathara, Merlyn; Newton, Jared M; Ho, Jason C; Hwang, Rosa; Rajapakshe, Kimal; Coarfa, Cristian; Huang, Shixia; Edwards, Dean; Curley, Steven A; Corr, Stuart J

2017-09-12

Surgical margin status in cancer surgery represents an important oncologic parameter affecting overall prognosis. The risk of disease recurrence is minimized and survival often prolonged if margin-negative resection can be accomplished during cancer surgery. Unfortunately, negative margins are not always surgically achievable due to tumor invasion into adjacent tissues or involvement of critical vasculature. Herein, we present a novel intra-operative device created to facilitate a uniform and mild heating profile to cause hyperthermic destruction of vessel-encasing tumors while safeguarding the encased vessel. We use pancreatic ductal adenocarcinoma as an in vitro and an in vivo cancer model for these studies as it is a representative model of a tumor that commonly involves major mesenteric vessels. In vitro data suggests that mild hyperthermia (41-46 °C for ten minutes) is an optimal thermal dose to induce high levels of cancer cell death, alter cancer cell's proteomic profiles and eliminate cancer stem cells while preserving non-malignant cells. In vivo and in silico data supports the well-known phenomena of a vascular heat sink effect that causes high temperature differentials through tissues undergoing hyperthermia, however temperatures can be predicted and used as a tool for the surgeon to adjust thermal doses delivered for various tumor margins.

Localization of needle tip with color doppler during pericardiocentesis: In vitro validation and initial clinical application

NASA Technical Reports Server (NTRS)

Armstrong, G.; Cardon, L.; Vilkomerson, D.; Lipson, D.; Wong, J.; Rodriguez, L. L.; Thomas, J. D.; Griffin, B. P.

2001-01-01

This study evaluates a new device that uses color Doppler ultrasonography to enable real-time image guidance of the aspirating needle, which has not been possible until now. The ColorMark device (EchoCath Inc, Princeton, NJ) induces high-frequency, low-amplitude vibrations in the needle to enable localization with color Doppler. We studied this technique in 25 consecutive patients undergoing pericardiocentesis, and in vitro, in a urethane phantom with which the accuracy of color Doppler localization of the needle tip was compared with that obtained by direct measurement. Tip localization was excellent in vitro; errors axial to the ultrasound beam (velocity Doppler -0.13 +/- 0.90 mm, power Doppler -0.05 +/- 1.7 mm) were less than lateral errors (velocity -0.36 +/- 1.8 mm, power -0.02 +/- 2.8 mm). In 18 of 25 patients, the needle was identified and guided into the pericardial space with the ColorMark technique, and it allowed successful, uncomplicated drainage of fluid. Initial failures were the result of incorrect settings on the echocardiographic machine and inappropriate combinations of the needle puncture site and imaging window. This study demonstrates a novel color Doppler technique that is highly accurate at localizing a needle tip. The technique is feasible for guiding pericardiocentesis. Further clinical validation of this technique is required.

Sequential compression device with thigh-high sleeves supports mean arterial pressure during Caesarean section under spinal anaesthesia.

PubMed

Adsumelli, R S N; Steinberg, E S; Schabel, J E; Saunders, T A; Poppers, P J

2003-11-01

This study investigated the use of a Sequential Compression Device (SCD) with thigh-high sleeves and a preset pressure of 50 mm Hg that recruits blood from the lower limbs intermittently, as a method to prevent spinal hypotension during elective Caesarean section. Possible association of arterial pressure changes with maternal, fetal, haemodynamic, and anaesthetic factors were studied. Fifty healthy parturients undergoing elective Caesarean section under spinal anaesthesia were randomly assigned to either SCD (n=25) or control (n=25) groups. A standardized protocol for pre-hydration and anaesthetic technique was followed. Hypotension was defined as a decrease in any mean arterial pressure (MAP) measurement by more than 20% of the baseline MAP. Systolic (SAP), MAP and diastolic (DAP) arterial pressure, pulse pressure (PP), and heart rate (HR) were noted at baseline and every minute after the spinal block until delivery. A greater than 20% decrease in MAP occurred in 52% of patients in the SCD group vs 92% in the control group (P=0.004, odds ratio 0.094, 95% CI 0.018-0.488). There were no significant differences in SAP, DAP, HR, and PP between the groups. SCD use in conjunction with vasopressor significantly reduced the incidence of a 20% reduction of MAP.

Compressive cryotherapy versus ice-a prospective, randomized study on postoperative pain in patients undergoing arthroscopic rotator cuff repair or subacromial decompression.

PubMed

Kraeutler, Matthew J; Reynolds, Kirk A; Long, Cyndi; McCarty, Eric C

2015-06-01

The purpose of this study was to compare the effect of compressive cryotherapy (CC) vs. ice on postoperative pain in patients undergoing shoulder arthroscopy for rotator cuff repair or subacromial decompression. A commercial device was used for postoperative CC. A standard ice wrap (IW) was used for postoperative cryotherapy alone. Patients scheduled for rotator cuff repair or subacromial decompression were consented and randomized to 1 of 2 groups; patients were randomized to use either CC or a standard IW for the first postoperative week. All patients were asked to complete a "diary" each day, which included visual analog scale scores based on average daily pain and worst daily pain as well as total pain medication usage. Pain medications were then converted to a morphine equivalent dosage. Forty-six patients completed the study and were available for analysis; 25 patients were randomized to CC and 21 patients were randomized to standard IW. No significant differences were found in average pain, worst pain, or morphine equivalent dosage on any day. There does not appear to be a significant benefit to use of CC over standard IW in patients undergoing shoulder arthroscopy for rotator cuff repair or subacromial decompression. Further study is needed to determine if CC devices are a cost-effective option for postoperative pain management in this population of patients. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Characterization and outcomes of reinterventions in Food and Drug Administration-approved versus trial endovascular aneurysm repair devices.

PubMed

Fairman, Alexander S; Wang, Grace J; Jackson, Benjamin M; Foley, Paul J; Damrauer, Scott M; Kalapatapu, Venkat; Golden, Michael A; Fairman, Ronald M

2018-04-01

Published rates of reintervention after endovascular aneurysm repair (EVAR) range from 10% to 30%. We evaluated a single university center's experience with reinterventions in the context of Food and Drug Administration (FDA)-approved and trial devices. Retrospective data collection was performed for patients who underwent infrarenal EVAR and required reintervention from 2000 to 2016. Trial devices included those used in FDA feasibility and pivotal trials. Time-to-event analysis was performed using Cox regression. Predictors of mortality and explantation were evaluated using logistic regression; survival analysis was performed using Kaplan-Meier methods. From 2000 to 2016, there were 1835 EVARs performed, and 137 patients (116 men; mean age, 72.2 ± 10.0 years) underwent reintervention with a mean aneurysm size of 5.9 ± 1.2 cm. The median follow-up was 5 years with an overall survival of 70.1%. The overall reintervention rate was 7.5%. FDA-approved devices had a reintervention rate of 6.4%, whereas trial devices had a rate of 14.4% (P < .001). For all devices, the most common cause of reintervention was type II endoleak (52.5%), followed by type I endoleak (18.2%), type III endoleak (9.5%), limb kink (7.3%), iliac occlusive disease (5.8%), endotension (1.5%), and other. The overall mean time to first reintervention was 2.3 ± 2.5 years, and univariate Cox regression identified male gender (hazard ratio, 1.91; 95% confidence interval [CI], 1.17-3.10; P = .010) and age at the time of EVAR (hazard ratio, 1.03; 95% CI, 1.01-1.05; P = .006) as risk factors for time to first reintervention. Among patients requiring reintervention, the mean number of reinterventions for trial devices was significantly greater than that for FDA-approved devices (2.18 vs 1.65; P = .01). Trial devices requiring reintervention had a nearly threefold higher odds for the need for more than two reinterventions (odds ratio, 2.88; 95% CI, 1.12-7.37; P = .034). Trial device, cause of reintervention, and type of reintervention were not predictive of the need for explantation or mortality, but the number of reinterventions was significantly associated with the need for explantation (odds ratio, 1.86; 95% CI, 1.17-2.96; P = .012). EVAR device and the need for explantation did not have an impact on mortality. Despite the rigorous nature of patient enrollment in clinical trials and the development of newer iterations of investigational devices, patients undergoing EVAR with trial devices are more likely to undergo a greater number of reinterventions than with FDA-approved devices. Although mortality and the need for explantation were not significantly associated with trial devices, the finding of a greater number of reinterventions highlights the need to properly inform patients willing to partake in investigational device trials. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

General surgical complications associated with the use of long-term mechanical circulatory support devices: are we 'under-reporting' problems?

PubMed

Tchantchaleishvili, Vakhtang; Umakanthan, Ramanan; Karp, Seth; Stulak, John M; Keebler, Mary E; Maltais, Simon

2013-05-01

Multiple complications are associated with use of ventricular assist devices (VADs). Cardiac-related complications and infections are most frequently reported. VADs, however, can also lead to a number of general surgical complications equally significant in terms of morbidity and mortality. The authors performed a systematic literature search to review current data that specifically relate general surgical complications to patients who undergo left VAD implantation. The review provides a relatively clear understanding of the spectrum of general surgical complications and shows that they contribute significantly to morbidity and mortality in these patients.

System Would Acquire Core and Powder Samples of Rocks

NASA Technical Reports Server (NTRS)

Bar-Cohen, Yoseph; Randolph, James; Bao, Xiaoqi; Sherrit, Stewart; Ritz, Chuck; Cook, Greg

2006-01-01

A system for automated sampling of rocks, ice, and similar hard materials at and immediately below the surface of the ground is undergoing development. The system, denoted a sample preparation, acquisition, handling, and delivery (SPAHD) device, would be mounted on a robotic exploratory vehicle that would traverse the terrain of interest on the Earth or on a remote planet. The SPAHD device would probe the ground to obtain data for optimization of sampling, prepare the surface, acquire samples in the form(s) of cores and/or powdered cuttings, and deliver the samples to a selected location for analysis and/or storage.

Acute Kidney Injury With the RenalGuard System in Patients Undergoing Transcatheter Aortic Valve Replacement: The PROTECT-TAVI Trial (PROphylactic effecT of furosEmide-induCed diuresis with matched isotonic intravenous hydraTion in Transcatheter Aortic Valve Implantation).

PubMed

Barbanti, Marco; Gulino, Simona; Capranzano, Piera; Immè, Sebastiano; Sgroi, Carmelo; Tamburino, Claudia; Ohno, Yohei; Attizzani, Guilherme F; Patanè, Martina; Sicuso, Rita; Pilato, Gerlando; Di Landro, Alessio; Todaro, Denise; Di Simone, Emanuela; Picci, Andrea; Giannetto, Giuliana; Costa, Giuliano; Deste, Wanda; Giannazzo, Daniela; Grasso, Carmelo; Capodanno, Davide; Tamburino, Corrado

2015-10-01

The purpose of this study was to investigate the effect of the RenalGuard System (PLC Medical Systems, Milford, Massachusetts) on prevention of acute kidney injury (AKI) in patients undergoing transcatheter aortic valve replacement (TAVR). TAVR is associated with varying degrees of post-procedural AKI. The RenalGuard System is a dedicated device designed for contrast-induced AKI prevention. Whether this device is also effective in patients with severe aortic stenosis undergoing TAVR is unexplored. The present is an investigator-driven, single-center, prospective, open-label, registry-based randomized study that used the TAVR institutional registry of the Ferrarotto Hospital in Catania, Italy, as the platform for randomization, data collection, and follow-up assessment. A total of 112 consecutive patients undergoing TAVR were randomly assigned to hydration with normal saline solution controlled by the RenalGuard system and furosemide (RenalGuard group) or normal saline solution (control group). The primary endpoint was the incidence of Valve Academic Research Consortium-defined AKI in the first 72 h after the procedure. The AKI rate was lower in the RenalGuard group than in the control group (n = 3 [5.4%] vs. n =14 [25.0%], respectively, p = 0.014). The majority of patients (5.4% vs. 23.2%) developed a mild AKI (stage 1); severe damage (stage 3) occurred only in 1 patient in the control group (0.0% vs. 1.8%). No case of in-hospital renal failure requiring dialysis was reported. No significant differences in terms of mortality, cerebrovascular events, bleeding, and hospitalization for heart failure were noted in both groups at 30 days. Furosemide-induced diuresis with matched isotonic intravenous hydration using the RenalGuard system is an effective therapeutic tool to reduce the occurrence of AKI in patients undergoing TAVR. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Identification of a Very High Cuff Pressure by Manual Palpation of the External Cuff Balloon on an Endotracheal Tube.

PubMed

Hedberg, Pia; Eklund, Carolina; Högqvist, Sandra

2015-06-01

The most common complication due to intubation is a high cuff pressure. A high cuff pressure can cause postanesthetic tracheal mucosal injuries in patients undergoing surgery. The aim of this cross-sectional study was to describe whether anesthetic nurses and anesthesiologists identified a very high cuff pressure by manual palpation of the external cuff balloon on an endotracheal tube. An airway device was intubated with an endotracheal tube cuffed to 95 cm H2O. Each participant palpated the external cuff balloon and then filled out a questionnaire, including estimation of the cuff pressure and user frequency of the cuff pressure manometer. The results showed that 89.1% estimated that the cuff pressure was high. Among the participants who rated the cuff pressure as high, 44.8% rated the pressure as quite high and 60.6% rated the pressure as very high. There was no significant relationship between profession and skill in identifying a very high cuff pressure (P = .843) or between work experience and skill in terms of identifying a very high cuff pressure (P = .816). These findings indicate that 10% of patients are at risk of tracheal erosion because of a high cuff pressure.

Feasibility of Crosslinked Acrylic Shape Memory Polymer for a Thrombectomy Device

PubMed Central

Muschenborn, Andrea D.; Hearon, Keith; Volk, Brent L.; Conway, Jordan W.; Maitland, Duncan J.

2014-01-01

Purpose To evaluate the feasibility of utilizing a system of SMP acrylates for a thrombectomy device by determining an optimal crosslink density that provides both adequate recovery stress for blood clot removal and sufficient strain capacity to enable catheter delivery. Methods Four thermoset acrylic copolymers containing benzylmethacrylate (BzMA) and bisphenol A ethoxylate diacrylate (Mn~512, BPA) were designed with differing thermomechanical properties. Finite element analysis (FEA) was performed to ensure that the materials were able to undergo the strains imposed by crimping, and fabricated devices were subjected to force-monitored crimping, constrained recovery, and bench-top thrombectomy. Results Devices with 25 and 35 mole% BPA exhibited the highest recovery stress and the highest brittle response as they broke upon constrained recovery. On the contrary, the 15 mole % BPA devices endured all testing and their recovery stress (5 kPa) enabled successful bench-top thrombectomy in 2/3 times, compared to 0/3 for the devices with the lowest BPA content. Conclusion While the 15 mole% BPA devices provided the best trade-off between device integrity and performance, other SMP systems that offer recovery stresses above 5 kPa without increasing brittleness to the point of causing device failure would be more suitable for this application. PMID:25414549

Control Board Digital Interface Input Devices – Touchscreen, Trackpad, or Mouse?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Thomas A. Ulrich; Ronald L. Boring; Roger Lew

The authors collaborated with a power utility to evaluate input devices for use in the human system interface (HSI) for a new digital Turbine Control System (TCS) at a nuclear power plant (NPP) undergoing a TCS upgrade. A standalone dynamic software simulation of the new digital TCS and a mobile kiosk were developed to conduct an input device study to evaluate operator preference and input device effectiveness. The TCS software presented the anticipated HSI for the TCS and mimicked (i.e., simulated) the turbine systems’ responses to operator commands. Twenty-four licensed operators from the two nuclear power units participated in themore » study. Three input devices were tested: a trackpad, mouse, and touchscreen. The subjective feedback from the survey indicates the operators preferred the touchscreen interface. The operators subjectively rated the touchscreen as the fastest and most comfortable input device given the range of tasks they performed during the study, but also noted a lack of accuracy for selecting small targets. The empirical data suggest the mouse input device provides the most consistent performance for screen navigation and manipulating on screen controls. The trackpad input device was both empirically and subjectively found to be the least effective and least desired input device.« less

Improving the neutron-to-photon discrimination capability of detectors used for neutron dosimetry in high energy photon beam radiotherapy.

PubMed

Irazola, L; Terrón, J A; Bedogni, R; Pola, A; Lorenzoli, M; Sánchez-Nieto, B; Gómez, F; Sánchez-Doblado, F

2016-09-01

The increasing interest of the medical community to radioinduced second malignancies due to photoneutrons in patients undergoing high-energy radiotherapy, has stimulated in recent years the study of peripheral doses, including the development of some dedicated active detectors. Although these devices are designed to respond to neutrons only, their parasitic photon response is usually not identically zero and anisotropic. The impact of these facts on measurement accuracy can be important, especially in points close to the photon field-edge. A simple method to estimate the photon contribution to detector readings is to cover it with a thermal neutron absorber with reduced secondary photon emission, such as a borated rubber. This technique was applied to the TNRD (Thermal Neutron Rate Detector), recently validated for thermal neutron measurements in high-energy photon radiotherapy. The positive results, together with the accessibility of the method, encourage its application to other detectors and different clinical scenarios. Copyright © 2016 Elsevier Ltd. All rights reserved.

Non-Fullerene Electron Acceptors for Use in Organic Solar Cells

PubMed Central

2015-01-01

Conspectus The active layer in a solution processed organic photovoltaic device comprises a light absorbing electron donor semiconductor, typically a polymer, and an electron accepting fullerene acceptor. Although there has been huge effort targeted to optimize the absorbing, energetic, and transport properties of the donor material, fullerenes remain as the exclusive electron acceptor in all high performance devices. Very recently, some new non-fullerene acceptors have been demonstrated to outperform fullerenes in comparative devices. This Account describes this progress, discussing molecular design considerations and the structure–property relationships that are emerging. The motivation to replace fullerene acceptors stems from their synthetic inflexibility, leading to constraints in manipulating frontier energy levels, as well as poor absorption in the solar spectrum range, and an inherent tendency to undergo postfabrication crystallization, resulting in device instability. New acceptors have to address these limitations, providing tunable absorption with high extinction coefficients, thus contributing to device photocurrent. The ability to vary and optimize the lowest unoccupied molecular orbital (LUMO) energy level for a specific donor polymer is also an important requirement, ensuring minimal energy loss on electron transfer and as high an internal voltage as possible. Initially perylene diimide acceptors were evaluated as promising acceptor materials. These electron deficient aromatic molecules can exhibit good electron transport, facilitated by close packed herringbone crystal motifs, and their energy levels can be synthetically tuned. The principal drawback of this class of materials, their tendency to crystallize on too large a length scale for an optimal heterojunction nanostructure, has been shown to be overcome through introduction of conformation twisting through steric effects. This has been primarily achieved by coupling two units together, forming dimers with a large intramolecular twist, which suppresses both nucleation and crystal growth. The generic design concept of rotationally symmetrical aromatic small molecules with extended π orbital delocalization, including polyaromatic hydrocarbons, phthalocyanines, etc., has also provided some excellent small molecule acceptors. In most cases, additional electron withdrawing functionality, such as imide or ester groups, can be incorporated to stabilize the LUMO and improve properties. New calamitic acceptors have been developed, where molecular orbital hybridization of electron rich and poor segments can be judiciously employed to precisely control energy levels. Conformation and intermolecular associations can be controlled by peripheral functionalization leading to optimization of crystallization length scales. In particular, the use of rhodanine end groups, coupled electronically through short bridged aromatic chains, has been a successful strategy, with promising device efficiencies attributed to high lying LUMO energy levels and subsequently large open circuit voltages. PMID:26505279

Surface Charge Transfer Doping via Transition Metal Oxides for Efficient p-Type Doping of II-VI Nanostructures.

PubMed

Xia, Feifei; Shao, Zhibin; He, Yuanyuan; Wang, Rongbin; Wu, Xiaofeng; Jiang, Tianhao; Duhm, Steffen; Zhao, Jianwei; Lee, Shuit-Tong; Jie, Jiansheng

2016-11-22

Wide band gap II-VI nanostructures are important building blocks for new-generation electronic and optoelectronic devices. However, the difficulty of realizing p-type conductivity in these materials via conventional doping methods has severely handicapped the fabrication of p-n homojunctions and complementary circuits, which are the fundamental components for high-performance devices. Herein, by using first-principles density functional theory calculations, we demonstrated a simple yet efficient way to achieve controlled p-type doping on II-VI nanostructures via surface charge transfer doping (SCTD) using high work function transition metal oxides such as MoO 3 , WO 3 , CrO 3 , and V 2 O 5 as dopants. Our calculations revealed that these oxides were capable of drawing electrons from II-VI nanostructures, leading to accumulation of positive charges (holes injection) in the II-VI nanostructures. As a result, Fermi levels of the II-VI nanostructures were shifted toward the valence band regions after surface modifications, along with the large enhancement of work functions. In situ ultraviolet photoelectron spectroscopy and X-ray photoelectron spectroscopy characterizations verified the significant interfacial charge transfer between II-VI nanostructures and surface dopants. Both theoretical calculations and electrical transfer measurements on the II-VI nanostructure-based field-effect transistors clearly showed the p-type conductivity of the nanostructures after surface modifications. Strikingly, II-VI nanowires could undergo semiconductor-to-metal transition by further increasing the SCTD level. SCTD offers the possibility to create a variety of electronic and optoelectronic devices from the II-VI nanostructures via realization of complementary doping.

Comparison of five video-assisted intubation devices by novice and expert laryngoscopists for use in the aeromedical evacuation environment.

PubMed

Wallace, Matthew C; Britton, SSgt Tyler; Meek, Robbie; Walsh-Hart, Sharon; Carter, Col Todd E; Lisco, Steven J

2017-01-01

The critically ill or injured patient undergoing military medical evacuation may require emergent intubation. Intubation may be life-saving, but it carries risks. The novice or infrequent laryngoscopist has a distinct disadvantage because experience is critical for the rapid and safe establishment of a secured airway. This challenge is compounded by the austere environment of the back of an aircraft under blackout conditions. This study determined which of five different video-assisted intubation devices (VAIDs) was best suited for in-flight use by U.S. Air Force Critical Care Air Transport Teams by comparing time to successful intubation between novice and expert laryngoscopists under three conditions, Normal Airway Lights on (NAL), Difficult Airway Lights on (DAL) and Difficult Airway Blackout (DAB), using manikins on a standard military transport stanchion and the floor with a minimal amount of setup time and extraneous light emission. A convenience sample size of 40 participants (24 novices and 16 experts) attempted intubation with each of the 5 different video laryngoscopic devices on high-fidelity airway manikins. Time to tracheal intubation and number of optimization maneuvers used were recorded. Kruskal-Wallis testing determined significant differences between the VAIDs in time to intubation for each particular scenario. Devices with significant differences underwent pair-wise comparison testing using rank-sum analysis to further clarify the difference. Device assembly times, startup times and the amount of light emitted were recorded. Perceived ease of use was surveyed. Novices were fastest with the Pentax AWS in all difficult airway scenarios. Experts recorded the shortest median times consistently using 3 of the 5 devices. The AWS was superior overall in 4 of the 6 scenarios tested. Experts and novices subjectively judged the GlideScope Ranger as easiest to use. The light emitted by all the devices was less than the USAF-issued headlamp. Novices intubated fastest with the Pentax AWS in all difficult airway scenarios. The GlideScope required the shortest setup time, and participants judged this device as the easiest to use. The GlideScope and AWS exhibited the two fastest total setup times. Both devices are suitable for in-flight use by infrequent and seasoned laryngoscopists.

Materials for programmed, functional transformation in transient electronic systems.

PubMed

Hwang, Suk-Won; Kang, Seung-Kyun; Huang, Xian; Brenckle, Mark A; Omenetto, Fiorenzo G; Rogers, John A

2015-01-07

Materials and device designs are presented for electronic systems that undergo functional transformation by a controlled time sequence in the dissolution of active materials and/or encapsulation layers. Demonstration examples include various biocompatible, multifunctional systems with autonomous behavior defined by materials selection and layout. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Private Sector Consultants and Public Universities: The Challenges of Cross-Sectoral Knowledge Transfers

ERIC Educational Resources Information Center

Serrano-Velarde, Kathia; Krucken, Georg

2012-01-01

Since the early 1990s, European higher education has been undergoing drastic changes with regard to the organisation and governance of academic work. The political emphasis on higher education autonomy and accountability went hand in hand with the introduction of market type steering devices and a new discourse regarding the universities'…

A Successful Anticoagulation Protocol for the First HeartMate® II Implantation in the United States

PubMed Central

Amir, Offer; Bracey, Arthur W.; Smart, Frank W.; Delgado, Reynolds M.; Shah, Nyma; Kar, Biswajit; Gregoric, Igor D.

2005-01-01

Bleeding and thrombus formation are common problems with life-threatening implications in patients receiving a left ventricular assist device. We describe the anticoagulation protocol for the 1st patient in the United States to undergo successful implantation of the HeartMate® II left ventricular assist system. PMID:16392229

Practical considerations and nuances in anesthesia for patients undergoing deep brain stimulation implantation surgery.

PubMed

Scharpf, Danielle Teresa; Sharma, Mayur; Deogaonkar, Milind; Rezai, Ali; Bergese, Sergio D

2015-08-01

The field of functional neurosurgery has expanded in last decade to include newer indications, new devices, and new methods. This advancement has challenged anesthesia providers to adapt to these new requirements. This review aims to discuss the nuances and practical issues that are faced while administering anesthesia for deep brain stimulation surgery.

Perioperative management of calves undergoing implantation of a left ventricular assist device.

PubMed

Wilson, D V; Kantrowitz, A; Pacholewicz, J; Salat, O; Paules, B R; Zhou, Y; Dawe, E J

2000-01-01

To describe perioperative management of calves that underwent left lateral thoracotomy, aortic cross-clamping, partial left heart bypass and implantation of a left ventricular assist device. A total of 43 healthy castrated male calves, weighing 121 +/- 24 kg. Diazepam (mean +/- SD, 0.26 +/- 0.07 mg/kg), ketamine (5.9 +/- 2.17 mg/kg) and isoflurane were used in the anesthetic management of calves undergoing implantation of a left ventricular assist device in the descending thoracic aorta. Other adjunctive agents administered were fentanyl (11 +/- 5.4 microg/kg), lidocaine (4.9 +/- 3.19 mg/kg), bupivacaine (0.75%) and butorphanol (0.49 +/- 0.13 mg/kg). None of the calves regurgitated at induction or during intubation. A tube was used to drain the rumen and prevent bloat during the procedure. Partial left heart bypass was used to perfuse the caudal half of the body during the period of aortic cross clamp and device implantation. Initial mean systemic blood pressure was 96 +/- 25 mm Hg, and pressures measured in the auricular artery increased during aortic cross-clamping and bypass. Vasoconstrictor therapy was required to treat caudal arterial hypotension during the procedure in 9 calves. Mean systemic arterial pressures returned to baseline values by the end of the anesthetic period. Initial mean pulmonary arterial pressures (PAP) were 22 +/- 3 mm Hg. A significant but transient increase in pulmonary arterial pressure occurred after both heparin and protamine administration. The described anesthetic protocol was effective for thoracotomy and implantation of an intra-aortic left ventricular assist device in normal calves. Partial left ventricular bypass was a useful adjunct during the period of aortic cross clamp. The doses of heparin and protamine administered were effective. Responsibility to monitor oxygenation of the cranial half of the animal continues during the bypass period as hypoxemia due to pulmonary dysfunction will not be detected by the perfusionist.

Totally endoscopic implant to effect a gastric bypass: 12-month safety and efficacy outcomes.

PubMed

Sandler, Bryan J; Biertho, Laurent; Anvari, Mehran; Rumbaut, Roberto; Morales-Garza, Luis Alonso; Torres-Barrera, Gustavo; Marceau, Simon; Hong, Dennis; Smith, C Daniel; Horgan, Santiago

2018-04-20

Only a small percentage of candidates for bariatric surgery ever undergo a procedure for weight loss. Devices duplicating key effects of bariatric surgeries with removable, fully trans-oral implants could extend their benefits to patients unwilling to undergo anatomy-altering abdominal surgeries. Thirty-two obese subjects (mean BMI: 42.3) were enrolled in a prospective, multicenter, single-arm, feasibility trial of the first fully trans-oral endoscopic gastrointestinal bypass device. The device is a cuff attached to the distal esophagus by transmural anchors and connected to a 120-cm sleeve diverting undigested nutrients to the jejunum. Bodyweight, vital signs, adverse events, medications, HbA1c, fasting glucose, and lipids were collected at baseline and follow-up visits. Device status was endoscopically assessed every 6 months. The fully trans-oral procedure was successful in all subjects without intraoperative adverse events or postoperative infections. Twenty-eight of 32 subjects (88%) remained implanted with continuing follow-up beyond their 12-month visit. At 12 months, the 32 subjects had lost an average of 44.8% of excess body weight, 17.6% of total body weight, 20.8 kg, and 7.5 BMI points. Weight loss depended on capture of ingesta by the esophageal cuff, with 18 of 32 subjects without visible gaps around their cuffs at the 6 month endoscopy having significantly greater EWL (53.6 vs. 33.4% in the remaining subjects, p < 0.002). Mean HbA1c and fasting glucose declined by 1.1% points and 29 mg/dL in type 2 diabetic subjects, 80% of whom had remission of their diabetes at 12 months. This study demonstrates the feasibility, safety, and efficacy of a fully trans-oral gastrointestinal bypass implant. This purely endoscopic device may provide a valuable addition to the armamentarium of treatment available for the management of morbid obesity.

Risk of iron overload is decreased in beating heart coronary artery surgery compared to conventional bypass.

PubMed

Mumby, S; Koh, T W; Pepper, J R; Gutteridge, J M

2001-11-29

Conventional cardiopulmonary bypass surgery (CCPB) increases the iron loading of plasma transferrin often to a state of plasma iron overload, with the presence of low molecular mass iron. Such iron is a potential risk factor for oxidative stress and microbial virulence. Here we assess 'off-pump' coronary artery surgery on the beating heart for changes in plasma iron chemistry. Seventeen patients undergoing cardiac surgery using the 'Octopus' myocardial wall stabilisation device were monitored at five time points for changes in plasma iron chemistry. This group was further divided into those (n=9) who had one- or two- (n=8) vessel grafts, and compared with eight patients undergoing conventional coronary artery surgery. Patients undergoing beating heart surgery had significantly lower levels of total plasma non-haem iron, and a decreased percentage saturation of their transferrin at all time points compared to conventional bypass patients. Plasma iron overload occurred in only one patient undergoing CCPB. Beating heart surgery appears to decrease red blood cell haemolysis, and tissue damage during the operative procedures and thereby significantly decreases the risk of plasma iron overload associated with conventional bypass.

Structural and chemical evolution of the CdS:O window layer during individual CdTe solar cell processing steps

DOE PAGES

Abbas, A.; Meysing, D. M.; Reese, M. O.; ...

2017-12-01

Oxygenated cadmium sulfide (CdS:O) is often used as the n-type window layer in high-performance CdTe heterojunction solar cells. The as-deposited layer prepared by reactive sputtering is XRD amorphous, with a bulk composition of CdS0.8O1.2. Recently it was shown that this layer undergoes significant transformation during device fabrication, but the roles of the individual high temperature processing steps was unclear. In this work high resolution transmission electron microscopy coupled to elemental analysis was used to understand the evolution of the heterojunction region through the individual high temperature fabrication steps of CdTe deposition, CdCl2 activation, and back contact activation. It is foundmore » that during CdTe deposition by close spaced sublimation at 600 degrees C the CdS:O film undergoes recrystallization, accompanied by a significant (~30%) reduction in thickness. It is observed that oxygen segregates during this step, forming a bi-layer morphology consisting of nanocrystalline CdS adjacent to the tin oxide contact and an oxygen-rich layer adjacent to the CdTe absorber. This bilayer structure is then lost during the 400 degrees C CdCl2 treatment where the film transforms into a heterogeneous structure with cadmium sulfate clusters distributed randomly throughout the window layer. The thickness of window layer remains essentially unchanged after CdCl2 treatment, but a ~25 nm graded interfacial layer between CdTe and the window region is formed. Finally, the rapid thermal processing step used to activate the back contact was found to have a negligible impact on the structure or composition of the heterojunction region.« less

Structural and chemical evolution of the CdS:O window layer during individual CdTe solar cell processing steps

DOE Office of Scientific and Technical Information (OSTI.GOV)

Abbas, A.; Meysing, D. M.; Reese, M. O.

Oxygenated cadmium sulfide (CdS:O) is often used as the n-type window layer in high-performance CdTe heterojunction solar cells. The as-deposited layer prepared by reactive sputtering is XRD amorphous, with a bulk composition of CdS0.8O1.2. Recently it was shown that this layer undergoes significant transformation during device fabrication, but the roles of the individual high temperature processing steps was unclear. In this work high resolution transmission electron microscopy coupled to elemental analysis was used to understand the evolution of the heterojunction region through the individual high temperature fabrication steps of CdTe deposition, CdCl2 activation, and back contact activation. It is foundmore » that during CdTe deposition by close spaced sublimation at 600 degrees C the CdS:O film undergoes recrystallization, accompanied by a significant (~30%) reduction in thickness. It is observed that oxygen segregates during this step, forming a bi-layer morphology consisting of nanocrystalline CdS adjacent to the tin oxide contact and an oxygen-rich layer adjacent to the CdTe absorber. This bilayer structure is then lost during the 400 degrees C CdCl2 treatment where the film transforms into a heterogeneous structure with cadmium sulfate clusters distributed randomly throughout the window layer. The thickness of window layer remains essentially unchanged after CdCl2 treatment, but a ~25 nm graded interfacial layer between CdTe and the window region is formed. Finally, the rapid thermal processing step used to activate the back contact was found to have a negligible impact on the structure or composition of the heterojunction region.« less

An Automatic Occlusion Device for Remote Control of Tumor Tissue Ischemia

PubMed Central

El-Dahdah, Hamid; Wang, Bei; He, Guanglong; Xu, Ronald X.

2015-01-01

We developed an automatic occlusion device for remote control of tumor tissue ischemia. The device consists of a flexible cannula encasing a shape memory alloy wire with its distal end connected to surgical suture. Regional tissue occlusion was tested on both the benchtop and the animal models. In the benchtop test, the occlusion device introduced quantitative and reproducible changes of blood flow in a tissue simulating phantom embedding a vessel simulator. In the animal test, the device generated a cyclic pattern of reversible ischemia in the right hinder leg tissue of a black male C57BL/6 mouse. We also developed a multimodal detector that integrates near infrared spectroscopy and electron paramagnetic resonance spectroscopy for continuous monitoring of tumor tissue oxygenation, blood content, and oxygen tension changes. The multimodal detector was tested on a cancer xenograft nude mouse undergoing reversible tumor ischemia. The automatic occlusion device and the multi-modal detector can be potentially integrated for closed-loop feedback control of tumor tissue ischemia. Such an integrated occlusion device may be used in multiple clinical applications such as regional hypoperfusion control in tumor resection surgeries and thermal ablation processes. In addition, the proposed occlusion device can also be used as a research tool to understand tumor oxygen transport and hemodynamic characteristics. PMID:20082532

Design and Fabrication of High-Efficiency CMOS/CCD Imagers

NASA Technical Reports Server (NTRS)

Pain, Bedabrata

2007-01-01

An architecture for back-illuminated complementary metal oxide/semiconductor (CMOS) and charge-coupled-device (CCD) ultraviolet/visible/near infrared- light image sensors, and a method of fabrication to implement the architecture, are undergoing development. The architecture and method are expected to enable realization of the full potential of back-illuminated CMOS/CCD imagers to perform with high efficiency, high sensitivity, excellent angular response, and in-pixel signal processing. The architecture and method are compatible with next-generation CMOS dielectric-forming and metallization techniques, and the process flow of the method is compatible with process flows typical of the manufacture of very-large-scale integrated (VLSI) circuits. The architecture and method overcome all obstacles that have hitherto prevented high-yield, low-cost fabrication of back-illuminated CMOS/CCD imagers by use of standard VLSI fabrication tools and techniques. It is not possible to discuss the obstacles in detail within the space available for this article. Briefly, the obstacles are posed by the problems of generating light-absorbing layers having desired uniform and accurate thicknesses, passivation of surfaces, forming structures for efficient collection of charge carriers, and wafer-scale thinning (in contradistinction to diescale thinning). A basic element of the present architecture and method - the element that, more than any other, makes it possible to overcome the obstacles - is the use of an alternative starting material: Instead of starting with a conventional bulk-CMOS wafer that consists of a p-doped epitaxial silicon layer grown on a heavily-p-doped silicon substrate, one starts with a special silicon-on-insulator (SOI) wafer that consists of a thermal oxide buried between a lightly p- or n-doped, thick silicon layer and a device silicon layer of appropriate thickness and doping. The thick silicon layer is used as a handle: that is, as a mechanical support for the device silicon layer during micro-fabrication.

Early Detection of Chronic Obstructive Pulmonary Disease in Primary Care.

PubMed

Kobayashi, Seiichi; Hanagama, Masakazu; Yanai, Masaru

2017-12-01

Objective To evaluate the effectiveness of an early detection program for chronic obstructive pulmonary disease (COPD) in a primary care setting in Japan. Methods Participants of ≥40 years of age who regularly visited a general practitioner's clinic due to chronic disease were asked to complete a COPD screening questionnaire (COPD Population Screener; COPD-PS) and undergo simplified spirometry using a handheld spirometric device. Patients who showed possible COPD were referred to a respiratory specialist and underwent a detailed examination that included spirometry and chest radiography. Results A total of 111 patients with possible COPD were referred for close examination. Among these patients, 27 patients were newly diagnosed with COPD. The patients with COPD were older, had lower BMI values, and had a longer smoking history in comparison to non-COPD patients. COPD patients also had more comorbid conditions. A diagnosis of COPD was significantly associated with a high COPD-PS score (p<0.001) and the detection of possible airflow limitation evaluated by the handheld spirometric device (p<0.01). An ROC curve analysis demonstrated that 5 points was the best COPD-PS cut-off value for the diagnosis of COPD. The combination of both tools showed 40.7% of sensitivity and 96.4% of specificity. Conclusion The use of the COPD-PS plus a handheld spirometric device could facilitate the early detection of undiagnosed COPD in primary care.

The Kaiser Permanente implant registries: effect on patient safety, quality improvement, cost effectiveness, and research opportunities.

PubMed

Paxton, Elizabeth W; Inacio, Maria Cs; Kiley, Mary-Lou

2012-01-01

Considering the high cost, volume, and patient safety issues associated with medical devices, monitoring of medical device performance is critical to ensure patient safety and quality of care. The purpose of this article is to describe the Kaiser Permanente (KP) implant registries and to highlight the benefits of these implant registries on patient safety, quality, cost effectiveness, and research. Eight KP implant registries leverage the integrated health care system's administrative databases and electronic health records system. Registry data collected undergo quality control and validation as well as statistical analysis. Patient safety has been enhanced through identification of affected patients during major recalls, identification of risk factors associated with outcomes of interest, development of risk calculators, and surveillance programs for infections and adverse events. Effective quality improvement activities included medical center- and surgeon-specific profiles for use in benchmarking reports, and changes in practice related to registry information output. Among the cost-effectiveness strategies employed were collaborations with sourcing and contracting groups, and assistance in adherence to formulary device guidelines. Research studies using registry data included postoperative complications, resource utilization, infection risk factors, thromboembolic prophylaxis, effects of surgical delay on concurrent injuries, and sports injury patterns. The unique KP implant registries provide important information and affect several areas of our organization, including patient safety, quality improvement, cost-effectiveness, and research.

E-cigarette puffing patterns associated with high and low nicotine e-liquid strength: effects on toxicant and carcinogen exposure.

PubMed

Cox, Sharon; Kośmider, Leon; McRobbie, Hayden; Goniewicz, Maciej; Kimber, Catherine; Doig, Mira; Dawkins, Lynne

2016-09-20

Contrary to intuition, use of lower strength nicotine e-liquids might not offer reduced health risk if compensatory puffing behaviour occurs. Compensatory puffing (e.g. more frequent, longer puffs) or user behaviour (increasing the wattage) can lead to higher temperatures at which glycerine and propylene glycol (solvents used in e-liquids) undergo decomposition to carbonyl compounds, including the carcinogens formaldehyde and acetaldehyde. This study aims to document puffing patterns and user behaviour associated with using high and low strength nicotine e-liquid and associated toxicant/carcinogen exposure in experienced e-cigarette users (known as vapers herein). A counterbalanced repeated measures design. Non-tobacco smoking vapers; have used an e-cigarette for ≥3 months; currently using nicotine strength e-liquid ≥12mg/mL and a second or third generation device. This study will measure puffing patterns in vapers whilst they use high and low strength nicotine e-liquid under fixed and user-defined settings, each for a week. The 4 counterbalanced conditions are: i) low strength (6mg/mL), fixed settings; ii) low strength user-defined settings; iii) high strength (18mg/mL) fixed settings; iv) high strength user-defined settings. Biomarkers of exposure to toxicants and carcinogens will be measured in urine. In the second phase of this study, toxicant yields will be measured in aerosol generated using a smoking machine operated to replicate the puffing behaviours of each participant. i) Puffing patterns (mean puff number, puff duration, inter-puff interval and mL of liquid consumed) and user behaviour (changes to device settings: voltage and air-flow) associated with using high and low strength nicotine e-liquid. ii) Toxicant/carcinogen exposure associated with the puffing patterns/device settings used by our participants. i) Subjective effects. ii) comparisons with toxicant exposure from tobacco smoke (using documented evidence) and with recommended safety limits. Twenty participants. The findings will have important implications for public health messaging regarding the relative risks and subjective effects associated with using high and low strength nicotine e-liquid, and for policy makers regarding regulations on nicotine concentrations in e-liquids.

DNA sequence-directed shape change of photopatterned hydrogels via high-degree swelling

NASA Astrophysics Data System (ADS)

Cangialosi, Angelo; Yoon, ChangKyu; Liu, Jiayu; Huang, Qi; Guo, Jingkai; Nguyen, Thao D.; Gracias, David H.; Schulman, Rebecca

2017-09-01

Shape-changing hydrogels that can bend, twist, or actuate in response to external stimuli are critical to soft robots, programmable matter, and smart medicine. Shape change in hydrogels has been induced by global cues, including temperature, light, or pH. Here we demonstrate that specific DNA molecules can induce 100-fold volumetric hydrogel expansion by successive extension of cross-links. We photopattern up to centimeter-sized gels containing multiple domains that undergo different shape changes in response to different DNA sequences. Experiments and simulations suggest a simple design rule for controlled shape change. Because DNA molecules can be coupled to molecular sensors, amplifiers, and logic circuits, this strategy introduces the possibility of building soft devices that respond to diverse biochemical inputs and autonomously implement chemical control programs.

A Multicenter Cohort Comparison Study of the Safety, Efficacy, and Cost of Ticagrelor Compared to Clopidogrel in Aneurysm Flow Diverter Procedures.

PubMed

Moore, Justin M; Adeeb, Nimer; Shallwani, Hussain; Gupta, Raghav; Patel, Apar S; Griessenauer, Christoph J; Youn, Roy; Siddiqui, Adnan; Ogilvy, Christopher S; Thomas, Ajith J

2017-10-01

Thromboembolic and hemorrhagic complications are among the most feared adverse events in the endovascular treatment of aneurysms, and this is particularly the case for flow diverter devices. Dual antiplatelet therapy has become standard of care; however, the safety, efficacy, and cost profiles of newer antiplatelet agents are not well characterized in the neurovascular context. To compare the safety, efficacy, and cost of one of these newer agents, ticagrelor, to the most frequently used agent, clopidogrel. A multicenter, retrospective, cohort comparison study design of consecutively treated aneurysms with flow diverter embolization device and treated with either ticagrelor or clopidogrel was performed. Data were collected on patient demographics and risk factors, procedural details, antiplatelet treatment regime, complications, and angiographic and functional outcomes. Fifty patients undergoing flow diverter device deployment and treatment with ticagrelor were compared to 53 patients undergoing flow diversion and treatment with clopidogrel. The patients' age, sex, smoking status, aneurismal morphology and size, and procedural details did not differ between the 2 groups; neither did the rate of thromboembolic and hemorrhagic complications, angiographical, and functional outcomes. Ticagrelor was more expensive when compared to clopidogrel. Ticagrelor is a safe and effective agent for prevention of thromboembolic complications following flow diverter deployment when compared to clopidogrel. However, ticagrelor remains significantly more expensive than clopidogrel, and, thus, we would advise ticagrelor be reserved for patients who are hyporesponsive to clopidogrel. Copyright © 2017 by the Congress of Neurological Surgeons

A descriptive study on the efficacy and complications of the Capio (Boston Scientific) suturing device for sacrospinous ligament fixation.

PubMed

Mowat, Alex; Wong, Vivien; Goh, Judith; Krause, Hannah; Pelecanos, Anita; Higgs, Peta

2018-02-01

Sacrospinous colpopexy is an effective vaginal apical support operation. Due to morbidity associated with traditional approaches which require wide dissection, slim-line suture delivery devices have been introduced in the hope of reducing morbidity without compromise to outcomes. The aim of our series was to report outcomes and complications (particularly buttock pain and blood loss) of the sacrospinous colpopexy using the Capio suturing device and evaluate it against published results using the Miya hook. This is a prospective, multi-centre descriptive study. The primary outcome is objective success at 12 months. Secondary outcomes include subjective success at 12 months, patient-reported outcomes at 12 months, operating time, estimated blood loss and post-operative buttock pain. Fifty-one consenting patients undergoing sacrospinous colpopexy were recruited at four Queensland hospitals. Objective success at 12 months was 95% (41/43) and subjective success at 12 months was 92% (44/48). Eighty-four percent of patients reported buttock pain at one week, reducing to 16% by six weeks, of which 7% required analgesia. At a mean of 17 months follow up, we found that the sacrospinous colpopexy using the Capio suturing device provided excellent apical support with a low requirement for blood transfusion and an average operating time of seven minutes. We found a high rate of buttock pain immediately post-operatively, but our rates became consistent with previous reports by six weeks post-operation. © 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Proximal protection with hybrid stent, a safer combination for carotid artery stenting against carotid endarterectomy?

PubMed

Gürkaş, E; Ak, F; Orhan, G; Bozkurt, E; Ulusoy, E K

2015-12-01

Carotid revascularization is an established theurapeutic modality in preventing stroke and death among patients with severe carotid stenosis. Although carotid endarterectomy remains as the primary option, carotid stenting is accepted as an alternative for patients with high risk for carotid endarterectomy. Recently published reports have better results with proximal protection devices when compared with distal protection devices. These studies have revealed less microembolic signals and less periprocedural new ischemic lesions on diffusion weighted magnetic resonance imaging. Stent choice may be also important for these procedures as open cell stent design has advantage of better flexibility whereas closed cell systems have an advantage of better scaffolding. Hybrid stents which are composed of open cells in the proximal and distal part and closed cells in the middle may carry both advantages. The aim of this study is to demonstrate whether combination of proximal protection devices with hybrid stents can be a safe alternative for carotid stenting in terms of periprocedural and 30-day outcomes. Here we retrospectively evaluated 68 symptomatic carotid stenosis patients undergoing carotid stenting with hybrid stent (Cristallo Ideale®, Invatec s.r.l., Medtronic, Italy) and proximal protection device (MO.MA®, Invatec s.r.l., Medtronic, Italy). Our results showed only 1 minor stroke in the periprocedural period and during the first 30-day after stenting, with no death or myocardial infarction. Although our case number is not large, we propose that carotid stenting may be safer with utilization of proximal protection system and hybrid type carotid stents.

Method of high purity silane preparation

DOEpatents

Tsuo, Y. Simon; Belov, Eugene P.; Gerlivanov, Vadim G.; Zadde, Vitali V.; Kleschevnikova, Solomonida I.; Korneev, Nikolai N.; Lebedev, Eugene N.; Pinov, Akhsarbek B.; Ryabenko, Eugene A.; Strebkov, Dmitry S.; Chernyshev, Eugene A.

2000-01-01

A process for the preparation of high purity silane, suitable for forming thin layer silicon structures in various semiconductor devices and high purity poly- and single crystal silicon for a variety of applications, is provided. Synthesis of high-purity silane starts with a temperature assisted reaction of metallurgical silicon with alcohol in the presence of a catalyst. Alcoxysilanes formed in the silicon-alcohol reaction are separated from other products and purified. Simultaneous reduction and oxidation of alcoxysilanes produces gaseous silane and liquid secondary products, including, active part of a catalyst, tetra-alcoxysilanes, and impurity compounds having silicon-hydrogen bonds. Silane is purified by an impurity adsorption technique. Unreacted alcohol is extracted and returned to the reaction with silicon. Concentrated mixture of alcoxysilanes undergoes simultaneous oxidation and reduction in the presence of a catalyst at the temperature -20.degree. C. to +40.degree. C. during 1 to 50 hours. Tetra-alcoxysilane extracted from liquid products of simultaneous oxidation and reduction reaction is directed to a complete hydrolysis. Complete hydrolysis of tetra-alcoxysilane results in formation of industrial silica sol and alcohol. Alcohol is dehydrated by tetra-alcoxysilane and returned to the reaction with silicon.

Electrically controlled polymeric gel actuators

DOEpatents

Adolf, Douglas B.; Shahinpoor, Mohsen; Segalman, Daniel J.; Witkowski, Walter R.

1993-01-01

Electrically controlled polymeric gel actuators or synthetic muscles capable of undergoing substantial expansion and contraction when subjected to changing pH environments, temperature, or solvent. The actuators employ compliant containers for the gels and their solvents. The gels employed may be cylindrical electromechanical gel fibers such as polyacrylamide fibers or a mixture of poly vinyl alcohol-polyacrylic acid arranged in a parallel aggregate and contained in an electrolytic solvent bath such as salt water. The invention includes smart, electrically activated devices exploiting this phenomenon. These devices are capable of being manipulated via active computer control as large displacement actuators for use in adaptive structure such as robots.

Electrically controlled polymeric gel actuators

DOEpatents

Adolf, D.B.; Shahinpoor, M.; Segalman, D.J.; Witkowski, W.R.

1993-10-05

Electrically controlled polymeric gel actuators or synthetic muscles are described capable of undergoing substantial expansion and contraction when subjected to changing pH environments, temperature, or solvent. The actuators employ compliant containers for the gels and their solvents. The gels employed may be cylindrical electromechanical gel fibers such as polyacrylamide fibers or a mixture of poly vinyl alcohol-polyacrylic acid arranged in a parallel aggregate and contained in an electrolytic solvent bath such as salt water. The invention includes smart, electrically activated devices exploiting this phenomenon. These devices are capable of being manipulated via active computer control as large displacement actuators for use in adaptive structure such as robots. 11 figures.

Noncontact rack-pinion-rack device as a differential vibration sensor.

PubMed

Miri, MirFaez; Nasiri, Mojtaba

2010-07-01

We study a nanoscale system composed of one corrugated cylinder (pinion) placed between two corrugated plates (racks). The pinion and racks have no mechanical contact, but are coupled via the lateral Casimir force-one of the most spectacular consequences of quantum fluctuations of the electromagnetic field. The noncontact design of the device could help with the noteworthy wear problem in nanoscale mechanical systems. We consider the case where both racks undergo harmonic lateral motion. We assume that the amplitude, frequency, and phase of one of the racks are known. We show that probing the pinion motion, one can determine the vibration characteristics of the other rack.

Strain-induced negative differential resistance in ultrasmall carbon nanotube

NASA Astrophysics Data System (ADS)

Fang, Hui; Zhang, Fei-Peng; Ruan, Xing-Xiang; Huang, Can-Sheng; Jiang, Zhi-Nian; Peng, Jin-Yun; Wang, Ru-Zhi

2017-08-01

The transport properties in ultrasmall single-wall carbon nanotubes (SWCNTs) under tensile strain have been theoretically investigated. The regular negative differential resistance (NDR) induced by the strain undergoes a process from enhancement to weakening in the zigzag (3,0) SWCNT. The NDR achieves maximum with applying 4% tensile strain. Compared to the case of (3,0) SWCNT, that NDR cannot be manipulated by applying strain clearly in (4,0) and (5,0) ultrasmall SWCNTs with tensile strain lower than 10%. It proposes this strain-induced NDR effect to demonstrate the possibility of finding potential applications in SWCNT-based NDR nanodevices such as in memory devices, oscillators and fast switching devices.

Clinical characteristics associated with pacing-induced cardiac dysfunction: a high incidence of undiagnosed cardiac sarcoidosis before permanent pacemaker implantation.

PubMed

Wakabayashi, Yasushi; Mitsuhashi, Takeshi; Akashi, Naoyuki; Hayashi, Takekuni; Umemoto, Tomio; Sugawara, Yoshitaka; Fujita, Hideo; Momomura, Shin-Ichi

2018-06-21

Previous studies suggested that right ventricular pacing was associated with pacing-induced cardiac dysfunction (PICD). The purpose of this study was to investigate the clinical characteristics including the incidence of undiagnosed cardiac sarcoidosis (CS) in patients with atrioventricular block (AVB) who manifest PICD. We retrospectively investigated consecutive patients with permanent pacemaker (PPM) undergoing a first-generator replacement surgery with a new PPM or an upgrade procedure to a cardiac resynchronization therapy (CRT) device between December 1, 2011 and June 30, 2017. Patients with AVB showing normal echocardiographic findings before PPM implantation were included and divided into 2 groups: patients with post-PPM left ventricular ejection fraction (LVEF) < 40% and/or undergoing an upgrade procedure to CRT (PICD group) and patients with post-PPM LVEF ≥ 40% who underwent replacement surgery with a new PPM (no-PICD group). There were 15 and 41 patients in the PICD and no-PICD groups, respectively. A wider-paced QRS duration just after the PPM implantation and/or lower pre-PPM LVEF was observed in the PICD group. Furthermore, 46.7% of the PICD patients (7/15) satisfied the diagnostic criteria for CS according to the guideline of the Japanese Circulation Society, although no patients fulfilled these criteria before PPM implantation. In conclusion, a high incidence of CS was observed in patients with AVB who had PICD. However, none of these patients was diagnosed with CS before PPM implantation.

Comparison of human papillomavirus infection and cervical cytology in women using copper-containing and levonorgestrel-containing intrauterine devices.

PubMed

Lekovich, Jovana P; Amrane, Selma; Pangasa, Misha; Pereira, Nigel; Frey, Melissa K; Varrey, Aneesha; Holcomb, Kevin

2015-05-01

To investigate whether there is a difference in cervical cytology and high-risk human papillomavirus (HPV) infection clearance between levonorgestrel- and copper-containing intrauterine device (IUD) users. The electronic medical record system was searched by the appropriate procedural code for IUD insertion for all patients undergoing IUD placement during the study period (January 31, 2005 to January 31, 2012). Patients who received treatment for cervical dysplasia, had their IUDs removed, or conceived during the study period were excluded. High-risk HPV and cervical cytology results immediately preceding and after IUD placement were obtained. One hundred fifty patients had a copper-containing and 152 patients a levonorgestrel-containing IUD placed. The groups were comparable in terms of age, body mass index, duration of follow-up, and percentage of smokers. Sixty-six patients were high-risk HPV-positive before IUD insertion (30 in copper compared with 36 in the levonorgestrel IUD group, P=.4), and the groups had similar follow-up times (364.1±26.3 compared with 357.2±29.7 days, respectively, between the IUD placement and a repeat Pap test with high-risk HPV cotesting, P=.2). Of those, 21 (70%; 95% confidence interval [CI] 53.6-86.4%) cleared the infection after copper-containing IUD placement compared with 15 (42%; 95% CI 25.6-57.8%) in the levonorgestrel group (P=.04). There were only two (1.7%) new high-risk HPV infections in the copper compared with eight (6.9%) in the levonorgestrel group (P=.056). Our data suggest that levonorgestrel-containing IUD could be associated with decreased high-risk HPV infection clearance and possibly increased acquisition compared with the copper-containing IUD. II.

Clinical Assessment of Intraventricular Blood Transport in Patients Undergoing Cardiac Resynchronization Therapy

NASA Astrophysics Data System (ADS)

Rossini, Lorenzo; Martinez-Legazpi, P.; Benito, Y.; Perez Del Villar, C.; Gonzalez-Mansilla, A.; Barrio, A.; Yotti, R.; Kahn, A. M.; Shadden, S. C.; Fernandez-Aviles, F.; Bermejo, J.; Del Alamo, J. C.

2015-11-01

In the healthy heart, left ventricular (LV) filling generates flow patterns which have been proposed to optimize blood transport by coupling diastole and systole phases. We present a novel image-based method to assess how flow patterns influence LV blood transport in patients undergoing cardiac resynchronization therapy (CRT). Solving the advection equation with time-varying inflow boundary conditions allows to track the transport of blood entering the LV in the different filling waves, as well as the transport barriers which couple filling and ejection. The velocity fields were obtained using echocardiographic color Doppler velocimetry, which provides two-dimensional time-resolved flow maps in the apical long axis three-chamber view of the LV. We analyze flow transport in a group of patients with CRT devices as well as in healthy volunteers. In the patients under CRT, the device programming was varied to analyze flow transport under different values of the atrioventricular (AV) conduction delay and to model tachycardia. This analysis illustrates how CRT influences the transit of blood inside the LV, contributes to conserving kinetic energy and favors the generation of hemodynamic forces that accelerate blood in the direction of the LV outflow tract.

Contraceptive Use Before and After Gastric Bypass: a Questionnaire Study.

PubMed

Ginstman, Charlotte; Frisk, Jessica; Ottosson, Johan; Brynhildsen, Jan

2015-11-01

At present, women are recommended to avoid pregnancy 12-18 months after bariatric surgery. Our aim in this study was to describe patterns of contraceptive use before and after gastric bypass in Sweden, and to describe the contraceptive counseling given preoperatively to women undergoing gastric bypass. In October 2012, a questionnaire was sent to 1000 Swedish women who all had undergone gastric bypass during 2010. The women had been included in the Scandinavian Obesity Surgery Register at time of surgery. The main outcome measures were patterns of use of contraception before and after bariatric surgery. The response rate was 57 %. The most commonly used contraceptive methods were intrauterine devices, 29 % preoperatively and 26 % postoperatively even though there was a postoperative switch from the copper intrauterine device to the levonorgestrel intrauterine system. Thirty percent did not use any contraceptive during the first 12 months after surgery. Sixty percent of the responders were aware of the recommendations to avoid pregnancy after surgery. Many women who undergo bariatric surgery are not using any contraceptive method despite the recommendation that they should avoid pregnancy for at least 12 months. There is a great need to improve contraceptive counseling for this growing group of women.

A Practical Scoring System to Select Optimally Sized Devices for Percutaneous Patent Foramen Ovale Closure.

PubMed

Venturini, Joseph M; Retzer, Elizabeth M; Estrada, J Raider; Mediratta, Anuj; Friant, Janet; Nathan, Sandeep; Paul, Jonathan D; Blair, John; Lang, Roberto M; Shah, Atman P

2016-10-01

Patent foramen ovale (PFO) has been linked to cryptogenic stroke, and closure has been reported to improve clinical outcomes. However, there are no clear guidelines to direct device sizing. This study sought to use patient characteristics and echocardiographic findings to create a prediction score for device sizing. This was a retrospective review of patients undergoing percutaneous PFO closure at our institution between July 2010 and December 2014. Demographic and clinical characteristics were recorded, and all pre- and intraprocedural echocardiography results were evaluated. Thirty-six patients underwent percutaneous PFO closure during the study period. All procedures were performed using an Amplatzer Septal Occluder "Cribriform" (ASOC) device in one of three disc diameters: 25, 30, or 35 mm. Closure was indicated for cryptogenic stroke/transient ischemic attack in 75% of cases. Every case (100%) was successful with durable shunt correction at the 6-month follow-up without complications of erosion or device embolization. The presence of atrial septal aneurysm (ASA) ( p = 0.027) and PFO tunnel length >10 mm ( p = 0.038) were independently associated with increased device size. A scoring system of 1 point for male sex, 1 point for ASA, and 1 point for PFO tunnel >10 mm long was associated with the size of closure device implanted ( p = 0.006). A simple scoring system may be used to select an optimally sized device for percutaneous PFO closure using the ASOC device.

"Power-on resets" in cardiac implantable electronic devices during magnetic resonance imaging.

PubMed

Higgins, John V; Sheldon, Seth H; Watson, Robert E; Dalzell, Connie; Acker, Nancy; Cha, Yong-Mei; Asirvatham, Samuel J; Kapa, Suraj; Felmlee, Joel P; Friedman, Paul A

2015-03-01

Magnetic resonance imaging (MRI) has been safely performed in some patients with cardiac implantable electronic devices (CIEDs) under careful monitoring and prespecified conditions. Pacemaker-dependent patients are often excluded, partly because of the potential for "power-on reset" (PoR), which can lead to a change from asynchronous to inhibited pacing with consequent inhibition of pacing due to electromagnetic interference during MRI. The purpose of this study was to review risk factors for PoR during MRI. A prospective study was performed between January 2008 and May 2013 in patients with CIEDs undergoing clinically indicated MRI. Eligible patients were not pacemaker dependent. Devices were interrogated before and after MRI, programmed to an asynchronous mode or an inhibition mode with tachyarrhythmia therapies turned off, and reprogrammed to their original settings after MRI. MRI scans (n = 256) were performed in 198 patients with non-MRI-conditional CIEDs between 2008 and 2013 (median age 66 years; interquartile range 57-77 years; 59% men). PoR occurred during 9 MRI scans (3.5%) in 8 patients. PoR was more frequent with Medtronic devices than with other generator brands (n = 9/139 vs 0/117 [6% vs 0%]; P = .005). Devices with PoR were all released before 2002 and were implanted from 1999 to 2004. Effects of PoR included a decrease in heart rate during MRI (n = 4) and transient anomalous battery life indication (n = 1). All devices functioned normally after MRI. PoR occurs infrequently but can cause deleterious changes in pacing mode and heart rate. MRI should not be performed in pacemaker-dependent patients with older at-risk generators. Continuous monitoring during MRI is essential because unrecognized PoR may inhibit pacing or accelerate battery depletion due to high pacing output. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

TriGuard™ HDH embolic deflection device for cerebral protection during transcatheter aortic valve replacement.

PubMed

Samim, Mariam; van der Worp, Bart; Agostoni, Pierfrancesco; Hendrikse, Jeroen; Budde, Ricardo P J; Nijhoff, Freek; Ramjankhan, Faiz; Doevendans, Pieter A; Stella, Pieter R

2017-02-15

This study aims to evaluate the safety and performance of the new embolic deflection device TriGuard™HDH in patients undergoing TAVR. Transcatheter aortic valve replacement (TAVR) is associated with a high incidence of new cerebral ischemic lesions. The use of an embolic protection device may reduce the frequency of TAVR-related embolic events. This prospective, single arm feasibility pilot study included 14 patients with severe symptomatic aortic stenosis scheduled for TAVR. Cerebral diffusion weighted magnetic resonance imaging (DWI) was planned in all patients one day before and at day 4 (±2) after the procedure. Major adverse cerebral and cardiac events (MACCEs) were recorded for all patients. Primary endpoints of this study were I) device performance success defined as coverage of the aortic arch takeoffs throughout the entire TAVR procedure and II) MACCE occurrence. Secondary endpoints included the number and the volume of new cerebral ischemic lesions on DWI. Thirteen patients underwent transfemoral TAVR and one patient a transapical procedure. Edwards SAPIEN valve prosthesis was implanted in 8 (57%) patients and Medtronic CoreValve prosthesis in the remaining 6 (43%). Predefined performance success of the TriGuard™HDH device was achieved in 9 (64%) patients. The composite endpoint MACCE occurred in none of the patients. Post-procedural DWI was performed in 11 patients. Comparing the DWI of these patients to a historical control group showed no reduction in number [median 5.5 vs. 5.0, P = 0.857], however there was a significant reduction in mean lesion volume per patient [median 13.8 vs. 25.1, P = 0.049]. This study showed the feasibility and safety of using the TriGuard™HDH for cerebral protection during TAVR. This device did not decrease the number of post-procedural new cerebral DWI lesions, however its use showed decreased lesion volume as compared to unprotected TAVR. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Analysis of emboli during carotid stenting with distal protection device.

PubMed

Chen, Chin-I; Iguchi, Yasuyuki; Garami, Zsolt; Malkoff, Marc D; Smalling, Richard W; Campbell, Morgan S; Alexandrov, Andrei V

2006-01-01

The newly developed multi-frequency transcranial Doppler (TCD) is able to differentiate gaseous from solid emboli. Our goal was to apply this technology to initially characterize emboli detected during carotid stenting with distal protection. Patients undergoing carotid angiography and stenting were monitored with 2-2.5 MHz TCD (Embo-Dop, DWL) over the middle cerebral artery unilateral to stent deployment. Sonographers insured optimal signal recordings during the procedures. Automated emboli detection and classification software (MultiXLab version 2.0) was applied for offline count and analysis. Monitoring using the Filter Wire EX (Boston Scientific) and ACCUNET system (Guidant Corporation) was performed. A total of 9,649 embolic signals were detected during 11 angiographic and 10 stenting procedures. An observer confirmed the signals using the International Consensus definition. Automated software classified these events into 5,900 gaseous and 3,749 solid emboli. During contrast injections without the protection device, 1,013 emboli were detected with 28% of these being solid. With deployment of the distal protection device, 8,636 emboli were found with 40% being solid (p < 0.001). During stenting and angioplasty with the protection device, 7,395 emboli with 42% solids were detected (p < 0.001). Finally injection of contrast after the procedure, with the protection device still deployed, yielded 1,241 emboli with 31% solids (NS). Only 1 patient developed transient hemiparesthesia during ballooning that reduced the flow velocity to zero for 14 s. Neither gaseous nor solid emboli resulted in a mean flow velocity decrease or clinical symptoms. Microembolization frequently occurs during stenting even with deployment of the distal protection device. More solid emboli are seen during manipulations associated with lesion crossing. Although novel TCD methods yield a high frequency of embolic signals, further validation of this technique to determine the true nature, size, and number of emboli is needed.

The Information Age and Hot Air.

PubMed

Austin, Paul N

2015-08-01

Forced-air warmers have been used for over twenty years to help prevent and treat inadvertent perioperative hypothermia. One result of hypothermia can be an increased risk of surgical site infection. Paradoxically, the question has been raised about the role of forced-air warmers in causing surgical site infections. A manufacturer of a competing device has been sending information directly to clinicians with warnings about using forced-air warmers with patients undergoing total joint arthroplasty. Three reviews have been published and none of these condemned the use of forced-air warmers in the operating room including with patients undergoing total joint arthroplasty. Clinicians must continue to seek information about this problem from peer-reviewed journals and not rely on interpretation by others such as manufacturers.

Medical devices and the Middle East: market, regulation, and reimbursement in Gulf Cooperation Council states

PubMed Central

Howard, Jason J

2014-01-01

With some of the richest economies in the world, the Gulf Cooperation Council (GCC) is undergoing rapid growth not only in its population but also in health care expenditure. Despite the GCC’s abundance of hydrocarbon-based wealth, the drivers of the medical device industry in the GCC are still in flux, with gains yet to be made in areas of infrastructure, regulation, and reimbursement. However, the regional disease burden, expanding health insurance penetration, increasing privatization, and a desire to attract skilled expatriate health care providers have led to favorable conditions for the medical device market in the GCC. The purpose of this article is to investigate the current state of the GCC medical device industry, with respect to market, regulation, and reimbursement, paying special attention to the three largest medical device markets: Saudi Arabia, the United Arab Emirates, and Qatar. The GCC would seem to represent fertile ground for the development of medical technologies, especially those in line with the regional health priorities of the respective member states. PMID:25429243

On-Chip Electrolytic Chemistry for the Tuning of Graphene Devices

NASA Astrophysics Data System (ADS)

Schmucker, Scott; Ruppalt, Laura; Culbertson, James; Do, Jae Won; Lyding, Joseph; Robinson, Jeremy; Cress, Cory

2015-03-01

The inherent interfacial nature of two-dimensional materials has motivated the tuning of these films by choice of substrate or chemical functionalization. Such parameters are generally selected during fabrication, and therefore remain static during device operation. However, the possibility of dynamic chemistry in a tunable solid-state system will enable the development of new devices which fully leverage the rich chemistry of graphenic materials. Here, we fabricate a novel device for localized, dynamic doping and functionalization of graphene that is compatible with CMOS processing. The device is enabled by a top-gated, solid electrochemical cell designed with calcium fluoride (CaF2) substituting the oxide of a traditional MOSFET. When the CaF2 is gated, F flows from cathode to anode, segregating Ca and F. In this work, one electrode is graphene. When saturated with fluorine, graphene undergoes covalent modification, becoming a wide-bandgap semiconductor. In contrast, when functionalized with calcium or dilute fluorine, graphene is electron or hole doped, respectively. With transport, Raman, and XPS, we demonstrate this lithographically localized and reversible modulation of graphene's electronic and chemical character.

TH-AB-202-07: Radar Tracking of Respiratory Motion in Real Time

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fung, A; Li, C; Torres, C

Purpose: To propose a method of real time tracking of respiratory motion in patients undergoing radiation therapy. Radar technology can be employed to detection the movement of diaphragm and thoracic anatomy. Methods: A radar transceiver was specially designed. During experiment, the radar device was securely attached to a fixed frame. Respiratory motion was simulated with: 1) Varian RPM phantom, 2) Standard Imaging Respiratory Gating Platform. Signals recorded with radar equipment were compared with those measured with Varian RPM system as a reference. Results: Motion generated by Varian RPM phantom was recorded by the radar device, and compared to the signalsmore » recorded by RPM camera. The results showed exact agreement between the two monitoring equipments. Motion was also generated by Standard Imaging Respiratory Motion Platform. The results showed the radar device was capable of measuring motion of various amplitudes and periods. Conclusion: The proposed radar device is able to measure movements such as respiratory motion. Compared to state-of-the-art respiratory detection instrument, the radar device is shown to be equally precise and effective for monitoring respiration in radiation oncology patients.« less

Penile measurements in Tanzanian males: guiding circumcision device design and supply forecasting.

PubMed

Chrouser, Kristin; Bazant, Eva; Jin, Linda; Kileo, Baldwin; Plotkin, Marya; Adamu, Tigistu; Curran, Kelly; Koshuma, Sifuni

2013-08-01

Voluntary medical male circumcision decreases the risk in males of HIV infection through heterosexual intercourse by about 60% in clinical trials and 73% at post-trial followup. In 2007 WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended that countries with a low circumcision rate and high HIV prevalence expand voluntary medical male circumcision programs as part of a national HIV prevention strategy. Devices for adult/adolescent male circumcision could accelerate the pace of scaling up voluntary medical male circumcision. Detailed penile measurements of African males are required for device development and supply size forecasting. Consenting males undergoing voluntary medical male circumcision at 3 health facilities in the Iringa region, Tanzania, underwent measurement of the penile glans, shaft and foreskin. Age, Tanner stage, height and weight were recorded. Measurements were analyzed by age categories. Correlations of penile parameters with height, weight and body mass index were calculated. In 253 Tanzanian males 10 to 47 years old mean ± SD penile length in adults was 11.5 ± 1.6 cm, mean shaft circumference was 8.7 ± 0.9 cm and mean glans circumference was 8.8 ± 0.9 cm. As expected, given the variability of puberty, measurements in younger males varied significantly. Glans circumference highly correlated with height (r = 0.80) and weight (r = 0.81, each p <0.001). Stretched foreskin diameter moderately correlated with height (r = 0.68) and weight (r = 0.71, each p <0.001). Our descriptive study provides penile measurements of males who sought voluntary medical male circumcision services in Iringa, Tanzania. To our knowledge this is the first study in a sub-Saharan African population that provides sufficiently detailed glans and foreskin dimensions to inform voluntary medical male circumcision device development and size forecasting. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Baseline Demographics, Safety, and Patient Acceptance of an Insertable Cardiac Monitor for Atrial Fibrillation Screening: The REVEAL-AF Study.

PubMed

Conti, Sergio; Reiffel, James A; Gersh, Bernard J; Kowey, Peter R; Wachter, Rolf; Halperin, Jonathan L; Kaplon, Rachelle E; Pouliot, Erika; Verma, Atul

2017-01-01

Given the high prevalence and risk of stroke associated with atrial fibrillation (AF), detection strategies have important public health implications. The ongoing prospective, single-arm, open-label, multicenter REVEAL AF trial is evaluating the incidence of previously undetected AF using an insertable cardiac monitor (ICM) in patients without prior AF or device implantation, but who could be at risk for AF due to their demographic characteristics, +/- non-specific but compatible symptoms. Enrollment required an elevated AF risk profile defined as CHADS2≥3 or CHADS 2 =2 plus one or more of the following: coronary artery disease, renal impairment, sleep apnea or chronic obstructive pulmonary disease. Exclusions included stroke or transient ischemic attack occurring in the previous year. Of 450 subjects screened, 399 underwent a device insertion attempt, and 395 were included in the final analysis (Reveal XT: n=122; Reveal LINQ: n=273; excluded: n=4). Participants were primarily identified by demographic characteristics and the presence of nonspecific symptoms, but without prior documentation of "overt" AF. The most common symptoms were palpitations (51%), dizziness/lightheadedness/pre-syncope (36%), and shortness of breath (36%). Over 100 subjects were enrolled in each pre-defined CHADS2 subgroup (2, 3 and ≥4). AF risk factors not included in the CHADS2 score were well represented (prevalence≥15%). Procedure and/or device related serious adverse events were low, with the miniaturized Reveal LINQ ICM having a more favorable safety profile than the predicate Reveal XT (all: n=13 [3.3%]; LINQ: n=6 [2.2%]; XT: n=7 [5.7%]). These data demonstrate that REVEAL AF was successful in enrolling its target population, high risk patients were willing to undergo ICM monitoring for AF screening, and ICM use in this group is becoming increasingly safe with advancements in technology. A clinically meaningful incidence of device detected AF in this study will inform clinical decisions regarding ICM use for AF screening in patients at risk.

Measurement of the passive stiffness of ankle joint in 3 DOF using stewart platform type ankle foot device.

PubMed

Nomura, Kenta; Yonezawa, Teru; Mizoguchi, Hiroshi; Takemura, Hiroshi

2016-08-01

This paper presents a method to measure the passive stiffness of an ankle joint in three degrees of freedom (DOF) under two motion speeds (1 Hz and 5 degree/s) using a developed Stewart platform-type device. The developed device can reproduce input motions of the foot in 6 DOF by controlling six pneumatic linear motion actuators. We used the device to measure the passive stiffness of an ankle joint undergoing three kinds of motion, namely dorsi-plantar flexion, inversion-eversion, and adduction-abduction. The measured values of the passive stiffness of the ankle joint in dorsiflexion that we obtained agreed well with that obtained in a previous study, indicating that the developed device is useful for measuring the passive stiffness of ankle joint. In addition, the developed device can be used to measure the stiffness in inversion-eversion and adduction-abduction motions as well, parameters that have never been measured. The results we obtained demonstrated certain interesting features as we varied both the direction and pace of motion (e.g., there were significant differences in the stiffness not only between adduction and abduction during the faster pace, but also between these and the other motions).

Motion stability of the magnetic levitation and suspension with YBa2Cu3O7-x high-Tc superconducting bulks and NdFeB magnets

NASA Astrophysics Data System (ADS)

Li, Jipeng; Zheng, Jun; Huang, Huan; Li, Yanxing; Li, Haitao; Deng, Zigang

2017-10-01

The flux pinning effect of YBa2Cu3O7-x high temperature superconducting (HTS) bulk can achieve self-stable levitation over a permanent magnet or magnet array. Devices based on this phenomenon have been widely developed. However, the self-stable flux pinning effect is not unconditional, under disturbances, for example. To disclose the roots of this amazing self-stable levitation phenomenon in theory, mathematical and mechanical calculations using Lyapunov's stability theorem and the Hurwitz criterion were performed under the conditions of magnetic levitation and suspension of HTS bulk near permanent magnets in Halbach array. It is found that the whole dynamical system, in the case of levitation, has only one equilibrium solution, and the singular point is a stable focus. In the general case of suspension, the system has two singular points: one is a stable focus, and the other is an unstable saddle. With the variation of suspension force, the two first-order singular points mentioned earlier will get closer and closer, and finally degenerate to a high-order singular point, which means the stable region gets smaller and smaller, and finally vanishes. According to the center manifold theorem, the high-order singular point is unstable. With the interaction force varying, the HTS suspension dynamical system undergoes a saddle-node bifurcation. Moreover, a deficient damping can also decrease the stable region. These findings, together with existing experiments, could enlighten the improvement of HTS devices with strong anti-interference ability.

Transmission of hepatitis B virus among persons undergoing blood glucose monitoring in long-term-care facilities--Mississippi, North Carolina, and Los Angeles County, California, 2003-2004.

PubMed

2005-03-11

Regular monitoring of blood glucose levels is an important component of routine diabetes care. Capillary blood is typically sampled with the use of a fingerstick device and tested with a portable glucometer. Because of outbreaks of hepatitis B virus (HBV) infections associated with glucose monitoring, CDC and the Food and Drug Administration (FDA) have recommended since 1990 that fingerstick devices be restricted to individual use. This report describes three recent outbreaks of HBV infection among residents in long-term-care (LTC) facilities that were attributed to shared devices and other breaks in infection-control practices related to blood glucose monitoring. Findings from these investigations and previous reports suggest that recommendations concerning standard precautions and the reuse of fingerstick devices have not been adhered to or enforced consistently in LTC settings. The findings underscore the need for education, training, adherence to standard precautions, and specific infection-control recommendations targeting diabetes-care procedures in LTC settings.

Normative Databases for Imaging Instrumentation.

PubMed

Realini, Tony; Zangwill, Linda M; Flanagan, John G; Garway-Heath, David; Patella, Vincent M; Johnson, Chris A; Artes, Paul H; Gaddie, Ian B; Fingeret, Murray

2015-08-01

To describe the process by which imaging devices undergo reference database development and regulatory clearance. The limitations and potential improvements of reference (normative) data sets for ophthalmic imaging devices will be discussed. A symposium was held in July 2013 in which a series of speakers discussed issues related to the development of reference databases for imaging devices. Automated imaging has become widely accepted and used in glaucoma management. The ability of such instruments to discriminate healthy from glaucomatous optic nerves, and to detect glaucomatous progression over time is limited by the quality of reference databases associated with the available commercial devices. In the absence of standardized rules governing the development of reference databases, each manufacturer's database differs in size, eligibility criteria, and ethnic make-up, among other key features. The process for development of imaging reference databases may be improved by standardizing eligibility requirements and data collection protocols. Such standardization may also improve the degree to which results may be compared between commercial instruments.

Normative Databases for Imaging Instrumentation

PubMed Central

Realini, Tony; Zangwill, Linda; Flanagan, John; Garway-Heath, David; Patella, Vincent Michael; Johnson, Chris; Artes, Paul; Ben Gaddie, I.; Fingeret, Murray

2015-01-01

Purpose To describe the process by which imaging devices undergo reference database development and regulatory clearance. The limitations and potential improvements of reference (normative) data sets for ophthalmic imaging devices will be discussed. Methods A symposium was held in July 2013 in which a series of speakers discussed issues related to the development of reference databases for imaging devices. Results Automated imaging has become widely accepted and used in glaucoma management. The ability of such instruments to discriminate healthy from glaucomatous optic nerves, and to detect glaucomatous progression over time is limited by the quality of reference databases associated with the available commercial devices. In the absence of standardized rules governing the development of reference databases, each manufacturer’s database differs in size, eligibility criteria, and ethnic make-up, among other key features. Conclusions The process for development of imaging reference databases may be improved by standardizing eligibility requirements and data collection protocols. Such standardization may also improve the degree to which results may be compared between commercial instruments. PMID:25265003

Immunologic effects of continuous-flow left ventricular assist devices before and after heart transplant.

PubMed

Ko, Byung-Soo; Drakos, Stavros; Kfoury, Abdallah G; Hurst, Denise; Stoddard, Gregory J; Willis, Carrie A; Delgado, Julio C; Hammond, Elizabeth H; Gilbert, Edward M; Alharethi, Rami; Revelo, Monica P; Nativi-Nicolau, Jose; Reid, Bruce B; McKellar, Stephen H; Wever-Pinzon, Omar; Miller, Dylan V; Eckels, David D; Fang, James C; Selzman, Craig H; Stehlik, Josef

2016-08-01

Immune allosensitization can be triggered by continuous-flow left ventricular assist devices (CF LVAD). However, the effect of this type of allosensitization on post-transplant outcomes remains controversial. This study examined the post-transplant course in a contemporary cohort of patients undergoing transplantation with and without LVAD bridging. We included consecutive patients who were considered for cardiac transplant from 2006 to 2015. Serum alloantibodies were detected with single-antigen beads on the Luminex platform (One Lambda Inc., Canoga Park, CA). Allosensitization was defined as calculated panel reactive antibody (cPRA) > 10%. cPRA was determined at multiple times. LVAD-associated allosensitization was defined as development of cPRA > 10% in patients with cPRA ≤ 10% before LVAD implantation. Post-transplant outcomes of interest were acute cellular rejection (ACR), antibody-mediated rejection (AMR), and survival. Allosensitization status was evaluated in 268 patients (20% female). Mean age was 52 ± 12 years, and 132 (49.3%) received CF LVADs. After LVAD implant, 30 patients (23%) became newly sensitized, and the level of sensitization appeared to diminish in many of these patients while awaiting transplant. During the study period, 225 of 268 patients underwent transplant, and 43 did not. A CF LVAD was used to bridge 50% of the transplant recipients. Compared with patients without new sensitization or those already sensitized at baseline, the patients with LVAD-associated sensitization had a higher risk of ACR (p = 0.049) and higher risk of AMR (p = 0.018) but a similar intermediate-term post-transplant survival. The patients who did not receive a transplant had higher level of allosensitization, with a baseline cPRA of 20% vs 6% in those who received an allograft and a high risk (40%) of death during follow-up. New allosensitization takes place in > 20% of patents supported with CF LVADs. Among patients who undergo transplant, this results in a higher risk of ACR and AMR, but survival remains favorable, likely due to the efficacy of current management after transplant. However, mortality in sensitized patients who do not reach transplant remains high, and new approaches are necessary to meet the needs of this group of patients. Published by Elsevier Inc.

Needleless Electrospinning Experimental Study and Nanofiber Application in Semiconductor Packaging

NASA Astrophysics Data System (ADS)

Sun, Tianwei

Electronics especially mobile electronics such as smart phones, tablet PCs, notebooks and digital cameras are undergoing rapid development nowadays and have thoroughly changed our lives. With the requirement of more transistors, higher power, smaller size, lighter weight and even bendability, thermal management of these devices became one of the key challenges. Compared to active heat management system, heat pipe, which is a passive fluidic system, is considered promising to solve this problem. However, traditional heat pipes have size, weight and capillary limitation. Thus new type of heat pipe with smaller size, lighter weight and higher capillary pressure is needed. Nanofiber has been proved with superior properties and has been applied in multiple areas. This study discussed the possibility of applying nanofiber in heat pipe as new wick structure. In this study, a needleless electrospinning device with high productivity rate was built onsite to systematically investigate the effect of processing parameters on fiber properties as well as to generate nanofiber mat to evaluate its capability in electronics cooling. Polyethylene oxide (PEO) and Polyvinyl Alcohol (PVA) nanofibers were generated. Tensiometer was used for wettability measurement. The results show that independent parameters including spinneret type, working distance, solution concentration and polymer type are strongly correlated with fiber morphology compared to other parameters. The results also show that the fabricated nanofiber mat has high capillary pressure.

Multifaceted Comparison of Two Cryotherapy Devices Used After Total Knee Arthroplasty: Cryotherapy Device Comparison.

PubMed

Schinsky, Mark F; McCune, Christine; Bonomi, Judith

2016-01-01

Some form of cryotherapy used after total knee arthroplasty is commonplace. However, various factors determine the specific device deployed. This study aimed to answer the following questions: : A group of 100 patients undergoing primary total knee arthroplasty by a single surgeon were enrolled in an institutional review board-approved, prospective study and randomized to receive either a circulating cold water or ice/gel pack cryotherapy device postoperatively. Demographic, pain, swelling, blood loss, range of motion, compliance, satisfaction, and adverse event outcomes were recorded until 6 weeks after surgery. Hospital staff satisfaction and economic variables were examined. The ice/gel pack cryotherapy wrap was noninferior to the cold water cryotherapy device for any patient outcome measured. Average pain level at 6 weeks postoperative was significantly less in the ice/gel pack cryotherapy wrap group. Hospital staff satisfaction was higher with the ice/gel pack cryotherapy wrap.Substantial economic savings can be realized at our institution by switching to the lower cost cryotherapy device. In this study, the lower cost ice/gel pack cryotherapy wrap was noninferior to the circulating ice water cryotherapy device with respect to objective patient outcomes and subjective patient satisfaction after total knee arthroplasty. Hospital staff satisfaction and economic considerations also favor the ice/gel pack compression cryotherapy wraps.

Multicenter Trial of the VenaTech Convertible Vena Cava Filter.

PubMed

Hohenwalter, Eric J; Stone, James R; O'Moore, Paul V; Smith, Steven J; Selby, J Bayne; Lewandowski, Robert J; Samuels, Shaun; Kiproff, Paul M; Trost, David W; Madoff, David C; Handel, Jeremy; Gandras, Eric J; Vlahos, Athanasios; Rilling, William S

2017-10-01

To demonstrate rates of successful filter conversion and 6-month major device-related adverse events in subjects with converted caval filters. An investigational device exemption multicenter, prospective, single-arm study was performed at 11 sites enrolling 149 patients. The VenaTech Convertible Vena Cava Filter (B. Braun Interventional Systems, Inc, Bethlehem, Pennsylvania) was implanted in 149 patients with venous thromboembolism and contraindication to or failure of anticoagulation (n = 119), with high-risk trauma (n = 14), and for surgical prophylaxis (n = 16). When the patient was no longer at risk for pulmonary embolism as determined by clinical assessment, an attempt at filter conversion was made. Follow-up of converted patients (n = 93) was conducted at 30 days, 3 months, and 6 months after conversion. Patients who did not undergo a conversion attempt (n = 53) had follow-up at 6 months after implant. All implants were successful. One 7-day migration to the right atrium required surgical removal. Technical success rate for filter conversion was 92.7% (89/96). Mean time from placement to conversion was 130.7 days (range, 15-391 d). No major conversion-related events were reported. The mean conversion procedure time was 30.7 minutes (range, 7-135 min). There were 89 converted and 32 unconverted patients who completed 6-month follow-up with no delayed complications. The VenaTech Convertible filter has a high conversion rate and low 6-month device-related adverse event rate. Further studies are necessary to determine long-term safety and efficacy in both converted and unconverted patients. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

Growing green electricity: progress and strategies for use of photosystem I for sustainable photovoltaic energy conversion.

PubMed

Nguyen, Khoa; Bruce, Barry D

2014-09-01

Oxygenic photosynthesis is driven via sequential action of Photosystem II (PSII) and (PSI)reaction centers via the Z-scheme. Both of these pigment-membrane protein complexes are found in cyanobacteria, algae, and plants. Unlike PSII, PSI is remarkably stable and does not undergo limiting photo-damage. This stability, as well as other fundamental structural differences, makes PSI the most attractive reaction centers for applied photosynthetic applications. These applied applications exploit the efficient light harvesting and high quantum yield of PSI where the isolated PSI particles are redeployed providing electrons directly as a photocurrent or, via a coupled catalyst to yield H₂. Recent advances in molecular genetics, synthetic biology, and nanotechnology have merged to allow PSI to be integrated into a myriad of biohybrid devices. In photocurrent producing devices, PSI has been immobilized onto various electrode substrates with a continuously evolving toolkit of strategies and novel reagents. However, these innovative yet highly variable designs make it difficult to identify the rate-limiting steps and/or components that function as bottlenecks in PSI-biohybrid devices. In this study we aim to highlight these recent advances with a focus on identifying the similarities and differences in electrode surfaces, immobilization/orientation strategies, and artificial redox mediators. Collectively this work has been able to maintain an annual increase in photocurrent density (Acm⁻²) of ~10-fold over the past decade. The potential drawbacks and attractive features of some of these schemes are also discussed with their feasibility on a large-scale. As an environmentally benign and renewable resource, PSI may provide a new sustainable source of bioenergy. This article is part of a special issue entitled: photosynthesis research for sustainability: keys to produce clean energy. Copyright © 2013. Published by Elsevier B.V.

Approach to cardio-oncologic patients with special focus on patients with cardiac implantable electronic devices planned for radiotherapy: results of the European Heart Rhythm Association survey.

PubMed

Lenarczyk, Radoslaw; Potpara, Tatjana S; Haugaa, Kristina H; Deharo, Jean-Claude; Hernandez-Madrid, Antonio; Del Carmen Exposito Pineda, Maria; Kiliszek, Marek; Dagres, Nikolaos

2017-09-01

The aim of this European Heart Rhythm Association (EHRA) survey was to evaluate clinical practice regarding cardio-oncologic patients, with special focus on patients with cardiac implantable electronic devices (CIEDs) planned for anticancer radiotherapy (RT), among members of the EHRA electrophysiology research network. Of the 36 responding centres, 89% managed patients who were diagnosed or treated oncologically, and this diagnosis affected 1-5% of cardiovascular patients in majority of centres (57%). The main side effects of anticancer therapy in patients treated by cardiologists were thromboembolic complications and left ventricular dysfunction (both reported as 'frequent' by 43% of the centres). The main agents associated with complications were anthracyclines, RT, and monoclonal antibodies. Echocardiography was the most common method of screening for cardiovascular complications (93%), and 10% of the centres did not routinely screen for treatment-induced cardiotoxicity. Opinions on the safe radiation dose, methods of device shielding, and risk calculation prior to RT in CIED patients differed among centres. Precaution measures in high-risk CIED patients were very heterogeneous among centres. Our survey has shown that the awareness of cardiac consequences of anticancer therapy is high, despite relatively low proportion of patients treated oncologically among all cardiovascular patients. There is a consensus of which screening methods should be used for cardiotoxicity of anticancer treatment, but the apprehension of screening necessity is low. Methods of risk assessment and safety measures in CIED patients undergoing RT are very heterogeneous among the European centres, underscoring the need for standardization of the approach to cardio-oncologic patients. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For Permissions, please email: journals.permissions@oup.com.

Diagnosis of obstructive sleep apnea using pulse oximeter derived photoplethysmographic signals.

PubMed

Romem, Ayal; Romem, Anat; Koldobskiy, Dafna; Scharf, Steven M

2014-03-15

Increasing awareness of the high prevalence of obstructive sleep apnea (OSA) and its impact on health in conjunction with high cost, inconvenience, and short supply of in-lab polysomnography (PSG) has led to the development of more convenient, affordable, and accessible diagnostic devices. We evaluated the reliability and accuracy of a single-channel (finger pulse-oximetry) photoplethysmography (PPG)-based device for detection of OSA (Morpheus Ox). Among a cohort of 73 patients referred for in-laboratory evaluation of OSA, 65 were simultaneously monitored with the PPG based device while undergoing PSG. Among these, 19 had significant cardiopulmonary comorbidities. Using the PSG as the "gold standard," the sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), as well as the positive likelihood ratio (+LR) for an apnea hypopnea index (AHI)PSG > 5/h and AHIPSG > 15/h were calculated for the PPG. Valid results were available for 65 subjects. Mean age: 52.1 ± 14.2, Male: 52%, and BMI: 36.3 ± 9.7 kg/m(2). Positive correlation was found between PPG-derived and PSG-derived AHI (r = 0.81, p < 0.001). For AHIPSG > 5/h, sensitivity was 80%, specificity 86%, PPV 93%, NPV 68%, and +LR was 5.9. For AHIPSG > 15/h, sensitivity was 70%, specificity 91%, PPV 80%, NPV 85%, and +LR was 7.83. The corresponding areas under the receiver operator curves were 0.91 and 0.9. PPG-derived data compare well with simultaneous in-lab PSG in the diagnosis of suspected OSA among patients with and without cardiopulmonary comorbidities. Romem A; Romem A; Koldobskiy D; Scharf SM. Diagnosis of obstructive sleep apnea using pulse oximeter derived photoplethysmographic signals.

A new fibre optic pulse oximeter probe for monitoring splanchnic organ arterial blood oxygen saturation.

PubMed

Hickey, M; Samuels, N; Randive, N; Langford, R; Kyriacou, P A

2012-12-01

A new, continuous method of monitoring splanchnic organ oxygen saturation (SpO(2)) would make the early detection of inadequate tissue oxygenation feasible, reducing the risk of hypoperfusion, severe ischaemia, and, ultimately, death. In an attempt to provide such a device, a new fibre optic based reflectance pulse oximeter probe and processing system were developed followed by an in vivo evaluation of the technology on seventeen patients undergoing elective laparotomy. Photoplethysmographic (PPG) signals of good quality and high signal-to-noise ratio were obtained from the small bowel, large bowel, liver and stomach. Simultaneous peripheral PPG signals from the finger were also obtained for comparison purposes. Analysis of the amplitudes of all acquired PPG signals indicated much larger amplitudes for those signals obtained from splanchnic organs than those obtained from the finger. Estimated SpO(2) values for splanchnic organs showed good agreement with those obtained from the finger fibre optic probe and those obtained from a commercial device. These preliminary results suggest that a miniaturized 'indwelling' fibre optic sensor may be a suitable method for pre-operative and post-operative evaluation of splanchnic organ SpO(2) and their health. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Overview of physical dosimetry methods for triage application integrated in the new European network RENEB.

PubMed

Trompier, François; Burbidge, Christopher; Bassinet, Céline; Baumann, Marion; Bortolin, Emanuela; De Angelis, Cinzia; Eakins, Jonathan; Della Monaca, Sara; Fattibene, Paola; Quattrini, Maria Cristina; Tanner, Rick; Wieser, Albrecht; Woda, Clemens

2017-01-01

In the EC-funded project RENEB (Realizing the European Network in Biodosimetry), physical methods applied to fortuitous dosimetric materials are used to complement biological dosimetry, to increase dose assessment capacity for large-scale radiation/nuclear accidents. This paper describes the work performed to implement Optically Stimulated Luminescence (OSL) and Electron Paramagnetic Resonance (EPR) dosimetry techniques. OSL is applied to electronic components and EPR to touch-screen glass from mobile phones. To implement these new approaches, several blind tests and inter-laboratory comparisons (ILC) were organized for each assay. OSL systems have shown good performances. EPR systems also show good performance in controlled conditions, but ILC have also demonstrated that post-irradiation exposure to sunlight increases the complexity of the EPR signal analysis. Physically-based dosimetry techniques present high capacity, new possibilities for accident dosimetry, especially in the case of large-scale events. Some of the techniques applied can be considered as operational (e.g. OSL on Surface Mounting Devices [SMD]) and provide a large increase of measurement capacity for existing networks. Other techniques and devices currently undergoing validation or development in Europe could lead to considerable increases in the capacity of the RENEB accident dosimetry network.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Azizah, N., E-mail: norazizahparmin84@gmail.com; Gopinath, Subash C. B.; Nadzirah, Sh.

Titanium dioxide (TiO{sub 2}) nanoparticles based Interdigitated Device Electrodes (IDEs) Nanobiosensor device was developed for intracellular biochemical detection. Fabrication and characterization of pH sensors using IDE nanocoated with TiO{sub 2} was studied in this paper. In this paper, a preliminary assessment of this intracellular sensor with electrical measurement under different pH levels. 3-aminopropyltriethoxysilane (APTES) was used to enhance the sensitivity of titanium dioxide layer as well as able to provide surface modification by undergoing protonation and deprotonation process. Different types of pH solution provide different resistivity and conductivity towards the surface. Base solution has the higher current compared to anmore » acid solution. Amine and oxide functionalized TiO{sub 2} based IDE exhibit pH-dependent could be understood in terms of the change in surface charge during protonation and deprotonation. The simple fabrication process, high sensitivity, and fast response of the TiO{sub 2} based IDEs facilitate their applications in a wide range of areas. The small size of semiconductor TiO{sub 2} based IDE for sensitive, label-free, real time detection of a wide range of biological species could be explored in vivo diagnostics and array-based screening.« less

Development of microtitre plates for electrokinetic assays

NASA Astrophysics Data System (ADS)

Burt, J. P. H.; Goater, A. D.; Menachery, A.; Pethig, R.; Rizvi, N. H.

2007-02-01

Electrokinetic processes have wide ranging applications in microsystems technology. Their optimum performance at micro and nano dimensions allows their use both as characterization and diagnostic tools and as a means of general particle manipulation. Within analytical studies, measurement of the electrokinesis of biological cells has the sensitivity and selectivity to distinguish subtle differences between cell types and cells undergoing changes and is gaining acceptance as a diagnostic tool in high throughput screening for drug discovery applications. In this work the development and manufacture of an electrokinetic-based microtitre plate is described. The plate is intended to be compatible with automated sample loading and handling systems. Manufacturing of the microtitre plate, which employs indium tin oxide microelectrodes, has been entirely undertaken using excimer and ultra-fast pulsed laser micromachining due to its flexibility in materials processing and accuracy in microstructuring. Laser micromachining has the ability to rapidly realize iterations in device prototype design while also having the capability to be scaled up for large scale manufacture. Device verification is achieved by the measurement of the electrorotation and dielectrophoretic properties of yeast cells while the flexibility of the developed microtitre plate is demonstrated by the selective separation of live yeast from polystyrene microbeads.

Electrolyte-gated transistors based on phenyl-C61-butyric acid methyl ester (PCBM) films: bridging redox properties, charge carrier transport and device performance.

PubMed

Lan, Tian; Soavi, Francesca; Marcaccio, Massimo; Brunner, Pierre-Louis; Sayago, Jonathan; Santato, Clara

2018-05-24

The n-type organic semiconductor phenyl-C61-butyric acid methyl ester (PCBM), a soluble fullerene derivative well investigated for organic solar cells and transistors, can undergo several successive reversible, diffusion-controlled, one-electron reduction processes. We exploited such processes to shed light on the correlation between electron transfer properties, ionic and electronic transport as well as device performance in ionic liquid (IL)-gated transistors. Two ILs were considered, based on bis(trifluoromethylsulfonyl)imide [TFSI] as the anion and 1-ethyl-3-methylimidazolium [EMIM] or 1-butyl-1-methylpyrrolidinium [PYR14] as the cation. The aromatic structure of [EMIM] and its lower steric hindrance with respect to [PYR14] favor a 3D (bulk) electrochemical doping. As opposed to this, for [PYR14] the doping seems to be 2D (surface-confined). If the n-doping of the PCBM is pursued beyond the first electrochemical process, the transistor current vs. gate-source voltage plots in [PYR14][TFSI] feature a maximum that points to the presence of finite windows of high conductivity in IL-gated PCBM transistors.

Management of patients with cardiac implantable electronic devices (CIED) undergoing radiotherapy: A consensus document from Associazione Italiana Aritmologia e Cardiostimolazione (AIAC), Associazione Italiana Radioterapia Oncologica (AIRO), Associazione Italiana Fisica Medica (AIFM).

PubMed

Zecchin, Massimo; Severgnini, Mara; Fiorentino, Alba; Malavasi, Vincenzo Livio; Menegotti, Loris; Alongi, Filippo; Catanzariti, Domenico; Jereczek-Fossa, Barbara Alicja; Stasi, Michele; Russi, Elvio; Boriani, Giuseppe

2018-03-15

The management of patients with a cardiac implanted electronic device (CIED) receiving radiotherapy (RT) is challenging and requires a structured multidisciplinary approach. A consensus document is presented as a result of a multidisciplinary working group involving cardiac electrophysiologists, radiation oncologists and physicists in order to stratify the risk of patients with CIED requiring RT and approaching RT sessions appropriately. When high radiation doses and beam energy higher than 6MV are used, CIED malfunctions can occur during treatment. In our document, we reviewed the different types of RT and CIED behavior in the presence of ionizing radiations and electromagnetic interferences, from the cardiologist's, radiation oncologist's and medical physicist's point of view. We also reviewed in vitro and in vivo literature data and other national published guidelines on this issue so far. On the basis of literature data and consensus of experts, a detailed approach based on risk stratification and appropriate management of RT patients with CIEDs is suggested, with important implications for clinical practice. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Claims in vapour device (e-cigarette) regulation: A Narrative Policy Framework analysis.

PubMed

O'Leary, Renée; Borland, Ron; Stockwell, Tim; MacDonald, Marjorie

2017-06-01

The electronic cigarette or e-cigarette (vapour device) is a consumer product undergoing rapid growth, and governments have been adopting regulations on the sale of the devices and their nicotine liquids. Competing claims about vapour devices have ignited a contentious debate in the public health community. What claims have been taken up in the state arena, and how have they possibly influenced regulatory outcomes? This study utilized Narrative Policy Framework to analyze the claims made about vapour devices in legislation recommendation reports from Queensland Australia, Canada, and the European Union, and the 2016 deeming rule legislation from the United States, and examined the claims and the regulatory outcomes in these jurisdictions. The vast majority of claims in the policy documents represented vapour devices as a threat: an unsafe product harming the health of vapour device users, a gateway product promoting youth tobacco uptake, and a quasi-tobacco product impeding tobacco control. The opportunity for vapour devices to promote cessation or reduce exposure to toxins was very rarely presented, and these positive claims were not discussed at all in two of the four documents studied. The dominant claims of vapour devices as a public health threat have supported regulations that have limited their potential as a harm reduction strategy. Future policy debates should evaluate the opportunities for vapour devices to decrease the health and social burdens of the tobacco epidemic. Copyright © 2017 Elsevier B.V. All rights reserved.

Powder Handling Device for Analytical Instruments

NASA Technical Reports Server (NTRS)

Sarrazin, Philippe C. (Inventor); Blake, David F. (Inventor)

2006-01-01

Method and system for causing a powder sample in a sample holder to undergo at least one of three motions (vibration, rotation and translation) at a selected motion frequency in order to present several views of an individual grain of the sample. One or more measurements of diffraction, fluorescence, spectroscopic interaction, transmission, absorption and/or reflection can be made on the sample, using light in a selected wavelength region.

Multiple p-n junction subwavelength gratings for transmission-mode electro-optic modulators

PubMed Central

Lee, Ki Young; Yoon, Jae Woong; Song, Seok Ho; Magnusson, Robert

2017-01-01

We propose a free-space electro-optic transmission modulator based on multiple p-n-junction semiconductor subwavelength gratings. The proposed device operates with a high-Q guided-mode resonance undergoing electro-optic resonance shift due to direct electrical control. Using rigorous electrical and optical modeling methods, we theoretically demonstrate a modulation depth of 84%, on-state efficiency 85%, and on-off extinction ratio of 19 dB at 1,550 nm wavelength under electrical control signals within a favorably low bias voltage range from −4 V to +1 V. This functionality operates in the transmission mode and sustainable in the high-speed operation regime up to a 10-GHz-scale modulation bandwidth in principle. The theoretical performance prediction is remarkably advantageous over plasmonic tunable metasurfaces in the power-efficiency and absolute modulation-depth aspects. Therefore, further experimental study is of great interest for creating practical-level metasurface components in various application areas. PMID:28417962

Luminescent Quantum Dots as Ultrasensitive Biological Labels

NASA Astrophysics Data System (ADS)

Nie, Shuming

2000-03-01

Highly luminescent semiconductor quantum dots have been covalently coupled to biological molecules for use in ultrasensitive biological detection. This new class of luminescent labels is considerably brighter and more resistant againt photobleaching in comparison with organic dyes. Quantum dots labeled with the protein transferrin undergo receptor-mediated endocytosis (RME) in cultured HeLa cells, and those dots that were conjugated to immunomolecules recognize specific antibodies or antigens. In addition, we show that DNA functionalized quantum dots can be used to target specific genes by hybridization. We expect that quantum dot bioconjugates will have a broad range of biological applications, such as ligand-receptor interactions, real-time monitoring of molecular trafficking inside living cells, multicolor fluorescence in-situ hybridization (FISH), high-sensitivity detection in miniaturized devices (e.g., DNA chips), and fluorescent tagging of combinatorial chemical libraries. A potential clinical application is the use of quantum dots for ultrasensitive viral RNA detection, in which as low as 100 copies of hepatitis C and HIV viruses per ml blood should be detected.

Digital holographic microscopy long-term and real-time monitoring of cell division and changes under simulated zero gravity.

PubMed

Pan, Feng; Liu, Shuo; Wang, Zhe; Shang, Peng; Xiao, Wen

2012-05-07

The long-term and real-time monitoring the cell division and changes of osteoblasts under simulated zero gravity condition were succeed by combing a digital holographic microscopy (DHM) with a superconducting magnet (SM). The SM could generate different magnetic force fields in a cylindrical cavity, where the gravitational force of biological samples could be canceled at a special gravity position by a high magnetic force. Therefore the specimens were levitated and in a simulated zero gravity environment. The DHM was modified to fit with SM by using single mode optical fibers and a vertically-configured jig designed to hold specimens and integrate optical device in the magnet's bore. The results presented the first-phase images of living cells undergoing dynamic divisions and changes under simulated zero gravity environment for a period of 10 hours. The experiments demonstrated that the SM-compatible DHM setup could provide a highly efficient and versatile method for research on the effects of microgravity on biological samples.

Survival affects decision making for fenestrated and branched endovascular aortic repair.

PubMed

Beach, Jocelyn M; Rajeswaran, Jeevanantham; Parodi, F Ezequiel; Kuramochi, Yuki; Brier, Corey; Blackstone, Eugene; Eagleton, Matthew J

2018-03-01

Repair options for complex abdominal and thoracoabdominal aortic aneurysms (TAAAs) are evolving with increased experience and availability of less invasive endovascular techniques. Identifying risk factors for mortality after fenestrated and branched endovascular aortic repair (F/B-EVAR) could improve patient selection and facilitate decision making regarding who may benefit from prophylactic F/B-EVAR. We evaluated 1091 patients in a prospective investigational device exemption trial who underwent F/B-EVAR from August 2001 to June 2015 for complex aortic aneurysms (CAAs). Multivariable analysis of risk factors for death was performed using a nonproportional hazards model and a nonparametric analysis using random survival forest technology. Operative mortality after F/B-EVAR was low (3.7%), with high CAA-related survival at 30 day and 5 years (96.8% and 94.0%, respectively). All-cause 5-year survival, however, was 46.2% and older age, heart failure, chronic obstructive pulmonary disease, renal disease, anemia, and coagulation disorders were risk factors. Risk was highest for those undergoing type I/II TAAA repairs and those with larger aneurysms. Patients with multiple comorbidities and those undergoing type I or II TAAA repair are at greatest risk of mortality; however, in this high-risk population, F/B-EVAR offers greater survival compared with that reported for the natural history of untreated aneurysms. Operative and early mortality is lower than the best-reported open repair outcomes, even in this high-risk population, suggesting a potential benefit in extending the use of F/B-EVAR to low-to-average risk CAA patients. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

[Governance of innovative cardiovascular devices: when evidence is not enough].

PubMed

Addis, Antonio; Davoli, Marina

2016-01-01

Aortic stenosis is the most common valve disease and transcatheter aortic valve implantation (TAVI) is considered as an alternative to surgical valve replacement or to medical treatment in inoperable or high-risk patients. Although physicians have learned how to care for critically ill old patients and enable many to survive, major surgical procedures, operating on patients at very high risk, are often not suitable. Studies showed that selected cohorts of patients undergoing TAVI might have better outcomes in terms of survival and quality of life. However, mortality and safety data associated with the less invasive intervention do not always justify such new technologies for all patients with severe aortic stenosis, taking into account also the high cost associated. A systematic review of the available scientific literature has been performed. In this context, a DECIDE framework has been used providing a systematic and transparent approach for going from evidence to healthcare decisions. Before suggesting final recommendations, historical data of interventions done at regional level and regulatory decisions adopted in other countries following health technology assessment analysis, have been analyzed. All final recommendations based on this document have been discussed and reviewed with a working group done by the health operators directly involved in this technology within the regional health service context. Recommendations for the identification of patients suitable for TAVI are given together with a list of characteristics that should be required to all centers eligible for the performance of TAVI and with a procedure able to allow better quality assurance and prospective monitoring process of all new cases enrolled for such intervention. Impact of these recommendations will be measured using a regional registry collecting data on new patients undergoing TAVI.

Biolimus-A9 polymer-free coated stent in high bleeding risk patients with acute coronary syndrome: a Leaders Free ACS sub-study

PubMed Central

Naber, Christoph K.; Urban, Philip; Ong, Paul J.; Valdes-Chavarri, Mariano; Abizaid, Alexandre A.; Pocock, Stuart J.; Fabbiocchi, Franco; Dubois, Christophe; Copt, Samuel; Greene, Samantha; Morice, Marie-Claude

2017-01-01

Aims Although a true clinical challenge, high bleeding risk patients with an acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) have never been specifically studied. Leaders Free ACS, a pre-specified Leaders Free sub-study, determined efficacy, and safety of a combination of 1-month dual anti-platelet therapy (DAPT) with implantation of either a polymer-free Biolimus-A9-coated stent (BA9-DCS) or a bare-metal stent (BMS) in these patients. Methods and results Leaders Free included 2466 patients undergoing PCI who had at least 1 of 13 pre-defined factors for an increased bleeding risk. Of these, 659 ACS patients were included in this analysis (BA9-DCS 330, BMS 329). At 12-month follow-up, treatment with the BA9-DCS was more effective (clinically driven target-lesion revascularization 3.9 vs. 9.0%, P = 0.009) and safer (cumulative incidence of cardiac death, myocardial infarction, or definite or probable stent thrombosis 9.3 vs. 18.5%, P = 0.001), driven by significantly lower rates of cardiac mortality (3.4 vs. 6.9%, P = 0.049) and myocardial infarction (6.9 vs. 13.8%, P = 0.005). Conclusion We believe that the results of this sub-analysis from the Leaders Free trial are likely to significantly impact clinical practice for high bleeding risk patients presenting with an ACS: the use of a BMS can, in our view, no longer be recommended, and, given the paucity of available data for second-generation DES with shortened DAPT in these patients, the BA9-DCS should currently be considered as the device with the strongest evidence to support its use for this indication. PMID:27190095

Does Age Influence Cardiac Resynchronization Therapy Use and Outcome?

PubMed

Heidenreich, Paul A; Tsai, Vivian; Bao, Haikun; Curtis, Jeptha; Goldstein, Mary; Curtis, Lesley; Hernandez, Adrian; Peterson, Pamela; Turakhia, Mintu P; Masoudi, Frederick A

2015-06-01

This study sought to describe the use of CRT-D and its association with survival for older patients. Many patients who receive cardiac resynchronization therapy with defibrillator (CRT-D) in practice are older than those included in clinical trials. We identified patients undergoing ICD implantation in the National Cardiovascular Disease Registry (NCDR) ICD registry from 2006 to 2009, who also met clinical trial criteria for CRT, including left ventricular ejection fraction (LVEF) ≤35%, QRS ≥120 ms, and New York Heart Association (NYHA) functional class III or IV. NCDR registry data were linked to the social security death index to determine the primary outcome of time to death from any cause. We identified 70,854 patients from 1,187 facilities who met prior trial criteria for CRT-D. The mean age of the 58,147 patients receiving CRT-D was 69.4 years with 6.4% of patients age 85 or older. CRT use was 80% or higher among candidates in all age groups. Follow-up was available for 42,285 patients age ≥65 years at 12 months. Receipt of CRT-D was associated with better survival at 1 year (82.1% vs. 77.1%, respectively) and 4 years (54.0% vs. 46.2% , respectively) than in those receiving only an ICD (p < 0.001). The CRT association with improved survival was not different for different age groups (p = 0.86 for interaction). More than 80% of older patients undergoing ICD implantation who were candidates for a CRT-D received the combined device. Mortality in older patients undergoing ICD implantation was high but was lower for those receiving CRT-D. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Assessment of the use of oral fluid as a matrix for drug monitoring in patients undergoing treatment for opioid addiction.

PubMed

Kunkel, Frank; Fey, Elizabeth; Borg, Damon; Stripp, Richard; Getto, Christine

2015-01-01

Drug testing is an important clinical tool that is available to physicians who are assessing the effectiveness of drug treatment as well as patient compliance to the administered program. While urine has traditionally been the matrix of choice for drug monitoring, oral fluid, a filtrate of the blood, has shown great promise as an alternative matrix for such applications. Oral fluid collection can be accomplished without the need for highly trained medical staff through the use of a simple, noninvasive oral fluid collection device, which obtains an adequate sample in only a few minutes. There has been a significant amount of research performed on the use of oral fluid for forensic toxicology application; however, more studies assessing the use of oral fluid drug testing are required to validate its ability to achieve clinical drug monitoring goals. Testing for various drugs in oral fluid may yield a different result when compared to the same drugs in urine, requiring an assessment of the utility of oral fluid for such practices. The purpose of this study was to examine the application of oral fluid drug testing in patients undergoing buprenorphine treatment for opioid dependence. A retrospective analysis of drug testing results obtained from 6,928 patients (4,560 unobserved urine collections and 2,368 observed oral fluid collections) monitored for heroin metabolite, amphetamine, benzodiazepines, buprenorphine, tetrahydrocannabinol, cocaine, codeine, hydrocodone, hydromorphone, methadone, morphine, oxycodone, and oxymorphone was completed. Results of this statistical exercise indicated that patients undergoing observed oral fluid collection tested positive more frequently than those unobserved urine collections for several illicit drugs and prescription medications targeted. Oral fluid was shown to detect illicit drug use as well as noncompliance in this patient population under the studied conditions more often than the urine specimens.

Intrinsically stretchable and healable semiconducting polymer for organic transistors

DOE PAGES

Oh, Jin Young; Rondeau-Gagné, Simon; Chiu, Yu-Cheng; ...

2016-11-16

Developing a molecular design paradigm for conjugated polymers applicable to intrinsically stretchable semiconductors is crucial toward the next generation of wearable electronics. Current molecular design rules for high charge carrier mobility semiconducting polymers are unable to render the fabricated devices simultaneously stretchable and mechanically robust. Here in this paper, we present a new design concept to address the above challenge, while maintaining excellent electronic performance. This concept involves introducing chemical moieties to promote dynamic non-covalent crosslinking of the conjugated polymers. These non-covalent covalent crosslinking moieties are able to undergo an energy dissipation mechanism through breakage of bonds when strain ismore » applied, while retaining its high charge transport ability. As a result, our polymer is able to recover its high mobility performance (>1 cm 2/Vs) even after 100 cycles at 100% applied strain. Furthermore, we observed that the polymer can be efficiently repaired and/or healed with a simple heat and solvent treatment. These improved mechanical properties of our fabricated stretchable semiconductor enabled us to fabricate highly stretchable and high performance wearable organic transistors. This material design concept should illuminate and advance the pathways for future development of fully stretchable and healable skin-inspired wearable electronics.« less

Hybrid supercapacitor-battery materials for fast electrochemical charge storage

PubMed Central

Vlad, A.; Singh, N.; Rolland, J.; Melinte, S.; Ajayan, P. M.; Gohy, J.-F.

2014-01-01

High energy and high power electrochemical energy storage devices rely on different fundamental working principles - bulk vs. surface ion diffusion and electron conduction. Meeting both characteristics within a single or a pair of materials has been under intense investigations yet, severely hindered by intrinsic materials limitations. Here, we provide a solution to this issue and present an approach to design high energy and high power battery electrodes by hybridizing a nitroxide-polymer redox supercapacitor (PTMA) with a Li-ion battery material (LiFePO4). The PTMA constituent dominates the hybrid battery charge process and postpones the LiFePO4 voltage rise by virtue of its ultra-fast electrochemical response and higher working potential. We detail on a unique sequential charging mechanism in the hybrid electrode: PTMA undergoes oxidation to form high-potential redox species, which subsequently relax and charge the LiFePO4 by an internal charge transfer process. A rate capability equivalent to full battery recharge in less than 5 minutes is demonstrated. As a result of hybrid's components synergy, enhanced power and energy density as well as superior cycling stability are obtained, otherwise difficult to achieve from separate constituents. PMID:24603843

Intrinsically stretchable and healable semiconducting polymer for organic transistors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Oh, Jin Young; Rondeau-Gagné, Simon; Chiu, Yu-Cheng

Developing a molecular design paradigm for conjugated polymers applicable to intrinsically stretchable semiconductors is crucial toward the next generation of wearable electronics. Current molecular design rules for high charge carrier mobility semiconducting polymers are unable to render the fabricated devices simultaneously stretchable and mechanically robust. Here in this paper, we present a new design concept to address the above challenge, while maintaining excellent electronic performance. This concept involves introducing chemical moieties to promote dynamic non-covalent crosslinking of the conjugated polymers. These non-covalent covalent crosslinking moieties are able to undergo an energy dissipation mechanism through breakage of bonds when strain ismore » applied, while retaining its high charge transport ability. As a result, our polymer is able to recover its high mobility performance (>1 cm 2/Vs) even after 100 cycles at 100% applied strain. Furthermore, we observed that the polymer can be efficiently repaired and/or healed with a simple heat and solvent treatment. These improved mechanical properties of our fabricated stretchable semiconductor enabled us to fabricate highly stretchable and high performance wearable organic transistors. This material design concept should illuminate and advance the pathways for future development of fully stretchable and healable skin-inspired wearable electronics.« less

Glaucoma Drainage Device Erosion Following Ptosis Surgery.

PubMed

Bae, Steven S; Campbell, Robert J

2017-09-01

To highlight the potential risk of glaucoma drainage device erosion following ptosis surgery. Case report. A 71-year-old man underwent uncomplicated superotemporal Ahmed glaucoma valve implantation in the left eye in 2008. Approximately 8 years later, the patient underwent bilateral ptosis repair, which successfully raised the upper eyelid position. Three months postoperatively, the patient's glaucoma drainage implant tube eroded through the corneal graft tissue and overlying conjunctiva to become exposed. A graft revision surgery was successfully performed with no further complications. Caution and conservative lid elevation may be warranted when performing ptosis repair in patients with a glaucoma drainage implant, and patients with a glaucoma implant undergoing ptosis surgery should be followed closely for signs of tube erosion.

Detection of geometric phases in superconducting nanocircuits

PubMed

Falci; Fazio; Palma; Siewert; Vedral

2000-09-21

When a quantum-mechanical system undergoes an adiabatic cyclic evolution, it acquires a geometrical phase factor' in addition to the dynamical one; this effect has been demonstrated in a variety of microscopic systems. Advances in nanotechnology should enable the laws of quantum dynamics to be tested at the macroscopic level, by providing controllable artificial two-level systems (for example, in quantum dots and superconducting devices). Here we propose an experimental method to detect geometric phases in a superconducting device. The setup is a Josephson junction nanocircuit consisting of a superconducting electron box. We discuss how interferometry based on geometrical phases may be realized, and show how the effect may be applied to the design of gates for quantum computation.

Test Standard Revision Update: JESD57, "Procedures for the Measurement of Single-Event Effects in Semiconductor Devices from Heavy-Ion Irradiation"

NASA Technical Reports Server (NTRS)

Lauenstein, Jean-Marie

2015-01-01

The JEDEC JESD57 test standard, Procedures for the Measurement of Single-Event Effects in Semiconductor Devices from Heavy-Ion Irradiation, is undergoing its first revision since 1996. In this talk, we place this test standard into context with other relevant radiation test standards to show its importance for single-event effect radiation testing for space applications. We show the range of industry, government, and end-user party involvement in the revision. Finally, we highlight some of the key changes being made and discuss the trade-space in which setting standards must be made to be both useful and broadly adopted.

Parabolic dish collectors - A solar option

NASA Astrophysics Data System (ADS)

Truscello, V. C.

1981-05-01

A description is given of several parabolic-dish high temperature solar thermal systems currently undergoing performance trials. A single parabolic dish has the potential for generating 20 to 30 kW of electricity with fluid temperatures from 300 to 1650 C. Each dish is a complete power-producing unit, and may function either independently or as part of a group of linked modules. The two dish designs under consideration are of 11 and 12 meter diameters, yielding receiver operating temperatures of 925 and 815 C, respectively. The receiver designs described include (1) an organic working fluid (toluene) Rankine cycle engine; (2) a Brayton open cycle unit incorporating a hybrid combustion chamber and nozzle and a shaft-coupled permanent magnet alternator; and (3) a modified Stirling cycle device originally designed for automotive use. Also considered are thermal buffer energy storage and thermochemical transport and storage.

Chronic Actinomyces Infection Caused by Retained Cervical Cerclage: A Case Report.

PubMed

Lyttle, Brianna; Johnson, Julia V

2016-01-01

Historically, Actinomyces infection has been associated primarily with the intrauterine device. Recently, case reports associating Actinomyces with other implants have been described, including nonwoven polypropylene mesh used for urethral slings and Mersilene cerclage placements. However, there are no reported cases of chronic Actinomyces infections associated with retained Mersilene cerclage. A 51-year-old woman, gravida 3, para 3, presented with a 10-year history of vaginal discharge and Actinomyces identified on endometrial biopsy. After failing medical treatment and undergoing a hysterectomy, the patient was found to have a retained Mersilene cerclage. This is the first case to report persistent Actinomyces infection with a retained Mersilene cerclage. No current recommendations exist for assessing full removal of cerclage. Clinicians should have a high suspicion of Actinomyces infection in a patient who presents with persistent vaginal discharge and history of cerclage placement.

Pectoral nerves (PECS) and intercostal nerve block for cardiac resynchronization therapy device implantation.

PubMed

Fujiwara, Atsushi; Komasawa, Nobuyasu; Minami, Toshiaki

2014-01-01

A 71-year-old man was scheduled to undergo cardiac resynchronization therapy device (CRTD) implantation. He was combined with severe chronic heart failure due to ischemic heart disease. NYHA class was 3 to 4 and electrocardiogram showed non-sustained ventricular. Ejection fraction was about 20% revealed by transthoracic echocardiogram. He was also on several anticoagulation medications. We planned to implant the device under the greater pectoral muscle. As general anesthesia was considered risky, monitored anesthesia care utilizing peripheral nerve block and slight sedation was scheduled. Pectoral nerves (PECS) block and intercostal block was performed under ultrasonography with ropivacaine. For sedation during the procedure, continuous infusion of dexmedetomidine without a loading dose was performed. The procedure lasted about 3 hours, but the patient showed no pain or restlessness. Combination of PECS block and intercostal block may provide effective analgesia for CRTD implantation.

Scaling Laws for NanoFET Sensors

NASA Astrophysics Data System (ADS)

Wei, Qi-Huo; Zhou, Fu-Shan

2008-03-01

In this paper, we report our numerical studies of the scaling laws for nanoplate field-effect transistor (FET) sensors by simplifying the nanoplates as random resistor networks. Nanowire/tube FETs are included as the limiting cases where the device width goes small. Computer simulations show that the field effect strength exerted by the binding molecules has significant impact on the scaling behaviors. When the field effect strength is small, nanoFETs have little size and shape dependence. In contrast, when the field-effect strength becomes stronger, there exists a lower detection threshold for charge accumulation FETs and an upper detection threshold for charge depletion FET sensors. At these thresholds, the nanoFET devices undergo a transition between low and large sensitivities. These thresholds may set the detection limits of nanoFET sensors. We propose to eliminate these detection thresholds by employing devices with very short source-drain distance and large width.

Ensuring safety of implanted devices under MRI using reversed RF polarization.

PubMed

Overall, William R; Pauly, John M; Stang, Pascal P; Scott, Greig C

2010-09-01

Patients with long-wire medical implants are currently prevented from undergoing magnetic resonance imaging (MRI) scans due to the risk of radio frequency (RF) heating. We have developed a simple technique for determining the heating potential for these implants using reversed radio frequency (RF) polarization. This technique could be used on a patient-to-patient basis as a part of the standard prescan procedure to ensure that the subject's device does not pose a heating risk. By using reversed quadrature polarization, the MR scan can be sensitized exclusively to the potentially dangerous currents in the device. Here, we derive the physical principles governing the technique and explore the primary sources of inaccuracy. These principles are verified through finite-difference simulations and through phantom scans of implant leads. These studies demonstrate the potential of the technique for sensitively detecting potentially dangerous coupling conditions before they can do any harm. 2010 Wiley-Liss, Inc.

Varying potential silicon carbide gas sensor

NASA Technical Reports Server (NTRS)

Shields, Virgil B. (Inventor); Ryan, Margaret A. (Inventor); Williams, Roger M. (Inventor)

1997-01-01

A hydrocarbon gas detection device operates by dissociating or electro-chemically oxidizing hydrocarbons adsorbed to a silicon carbide detection layer. Dissociation or oxidation are driven by a varying potential applied to the detection layer. Different hydrocarbon species undergo reaction at different applied potentials so that the device is able to discriminate among various hydrocarbon species. The device can operate at temperatures between 100.degree. C. and at least 650.degree. C., allowing hydrocarbon detection in hot exhaust gases. The dissociation reaction is detected either as a change in a capacitor or, preferably, as a change of current flow through an FET which incorporates the silicon carbide detection layers. The silicon carbide detection layer can be augmented with a pad of catalytic material which provides a signal without an applied potential. Comparisons between the catalytically produced signal and the varying potential produced signal may further help identify the hydrocarbon present.

Thermal modeling of phase change solidification in thermal control devices including natural convection effects

NASA Technical Reports Server (NTRS)

Ukanwa, A. O.; Stermole, F. J.; Golden, J. O.

1972-01-01

Natural convection effects in phase change thermal control devices were studied. A mathematical model was developed to evaluate natural convection effects in a phase change test cell undergoing solidification. Although natural convection effects are minimized in flight spacecraft, all phase change devices are ground tested. The mathematical approach to the problem was to first develop a transient two-dimensional conduction heat transfer model for the solidification of a normal paraffin of finite geometry. Next, a transient two-dimensional model was developed for the solidification of the same paraffin by a combined conduction-natural-convection heat transfer model. Throughout the study, n-hexadecane (n-C16H34) was used as the phase-change material in both the theoretical and the experimental work. The models were based on the transient two-dimensional finite difference solutions of the energy, continuity, and momentum equations.

Percutaneous left ventricular assist device with TandemHeart for high-risk percutaneous coronary intervention: the Mayo Clinic experience.

PubMed

Alli, Oluseun O; Singh, Inder M; Holmes, David R; Pulido, Juan N; Park, Soon J; Rihal, Charanjit S

2012-11-01

In patients with poor left ventricular function and severe left main or multivessel coronary disease, coronary artery bypass grafting (CABG) surgery has been the preferred therapy. However, a number of these patients are either inoperable or poor surgical candidates due to comorbid conditions and previous cardiac surgical procedures. These patients are generally poor candidates for standard percutaneous coronary intervention (PCI) techniques. A hybrid PCI approach with hemodynamic support may be a viable strategy for these patients. We report our experience using the TandemHeart percutaneous left ventricular assist device during high-risk PCI. Retrospective cross-sectional analysis of prospectively collected data in 54 patients undergoing high-risk PCI using the TandemHeart device for support. Hemodynamic and clinical data were collected and analyzed. Baseline clinical characteristics were as follows: mean age 72 ± 1.7 years, males 78%, median ejection fraction 20%, mean serum creatinine 1.6 ± 0.3 2 mg/dL, recent myocardial infarction 52%, COPD 33%, previous CABG 50%, diabetes mellitus 41%, and hypertension 83%. The median SYNTAX score was 33, and the median Jeopardy score was 10. The predicted surgical revascularization mortality was 13% by the Society for Thoracic Surgery risk score and 33% by Euroscore. There was a significant decrease in right and left heart pressures (P < 0.05) with a concomitant increase in the cardiac output from 4.7 to 5.7 L/min (P = 0.03) during TandemHeart support. Left main and multivessel PCI was performed in 62% of patients, and rotablation was used in 48%. Procedural success rate was 97%, whereas 30-day and 6 month survival were 90% and 87%, respectively. Major vascular complications occurred in 13% of cases. None of our patients developed contrast induced nephropathy or needed dialysis. High-risk PCI with percutaneous left ventricular support using TandemHeart is a viable therapeutic strategy for a select subset of patients at very high risk with standard percutaneous revascularization techniques. Copyright © 2012 Wiley Periodicals, Inc.

Advanced Sensor Arrays and Packaging

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ryter, John Wesley; Romero, Christopher J.; Ramaiyan, Kannan

2016-08-11

Novel sensor packaging elements were designed, fabricated, and tested in order to facilitate the transition of electrochemical mixed-potential sensors toward commercialization. Of the two designs completed, the first is currently undergoing field trials, taking direct measurements within vehicle exhaust streams, while the second is undergoing preliminary laboratory testing. The sensors’ optimal operating conditions, sensitivity to hydrogen, and long-­term baseline stability were also investigated. The sensing capabilities of lanthanum chromite (La 0.8Sr 0.2CrO 3) and indium-­doped tin oxide (ITO) working electrodes were compared, and the ITO devices were selected for pre-­commercial field trials testing at a hydrogen fuel cell vehicle fuelingmore » station in California. Previous data from that fueling station were also analyzed, and the causes of anomalous baseline drift were identified.« less

Mechanically triggered heterolytic unzipping of a low-ceiling-temperature polymer

NASA Astrophysics Data System (ADS)

Diesendruck, Charles E.; Peterson, Gregory I.; Kulik, Heather J.; Kaitz, Joshua A.; Mar, Brendan D.; May, Preston A.; White, Scott R.; Martínez, Todd J.; Boydston, Andrew J.; Moore, Jeffrey S.

2014-07-01

Biological systems rely on recyclable materials resources such as amino acids, carbohydrates and nucleic acids. When biomaterials are damaged as a result of aging or stress, tissues undergo repair by a depolymerization-repolymerization sequence of remodelling. Integration of this concept into synthetic materials systems may lead to devices with extended lifetimes. Here, we show that a metastable polymer, end-capped poly(o-phthalaldehyde), undergoes mechanically initiated depolymerization to revert the material to monomers. Trapping experiments and steered molecular dynamics simulations are consistent with a heterolytic scission mechanism. The obtained monomer was repolymerized by a chemical initiator, effectively completing a depolymerization-repolymerization cycle. By emulating remodelling of biomaterials, this model system suggests the possibility of smart materials where aging or mechanical damage triggers depolymerization, and orthogonal conditions regenerate the polymer when and where necessary.

Is bioresorbable vascular scaffold acute recoil affected by baseline renal function and scaffold selection?

PubMed

Gunes, Haci Murat; Yılmaz, Filiz Kizilirmak; Gokdeniz, Tayyar; Demir, Gultekin Gunhan; Guler, Ekrem; Guler, Gamze Babur; Karaca, Oğuz; Cakal, Beytullah; İbişoğlu, Ersin; Boztosun, Bilal

2016-12-01

The aim of the present study was to investigate the relationship between glomerular filtration rate (GFR) and acute post-scaffold recoil (PSR) in patients undergoing bioresorbable scaffold (BVS) implantation. We included 130 patients who underwent everolimus-eluting BVS device (Absorb BVS; Abbott Vascular, Santa Clara, CA, USA) or the novolimus-eluting BVS device (Elixir Medical Corporation) implantations for single or multi-vessel disease. Clinical, angiographic variables and procedural characteristics were defined and pre-procedural GFR was calculated for each patient. Post-procedural angiographic parameters of each patient were analyzed. Primary objective of the study was to evaluate the effect of GFR on angiographic outcomes after BVS implantation while secondary objective was to compare post-procedural angiographic results between the two BVS device groups. Baseline clinical characteristics and angiographic parameters were similar between the two BVS groups. Post-procedural angiographic analysis revealed significantly lower PSR in the DESolve group than the Absorb group (0.10±0.04 vs. 0.13±0.05, p: 0.003). When PSR in the whole study population was evaluated, it was positively correlated with age, tortuosity , calcification and PBR as there was a negative correlation between GFR. Besides GFR were found to be independent predictors for PSR in all groups and the whole study population. In patients undergoing BVS implantation, pre-procedural low GFR is associated with increased post-procedural PSR. Calcification, age, PBR, dyslipidemia and tortuosity are other independent risk factors for PSR. DESolve has lower PSR when compared with Absorb. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Effect of a heat and moisture exchanger on heat loss in isoflurane-anesthetized dogs undergoing single-limb orthopedic procedures.

PubMed

Hofmeister, Erik H; Brainard, Benjamin M; Braun, Christina; Figueiredo, Juliana P

2011-12-15

To determine whether a heat and moisture exchange device (HME) prevents a decrease in body temperature in isoflurane-anesthetized dogs undergoing orthopedic procedures. Blinded randomized controlled clinical trial. 60 privately owned dogs weighing at least 15 kg (33 lb). Dogs were randomly assigned to 1 of 3 treatment groups (n = 20/group): HME placed immediately after anesthetic induction with isoflurane, after transfer to the operating room, or not at all. The device consisted of a hygroscopic filter placed between the endotracheal tube and the Y piece of the anesthesia circuit. Each dog was positioned on a circulating warm water blanket and had a forced-air warming blanket placed over its body. Body temperature was monitored after transfer to the operating room with a probe placed in the thoracic aspect of the esophagus. Study groups did not differ significantly with respect to body weight, body condition score, reproductive status, breed, surgical procedure, preoperative sedative and opioid administration, anesthetic induction drug, local nerve block technique, or operating room assignment. There were no significant differences among groups in esophageal temperature variables, interval between anesthetic induction and surgery, surgery duration, anesthesia duration, or oxygen flow rate. However, the relationship between temperature delta and body weight was significant and relevant (R(2) = 0.23), as was the association between temperature nadir and body weight (R(2)= 0.10). As body weight increased, the temperature delta decreased and temperature nadir increased. No other significant relationships were identified. Inclusion of an HME in healthy dogs undergoing anesthesia for an elective orthopedic surgery did not facilitate maintenance of body temperature throughout the procedure.

Laparoscopic adjustable gastric bandings: a prospective randomized study of 400 operations performed with 2 different devices.

PubMed

Gravante, Gianpiero; Araco, Antonino; Araco, Francesco; Delogu, Daniela; De Lorenzo, Antonino; Cervelli, Valerio

2007-10-01

To evaluate potential differences between 2 devices used to perform laparoscopic adjustable gastric bandings (the Swedish adjustable gastric band and the Lap-Band). The following groups were considered eligible: (1) patients with a body mass index (calculated as weight in kilograms divided by height in meters squared) of greater than 40; (2) patients with a body mass index between 35 and 40, with associated comorbidities; and (3) patients with a body mass index of greater than 60 who could not undergo derivative procedures. We recruited 400 patients. The mean +/- SD body mass index decreased to 40.6 +/- 3.0 after the first year and to 35.2 +/- 7.0 after 2 years. The average excess weight loss reduction was 48.2% after 1 year and 56.0% after 2 years. The excess weight loss reduction was inversely related to the initial weight: patients with an estimated weight excess of 50 kg or less (108 patients [27.0%]) had an excess weight loss reduction of 55% after 2 years; those with a weight excess of greater than 50 kg (292 patients [73.0%]) had an excess weight loss reduction of 44% (P = .004). We recorded 1 death (0.2%). Transient gastric occlusions (24 patients [6.0%]) and slippages (12 patients [3.0%]) were the most common complications. The devices used (Swedish adjustable gastric band and Lap-Band) were similar in terms of correction of obesity and morbidity. Laparoscopic adjustable gastric banding is a safe and feasible technique with specific indications in moderately obese patients and, secondarily, in highly obese patients who are unfit for more invasive techniques. No differences were found among the devices examined. isrctn.org Identifier: ISRCTN22839090.

Nitinol Embolic Protection Filters: Design Investigation by Finite Element Analysis

NASA Astrophysics Data System (ADS)

Conti, Michele; de Beule, Matthieu; Mortier, Peter; van Loo, Denis; Verdonck, Pascal; Vermassen, Frank; Segers, Patrick; Auricchio, Ferdinando; Verhegghe, Benedict

2009-08-01

The widespread acceptance of carotid artery stenting (CAS) to treat carotid artery stenosis and its effectiveness compared with surgical counterpart, carotid endarterectomy (CEA), is still a matter of debate. Transient or permanent neurological deficits may develop in patients undergoing CAS due to distal embolization or hemodynamic changes. Design, development, and usage of embolic protection devices (EPDs), such as embolic protection filters, appear to have a significant impact on the success of CAS. Unfortunately, some drawbacks, such as filtering failure, inability to cross tortuous high-grade stenoses, malpositioning and vessel injury, still remain and require design improvement. Currently, many different designs of such devices are available on the rapidly growing dedicated market. In spite of such a growing commercial interest, there is a significant need for design tools as well as for careful engineering investigations and design analyses of such nitinol devices. The present study aims to investigate the embolic protection filter design by finite element analysis. We first developed a parametrical computer-aided design model of an embolic filter based on micro-CT scans of the Angioguard™ XP (Cordis Endovascular, FL) EPD by means of the open source pyFormex software. Subsequently, we used the finite element method to simulate the deployment of the nitinol filter as it exits the delivery sheath. Comparison of the simulations with micro-CT images of the real device exiting the catheter showed excellent correspondence with our simulations. Finally, we evaluated circumferential basket-vessel wall apposition of a 4 mm size filter in a straight vessel of different sizes and shape. We conclude that the proposed methodology offers a useful tool to evaluate and to compare current or new designs of EPDs. Further simulations will investigate vessel wall apposition in a realistic tortuous anatomy.

Electronic compliance monitoring of topical treatment after ophthalmic surgery.

PubMed

Hermann, Manuel Marcel; Ustündag, Can; Diestelhorst, Michael

2010-08-01

The success of many medical treatments is built on compliance. Electronic monitoring is the most accurate tool to quantify compliance by measuring adherence. In order to assess the efficiency of a recently introduced miniature monitoring device for eye drop application, we evaluated adherence in ophthalmic patients undergoing post-operative short-term topical treatment. This pilot study enrolled 30 outpatients (mean age 61.8 +/- 18.5 years) after cataract (n = 24) and glaucoma filtration surgery (n = 6) applying fixed-combination eye drops containing prednisolone and gentamicin five times daily for 2 weeks. Patients received eye drops in conventional bottles each equipped with a miniature monitoring device recording events of application. Two patients failed to bring back the monitoring device; therefore data collected from only 28 patients could be examined. Data showed highly variable results with a mean dose compliance of 50.2%. Dose compliance was below 25% in approximately one out of five patients. Four cataract patients, but no glaucoma patient, discontinued therapy prematurely. The observed mean dosage interval was calculated for each patient and ranged 4.6-19.7 h. Thirty percent of analysed dosage intervals exceeded 12.0 h. Different patterns of compliance behaviour-like early non-persistence, drug holiday and low treatment frequency could be identified and illustrated using electronic data. Age or gender did not significantly influence compliance rates. Our pilot study demonstrates successful electronic compliance monitoring using a technology capable of continuous data recording over weeks of treatment. The low compliance rate for a relevant part of the patients demonstrates the necessity to study and improve compliance in ophthalmology. In future, new application methods and electronic application devices may improve treatment response in eye care.

Laboratory validation of MEMS-based sensors for post-earthquake damage assessment image

NASA Astrophysics Data System (ADS)

Pozzi, Matteo; Zonta, Daniele; Santana, Juan; Colin, Mikael; Saillen, Nicolas; Torfs, Tom; Amditis, Angelos; Bimpas, Matthaios; Stratakos, Yorgos; Ulieru, Dumitru; Bairaktaris, Dimitirs; Frondistou-Yannas, Stamatia; Kalidromitis, Vasilis

2011-04-01

The evaluation of seismic damage is today almost exclusively based on visual inspection, as building owners are generally reluctant to install permanent sensing systems, due to their high installation, management and maintenance costs. To overcome this limitation, the EU-funded MEMSCON project aims to produce small size sensing nodes for measurement of strain and acceleration, integrating Micro-Electro-Mechanical Systems (MEMS) based sensors and Radio Frequency Identification (RFID) tags in a single package that will be attached to reinforced concrete buildings. To reduce the impact of installation and management, data will be transmitted to a remote base station using a wireless interface. During the project, sensor prototypes were produced by assembling pre-existing components and by developing ex-novo miniature devices with ultra-low power consumption and sensing performance beyond that offered by sensors available on the market. The paper outlines the device operating principles, production scheme and working at both unit and network levels. It also reports on validation campaigns conducted in the laboratory to assess system performance. Accelerometer sensors were tested on a reduced scale metal frame mounted on a shaking table, back to back with reference devices, while strain sensors were embedded in both reduced and full-scale reinforced concrete specimens undergoing increasing deformation cycles up to extensive damage and collapse. The paper assesses the economical sustainability and performance of the sensors developed for the project and discusses their applicability to long-term seismic monitoring.

New diagnostic pathways urgently needed. Protocol of PET Guidance I pilot study: positron emission tomography in suspected cardiac implantable electronic device-related infection.

PubMed

Marciniak-Emmons, Marta Barbara; Sterliński, Maciej; Syska, Paweł; Maciąg, Aleksander; Farkowski, Michał Mirosław; Firek, Bohdan; Dziuk, Mirosław; Zając, Dariusz; Pytkowski, Mariusz; Szwed, Hanna

2016-01-01

Cardiovascular implantable electronic device (CIED) infection is a complication of increasing incidence. We present a protocol of an observational case control clinical trial "Positron Emission Tomography Combined With Computed Tomography (PET CT) in Suspected Cardiac Implantable Electronic Device Infection, a Pilot Study - PET Guidance I" (NCT02196753). The aim of this observational clinical trial is to assess and standardise diagnostic algorithms for CIED infections (lead-dependent infective endocarditis, generator pocket infection, fever of unknown origin) with PET CT in Poland. Study group will consist of 20 patients with initial diagnosis of CIED-related infection paired with a control group of 20 patients with implanted CIEDs, who underwent PET CT due to other non-infectious indications and have no data for infectious process in follow-up. All patients included in the study will undergo standard diagnostic pro-cess. Conventional/standard diagnostic and therapeutic process will consist of: medical interview, physical examination, laboratory tests, blood cultures; imaging studies: echocardiography: transthoracic (TTE), and, if there are no contraindications transoesophageal, computed tomography scan for pulmonary embolism if indicated; if there are abnormalities in other systems, decisions concerning further diagnostics will be made at the physician's discretion. As well as standard diagnostic procedures, patients will undergo whole body PET CT scan to localise infection or inflammation. Diagnosis and therapeutic decision will be obtained from the Study Committee. Follow-up will be held within six months with control visits at three and six months. During each follow-up visit, all patients will undergo laboratory tests, two blood cultures collected 1 h apart, and TTE. In case of actual clinical suspicion of infective endocarditis or local generator pocket infection, patients will be referred for further diagnostics. Endpoints for the results assessment - primary endpoints are to standardise PET CT in the diagnostic process: sensitivity, specificity, positive predictive value, and negative predictive value of the diagnosis made by PET CT; secondary endpoints are: assessment of usefulness of PET CT for detection of remote infective complications (metastatic abscesses, infected pulmonary emboli), incidence of particular localisations of infection, influence of PET CT on therapeutic decision: confirmation or change of decision based on PET CT, safety and complications of diagnostic process of CIED-related infections with PET CT. Evaluation of PET CT use for device-related infections in a case control study may be conclusive and improve diagnostic pathway.

A comparison of outcomes involving highly cohesive, form-stable breast implants from two manufacturers in patients undergoing primary breast augmentation.

PubMed

Jewell, Mark L; Jewell, James L

2010-01-01

Although there have been reports of single-surgeon outcomes with highly cohesive, form-stable silicone gel implants in women undergoing primary breast augmentation, there has been only one study published that compares the outcomes between the Allergan 410 and the Mentor CPG devices. The goal of the study is to compare outcomes in each cohort and to determine if quality systems and processes would have an impact on lowering the surgical revision rate, as compared to published reports for round gel implants and form-stable implants. Patients selected for the study were required to meet predefined inclusion criteria and general indications for breast augmentation. All subjects were treated uniformly with extensive informed consent prior to surgery. The entire process of breast augmentation (patient assessment, informed consent, the surgical procedure itself and postoperative instructions) was identical between the two groups. Patients were not randomized, as the studies did not start at the same time. The process for management of each patient was based on adaptation of the Toyota Production System and Lean Manufacturing, with emphasis on achieving operational excellence in the use of planning templates for surgery, including accurate management of patient expectations regarding size outcome. Outcomes data included physical breast measurements, quality of life metrics, and patient/surgeon satisfaction assessment. Adverse events were compared against published data for breast implants. Follow-up ranged between 20-77 months (Allergan 410) and 16-77 months (Mentor CPG). The outcome data indicate that these devices produce natural-appearing breasts with extremely low aggregate reoperation rate (4.2%). Only 0.8% of the reoperations were attributable to surgeon-related factors. There were no reoperations to correct mismanaged size expectations during the course of each study. There were 13 pregnancies and no difficulties with lactation were reported. Rippling (lateral/medial, palpable and/or visible) was encountered in both cohorts. The Mentor CPG cohort had a fivefold greater incidence of rippling (37.3% versus 7.6% in Allergan 410 cohort). This was highly statistically significant (P < .001). Provided that there is adherence to core principles and avoidance of errors in planning, patient expectations, and surgery, highly cohesive, form-stable breast implants can deliver excellent long term outcomes in primary breast augmentation in a diverse patient population. The impact of quality processes such as Toyota Production System and Lean Manufacturing was substantive in delivering operational excellence in primary breast augmentation.

Optimizing care of ventilated infants by improving weighing accuracy on incubator scales.

PubMed

El-Kafrawy, Ula; Taylor, R J

2016-01-01

To determine the accuracy of weighing ventilated infants on incubator scales and whether the accuracy can be improved by the addition of a ventilator tube compensator (VTC) device to counterbalance the force exerted by the ventilator tubing. Body weights on integral incubator scales were compared in ventilated infants (with and without a VTC), with body weights on standalone electronic scales (true weight). Individual and series of trend weights were obtained on the infants. The method of Bland and Altman was used to assess the introduced bias. The study included 60 ventilated infants; 66% of them weighed <1000 g. A total of 102 paired-weight datasets for 30 infants undergoing conventional ventilation and 30 undergoing high frequency oscillator ventilation (HFOV) supported by a SensorMedics oscillator, (with and without a VTC) were obtained. The mean differences and (95% CI for the bias) between the integral and true scale weighing methods was 60.8 g (49.1 g to 72.5 g) without and -2.8 g (-8.9 g to 3.3 g) with a VTC in HFOV infants; 41.0 g (32.1 g to 50.0 g) without and -5.1 g (-9.3 g to -0.8 g) with a VTC for conventionally ventilated infants. Differences of greater than 2% were considered clinically relevant and occurred in 93.8% without and 20.8% with a VTC in HFOV infants and 81.5% without and 27.8% with VTC in conventionally ventilated infants. The use of the VTC device represents a substantial improvement on the current practice for weighing ventilated infants, particularly in the extreme preterm infants where an over- or underestimated weight can have important clinical implications for treatment. A large-scale clinical trial to validate these findings is needed.

The demographic characteristics of high-level and recreational athletes undergoing hip arthroscopy for femoroacetabular impingement: a sports-specific analysis.

PubMed

Nawabi, Danyal H; Bedi, Asheesh; Tibor, Lisa M; Magennis, Erin; Kelly, Bryan T

2014-03-01

The purpose of this study was to determine differences in age, gender, and the need for bilateral surgery between high-level athletes grouped by sports with similar mechanical demands on the hip and recreational athletes undergoing hip arthroscopy for femoroacetabular impingement (FAI). By use of a hip-preservation center registry, a retrospective review of patients undergoing hip arthroscopy for FAI between March 2010 and April 2012 was performed. Athletes were categorized as high level (high school, collegiate, or professional) or recreational. We performed a subgroup analysis for high-level athletes, looking at differences among contact, cutting, impingement, overhead/asymmetric, endurance, and flexibility sports. The study included 288 high-level athletes and 334 recreational athletes. Being a high-level athlete was associated with a younger age (mean age, 20.2 years v 33.0 years; odds ratio, 0.69; P < .001) and male gender (61.5% v 53.6%; odds ratio, 1.75; P = .03). The percentage of high-level athletes undergoing bilateral surgery was higher than that of recreational athletes (28.4% v 15.9%); however, this association was found to be confounded by age on multivariate analysis. The most common sports for high-level athletes were soccer, hockey, and football. Athletes participating in cutting sports were significantly younger than athletes participating flexibility, contact, or impingement sports. When compared with recreational athletes undergoing arthroscopic treatment for FAI, high-level athletes are more likely to be younger, to be male, and to undergo bilateral surgery. When high-level athletes are grouped by the mechanical demands placed on the hip by their sport, athletes participating in cutting sports are more likely to be younger than those in the other groups. Level IV, case series. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Rapid Prototyping of a Smart Device-based Wireless Reflectance Photoplethysmograph

PubMed Central

Ghamari, M.; Aguilar, C.; Soltanpur, C.; Nazeran, H.

2017-01-01

This paper presents the design, fabrication, and testing of a wireless heart rate (HR) monitoring device based on photoplethysmography (PPG) and smart devices. PPG sensors use infrared (IR) light to obtain vital information to assess cardiac health and other physiologic conditions. The PPG data that are transferred to a computer undergo further processing to derive the Heart Rate Variability (HRV) signal, which is analyzed to generate quantitative markers of the Autonomic Nervous System (ANS). The HRV signal has numerous monitoring and diagnostic applications. To this end, wireless connectivity plays an important role in such biomedical instruments. The photoplethysmograph consists of an optical sensor to detect the changes in the light intensity reflected from the illuminated tissue, a signal conditioning unit to prepare the reflected light for further signal conditioning through amplification and filtering, a low-power microcontroller to control and digitize the analog PPG signal, and a Bluetooth module to transmit the digital data to a Bluetooth-based smart device such as a tablet. An Android app is then used to enable the smart device to acquire and digitally display the received analog PPG signal in real-time on the smart device. This article is concluded with the prototyping of the wireless PPG followed by the verification procedures of the PPG and HRV signals acquired in a laboratory environment. PMID:28959119

Rapid Prototyping of a Smart Device-based Wireless Reflectance Photoplethysmograph.

PubMed

Ghamari, M; Aguilar, C; Soltanpur, C; Nazeran, H

2016-03-01

This paper presents the design, fabrication, and testing of a wireless heart rate (HR) monitoring device based on photoplethysmography (PPG) and smart devices. PPG sensors use infrared (IR) light to obtain vital information to assess cardiac health and other physiologic conditions. The PPG data that are transferred to a computer undergo further processing to derive the Heart Rate Variability (HRV) signal, which is analyzed to generate quantitative markers of the Autonomic Nervous System (ANS). The HRV signal has numerous monitoring and diagnostic applications. To this end, wireless connectivity plays an important role in such biomedical instruments. The photoplethysmograph consists of an optical sensor to detect the changes in the light intensity reflected from the illuminated tissue, a signal conditioning unit to prepare the reflected light for further signal conditioning through amplification and filtering, a low-power microcontroller to control and digitize the analog PPG signal, and a Bluetooth module to transmit the digital data to a Bluetooth-based smart device such as a tablet. An Android app is then used to enable the smart device to acquire and digitally display the received analog PPG signal in real-time on the smart device. This article is concluded with the prototyping of the wireless PPG followed by the verification procedures of the PPG and HRV signals acquired in a laboratory environment.

Efficacy of a new device to optimize positive pressure ventilation via face mask in edentulous patients: a randomized trial.

PubMed

Niño, Maria C; Pauwels, Andres; Raffan, Fernando; Arango, Enrique; Romero, David J; Benitez, Daniel

2017-04-01

Mask ventilation is routinely performed during anesthesia. Under some circumstances, it might be difficult to perform, such as in edentulous patients, due to inadequate mask seal. We developed a new device called NIPARA and studied its use For ventilation optimization in edentulous patients. This randomized controlled trial included edentulous adults who had no other predictors of difficult airway, scheduled to undergo general anesthesia. Patients were assigned either to the NIPARA device group or to the control group (oral airway only). The primary outcomes were peak inspiratory pressure and tidal volume values of the first 14 breaths. The secondary outcome was the incidence of complications. Data from 37 patients were collected during a one-year period (twenty in the NIPARA device group and 17 in the control group). The difference in mean PIP was not statistically significant. The tidal volume was 1.5 times greater in the NIPARA group than in the control group. One patient from the intervention group had minimal oral trauma. In the administration of face mask ventilation, NIPARA is an effective device that significantly improves the tidal volume administered in edentulous patients.

Buckling of Elastomeric Beams Enables Actuation of Soft Machines

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yang, Dian; Mosadegh, Bobak; Ainla, Alar

2015-09-21

Soft, pneumatic actuators that buckle when interior pressure is less than exterior provide a new mechanism of actuation. Upon application of negative pneumatic pressure, elastic beam elements in these actuators undergo reversible, cooperative collapse, and generate a rotational motion. These actuators are inexpensive to fabricate, lightweight, easy to control, and safe to operate. They can be used in devices that manipulate objects, locomote, or interact cooperatively with humans.

Summary of Research: Academic Departments 1990-1991

DTIC Science & Technology

1991-10-01

Soviet cinema . The Aesopian devices are no longer The author lists the sources and describes the needed; Soviet cinema is undergoing major changes. tapes...name of a contact person. growing interest in Soviet cinema in the United 271 LANGUAGE STUDIES States encourages a new market for Soviet and Conference...discussed issues related to early years of Russian video. The present publication provides Soviet cinema while the Cinema panel at the Fourth

Thermic sealing in femoral catheterisation: First experience with the Secure Device.

PubMed

Sacherer, Michael; Kolesnik, Ewald; von Lewinski, Friederike; Verheyen, Nicolas; Brandner, Karin; Wallner, Markus; Eaton, Deborah M; Luha, Olev; Zweiker, Robert; von Lewinski, Dirk

2018-04-03

Devices currently used to achieve hemostasis of the femoral artery following percutaneous cardiac catheterization are associated with vascular complications and remnants of artificial materials are retained at the puncture site. The SECURE arterial closure device induces hemostasis by utilizing thermal energy, which causes collagen shrinking and swelling. In comparison to established devices, it has the advantage of leaving no foreign material in the body following closing. This study was designed to evaluate the efficacy and safety of the SECURE device to close the puncture site following percutaneous cardiac catheterization. The SECURE device was evaluated in a prospective non-randomized single-centre trial with patients undergoing 6 F invasive cardiac procedures. A total of 67 patients were enrolled and the device was utilized in 63 patients. 50 diagnostic and 13 interventional cases were evaluated. Femoral artery puncture closure was performed immediately after completion of the procedure. Time to hemostasis (TTH), time to ambulation (TTA) and data regarding short-term and 30-day clinical follow-up were recorded. Mean TTH was 4:30 ± 2:15 min in the overall observational group. A subpopulation of patients receiving anticoagulants had a TTH of 4:53 ± 1:43 min. There were two access site complications (hematoma > 5 cm). No major adverse events were identified during hospitalization or at the 30 day follow-up. The new SECURE device demonstrates that it is feasible in diagnostic and interventional cardiac catheterization. With respect to safety, the SECURE device was non-inferior to other closure devices as tested in the ISAR closure trial.

Infections in patients undergoing craniotomy: risk factors associated with post-craniotomy meningitis.

PubMed

Kourbeti, Irene S; Vakis, Antonis F; Ziakas, Panayiotis; Karabetsos, Dimitris; Potolidis, Evangelos; Christou, Silvana; Samonis, George

2015-05-01

OBJECT The authors performed a prospective study to define the prevalence and microbiological characteristics of infections in patients undergoing craniotomy and to clarify the risk factors for post-craniotomy meningitis. METHODS Patients older than 18 years who underwent nonstereotactic craniotomies between January 2006 and December 2008 were included. Demographic, clinical, laboratory, and microbiological data were systemically recorded. Patient characteristics, craniotomy type, and pre- and postoperative variables were evaluated as risk factors for meningitis RESULTS Three hundred thirty-four procedures were analyzed (65.6% involving male patients). Traumatic brain injury was the most common reason for craniotomy. Almost 40% of the patients developed at least 1 infection. Ventilator-associated pneumonia (VAP) was the most common infection recorded (22.5%) and Acinetobacter spp. were isolated in 44% of the cases. Meningitis was encountered in 16 procedures (4.8%), and CSF cultures were positive for microbial growth in 100% of these cases. Gram-negative pathogens (Acinetobacter spp., Klebsiella spp., Pseudomonas aeruginosa, Enterobacter cloaceae, Proteus mirabilis) represented 88% of the pathogens. Acinetobacter and Klebsiella spp. demonstrated a high percentage of resistance in several antibiotic classes. In multivariate analysis, the risk for meningitis was independently associated with perioperative steroid use (OR 11.55, p = 0.005), CSF leak (OR 48.03, p < 0.001), and ventricular drainage (OR 70.52, p < 0.001). CONCLUSIONS Device-related postoperative communication between the CSF and the environment, CSF leak, and perioperative steroid use were defined as risk factors for meningitis in this study. Ventilator-associated pneumonia was the most common infection overall. The offending pathogens presented a high level of resistance to several antibiotics.

Rationale and design of a randomised clinical trial comparing vascular closure device and manual compression to achieve haemostasis after diagnostic coronary angiography: the Instrumental Sealing of ARterial puncture site - CLOSURE device versus manual compression (ISAR-CLOSURE) trial.

PubMed

Xhepa, Erion; Byrne, Robert A; Schulz, Stefanie; Helde, Sandra; Gewalt, Senta; Cassese, Salvatore; Linhardt, Maryam; Ibrahim, Tareq; Mehilli, Julinda; Hoppe, Katharina; Grupp, Katharina; Kufner, Sebastian; Böttiger, Corinna; Hoppmann, Petra; Burgdorf, Christof; Fusaro, Massimiliano; Ott, Ilka; Schneider, Simon; Hengstenberg, Christian; Schunkert, Heribert; Laugwitz, Karl-Ludwig; Kastrati, Adnan

2014-06-01

Vascular closure devices (VCD) have been introduced into clinical practice with the aim of increasing the procedural efficiency and clinical safety of coronary angiography. However, clinical studies comparing VCD and manual compression have yielded mixed results, and large randomised clinical trials comparing the two strategies are missing. Moreover, comparative efficacy studies between different VCD in routine clinical use are lacking. The Instrumental Sealing of ARterial puncture site - CLOSURE device versus manual compression (ISAR-CLOSURE) trial is a prospective, randomised clinical trial designed to compare the outcomes associated with the use of VCD or manual compression to achieve femoral haemostasis. The test hypothesis is that femoral haemostasis after coronary angiography achieved using VCD is not inferior to manual compression in terms of access-site-related vascular complications. Patients undergoing coronary angiography via the common femoral artery will be randomised in a 1:1:1 fashion to receive FemoSeal VCD, EXOSEAL VCD or manual compression. The primary endpoint is the incidence of the composite of arterial access-related complications (haematoma ≥5 cm, pseudoaneurysm, arteriovenous fistula, access-site-related bleeding, acute ipsilateral leg ischaemia, the need for vascular surgical/interventional treatment or documented local infection) at 30 days after randomisation. According to power calculations based on non-inferiority hypothesis testing, enrolment of 4,500 patients is planned. The trial is registered at www.clinicaltrials.gov (study identifier: NCT01389375). The safety of VCD as compared to manual compression in patients undergoing transfemoral coronary angiography remains an issue of clinical equipoise. The aim of the ISAR-CLOSURE trial is to assess whether femoral haemostasis achieved through the use of VCD is non-inferior to manual compression in terms of access-site-related vascular complications.

Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement Significantly Reduces Death and Stroke Compared With Unprotected Procedures.

PubMed

Seeger, Julia; Gonska, Birgid; Otto, Markus; Rottbauer, Wolfgang; Wöhrle, Jochen

2017-11-27

The aim of this study was to evaluate the impact of cerebral embolic protection on stroke-free survival in patients undergoing transcatheter aortic valve replacement (TAVR). Imaging data on cerebral embolic protection devices have demonstrated a significant reduction in number and volume of cerebral lesions. A total of 802 consecutive patients were enrolled. The Sentinel cerebral embolic protection device (Claret Medical Inc., Santa Rosa, California) was used in 34.9% (n = 280) of consecutive patients. In 65.1% (n = 522) of patients TAVR was performed in the identical setting except without cerebral embolic protection. Neurological follow-up was done within 7 days post-procedure. The primary endpoint was a composite of all-cause mortality or all-stroke according to Valve Academic Research Consortium-2 criteria within 7 days. Propensity score matching was performed to account for possible confounders. Both filters of the device were successfully positioned in 280 of 305 (91.8%) consecutive patients. With use of cerebral embolic protection rate of disabling and nondisabling stroke was significantly reduced from 4.6% to 1.4% (p = 0.03; odds ratio: 0.29, 95% confidence interval: 0.10 to 0.93) in the propensity-matched population (n = 560). The primary endpoint occurred significantly less frequently, with 2.1% (n = 6 of 280) in the protected group compared with 6.8% (n = 19 of 280) in the control group (p = 0.01; odds ratio: 0.30; 95% confidence interval: 0.12 to 0.77). In multivariable analysis Society of Thoracic Surgeons score for mortality (p = 0.02) and TAVR without protection (p = 0.02) were independent predictors for the primary endpoint. In patients undergoing TAVR use of a cerebral embolic protection device demonstrated a significant higher rate of stroke-free survival compared with unprotected TAVR. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

The effect of topical anesthetic hydration on the depth of thermal injury from the plasma skin regeneration device.

PubMed

Sanderson, Alicia R; Wu, Edward C; Liaw, Lih-Huei L; Garg, Rohit; Gangnes, Richard A

2014-02-01

The plasma skin regeneration (PSR) device delivers thermal energy to the skin by converting nitrogen gas to plasma. Prior to treatment, hydration of the skin is recommended as it is thought to limit the zone of thermal damage. However, there is limited data on optimal hydration time. This pilot study aims to determine the effect of topical anesthetic application time on the depth of thermal injury from a PSR device using histology. PSR (1.8 and 3.5 J) was performed after 0, 30, or 60 minutes of topical anesthetic application. Rhytidectomy was then performed and skin was fixed for histologic analysis. Four patients (two control and four treatment sites per patient) undergoing rhytidectomy were recruited for the study. Each patient served as his/her own control (no hydration). A scoring system for tissue injury was developed. Epidermal injury, the presence of vacuolization, blistering, damage to adnexal structures, and depth of dermal collagen changes were evaluated in over 1,400 high-power microscopy fields. There was a significant difference in the average thermal injury score, depth of thermal damage, and epidermal injury when comparing controls to 30 minutes of hydration (P = 0.012, 0.012, 0.017, respectively). There was no statistical difference between controls and 60 minutes of hydration or between 30 and 60 minutes of hydration. Epidermal vacuolization at low energy and patchy distribution of thermal injury was also observed. Topical hydration influences the amount of thermal damage when applied to skin for 30 minutes prior to treatment with the PSR device. There was a trend toward decreasing thermal damage at 60 minutes, and there was no difference between treatment for 30 or 60 minutes. The data suggest that application of topical anesthetic for a short period of time prior to treatment with the PSR device is cost-effective, safe, and may be clinically beneficial. © 2013 Wiley Periodicals, Inc.

Reliability over time of EEG-based mental workload evaluation during Air Traffic Management (ATM) tasks.

PubMed

Arico, Pietro; Borghini, Gianluca; Di Flumeri, Gianluca; Colosimo, Alfredo; Graziani, Ilenia; Imbert, Jean-Paul; Granger, Geraud; Benhacene, Railene; Terenzi, Michela; Pozzi, Simone; Babiloni, Fabio

2015-08-01

Machine-learning approaches for mental workload (MW) estimation by using the user brain activity went through a rapid expansion in the last decades. In fact, these techniques allow now to measure the MW with a high time resolution (e.g. few seconds). Despite such advancements, one of the outstanding problems of these techniques regards their ability to maintain a high reliability over time (e.g. high accuracy of classification even across consecutive days) without performing any recalibration procedure. Such characteristic will be highly desirable in real world applications, in which human operators could use such approach without undergo a daily training of the device. In this work, we reported that if a simple classifier is calibrated by using a low number of brain spectral features, between those ones strictly related to the MW (i.e. Frontal and Occipital Theta and Parietal Alpha rhythms), those features will make the classifier performance stable over time. In other words, the discrimination accuracy achieved by the classifier will not degrade significantly across different days (i.e. until one week). The methodology has been tested on twelve Air Traffic Controls (ATCOs) trainees while performing different Air Traffic Management (ATM) scenarios under three different difficulty levels.

Magnetic resonance imaging safety in pacemaker and implantable cardioverter defibrillator patients: how far have we come?

PubMed Central

Nordbeck, Peter; Ertl, Georg; Ritter, Oliver

2015-01-01

Magnetic resonance imaging (MRI) has long been regarded a general contraindication in patients with cardiovascular implanted electronic devices such as cardiac pacemakers or cardioverter defibrillators (ICDs) due to the risk of severe complications and even deaths caused by interactions of the magnetic resonance (MR) surrounding and the electric devices. Over the last decade, a better understanding of the underlying mechanisms responsible for such potentially life-threatening complications as well as technical advances have allowed an increasing number of pacemaker and ICD patients to safely undergo MRI. This review lists the key findings from basic research and clinical trials over the last 20 years, and discusses the impact on current day clinical practice. With ‘MR-conditional’ devices being the new standard of care, MRI in pacemaker and ICD patients has been adopted to clinical routine today. However, specific precautions and specifications of these devices should be carefully followed if possible, to avoid patient risks which might appear with new MR technology and further increasing indications and patient numbers. PMID:25796053

Predictive Factors for Patients Undergoing ASD Device Occlusion Who "Crossover" to Surgery.

PubMed

Mulukutla, Venkatachalam; Qureshi, Athar M; Pignatelli, Ricardo; Ing, Frank F

2018-03-01

The aim of this study was to define characteristics of those patients who are referred for device closure of an Atrial septal defect (ASD), but identified to "crossover" surgery. All patients who underwent surgical and device (Amplatzer or Helex occluder) closures of secundum ASDs from 2001 to 2010 were reviewed and organized into three groups: surgical closure, device closure, and "crossover" group. 369 patients underwent ASD closure (265 device, 104 surgical). 42 of the 265 patients referred for device closure "crossed over" to the surgical group at various stages of the catheterization procedure. The device group had defect size measuring 14.2 mm (mean) and an ASD index (Defect Size (mm)/BSA) of 14.0 compared to the corresponding values in the surgical group (20.1 mm, ASD index 25.9) (P < 0.001) and in the "crossover" group (20.7 mm, 22.6 ASD index) (P < 0.001). 79 patients in the device group had a deficient rim, and 86% were located in the retroaortic region. 33 patients in the "crossover" group had deficient rims with 70% deficiency in the posterior/inferior rim. The device group with deficient rims had an ASD index of 14.7 compared with the crossover group ASD index of 23.8 (P < 0.001). Comparing the device and "crossover" groups, an ASD index greater than 23.7 had a 90% specificity in "crossing over" to surgery. The crossover and surgical groups had statistically larger ASD defect size indexes compared with the device group. Deficient rim in the posterior/inferior rim is associated with a large ASD size index which is a predictive factor for crossing over to surgery. Catheterization did not negatively impact surgical results in the "crossover" group.

Placebo Devices as Effective Control Methods in Acupuncture Clinical Trials: A Systematic Review

PubMed Central

Zhang, Claire Shuiqing; Tan, Hsiewe Ying; Zhang, George Shengxi; Zhang, Anthony Lin; Xue, Charlie Changli; Xie, Yi Min

2015-01-01

While the use of acupuncture has been recognised by the World Health Organisation, its efficacy for many of the common clinical conditions is still undergoing validation through randomised controlled trials (RCTs). A credible placebo control for such RCTs to enable meaningful evaluation of its efficacy is to be established. While several non-penetrating acupuncture placebo devices, namely the Streitberger, the Park and the Takakura Devices, have been developed and used in RCTs, their suitability as inert placebo controls needs to be rigorously determined. This article systematically reviews these devices as placebo interventions. Electronic searches were conducted on four English and two Chinese databases from their inceptions to July 2014; hand searches of relevant references were also conducted. RCTs, in English or Chinese language, comparing acupuncture with one of the aforementioned devices as the control intervention on human participants with any clinical condition and evaluating clinically related outcomes were included. Thirty-six studies were included for qualitative analysis while 14 were in the meta-analysis. The meta-analysis does not support the notion of either the Streitberger or the Park Device being inert control interventions while none of the studies involving the Takakura Device was included in the meta-analysis. Sixteen studies reported the occurrence of adverse events, with no significant difference between verum and placebo acupuncture. Author-reported blinding credibility showed that participant blinding was successful in most cases; however, when blinding index was calculated, only one study, which utilised the Park Device, seemed to have an ideal blinding scenario. Although the blinding index could not be calculated for the Takakura Device, it was the only device reported to enable practitioner blinding. There are limitations with each of the placebo devices and more rigorous studies are needed to further evaluate their effects and blinding credibility. PMID:26536619

Controlling the Electronic Properties in La1/3Sr 2/3FeO3-delta Complex Perovskite Oxides

NASA Astrophysics Data System (ADS)

Krick, Alex L.

For nearly 5 decades, the global semiconductor industry has followed Moore's law, which employs the iterative concept of transistor scaling in silicon-based technology. Though this approach has been massively successful at maintaining consistent increases in computational speed and power, silicon technology is quickly approaching its physical limitations with respect to continued scaling. In recent years, a growing effort has been adopted to pursue new materials and technologies as alternative platforms for information processing. Complex oxides are a potential candidate material system for next generation electronic devices due to their rich material properties such as metal-insulator transitions, high Tc superconductivity, and colossal magnetoresistance. In particular, there is growing interest to understand and control the unique electronic properties of complex oxides for applications in transistor-like devices. This dissertation is focused on understanding the growth, characterization and application of La1/3Sr2/3FeO3 (LSFO) thin films, which are known to undergo an abrupt charge ordering phase transition at 190 K in bulk materials. This phase transition is accompanied by an order of magnitude increase in resistivity going from a conductive to insulating state as well as the spontaneous ordering of charge and antiferromagnetic spin structure along the [111] direction. Isocompositional cation-ordered superlattices of LSFO were synthesized via oxygen-assisted molecular beam epitaxy and explored through synchrotron X-ray diffraction, electronic transport, and density functional theory modeling. By adjusting the cation ordering of LaFeO3 (LFO), an antiferromagnetic insulator, and SrFeO3 (SFO), a conductor with a helical magnetic ground state, three isocompositional systems of LSFO were investigated. The superlattices were found to exhibit a charge ordering phase transition similar to LSFO for two of the three structures, as measured by an abrupt discontinuity in the temperature-dependent resistivity. Carrier behavior within the superlattices was also explored by fitting the temperature dependent resistivity to common conduction models. The conduction mechanism fits show that the transport at high temperatures is dominated by weakly insulating behavior due to small polaron conduction and at low temperatures the resistivity can be fit to both a novel power law and 3-dimensional variable range hopping. Additionally, reversible changes of the structural and electronic transport properties of La1/3Sr2/3FeO3-delta/Gd-doped CeO2 (GDC) heterostructures arising from the manipulation of delta are presented. Thermally induced oxygen loss leads to a c-axis lattice expansion and an increase in resistivity in an LSFO film capped with GDC. In a three-terminal device where a gate bias is applied across the GDC layer to alter the LSFO oxygen stoichiometry, the ferrite channel is shown to undergo an order of magnitude change in resistance using gate voltages of less than 1 V applied at 500 K. The changes in resistance remain upon cooling to room temperature, in the absence of a gate bias, suggesting solid state ionic gating of perovskite oxides as a promising platform for applications in non-volatile, multistate devices. Along with the experiments of controlling delta in a device format, the kinetics of oxygen loss as a function of biaxial strain was investigated.

Evaluation of the perceptions and cosmetic satisfaction of breast cancer patients undergoing totally implantable vascular access device (TIVAD) placement.

PubMed

Liberale, Gabriel; El Houkayem, Michel; Viste, Claire; Bouazza, Fikri; Moreau, Michel; El Nakadi, Issam; Veys, Isabelle

2016-12-01

Totally implantable vascular access devices (TIVADs) are widely used to administer chemotherapy to cancer patients. While great progress has been made with respect to breast surgical reconstruction to take into account both aesthetics and patients' perceptions of body integrity, these aspects have not been considered with regard to the impact of TIVAD. In order to address this practice gap, we have adapted our TIVAD implantation technique to improve cosmetic results. The aim of this study was to assess breast cancer patients' comfort level and aesthetic satisfaction with regard to TIVAD insertion. Patients with breast cancer admitted for chemotherapy at an outpatient clinic completed a previously validated survey evaluating three main domains: symptoms (pain, discomfort) related to the TIVAD itself in daily activity, information received before and during the surgical procedure, and cosmetic aspects regarding the port insertion site (scar, port, and catheter location). Between September 2010 and June 2011, 232 patients were evaluated. Cosmetic satisfaction with scar location was high (93.3 %). Information given to patients before and during the procedure had a major impact on both symptom perception in daily activity and on cosmetic satisfaction. Obtaining a more aesthetic scar by placing the TIVAD in the deltopectoral groove contributed to a high rate of cosmetic satisfaction. Furthermore, the relevance of information given to patients before and/or during surgery had a major impact on symptom perception. Therefore, we suggest including a pre-operative information session in the care pathway.

The Effect of Preoperative Cognitive Behavior and Exercise Therapy for a Patient With an Implanted Left Ventricular Assist Device in Korea.

PubMed

Seo, Yong Gon; Park, Won Hah; Jeon, Eun Seok; Sung, Ji Dong; Jang, Mi Ja

2017-10-01

Left ventricular assist devices (LVADs) are used in patients with progressive heart failure symptoms to provide circulatory support. Patients with LVADs are referred to inpatient cardiac rehabilitation to prevent postoperative complications and improve aerobic capacity and quality of life. Preoperative exercise therapy for cardiac patients is an emerging treatment modality, and several studies have reported that it improves postoperative outcomes, such as length of hospital stay and postoperative complications. This case report describes the benefits of preoperative cognitive behavioral and exercise therapy in a Korean patient undergoing LVAD implantation. V. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Urodynamic catheter moisture sensor: A novel device to improve leak point pressure detection.

PubMed

Marshall, Blake R; Arlen, Angela M; Kirsch, Andrew J

2016-06-01

High-quality urodynamic studies in patients with neurogenic lower urinary tract dysfunction are important, as UDS may be the only reliable gauge of potential risk for upper tract deterioration and the optimal tool to guide lower urinary tract management. Reliance on direct visualization of leakage during typical UDS remains a potential source of error. Given the necessity of accurate leak point pressures, we developed a wireless leak detection sensor to eliminate the need for visual inspection during UDS. A mean decrease in detrusor leak point pressure of 3 cm/H2 0 and a mean 11% decrease in capacity at leakage was observed when employing the sensor compared to visual inspection in children undergoing two fillings during a single UDS session. Removing the visual inspection component of UDS may improve accuracy of pressure readings. Neurourol. Urodynam. 35:647-648, 2016. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

Magnetic assembly of transparent and conducting graphene-based functional composites

NASA Astrophysics Data System (ADS)

Le Ferrand, Hortense; Bolisetty, Sreenath; Demirörs, Ahmet F.; Libanori, Rafael; Studart, André R.; Mezzenga, Raffaele

2016-06-01

Innovative methods producing transparent and flexible electrodes are highly sought in modern optoelectronic applications to replace metal oxides, but available solutions suffer from drawbacks such as brittleness, unaffordability and inadequate processability. Here we propose a general, simple strategy to produce hierarchical composites of functionalized graphene in polymeric matrices, exhibiting transparency and electron conductivity. These are obtained through protein-assisted functionalization of graphene with magnetic nanoparticles, followed by magnetic-directed assembly of the graphene within polymeric matrices undergoing sol-gel transitions. By applying rotating magnetic fields or magnetic moulds, both graphene orientation and distribution can be controlled within the composite. Importantly, by using magnetic virtual moulds of predefined meshes, graphene assembly is directed into double-percolating networks, reducing the percolation threshold and enabling combined optical transparency and electrical conductivity not accessible in single-network materials. The resulting composites open new possibilities on the quest of transparent electrodes for photovoltaics, organic light-emitting diodes and stretchable optoelectronic devices.

Ultrasound-Induced Organogel Formation Followed by Thin Film Fabrication via Simple Doctor Blading Technique for Field-Effect Transistor Applications.

PubMed

Xu, Jiaju; Wang, Yulong; Shan, Haiquan; Lin, Yiwei; Chen, Qian; Roy, V A L; Xu, Zongxiang

2016-07-27

We demonstrate doctor blading technique to fabricate high performance transistors made up of printed small molecular materials. In this regard, we synthesize a new soluble phthalocyanine, tetra-n-butyl peripheral substituted copper(II) phthalocaynine (CuBuPc), that can easily undergo gel formation upon ultrasonic irradiation, leading to the formation of three-dimensional (3D) network composed of one-dimensional (1D) nanofibers structure. Finally, taking the advantage of thixotropic nature of the CuBuPc organogel, we use the doctor blade processing technique that limits the material wastage for the fabrication of transistor devices. Due to the ultrasound induced stronger π-π interaction, the transistor fabricated by doctor blading based on CuBuPc organogel exhibits significant increase in charge carrier mobility in comparison with other solution process techniques, thus paving a way for a simple and economically viable preparation of electronic circuits.

Complex permittivity measurements during high temperature recycling of space shuttle antenna window and dielectric heat shield materials

NASA Technical Reports Server (NTRS)

Bassett, H. L.; Bomar, S. H., Jr.

1973-01-01

The research performed and the data obtained on candidate space shuttle antenna window and heat shield materials are presented. The measurement technique employs a free-space focused beam microwave bridge for obtaining RF transmission data, and a device which rotates a sample holder which is heated on one side by natural gas-air flames. The surface temperature of each sample is monitored by IR pyrometry; embedded and rear surface thermocouples are also used in obtaining temperature data. The surface of the sample undergoing test is subjected to approximately the same temperature/time profile that occurs at a proposed antenna position on the space shuttle as it re-enters. The samples are cycled through ten of these temperature profiles to determine the recycling effects. Very little change was noted in the materials due to the recycling.

Noninvasive imaging systems for gametes and embryo selection in IVF programs: a review.

PubMed

Omidi, Marjan; Faramarzi, Azita; Agharahimi, Azam; Khalili, Mohammad Ali

2017-09-01

Optimizing the efficiency of the in vitro fertilization procedure by improving pregnancy rates and reducing the risks of multiple pregnancies simultaneously are the primary goals of the current assisted reproductive technology program. With the move to single embryo transfers, the need for more cost-effective and noninvasive methods for embryo selection prior to transfer is paramount. These aims require advancement in a more acquire gametes/embryo testing and selection procedures using high-tech devices. Therefore, the aim of the present review is to evaluate the efficacy of noninvasive imaging systems in the current literatures, focusing on the potential clinical application in infertile patients undergoing assisted reproductive technology treatments. In this regards, three advanced imaging systems of motile sperm organelle morphology examination, polarization microscopy and time-lapse monitoring for the best selection of the gametes and preimplantation embryos are introduced in full. © 2017 The Authors Journal of Microscopy © 2017 Royal Microscopical Society.

Preparation of redox polymer cathodes for thin film rechargeable batteries

DOEpatents

Skotheim, T.A.; Lee, H.S.; Okamoto, Yoshiyuki.

1994-11-08

The present invention relates to the manufacture of thin film solid state electrochemical devices using composite cathodes comprising a redox polymer capable of undergoing oxidation and reduction, a polymer solid electrolyte and conducting carbon. The polymeric cathode material is formed as a composite of radiation crosslinked polymer electrolytes and radiation crosslinked redox polymers based on polysiloxane backbones with attached organosulfur side groups capable of forming sulfur-sulfur bonds during electrochemical oxidation.

Copy Hiding Application Interface

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jones, Holger; Poliakoff, David; Robinson, Peter

2016-10-06

CHAI is a light-weight framework which abstracts the automated movement of data (e.g. to/from Host/Device) via RAJA like performance portability programming model constructs. It can be viewed as a utility framework and an adjunct to FAJA (A Performance Portability Framework). Performance Portability is a technique that abstracts the complexities of modern Heterogeneous Architectures while allowing the original program to undergo incremental minimally invasive code changes in order to adapt to the newer architectures.

Research Investigation Directed Toward Extending the Useful Range of the Electromagnetic Spectrum.

DTIC Science & Technology

1981-03-31

tunneling devices are predicted to undergo a transition from energy detectors to photon counters at frequencies where the photon energy becomes...Ed. (Springer-Verlag, Berlin/Heidelberg, 1977), vol. 19, Optical and Infrared Detectors , ch. 7, pp. 229-300. (16) M. C. Teich, Opt. Engineering 17...InSb, AuGe or a HgCdTe infrared detector . These detectors only viewed the emission through the appropriate infrared filters. The output from the

Can cemented dual-mobility cups be used without a reinforcement device in cases of mild acetabular bone stock alteration in total hip arthroplasty?

PubMed

Haen, T X; Lonjon, G; Vandenbussche, E

2015-12-01

Cemented versions of dual-mobility cups (DMCs), helpful in cases of bone stock alteration, are usually used in association with a reinforcement device. To simplify the intervention in elderly subjects or those with a poor bone stock, the cups can be cemented directly into the bone, but the long-term result remains uncertain. We conducted a retrospective study in this population so as to: (1) assess whether cemented fixation of a DMC without a reinforcement device leads to a higher loosening rate, (2) confirm its efficacy in preventing dislocations in subjects at high risk of instability, and (3) measure the functional results. Cemented fixation of a DMC is reliable in cases of moderate alteration of bone stock. Sixty-four patients (66 hips) undergoing implantation of a cemented DMC (Saturne™) without a reinforcement device were included in this single-center retrospective study. Their mean age was 79.8 years (range, 40-95 years). The indications varied: hip osteoarthritis (30.3%), prosthesis revision (44.0%), and trauma (25.8%). The patients were evaluated radiologically and clinically at follow-up. The main evaluation criterion was the revision rate for aseptic loosening. Dislocations, the infection rate, and the Postel Merle d'Aubigné (PMA) score were noted. At the mean follow-up of 4.2 years, three (4.6%) patients had been lost to follow-up and 22 (33.3%) had died. There was one case of aseptic loosening (1.5%). Cup survival was 98% at 5 years (95%CI [94-100]). There were no dislocations. There was one revision for infection. The mean PMA score was 15.5 (range, 9-18). The frequency of acetabular loosening was comparable to the frequency in cemented DMCs with a reinforcement device. A cemented DMC without a reinforcement device is possible and is a simple and viable option when there is moderate bone stock alteration. IV, retrospective cohort study. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Bipolar radiofrequency in the treatment of dermatologic imperfections: clinicopathological and immunohistochemical aspects.

PubMed

Montesi, Gianni; Calvieri, Stefano; Balzani, Alberto; Gold, Michael H

2007-09-01

Rapid progress in the technology for skin rejuvenation has allowed for shorter post-treatment times than ever before. An example of such technology is the radiofrequency (RF) device, which offers nonablative skin rejuvenation, particularly for skin tightening and wrinkle reduction. Medical devices that emit RF energy produce a change in the electrical charges of the treated skin creating an electron movement, and the resistance of the tissue to the electron movement generates heat. This article examines the mechanism of action of a new bipolar RF device, which emits RF energy through a handpiece with a bipolar electrode configuration, and assesses the clinical histological and immunohistochemical results on a sample group of patients who underwent a cycle of sessions with this device. Thirty patients affected with periocular wrinkles, glabellar wrinkles, slackness of the cheeks with accentuation of the nasogenian furrow, striae distensae at the scapulohumeral joint, abdomen, and gluteal-trochanteric areas, or acne scars were included. These patients underwent a cycle of 6 to 8 sessions with 2-week intervals with the new bipolar RF device undergoing photographic monitoring before treatment and at the end of the cycle of sessions. In addition, 15 patients from the sample group were subjected to 2 biopsies, one at the start of treatment and the other 3 months after the last treatment. All the patients showed improvement in treated imperfections from the second session onward, and they expressed their satisfaction at the end of the treatment cycle. The most notable clinical, histological, and immunohistochemical results were observed in the patients with abdominal striae distensae. In most cases, the temporary side effects observed consisted of rashes and ecchymosis. Two patients reported the formation of blisters on the treated area caused by excessively high RF settings. The new bipolar RF device proved to be effective, noninvasive, and easy to use. The improvement in the treated areas is progressive and continues to be apparent several months after the last session. The duration of the results achieved still remains to be accurately determined.

Surgical site infections following craniotomy focusing on possible post-operative acquisition of infection: prospective cohort study.

PubMed

Sneh-Arbib, O; Shiferstein, A; Dagan, N; Fein, S; Telem, L; Muchtar, E; Eliakim-Raz, N; Rubinovitch, B; Rubin, G; Rappaport, Z H; Paul, M

2013-12-01

Neurosurgery is characterized by a prolonged risk period for surgical site infection (SSI), mainly related to the presence of cerebrospinal fluid (CSF) drains. We aimed to examine factors associated with post-neurosurgical SSIs, focusing on post-operative factors. A prospective cohort study was conducted in a single center over a period of 18 months in Israel. Included were adult patients undergoing clean or clean-contaminated craniotomy, including craniotomies with external CSF drainage or shunts. SSIs were defined by the Centers for Disease Control and Prevention (CDC) criteria for healthcare-associated infections. All patients were followed up for 90 days and those with foreign body insertion for 1 year. We compared patients with and without SSI. A multivariable regression analysis for SSI was conducted including uncorrelated variables significantly associated with SSI. A total of 502 patients were included, with 138 (27.5%) undergoing emergent or urgent craniotomy. The overall SSI rate was 5.6% (28 patients), of which 3.2% (16 patients) were intracerebral. Non-elective surgery, external CSF drainage/monitoring devices, re-operation, and post-operative respiratory failure were independently associated with subsequent SSI. External CSF devices was the only significant risk factor for intracerebral SSIs (p < 0.001). Internal shunts or other foreign body insertions were not associated with SSIs. A phenotypically identical isolate to that causing the SSI was isolated from respiratory secretions prior to the SSI in 4/9 patients with microbiologically documented intracerebral SSIs. Patients with SSIs had longer hospital stay, poorer functional capacity on discharge, and higher 90-day mortality. We raise the possibility of post-operative infection acquisition through external CSF devices. Standard operating procedures for their maintenance are necessary.

Prevalence, correlates, and impact of coronary calcification on adverse events following PCI with newer-generation DES: Findings from a large multiethnic registry.

PubMed

Copeland-Halperin, Robert S; Baber, Usman; Aquino, Melissa; Rajamanickam, Anitha; Roy, Swathi; Hasan, Choudhury; Barman, Nitin; Kovacic, Jason C; Moreno, Pedro; Krishnan, Prakash; Sweeny, Joseph M; Mehran, Roxana; Dangas, George; Kini, Annapoorna S; Sharma, Samin K

2018-04-01

We sought to determine the prevalence, predictors, and clinical impact of target lesion calcification in patients undergoing percutaneous coronary intervention (PCI) with newer generation drug-eluting stents (DES) and devices. Coronary calcification is independently associated with adverse outcomes following PCI. While newer DES and contemporary devices are considered safer and more efficacious, their influence on outcomes following PCI of heavily calcified lesions is unknown. We performed a retrospective analysis of a large, multiethnic cohort of patients undergoing PCI with new generation DES at an academic center between 2009 and 2013. Coronary calcification was qualitatively assessed as none/mild, moderate, or severe. Independent demographic, clinical, and anatomic predictors of moderate/severe calcification were identified using logistic regression. Associations between coronary calcification and 1-year MACE (death, myocardial infarction, or target vessel revascularization) were examined using Cox modeling. Compared to patients with none/mild (n = 10,180; 82.0%), those with moderate (n = 1,271; 10.0%) or severe (n = 994; 8.0%) calcification were older, more often Caucasian, had more complex target lesions, and worse renal function. The strongest demographic, clinical, and anatomic correlates of moderate/severe calcification were age, Caucasian race, renal dysfunction, lesion length, and left main location. Unadjusted MACE rates among those with none/mild, moderate, and severe calcification were 8.3, 14.6, and 17.8%, respectively (P < 0.001). After multivariable adjustment, the hazard ratio (95% CI) for MACE associated with moderate or severe coronary calcification was 1.63. Target lesion calcification remains independently associated with adverse outcomes in patients treated with newer generation DES and modern devices. © 2017 Wiley Periodicals, Inc.

Cryoablation during left ventricular assist device implantation reduces postoperative ventricular tachyarrhythmias.

PubMed

Mulloy, Daniel P; Bhamidipati, Castigliano M; Stone, Matthew L; Ailawadi, Gorav; Bergin, James D; Mahapatra, Srijoy; Kern, John A

2013-05-01

The number of patients undergoing implantation of a HeartMate II left ventricular assist device (LVAD; Thoratec Corporation, Pleasanton, Calif) is rising. Ventricular tachyarrhythmia (VA) after placement of the device is common, especially among patients with preoperative VA. We sought to determine whether intraoperative cryoablation in select patients reduces the incidence of postoperative VA. From January 2009 through September 2010, 50 consecutive patients undergoing implantation of the HeartMate II LVAD were examined. Fourteen of these patients had recurrent preoperative VA. Of those patients with recurrent VA, half underwent intraoperative cryoablation (Cryo: n = 7) and half did not (NoCryo: n = 7). Intraoperatively, patients underwent localized epicardial and endocardial cryoablation via LVAD ventriculotomy. Cryothermal lesions were created to connect scar to fixed anatomic borders in the region of clinical VA. Demographics, risk factors, intraoperative features, and outcomes were analyzed to investigate the feasibility of cryoablation. Thirty-day mortality remained low (n = 1, 2%) among all LVAD recipients. There were no differences in risk factors between groups except that preoperative inotropes were less prevalent in Cryo patients (P = .09). Compared with NoCryo, the Cryo group had significantly decreased postoperative resource use and complications (P < .05). Recurrent postoperative VA did not develop in any of the Cryo patients (P = .02). Postoperative VA can be minimized by preoperative risk assessment and intraoperative treatment. Localized cryoablation in select patients offers promising early feasibility when performed during HeartMate II LVAD implantation. Further prospective analysis is required to investigate this novel approach. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Innovative postmarket device evaluation using a quality registry to monitor thoracic endovascular aortic repair in the treatment of aortic dissection.

PubMed

Beck, Adam W; Lombardi, Joseph V; Abel, Dorothy B; Morales, J Pablo; Marinac-Dabic, Danica; Wang, Grace; Azizzadeh, Ali; Kern, John; Fillinger, Mark; White, Rodney; Cronenwett, Jack L; Cambria, Richard P

2017-05-01

United States Food and Drug Administration (FDA)-mandated postapproval studies have long been a mainstay of the continued evaluation of high-risk medical devices after initial marketing approval; however, these studies often present challenges related to patient/physician recruitment and retention. Retrospective single-center studies also do not fully represent the spectrum of real-world performance nor are they likely to have a sufficiently large enough sample size to detect important signals. In recent years, The FDA Center for Devices and Radiological Health has been promoting the development and use of patient registries to advance infrastructure and methodologies for medical device investigation. The FDA 2012 document, "Strengthening the National System for Medical Device Post-market Surveillance," highlighted registries as a core foundational infrastructure when linked to other complementary data sources, including embedded unique device identification. The Vascular Quality Initiative (VQI) thoracic endovascular aortic repair for type B aortic dissection project is an innovative method of using quality improvement registries to meet the needs of device evaluation after market approval. Here we report the organization and background of this project and highlight the innovation facilitated by collaboration of physicians, the FDA, and device manufacturers. This effort used an existing national network of VQI participants to capture patients undergoing thoracic endovascular aortic repair for acute type B aortic dissection within a registry that aligns with standard practice and existing quality efforts. The VQI captures detailed patient, device, and procedural data for consecutive eligible cases under the auspices of a Patient Safety Organization (PSO). Patients were divided into a 5-year follow-up group (200 acute; 200 chronic dissections) and a 1-year follow-up group (100 acute; 100 chronic). The 5-year cohort required additional imaging details, and the 1-year group required standard VQI registry data entry. The sample size of patients in each of the 5-year acute and chronic dissection arms was achieved ≤24 months of project initiation, and data capture for the 1-year follow-up group is also nearly complete. Data completeness and follow-up has been excellent, and the two FDA-approved devices for dissection are equally represented. Although the completeness of long-term follow-up is yet to be determined, the rapidity of data collection supports the use of this construct for device assessment after market approval. The alignment of this effort with routine clinical practice and ongoing quality improvement initiatives is critical and has required minimal additional effort by practitioners, thus facilitating patient inclusion. Importantly, the success and development of this unique project has helped inform FDA strategy for future device evaluation after market approval. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

CLINICAL EVALUATION OF THE RAPID ACCESS VITREAL INJECTION GUIDE: A Handheld Instrument for Assisting Intravitreal Injections.

PubMed

Han, Dennis P; McKenney, Kaitlin C; Kim, Judy E; Weinberg, David V; Musch, David C; Singh, Ravi S J

2017-04-01

The Rapid Access Vitreal Injection (RAVI) guide combines the function of an eyelid speculum and measuring caliper into a single instrument for assisting intravitreal injections. This study clinically evaluated the RAVI guide with respect to patient acceptance, complication rates, and operative goals. A prospective study was performed on 54 patients undergoing intravitreal injections using the RAVI guide (n = 32) or the speculum/caliper (n = 22). Device-related pain was assessed using the Wong-Baker scoring system, scaled from 0 (no pain) to 10 (agonizing pain). Mean device-related pain score did not differ significantly between the 2 groups, with scores of 0.6 and 0.7 for the RAVI guide and speculum groups, respectively. The rate of significant pain (score of ≥2) was twice as high in the speculum group (7 of 22, 32%) compared with the RAVI guide group (5 of 32, 16%), but this difference was not statistically significant (P = 0.19, Fisher's exact test). Operative goals of avoiding needle touch to lashes/lids and guiding needle insertion to the intended site were achieved in all patients. The RAVI guide appeared equivalent to the eyelid speculum in achieving operative goals, with similarly low pain scores. It has the potential for facilitating efficient, accurate, and safe intravitreal injections.

Nonequilibrium Kondo effect by the equilibrium numerical renormalization group method: The hybrid Anderson model subject to a finite spin bias

NASA Astrophysics Data System (ADS)

Fang, Tie-Feng; Guo, Ai-Min; Sun, Qing-Feng

2018-06-01

We investigate Kondo correlations in a quantum dot with normal and superconducting electrodes, where a spin bias voltage is applied across the device and the local interaction U is either attractive or repulsive. When the spin current is blockaded in the large-gap regime, this nonequilibrium strongly correlated problem maps into an equilibrium model solvable by the numerical renormalization group method. The Kondo spectra with characteristic splitting due to the nonequilibrium spin accumulation are thus obtained at high precision. It is shown that while the bias-induced decoherence of the spin Kondo effect is partially compensated by the superconductivity, the charge Kondo effect is enhanced out of equilibrium and undergoes an additional splitting by the superconducting proximity effect, yielding four Kondo peaks in the local spectral density. In the charge Kondo regime, we find a universal scaling of charge conductance in this hybrid device under different spin biases. The universal conductance as a function of the coupling to the superconducting lead is peaked at and hence directly measures the Kondo temperature. Our results are of direct relevance to recent experiments realizing a negative-U charge Kondo effect in hybrid oxide quantum dots [Nat. Commun. 8, 395 (2017), 10.1038/s41467-017-00495-7].

Testing of visual field with virtual reality goggles in manual and visual grasp modes.

PubMed

Wroblewski, Dariusz; Francis, Brian A; Sadun, Alfredo; Vakili, Ghazal; Chopra, Vikas

2014-01-01

Automated perimetry is used for the assessment of visual function in a variety of ophthalmic and neurologic diseases. We report development and clinical testing of a compact, head-mounted, and eye-tracking perimeter (VirtualEye) that provides a more comfortable test environment than the standard instrumentation. VirtualEye performs the equivalent of a full threshold 24-2 visual field in two modes: (1) manual, with patient response registered with a mouse click, and (2) visual grasp, where the eye tracker senses change in gaze direction as evidence of target acquisition. 59 patients successfully completed the test in manual mode and 40 in visual grasp mode, with 59 undergoing the standard Humphrey field analyzer (HFA) testing. Large visual field defects were reliably detected by VirtualEye. Point-by-point comparison between the results obtained with the different modalities indicates: (1) minimal systematic differences between measurements taken in visual grasp and manual modes, (2) the average standard deviation of the difference distributions of about 5 dB, and (3) a systematic shift (of 4-6 dB) to lower sensitivities for VirtualEye device, observed mostly in high dB range. The usability survey suggested patients' acceptance of the head-mounted device. The study appears to validate the concepts of a head-mounted perimeter and the visual grasp mode.

A study of the transport and immobilisation mechanisms of human red blood cells in a paper-based blood typing device using confocal microscopy.

PubMed

Li, Lizi; Tian, Junfei; Ballerini, David; Li, Miaosi; Shen, Wei

2013-09-07

Recent research on the use of bioactive paper for human blood typing has led to the discovery of a new method for identifying the haemagglutination of red blood cells (RBCs). When a blood sample is introduced onto paper treated with the grouping antibodies, RBCs undergo haemagglutination with the corresponding grouping antibodies, forming agglutinated cell aggregates in the paper. A subsequent washing of the paper with saline buffer could not remove these aggregates from the paper; this phenomenon provides a new method for rapid, visual identification of the antibody-specific haemagglutination reactions and thus the determination of the blood type. This study aims to understand the mechanism of RBC immobilization inside the paper which follows haemagglutination reactions. Confocal microscopy is used to observe the morphology of the free and agglutinated RBCs that are labelled with FITC. Chromatographic elution patterns of both agglutinated and non-agglutinated RBCs are studied to gain insight into the transport behaviour of free RBCs and agglutinated aggregates. This work provides new information about RBC haemagglutination inside the fibre network of paper on a microscopic level, which is important for the future design of paper-based blood typing devices with high sensitivity and assaying speed.

A study on the flow characteristics of a direct drive turbine for energy conversion generation by experiment and CFD

NASA Astrophysics Data System (ADS)

Cho, Y. J.; Zullah, M. A.; Faizal, M.; Choi, Y. D.; Lee, Y. H.

2012-11-01

A variety of technologies has been proposed to capture the energy from waves. Some of the more promising designs are undergoing demonstration testing at commercial scales. Due to the complexity of most offshore wave energy devices and their motion response in different sea states, physical tank tests are common practice for WEC design. Full scale tests are also necessary, but are expensive and only considered once the design has been optimized. Computational Fluid Dynamics (CFD) is now recognized as an important complement to traditional physical testing techniques in offshore engineering. Once properly calibrated and validated to the problem, CFD offers a high density of test data and results in a reasonable timescale to assist with design changes and improvements to the device. The purpose of this study is to investigate the performance of a newly developed direct drive hydro turbine (DDT), which will be built in a caisson for extraction of wave energy. Experiments and CFD analysis are conducted to clarify the turbine performance and internal flow characteristics. The results show that commercial CFD code can be applied successfully to the simulation of the wave motion in the water tank. The performance of the turbine for wave energy converter is studied continuously for a ongoing project.

Bending impact on the performance of a flexible Li4Ti5O12-based all-solid-state thin-film battery.

PubMed

Sepúlveda, Alfonso; Speulmanns, Jan; Vereecken, Philippe M

2018-01-01

The growing demand of flexible electronic devices is increasing the requirements of their power sources. The effect of bending in thin-film batteries is still not well understood. Here, we successfully developed a high active area flexible all-solid-state battery as a model system that consists of thin-film layers of Li 4 Ti 5 O 12 , LiPON, and Lithium deposited on a novel flexible ceramic substrate. A systematic study on the bending state and performance of the battery is presented. The battery withstands bending radii of at least 14 mm achieving 70% of the theoretical capacity. Here, we reveal that convex bending has a positive effect on battery capacity showing an average increase of 5.5%, whereas concave bending decreases the capacity by 4% in contrast with recent studies. We show that the change in capacity upon bending may well be associated to the Li-ion diffusion kinetic change through the electrode when different external forces are applied. Finally, an encapsulation scheme is presented allowing sufficient bending of the device and operation for at least 500 cycles in air. The results are meant to improve the understanding of the phenomena present in thin-film batteries while undergoing bending rather than showing improvements in battery performance and lifetime.

Comparison of the Roche Cobas(®) 4800 HPV assay to Digene Hybrid Capture 2, Roche Linear Array and Roche Amplicor for Detection of High-Risk Human Papillomavirus Genotypes in Women undergoing treatment for cervical dysplasia.

PubMed

Phillips, Samuel; Garland, Suzanne M; Tan, Jeffery H; Quinn, Michael A; Tabrizi, Sepehr N

2015-01-01

The recently FDA (U.S. food and drug administration) approved Roche Cobas(®) 4800 (Cobas) human papillomavirus (HPV) has limited performance data compared to current HPV detection methods for test of cure in women undergoing treatment for high grade lesions. Evaluation of Cobas HPV assay using historical samples from women undergoing treatment for cervical dysplasia. A selection of 407 samples was tested on the Cobas assay and compared to previous results from Hybrid Capture 2, HPV Amplicor and Roche Linear Array. Overall, a correlation between high-risk HPV positivity and high grade histological diagnosis was 90.6% by the Cobas, 86.1% by Hybrid Capture 2, 92.9% by HPV Amplicor and 91.8% by Roche Linear Array. The Cobas HPV assay is comparative to both the HPV Amplicor and Roche Linear Array assays and better than Hybrid capture 2 assay in the detection of High-Risk HPV in women undergoing treatment for cervical dysplasia. Copyright © 2014 Elsevier B.V. All rights reserved.

Experimental and numerical studies of a microfluidic device with compliant chambers for flow stabilization

NASA Astrophysics Data System (ADS)

Iyer, V.; Raj, A.; Annabattula, R. K.; Sen, A. K.

2015-07-01

This paper reports experimental and numerical studies of a passive microfluidic device that stabilizes a pulsating incoming flow and delivers a steady flow at the outlet. The device employs a series of chambers along the flow direction with a thin polymeric membrane (of thickness 75-250 µm) serving as the compliant boundary. The deformation of the membrane allows accumulation of fluid during an overflow and discharge of fluid during an underflow for flow stabilization. Coupled fluid-structure simulations are performed using Mooney-Rivlin formulations to account for a thin hyperelastic membrane material undergoing large deformations to accurately predict the device performance. The device was fabricated with PDMS as the substrate material and thin PDMS membrane as the compliant boundary. The performance of the device is defined in terms of a parameter called ‘Attenuation Factor (AF)’. The effect of various design parameters including membrane thickness, elastic modulus, chamber size and number of chambers in series as well as operating conditions including the outlet pressure, mean input flow rate, fluctuation amplitude and frequency on the device performance were studied using experiments and simulations. The simulation results successfully confront the experimental data (within 10%) which validates the numerical simulations. The device was used at the exit of a PZT actuated valveless micropump to take pulsating flow at the upstream and deliver steady flow downstream. The amplitude of the pulsating flow delivered by the micropump was significantly reduced (AF = 0.05 for a device with three 4 mm chambers) but at the expense of a reduction in the pressure capability (<20%). The proposed device could potentially be used for reducing flow pulsations in practical microfluidic circuits.

Risk factors and outcomes of in-hospital cardiac arrest following pediatric heart operations of varying complexity.

PubMed

Gupta, Punkaj; Rettiganti, Mallikarjuna; Jeffries, Howard E; Scanlon, Matthew C; Ghanayem, Nancy S; Daufeldt, Jennifer; Rice, Tom B; Wetzel, Randall C

2016-08-01

Multi center data regarding cardiac arrest in children undergoing heart operations of varying complexity are limited. Children <18 years undergoing heart surgery (with or without cardiopulmonary bypass) in the Virtual Pediatric Systems (VPS, LLC) Database (2009-2014) were included. Multivariable mixed logistic regression models were adjusted for patient's characteristics, surgical risk category (STS-EACTS Categories 1, 2, and 3 classified as "low" complexity and Categories 4 and 5 classified as "high" complexity), and hospital characteristics. Overall, 26,909 patients (62 centers) were included. Of these, 2.7% had cardiac arrest after cardiac surgery with an associated mortality of 31%. The prevalence of cardiac arrest was lower among patients undergoing low complexity operations (low complexity vs. high complexity: 1.7% vs. 5.9%). Unadjusted outcomes after cardiac arrest were significantly better among patients undergoing low complexity operations (mortality: 21.6% vs. 39.1%, good neurological outcomes: 78.7% vs. 71.6%). In adjusted models, odds of cardiac arrest were significantly lower among patients undergoing low complexity operations (OR: 0.55, 95% CI: 0.46-0.66). Adjusted models, however, showed no difference in mortality or neurological outcomes after cardiac arrest regardless of surgical complexity. Further, our results suggest that incidence of cardiac arrest and mortality after cardiac arrest are a function of patient characteristics, surgical risk category, and hospital characteristics. Presence of around the clock in-house attending level pediatric intensivist coverage was associated with lower incidence of post-operative cardiac arrest, and presence of a dedicated cardiac ICU was associated with lower mortality after cardiac arrest. This study suggests that the patients undergoing high complexity operations are a higher risk group with increased prevalence of post-operative cardiac arrest. These data further suggest that patients undergoing high complexity operations can be rescued after cardiac arrest with a high survival rate. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Technical advances of interventional fluoroscopy and flat panel image receptor.

PubMed

Lin, Pei-Jan Paul

2008-11-01

In the past decade, various radiation reducing devices and control circuits have been implemented on fluoroscopic imaging equipment. Because of the potential for lengthy fluoroscopic procedures in interventional cardiovascular angiography, these devices and control circuits have been developed for the cardiac catheterization laboratories and interventional angiography suites. Additionally, fluoroscopic systems equipped with image intensifiers have benefited from technological advances in x-ray tube, x-ray generator, and spectral shaping filter technologies. The high heat capacity x-ray tube, the medium frequency inverter generator with high performance switching capability, and the patient dose reduction spectral shaping filter had already been implemented on the image intensified fluoroscopy systems. These three underlying technologies together with the automatic dose rate and image quality (ADRIQ) control logic allow patients undergoing cardiovascular angiography procedures to benefit from "lower patient dose" with "high image quality." While photoconductor (or phosphor plate) x-ray detectors and signal capture thin film transistor (TFT) and charge coupled device (CCD) arrays are analog in nature, the advent of the flat panel image receptor allowed for fluoroscopy procedures to become more streamlined. With the analog-to-digital converter built into the data lines, the flat panel image receptor appears to become a digital device. While the transition from image intensified fluoroscopy systems to flat panel image receptor fluoroscopy systems is part of the on-going "digitization of imaging," the value of a flat panel image receptor may have to be evaluated with respect to patient dose, image quality, and clinical application capabilities. The advantage of flat panel image receptors has yet to be fully explored. For instance, the flat panel image receptor has its disadvantages as compared to the image intensifiers; the cost of the equipment is probably the most obvious. On the other hand, due to its wide dynamic range and linearity, lowering of patient dose beyond current practice could be achieved through the calibration process of the flat panel input dose rate being set to, for example, one half or less of current values. In this article various radiation saving devices and control circuits are briefly described. This includes various types of fluoroscopic systems designed to strive for reduction of patient exposure with the application of spectral shaping filters. The main thrust is to understand the ADRIQ control logic, through equipment testing, as it relates to clinical applications, and to show how this ADRIQ control logic "ties" those three technological advancements together to provide low radiation dose to the patient with high quality fluoroscopic images. Finally, rotational angiography with computed tomography (CT) and three dimensional (3-D) images utilizing flat panel technology will be reviewed as they pertain to diagnostic imaging in cardiovascular disease.

Quantifying opportunities for hospital cost control: medical device purchasing and patient discharge planning.

PubMed

Robinson, James C; Brown, Timothy T

2014-09-01

To quantify the potential reduction in hospital costs from adoption of best local practices in supply chain management and discharge planning. We performed multivariate statistical analyses of the association between total variable cost per procedure and medical device price and length of stay, controlling for patient and hospital characteristics. Ten hospitals in 1 major metropolitan area supplied patient-level administrative data on 9778 patients undergoing joint replacement, spine fusion, or cardiac rhythm management (CRM) procedures in 2008 and 2010. The impact on each hospital of matching lowest local market device prices and lowest patient length of stay (LOS) was calculated using multivariate regression analysis controlling for patient demographics, diagnoses, comorbidities, and implications. Average variable costs ranged from $11,315 for joint replacement to $16,087 for CRM and $18,413 for spine fusion. Implantable medical devices accounted for a large share of each procedure's variable costs: 44% for joint replacement, 39% for spine fusion, and 59% for CRM. Device prices and patient length-of-stay exhibited wide variation across hospitals. Total potential hospital cost savings from achieving best local practices in device prices and patient length of stay are 14.5% for joint replacement, 18.8% for spine fusion;,and 29.1% for CRM. Hospitals have opportunities for cost reduction from adoption of best local practices in supply chain management and discharge planning.

Significance of coupling device for vessel anastomosis in esophageal reconstruction.

PubMed

Watanabe, Y; Horiuchi, A; Yamamoto, Y; Kikkawa, H; Kusunose, H; Sugishita, H; Sato, K; Yoshida, M; Yukumi, S; Kawachi, K

2005-01-01

To prevent an anastomotic failure due to impaired blood supply, several trials have been performed such as preoperative ischemic conditioning by transarterial embolization of the left gastric, right gastric and splenic arteries or microvascular anastomosis. We assess the significance of an automatic anastomotic coupling device for vessel anastomosis, which we have continuously utilized, to simplify the task and shorten the anastomotic time since March 1999. 8 patients who underwent venous anastomosis by an automatic anastomotic coupling device were evaluated for the time of anastomosis, total ischemic time and outcomes. Venous anastomosis was completed within 5 minutes on average. Microscopic arterial anastomosis by hand took 35 minutes on average. For gastric tube reconstruction, venous anastomosis by an automatic coupling device took only 5 minutes. The top of the gastric tube showed congestion before venous anastomosis, but rapidly recovered from it after anastomosis. Postoperative endoscopic observation of the mucosal color of the replaced intestine or gastric tube was started 3 days after surgery and revealed no ischemia or congestion. The postoperative course was uneventful except one case suffering from pneumonia but leakage was not observed in any case. An automatic anastomotic coupling device can perform an easy and reliable vascular anastomosis for patients who undergo esophageal reconstruction. The device may shorten the operating time and consequently the ischemic time of the gastric tube or jejunal or colonic graft, which in turn may lead to a decrease of complications.

A manual carotid compression technique to overcome difficult filter protection device retrieval during carotid artery stenting.

PubMed

Nii, Kouhei; Nakai, Kanji; Tsutsumi, Masanori; Aikawa, Hiroshi; Iko, Minoru; Sakamoto, Kimiya; Mitsutake, Takafumi; Eto, Ayumu; Hanada, Hayatsura; Kazekawa, Kiyoshi

2015-01-01

We investigated the incidence of embolic protection device retrieval difficulties at carotid artery stenting (CAS) with a closed-cell stent and demonstrated the usefulness of a manual carotid compression assist technique. Between July 2010 and October 2013, we performed 156 CAS procedures using self-expandable closed-cell stents. All procedures were performed with the aid of a filter design embolic protection device. We used FilterWire EZ in 118 procedures and SpiderFX in 38 procedures. The embolic protection device was usually retrieved by the accessory retrieval sheath after CAS. We applied a manual carotid compression technique when it was difficult to navigate the retrieval sheath through the deployed stent. We compared clinical outcomes in patients where simple retrieval was possible with patients where the manual carotid compression assisted technique was used for retrieval. Among the 156 CAS procedures, we encountered 12 (7.7%) where embolic protection device retrieval was hampered at the proximal stent terminus. Our manual carotid compression technique overcame this difficulty without eliciting neurologic events, artery dissection, or stent deformity. In patients undergoing closed-cell stent placement, embolic protection device retrieval difficulties may be encountered at the proximal stent terminus. Manual carotid compression assisted retrieval is an easy, readily available solution to overcome these difficulties. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Levosimendan in Patients with Left Ventricular Dysfunction Undergoing Cardiac Surgery.

PubMed

Mehta, Rajendra H; Leimberger, Jeffrey D; van Diepen, Sean; Meza, James; Wang, Alice; Jankowich, Rachael; Harrison, Robert W; Hay, Douglas; Fremes, Stephen; Duncan, Andra; Soltesz, Edward G; Luber, John; Park, Soon; Argenziano, Michael; Murphy, Edward; Marcel, Randy; Kalavrouziotis, Dimitri; Nagpal, Dave; Bozinovski, John; Toller, Wolfgang; Heringlake, Matthias; Goodman, Shaun G; Levy, Jerrold H; Harrington, Robert A; Anstrom, Kevin J; Alexander, John H

2017-05-25

Levosimendan is an inotropic agent that has been shown in small studies to prevent or treat the low cardiac output syndrome after cardiac surgery. In a multicenter, randomized, placebo-controlled, phase 3 trial, we evaluated the efficacy and safety of levosimendan in patients with a left ventricular ejection fraction of 35% or less who were undergoing cardiac surgery with the use of cardiopulmonary bypass. Patients were randomly assigned to receive either intravenous levosimendan (at a dose of 0.2 μg per kilogram of body weight per minute for 1 hour, followed by a dose of 0.1 μg per kilogram per minute for 23 hours) or placebo, with the infusion started before surgery. The two primary end points were a four-component composite of death through day 30, renal-replacement therapy through day 30, perioperative myocardial infarction through day 5, or use of a mechanical cardiac assist device through day 5; and a two-component composite of death through day 30 or use of a mechanical cardiac assist device through day 5. A total of 882 patients underwent randomization, 849 of whom received levosimendan or placebo and were included in the modified intention-to-treat population. The four-component primary end point occurred in 105 of 428 patients (24.5%) assigned to receive levosimendan and in 103 of 421 (24.5%) assigned to receive placebo (adjusted odds ratio, 1.00; 99% confidence interval [CI], 0.66 to 1.54; P=0.98). The two-component primary end point occurred in 56 patients (13.1%) assigned to receive levosimendan and in 48 (11.4%) assigned to receive placebo (adjusted odds ratio, 1.18; 96% CI, 0.76 to 1.82; P=0.45). The rate of adverse events did not differ significantly between the two groups. Prophylactic levosimendan did not result in a rate of the short-term composite end point of death, renal-replacement therapy, perioperative myocardial infarction, or use of a mechanical cardiac assist device that was lower than the rate with placebo among patients with a reduced left ventricular ejection fraction who were undergoing cardiac surgery with the use of cardiopulmonary bypass. (Funded by Tenax Therapeutics; LEVO-CTS ClinicalTrials.gov number, NCT02025621 .).

Configurational and constitutional information storage: multiple dynamics in systems based on pyridyl and acyl hydrazones.

PubMed

Chaur, Manuel N; Collado, Daniel; Lehn, Jean-Marie

2011-01-03

The C=N group of hydrazones can undergo E/Z isomerization both photochemically and thermally, allowing the generation of a closed process that can be tuned by either of these two physical stimuli. On the other hand, hydrazine-exchange reactions enable a constitutional change in a given hydrazone. The two classes of processes: 1) configurational (physically stimulated) and 2) constitutional (chemically stimulated) give access to short-term and long-term information storage, respectively. Such transformations are reported herein for two hydrazones (bis-pyridyl hydrazone and 2-pyridinecarboxaldehyde phenylhydrazone) that undergo a closed, chemically or physically driven process, and, in addition, can be locked or unlocked at will by metal-ion coordination or removal. These features also extend to acyl hydrazones derived from 2-pyridinecarboxaldehyde. Similarly to the terpydine-like hydrazones, such acyl hydrazones can undergo both constitutional and configurational changes, as well as metal-ion coordination. All these types of hydrazones represent dynamic systems capable of acting as multiple state molecular devices, in which the presence of coordination sites furthermore allows the metal ion-controlled locking and unlocking of the interconversion of the different states. Copyright © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Outcomes in variceal hemorrhage following the use of a balloon tamponade device.

PubMed

Nadler, Jonathan; Stankovic, Nikola; Uber, Amy; Holmberg, Mathias J; Sanchez, Leon D; Wolfe, Richard E; Chase, Maureen; Donnino, Michael W; Cocchi, Michael N

2017-10-01

Variceal hemorrhage is associated with high morbidity and mortality. A balloon tamponade device (BTD), such as the Sengstaken-Blakemore or Minnesota tube, may be used in cases of variceal hemorrhage. While these devices may be effective at controlling acute bleeding, the effect on patient outcomes remains less clear. We sought to describe the number of patients with variceal hemorrhage and a BTD who survive to discharge, survive to one-year, and develop complications related to a BTD. In this retrospective study, we identified patients at a single, tertiary care center who underwent placement of a BTD for upper gastrointestinal hemorrhage between 2003 and 2014. Patient characteristics and outcomes were summarized using descriptive statistics. 34 patients with a BTD were identified. Median age was 57.5 (IQR 47-63) and 76% (26/34) were male. Approximately 59% (20/34) of patients survived to discharge, and 41% (13/32) were alive after one year. Two patients were lost to follow-up. Of those surviving to discharge, 95% (19/20) had undergone transjugular intrahepatic portosystemic shunt (TIPS), while 36% (5/14) of patients who did not survive to discharge had TIPS (p<0.01). One complication, an esophageal perforation, was identified and managed conservatively. In this cohort of patients undergoing BTD placement for variceal hemorrhage, approximately 59% of patients were alive at discharge and 41% were alive after one year. Placement of a BTD as a temporizing measure in the management of acute variceal hemorrhage may be helpful, particularly when utilized as a bridge to more definitive therapy. Copyright © 2017 Elsevier Inc. All rights reserved.

Outcomes in variceal hemorrhage following the use of a balloon tamponade device

PubMed Central

Nadler, Jonathan; Stankovic, Nikola; Uber, Amy; Holmberg, Mathias J.; Sanchez, Leon D.; Wolfe, Richard E.; Chase, Maureen; Donnino, Michael W.; Cocchi, Michael N.

2017-01-01

Background Variceal hemorrhage is associated with high morbidity and mortality. A balloon tamponade device (BTD), such as the Sengstaken-Blakemore or Minnesota tube, may be used in cases of variceal hemorrhage. While these devices may be effective at controlling acute bleeding, the effect on patient outcomes remains less clear. We sought to describe the number of patients with variceal hemorrhage and a BTD who survive to discharge, survive to one-year, and develop complications related to a BTD. Methods In this retrospective study, we identified patients at a single, tertiary care center who underwent placement of a BTD for upper gastrointestinal hemorrhage between 2003 and 2014. Patient characteristics and outcomes were summarized using descriptive statistics. Results 34 patients with a BTD were identified. Median age was 57.5 (IQR 47–63) and 76% (26/34) were male. Approximately 59% (20/34) of patients survived to discharge, and 41% (13/32) were alive after one year. Two patients were lost to follow-up. Of those surviving to discharge, 95% (19/20) had undergone transjugular intrahepatic portosystemic shunt (TIPS), while 36% (5/14) of patients who did not survive to discharge had TIPS (p < 0.01). One complication, an esophageal perforation, was identified and managed conservatively. Conclusion In this cohort of patients undergoing BTD placement for variceal hemorrhage, approximately 59% of patients were alive at discharge and 41% were alive after one year. Placement of a BTD as a temporizing measure in the management of acute variceal hemorrhage may be helpful, particularly when utilized as a bridge to more definitive therapy. PMID:28460805

Circular stapler introducer: a novel device to facilitate stapled colorectal anastomosis.

PubMed

Guweidhi, Ahmed; Steffen, Rudolf; Metzger, Alejandro; Teuscher, Jürg; Flückiger, Petra; Z'graggen, Kaspar

2009-04-01

A circular stapler introducer was developed to protect the head of the circular stapler and enable atraumatic introduction and advancement of the circular stapler without interfering with the application and safety of an anastomosis. In a Phase I prospective study, we tested the feasibility and safety of the novel circular stapler introducer device in 60 consecutive patients undergoing left-sided colorectal resections. The median distance of the anastomoses from the anal verge was 12 cm (7-20, n = 60). Total morbidity was 15 percent. No mortality was observed. Handling of the circular stapler introducer was considered nonproblematic by all surgeons who participated in the study. No interference of the circular stapler introducer with the circular stapling devices used was encountered. The advancement of the stapler into the end of the colorectal stump was always possible with the aid of the circular stapler introducer. Use of the circular stapler introducer facilitates the double-stapling technique of colorectal anastomosis. The circular stapler introducer has great potential and should be tested in larger studies.

State-of-the-Art Review of Echocardiographic Imaging in the Evaluation and Treatment of Functional Tricuspid Regurgitation.

PubMed

Hahn, Rebecca T

2016-12-01

Functional or secondary tricuspid regurgitation (TR) is the most common cause of severe TR in the Western world. The presence of functional TR, either isolated or in combination with left heart disease, is associated with unfavorable natural history. Surgical mortality for isolated tricuspid valve interventions remains higher than for any other single valve surgery, and surgical options for repair do not have consistent long-term durability. In addition, as more patients undergo transcatheter left valve interventions, developing transcatheter solutions for functional TR has gained greater momentum. Numerous transcatheter devices are currently in early clinical trials. All patients require an assessment of valve morphology and function, and transcatheter devices typically require intraprocedural guidance by echocardiography. The following review will describe tricuspid anatomy, define echocardiographic views for evaluating tricuspid valve morphology and function, and discuss imaging requirements for the current transcatheter devices under development for the treatment of functional TR. © 2016 American Heart Association, Inc.

Controllable Molecule Transport and Release by a Restorable Surface-tethered DNA nanodevice

PubMed Central

Wang, Zhaoyin; Xu, Yuanyuan; Wang, Haiyan; Liu, Fengzhen; Ren, Zhenning; Wang, Zhaoxia

2016-01-01

In this paper, we report a novel surface-tethered DNA nanodevice that may present three states and undergo conformational changes under the operation of pH. Besides, convenient regulation on the electrode surface renders the construction and operation of this DNA nanodevice restorable. To make full use of this DNA nanodevice, ferrocene (Fc) has been further employed for the fabrication of the molecular device. On one hand, the state switches of the DNA nanodevice can be characterized conveniently and reliably by the obtained electrochemical signals from Fc. On the other hand, β-cyclodextrin-ferrocene (β-CD-Fc) host-guest system can be introduced by Fc, which functionalizes this molecular device. Based on different electrochemical behaviors of β-CD under different states, this DNA nanodevice can actualize directional loading, transporting and unloading of β-CD in nanoscale. Therefore, this DNA nanodevice bares promising applications in controllable molecular transport and release, which are of great value to molecular device design. PMID:27384943

Study of hollow corner retroreflectors for use in a synchronous orbit

NASA Technical Reports Server (NTRS)

Yoder, P. R., Jr.

1975-01-01

The performance of a hollow corner cube retroreflector made up of three mutually perpendicular optically flat mirrors when undergoing the thermal-mechanical strains induced by a spacecraft environment was studied. Of particular interest was a device of 200 square centimeter optical aperture used on a satellite in a synchronous orbit. It was assumed that the reflector always faces the earth. The effects of direct solar irradiance, earthshine, and albedo were considered. The results included the maximum mirror surface temperature during the orbit as well as the worst-case loss of optical performance due to thermally-induced mirror distortions. It was concluded that a device made of three suitably coated flat ULE mirrors, optically contacted to each other and supported mechanically in a nonrigid mount, would be expected to concentrate over 80 percent of the theoretical maximum energy in the central of the far field diffraction pattern. Continued development of the device through a detailed design, fabrication, and test phase was recommended.

Experimental and Analytic Evaluation of the Effects of Visual and Motion Simulation in SH-3 Helicopter Training. Technical Report 85-002.

ERIC Educational Resources Information Center

Pfeiffer, Mark G.; Scott, Paul G.

A fly-only group (N=16) of Navy replacement pilots undergoing fleet readiness training in the SH-3 helicopter was compared with groups pre-trained on Device 2F64C with: (1) visual only (N=13); (2) no visual/no motion (N=14); and (3) one visual plus motion group (N=19). Groups were compared for their SH-3 helicopter performance in the transition…

Usefulness of Sodium Bicarbonate for the Prevention of Contrast-Induced Nephropathy in Patients Undergoing Cardiac Resynchronization Therapy.

PubMed

Alonso, Pau; Sanz, Jorge; García-Orts, Ana; Reina, Samuel; Jiménez, Sonia; Osca, Joaquín; Cano, Oscar; Andrés, Ana; Sancho-Tello, María José; Martínez, Luis

2017-11-01

The use of contrast media during cardiac resynchronization therapy (CRT) devices implantation is associated with the risk of contrast-induced nephropathy (CIN). The aim of this study was to evaluate the possible beneficial role of periprocedural intravenous volume expansion with isotonic saline and sodium bicarbonate solution in patients who undergo CRT implantation. Eligible patients were randomly assigned in a 1:1 ratio to receive hydration plus one-sixth molar sodium bicarbonate (study group) or not (control group). Primary end point was CIN incidence. Secondary end points were (1) a combined end point of death, heart transplantation, or hospitalization for heart failure at 12 months, (2) incidence of death, and (3) the need for renal replacement therapy at 12 months. Final analysis was performed with 93 patients. In the hydration group CIN incidence was significantly reduced related to control group (0% vs 11%, p = 0.02). There was a trend to reduce the combined end point in hydration group (12.5% vs 22%, p = 0.14). Finally, CIN incidence was related to a higher 12 months mortality (25% vs 7%, p = 0.03). In conclusion, CIN incidence was 11% in a nonselected population of patients receiving a CRT device. CIN appearance could be reduced by using a hydration protocol based on sodium bicarbonate and isotonic saline. Copyright © 2017 Elsevier Inc. All rights reserved.

Two-port laparoscopic appendectomy assisted with needle grasper comparison with conventional laparoscopic appendectomy.

PubMed

Donmez, Turgut; Hut, Adnan; Avaroglu, Huseyin; Uzman, Sinan; Yildirim, Dogan; Ferahman, Sina; Cekic, Erdinc

2016-08-01

The 2-port laparoscopic appendectomy technique (TLA) is between the conventional 3-port and single-port laparoscopic appendectomy surgeries. We compared postoperative pain and cosmetic results after TLA with conventional laparoscopic appendectomy (CLA) by a 3-port device. Patients undergoing TLA were matched with patients undergoing CLA between February 2015 and November 2015 at the same institution. Thirty-two patients underwent TLA with a needle grasper. The appendix was secured by a percutaneous organ-holding device (needle grasper), then removed through a puncture at McBurney's point. Another 38 patients underwent CLA. Patient demographics, operative details, and postoperative outcomes were collected and evaluated. One patient in the TLA group developed a wound infection and 1 patient in the CLA group developed a postoperative intra-abdominal abscess and 3 wound infections. There was no significant difference between the groups when comparing the length of hospital stay, time until oral intake, and other complications. The pain score in the first 12 hours after surgery was significanly higher in CLA group than the TLA group (P < 0.001). Operative time was significantly shorter in the CLA group compared to the TLA group (P < 0.001). TLA using a needle grasper was associated with a significantly lower pain score 12 hours after surgery, better cosmetic results, and lower cost, than the CLA 3-port procedure because of the fewer number of ports.

Measuring Conformational Dynamics of Single Biomolecules Using Nanoscale Electronic Devices

NASA Astrophysics Data System (ADS)

Akhterov, Maxim V.; Choi, Yongki; Sims, Patrick C.; Olsen, Tivoli J.; Gul, O. Tolga; Corso, Brad L.; Weiss, Gregory A.; Collins, Philip G.

2014-03-01

Molecular motion can be a rate-limiting step of enzyme catalysis, but motions are typically too quick to resolve with fluorescent single molecule techniques. Recently, we demonstrated a label-free technique that replaced fluorophores with nano-electronic circuits to monitor protein motions. The solid-state electronic technique used single-walled carbon nanotube (SWNT) transistors to monitor conformational motions of a single molecule of T4 lysozyme while processing its substrate, peptidoglycan. As lysozyme catalyzes the hydrolysis of glycosidic bonds, two protein domains undergo 8 Å hinge bending motion that generates an electronic signal in the SWNT transistor. We describe improvements to the system that have extended our temporal resolution to 2 μs . Electronic recordings at this level of detail directly resolve not just transitions between open and closed conformations but also the durations for those transition events. Statistical analysis of many events determines transition timescales characteristic of enzyme activity and shows a high degree of variability within nominally identical chemical events. The high resolution technique can be readily applied to other complex biomolecules to gain insights into their kinetic parameters and catalytic function.

Recognizing stationary and locomotion activities using combinational of spectral analysis with statistical descriptors features

NASA Astrophysics Data System (ADS)

Zainudin, M. N. Shah; Sulaiman, Md Nasir; Mustapha, Norwati; Perumal, Thinagaran

2017-10-01

Prior knowledge in pervasive computing recently garnered a lot of attention due to its high demand in various application domains. Human activity recognition (HAR) considered as the applications that are widely explored by the expertise that provides valuable information to the human. Accelerometer sensor-based approach is utilized as devices to undergo the research in HAR since their small in size and this sensor already build-in in the various type of smartphones. However, the existence of high inter-class similarities among the class tends to degrade the recognition performance. Hence, this work presents the method for activity recognition using our proposed features from combinational of spectral analysis with statistical descriptors that able to tackle the issue of differentiating stationary and locomotion activities. The noise signal is filtered using Fourier Transform before it will be extracted using two different groups of features, spectral frequency analysis, and statistical descriptors. Extracted signal later will be classified using random forest ensemble classifier models. The recognition results show the good accuracy performance for stationary and locomotion activities based on USC HAD datasets.

Gas-core reactor power transient analysis

NASA Technical Reports Server (NTRS)

Kascak, A. F.

1972-01-01

The gas core reactor is a proposed device which features high temperatures. It has applications in high specific impulse space missions, and possibly in low thermal pollution MHD power plants. The nuclear fuel is a ball of uranium plasma radiating thermal photons as opposed to gamma rays. This thermal energy is picked up before it reaches the solid cavity liner by an inflowing seeded propellant stream and convected out through a rocket nozzle. A wall-burnout condition will exist if there is not enough flow of propellant to convect the energy back into the cavity. A reactor must therefore operate with a certain amount of excess propellant flow. Due to the thermal inertia of the flowing propellant, the reactor can undergo power transients in excess of the steady-state wall burnout power for short periods of time. The objective of this study was to determine how long the wall burnout power could be exceeded without burning out the cavity liner. The model used in the heat-transfer calculation was one-dimensional, and thermal radiation was assumed to be a diffusion process.

Contemporary management of patients with high-risk non-muscle-invasive bladder cancer who fail intravesical BCG therapy.

PubMed

Yates, D R; Rouprêt, M

2011-08-01

It is advocated that patients with high-risk non-muscle-invasive bladder cancer (NMIBC) receive an adjuvant course of intravesical Bacille Calmette-Guerin (BCG) as first-line treatment. However, a substantial proportion of patients will 'fail' BCG, either early with persistent (refractory) disease or recur late after a long disease-free interval (relapsing). Guideline recommendation in the 'refractory' setting is radical cystectomy, but there are situations when extirpative surgery is not feasible due to competing co-morbidity, a patient's desire for bladder preservation or reluctance to undergo surgery. In this review, we discuss the contemporary management of NMIBC in patients who have failed prior BCG and are not suitable for radical surgery and highlight the potential options available. These options can be categorised as immunotherapy, chemotherapy, device-assisted therapy and combination therapy. However, the current data are still inadequate to formulate definitive recommendations, and data from ongoing trials and maturing studies will give us an insight into whether there is a realistic efficacious second-line treatment for patients who fail intravesical BCG but are not candidates for definitive surgery.

Exposure to Bisphenol A and Other Phenols in Neonatal Intensive Care Unit Premature Infants

PubMed Central

Calafat, Antonia M.; Weuve, Jennifer; Ye, Xiaoyun; Jia, Lily T.; Hu, Howard; Ringer, Steven; Huttner, Ken; Hauser, Russ

2009-01-01

Objective We previously demonstrated that exposure to polyvinyl chloride plastic medical devices containing di(2-ethylhexyl) phthalate (DEHP) was associated with higher urinary concentrations of several DEHP metabolites in 54 premature infants in two neonatal intensive care units than in the general population. For 42 of these infants, we evaluated urinary concentrations of several phenols, including bisphenol A (BPA), in association with the use of the same medical devices. Measurements We measured the urinary concentrations of free and total (free plus conjugated) species of BPA, triclosan, benzophenone-3, methyl paraben, and propyl paraben. Results The percentage of BPA present as its conjugated species was > 90% in more than three-quarters of the premature infants. Intensity of use of products containing DEHP was strongly associated with BPA total concentrations but not with any other phenol. Adjusting for institution and sex, BPA total concentrations among infants in the group of high use of DEHP-containing products were 8.75 times as high as among infants in the low use group (p < 0.0001). Similarly, after adjusting for sex and DEHP-containing product use category, BPA total concentrations among infants in Institution A were 16.6 times as high as those among infants in Institution B (p < 0.0001). Conclusion BPA geometric mean urinary concentration (30.3 μg/L) among premature infants undergoing intensive therapeutic medical interventions was one order of magnitude higher than that among the general population. Conjugated species were the primary urinary metabolites of BPA, suggesting that premature infants have some capacity to metabolize BPA. The differences in exposure to BPA by intensity of use of DEHP-containing medical products highlight the need for further studies to determine the specific source(s) of exposure to BPA. PMID:19440505

A first-in-man study of the Reitan catheter pump for circulatory support in patients undergoing high-risk percutaneous coronary intervention.

PubMed

Smith, Elliot J; Reitan, Oyvind; Keeble, Thomas; Dixon, Kerry; Rothman, Martin T

2009-06-01

To investigate the safety of a novel percutaneous circulatory support device during high-risk percutaneous coronary intervention (PCI). The Reitan catheter pump (RCP) consists of a catheter-mounted pump-head with a foldable propeller and surrounding cage. Positioned in the descending aorta the pump creates a pressure gradient, reducing afterload and enhancing organ perfusion. Ten consecutive patients requiring circulatory support underwent PCI; mean age 71 +/- 9; LVEF 34% +/- 11%; jeopardy score 8 +/- 2.3. The RCP was inserted via the femoral artery. Hemostasis was achieved using Perclose sutures. PCI was performed via the radial artery. Outcomes included in-hospital death, MI, stroke, and vascular injury. Hemoglobin (Hb), free plasma Hb (fHb), platelets, and creatinine (cre) were measured pre PCI and post RCP removal. The pump was inserted and operated successfully in 9/10 cases (median 79 min). Propeller rotation at 10,444 +/- 1,424 rpm maintained an aortic gradient of 9.8 +/- 2 mm Hg. Although fHb increased, there was no significant hemolysis (4.7 +/- 2.4 mg/dl pre vs. 11.9 +/- 10.5 post, P = 0.04, reference 20 mg/dl). Platelets were unchanged (pre 257 +/- 74 x 10(9) vs. 245 +/- 63, P = NS). Renal function improved (cre pre 110 +/- 27 micromol/l vs. 99 +/- 28, P = 0.004). The RCP was not used in one patient following femoral introducer sheath related aortic dissection. All PCI procedures were successful with no deaths or strokes, one MI, and no vascular complications following pump removal. The RCP can be used safely in high-risk PCI patients. This device may be an alternative to other percutaneous systems when substantial cardiac support is needed. (c) 2009 Wiley-Liss, Inc.

Calcification Characteristics of Low-Flow Low-Gradient Severe Aortic Stenosis in Patients Undergoing Transcatheter Aortic Valve Replacement

PubMed Central

Stähli, Barbara E.; Nguyen-Kim, Thi Dan Linh; Gebhard, Cathérine; Frauenfelder, Thomas; Tanner, Felix C.; Nietlispach, Fabian; Maisano, Francesco; Falk, Volkmar; Lüscher, Thomas F.; Maier, Willibald; Binder, Ronald K.

2015-01-01

Low-flow low-gradient severe aortic stenosis (LFLGAS) is associated with worse outcomes. Aortic valve calcification patterns of LFLGAS as compared to non-LFLGAS have not yet been thoroughly assessed. 137 patients undergoing transcatheter aortic valve replacement (TAVR) with preprocedural multidetector computed tomography (MDCT) and postprocedural transthoracic echocardiography were enrolled. Calcification characteristics were assessed by MDCT both for the total aortic valve and separately for each leaflet. 34 patients had LFLGAS and 103 non-LFLGAS. Total aortic valve calcification volume (p < 0.001), mass (p < 0.001), and density (p = 0.004) were lower in LFLGAS as compared to non-LFLGAS patients. At 30-day follow-up, mean transaortic pressure gradients and more than mild paravalvular regurgitation did not differ between groups. In conclusion, LFLGAS and non-LFLGAS express different calcification patterns which, however, did not impact on device success after TAVR. PMID:26435875

Use of the Hemobag® for Modified Ultrafiltration in a Jehovah’s Witness Patient Undergoing Cardiac Surgery

PubMed Central

Moskowitz, David M.; Klein, James J.; Shander, Aryeh; Perelman, Seth I.; McMurtry, Kirk A.; Cousineau, Katherine M.; Ergin, M. Arisan

2006-01-01

Abstract: Modified ultrafiltration is an important technique to concentrate the patient’s circulating blood volume and the residual whole blood in the extracorporeal circuit post-cardiopulmonary bypass. The Hemobag system is a device cleared by the US Food and Drug Administration and represents a novel and safe modification of traditional modified ultrafiltration systems. It is quick and easy to operate by the perfusionist during the hemoconcentration process. Hemoconcentration is accomplished by having the Hemobag “recovery loop” circuit separate from the extracorporeal circuit. This allows the surgeons to continue with surgery, decannulate, and administer protamine simultaneously while the Hemobag is in use. The successful use of the Hemobag in a Jehovah’s Witness patient has not been previously described in the literature. This case report describes how to set up and operate the Hemobag in a Jehovah’s Witness patient undergoing cardiac surgery that requires an extracorporeal circuit. PMID:17089515

Biomaterial adherent macrophage apoptosis is increased by hydrophilic and anionic substrates in vivo

NASA Astrophysics Data System (ADS)

Brodbeck, William G.; Patel, Jasmine; Voskerician, Gabriela; Christenson, Elizabeth; Shive, Matthew S.; Nakayama, Yasuhide; Matsuda, Takehisa; Ziats, Nicholas P.; Anderson, James M.

2002-08-01

An in vivo rat cage implant system was used to identify potential surface chemistries that prevent failure of implanted biomedical devices and prostheses by limiting monocyte adhesion and macrophage fusion into foreign-body giant cells while inducing adherent-macrophage apoptosis. Hydrophobic, hydrophilic, anionic, and cationic surfaces were used for implantation. Analysis of the exudate surrounding the materials revealed no differences between surfaces in the types or levels of cells present. Conversely, the proportion of adherent cells undergoing apoptosis was increased significantly on anionic and hydrophilic surfaces (46 ± 3.7 and 57 ± 5.0%, respectively) when compared with the polyethylene terephthalate base surface. Additionally, hydrophilic and anionic substrates provided decreased rates of monocyte/macrophage adhesion and fusion. These studies demonstrate that biomaterial-adherent cells undergo material-dependent apoptosis in vivo, rendering potentially harmful macrophages nonfunctional while the surrounding environment of the implant remains unaffected.

CT-based investigation of the contraction of ex vivo tissue undergoing microwave thermal ablation

NASA Astrophysics Data System (ADS)

Lopresto, Vanni; Strigari, Lidia; Farina, Laura; Minosse, Silvia; Pinto, Rosanna; D'Alessio, Daniela; Cassano, Bartolomeo; Cavagnaro, Marta

2018-03-01

Treatment planning in microwave thermal ablation (MTA) requires the capability to predict and estimate the shape and dimension of the thermally coagulated zone obtainable following a clinical protocol. The ultimate result relies on the knowledge of the performance of the ablation device, as well as of the temperature-dependent structural modifications that the tissue undergoes during the treatment, because of the very high temperatures reached (up to 100 °C or higher). In this respect, tissue shrinkage plays an important role, since the dimension of the ablated tissue evaluated at the end of the MTA procedure (e.g. by way of CT imaging) could underestimate the actual treated tissue, leading to inaccurate assessment of the treatment outcome. In this study, CT imaging was used for real-time monitoring of tissue contraction during MTA experiments carried out in ex vivo bovine liver. Fiducial lead markers were positioned into the tissue in a 3D spatial grid around the MTA applicator. The spatial and temporal evolution of tissue contraction was imaged during the experiments, and analysed in terms of displacements of clusters of fiducial markers. The results obtained indicated that contraction is highly heterogeneous in the zone of ablation, depending both on the heating and on interactions with nearby tissue. In particular, tissue shrinkage appeared asymmetric with respect to the direction of insertion of the microwave applicator in the central area of carbonised tissue (about 30% and 19% along the radial and longitudinal directions, respectively), and isotropic in the region of coagulated (but not carbonised) tissue (about 11%). The total ablated volume was reduced by approximately 43% with respect to its pre-ablation value. Finally, temperature measurements displayed a correlation between temperature increment and temporal evolution of tissue contraction in the zone of ablation.

Use of inverse quasi-epitaxy to modify order during post-deposition processing of organic photovoltaics

DOE Office of Scientific and Technical Information (OSTI.GOV)

Forrest, Stephen R.; Zimmerman, Jeramy D.; Lassiter, Brian E .

Disclosed herein are methods for fabricating an organic photovoltaic device comprising depositing an amorphous organic layer and a crystalline organic layer over a first electrode, wherein the amorphous organic layer and the crystalline organic layer contact one another at an interface; annealing the amorphous organic layer and the crystalline organic layer for a time sufficient to induce at least partial crystallinity in the amorphous organic layer; and depositing a second electrode over the amorphous organic layer and the crystalline organic layer. In the methods and devices herein, the amorphous organic layer may comprise at least one material that undergoes inverse-quasimore » epitaxial (IQE) alignment to a material of the crystalline organic layer as a result of the annealing.« less

Methods and devices for fabricating three-dimensional nanoscale structures

DOEpatents

Rogers, John A.; Jeon, Seokwoo; Park, Jangung

2010-04-27

The present invention provides methods and devices for fabricating 3D structures and patterns of 3D structures on substrate surfaces, including symmetrical and asymmetrical patterns of 3D structures. Methods of the present invention provide a means of fabricating 3D structures having accurately selected physical dimensions, including lateral and vertical dimensions ranging from 10s of nanometers to 1000s of nanometers. In one aspect, methods are provided using a mask element comprising a conformable, elastomeric phase mask capable of establishing conformal contact with a radiation sensitive material undergoing photoprocessing. In another aspect, the temporal and/or spatial coherence of electromagnetic radiation using for photoprocessing is selected to fabricate complex structures having nanoscale features that do not extend entirely through the thickness of the structure fabricated.

Device Longevity in a Contemporary Cohort of ICD/CRT-D Patients Undergoing Device Replacement.

PubMed

Zanon, Francesco; Martignani, Cristian; Ammendola, Ernesto; Menardi, Endrj; Narducci, Maria Lucia; DE Filippo, Paolo; Santamaria, Matteo; Campana, Andrea; Stabile, Giuseppe; Potenza, Domenico Rosario; Pastore, Gianni; Iori, Matteo; LA Rosa, Concetto; Biffi, Mauro

2016-07-01

The longevity of defibrillators (ICD) is extremely important from both a clinical and economic perspective. We studied the reasons for device replacement, the longevity of removed ICD, and the existence of possible factors associated with shorter service life. Consecutive patients who underwent ICD replacement from March 2013 to May 2015 in 36 Italian centers were included in this analysis. Data on replaced devices were collected. A total of 953 patients were included in this analysis. In 813 (85%) patients the reason for replacement was battery depletion, while 88 (9%) devices were removed for clinical reasons and the remaining 52 because of system failure (i.e., lead or ICD generator failure or a safety advisory indication). The median service life was 5.9 years (25th-75th percentile, 4.9-6.9) for single- and dual-chamber ICD and 4.9 years (25th-75th percentile, 4.0-5.7) for CRT-D. On multivariate analysis, the factors CRT-D device, SC/DC ICD generator from Biotronik, percentage of ventricular pacing, and the occurrence of a system failure were positively associated with a replacement procedure. By contrast, the device from Boston Scientific was an independent protective factor against replacement. Considerable differences were seen in battery duration in both ICD and CRT-D. Specifically, Biotronik devices showed the shortest longevity among ICD and Boston Scientific showed the longest longevity among CRT-D (log-rank test, P < 0.001 for pairwise comparisons). Several factors were associated with shorter service life of ICD devices: CRT-D, occurrence of system failure and percentage of ventricular pacing. Our results confirmed significant differences among manufacturers. © The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals, Inc.

Use of intraosseous devices in trauma: a survey of trauma practitioners in Canada, Australia and New Zealand

PubMed Central

Engels, Paul T.; Erdogan, Mete; Widder, Sandy L.; Butler, Michael B.; Kureshi, Nelofar; Martin, Kate; Green, Robert S.

2016-01-01

Background Although used primarily in the pediatric population for decades, the use of intraosseous (IO) devices in the resuscitation of severely injured adult trauma patients has recently become more commonplace. The objective of this study was to determine the experience level, beliefs and attitudes of trauma practitioners in Canada, Australia and New Zealand regarding the use of IO devices in adult trauma patients. Methods We administered a web-based survey to all members of 4 national trauma and emergency medicine organizations in Canada, Australia and New Zealand. Survey responses were analyzed using descriptive statistics, univariate comparisons and a proportional odds model. Results Overall, 425 of 1771 members completed the survey, with 375 being trauma practitioners. IO devices were available to 97% (353 of 363), with EZ-IO being the most common. Nearly all physicians (98%, 357 of 366) had previous training with IO devices, and 85% (223 of 261) had previously used an IO device in adult trauma patients. Most respondents (79%, 285 of 361) were very comfortable placing an IO catheter in the proximal tibia. Most physicians would always or often use an IO catheter in a patient without intravenous access undergoing CPR for traumatic cardiac arrest (84%, 274 of 326) or in a hypotensive patient (without peripheral intravenous access) after 2 attempts or 90 s of trying to establish vascular access (81%, 264 of 326). Conclusion Intraosseous devices are readily available to trauma practitioners in Canada, Australia and New Zealand, and most physicians are trained in device placement. Most physicians surveyed felt comfortable using an IO device in resuscitation of adult trauma patients and would do so for indications broader than current guidelines. PMID:27669404

A Novel Method to Assess Wear Rates of Retrieved Tibial Inserts Following in-vivo Use

NASA Astrophysics Data System (ADS)

Paniogue, Tanille J.

Ultra-high molecular weight polyethylene (UHMWPE) on cobalt chrome is the bearing couple of choice for total knee arthroplasty. The number of patients undergoing total knee arthroplasty has been steadily growing and is projected to continue increasing rapidly in the near future. Many of these patients are younger and more active and therefore need a longer lasting device. However, many of these devices fail prematurely and often the primary reason for failure and ultimately revision is due to wear related issues. Therefore, examining how wear rates of the UHMWPE tibial insert change during in-vivo use can help elucidate the mechanisms of accelerated wear and hopefully aid in finding solutions to combat wear related failures. Different crosslinking treatments have been employed by manufacturers to improve wear resistance of the polyethylene. While this has been shown to be an effective way to reduce wear, crosslinking has led to other issues such as oxidative instability and a decline in mechanical properties. The purpose of this body of work is to examine how changes in oxidation, after in-vivo use, affect wear resistance. A novel testing method was developed to test the native articular surface from retrieved tibial inserts in a laboratory Pin-on-Disk (POD) simulator. The method was validated using short-duration implant articular surfaces and non-articular control pins. In the absence of high surface oxidation or severe surface damage, the articular surface pins had comparable steady state wear rates to their bulk counterparts. Tests of devices with longer in-vivo service show chemical changes consistent with a free-radical mediated oxidation mechanism. Tribological assessment of the articular surfaces shows increasing wear rates as a function of oxidation. While this relationship has been hypothesized in the literature, these experiments represent the first physical demonstration of the phenomenon. The wear mechanism is further explored through infrared spectroscopy, assessment of the wear scar, and documentation of evolution of the contact surfaces in the articulation.

Magnetic resonance imaging in patients with cardiac pacemakers: era of "MR Conditional" designs.

PubMed

Shinbane, Jerold S; Colletti, Patrick M; Shellock, Frank G

2011-10-27

Advances in cardiac device technology have led to the first generation of magnetic resonance imaging (MRI) conditional devices, providing more diagnostic imaging options for patients with these devices, but also new controversies. Prior studies of pacemakers in patients undergoing MRI procedures have provided groundwork for design improvements. Factors related to magnetic field interactions and transfer of electromagnetic energy led to specific design changes. Ferromagnetic content was minimized. Reed switches were modified. Leads were redesigned to reduce induced currents/heating. Circuitry filters and shielding were implemented to impede or limit the transfer of certain unwanted electromagnetic effects. Prospective multicenter clinical trials to assess the safety and efficacy of the first generation of MR conditional cardiac pacemakers demonstrated no significant alterations in pacing parameters compared to controls. There were no reported complications through the one month visit including no arrhythmias, electrical reset, inhibition of generator output, or adverse sensations. The safe implementation of these new technologies requires an understanding of the well-defined patient and MR system conditions. Although scanning a patient with an MR conditional device following the strictly defined patient and MR system conditions appears straightforward, issues related to patients with pre-existing devices remain complex. Until MR conditional devices are the routine platform for all of these devices, there will still be challenging decisions regarding imaging patients with pre-existing devices where MRI is required to diagnose and manage a potentially life threatening or serious scenario. A range of other devices including ICDs, biventricular devices, and implantable physiologic monitors as well as guidance of medical procedures using MRI technology will require further biomedical device design changes and testing. The development and implementation of cardiac MR conditional devices will continue to require the expertise and collaboration of multiple disciplines and will need to prove safety, effectiveness, and cost effectiveness in patient care.

Magnetic resonance imaging in patients with cardiac pacemakers: era of "MR Conditional" designs

PubMed Central

2011-01-01

Advances in cardiac device technology have led to the first generation of magnetic resonance imaging (MRI) conditional devices, providing more diagnostic imaging options for patients with these devices, but also new controversies. Prior studies of pacemakers in patients undergoing MRI procedures have provided groundwork for design improvements. Factors related to magnetic field interactions and transfer of electromagnetic energy led to specific design changes. Ferromagnetic content was minimized. Reed switches were modified. Leads were redesigned to reduce induced currents/heating. Circuitry filters and shielding were implemented to impede or limit the transfer of certain unwanted electromagnetic effects. Prospective multicenter clinical trials to assess the safety and efficacy of the first generation of MR conditional cardiac pacemakers demonstrated no significant alterations in pacing parameters compared to controls. There were no reported complications through the one month visit including no arrhythmias, electrical reset, inhibition of generator output, or adverse sensations. The safe implementation of these new technologies requires an understanding of the well-defined patient and MR system conditions. Although scanning a patient with an MR conditional device following the strictly defined patient and MR system conditions appears straightforward, issues related to patients with pre-existing devices remain complex. Until MR conditional devices are the routine platform for all of these devices, there will still be challenging decisions regarding imaging patients with pre-existing devices where MRI is required to diagnose and manage a potentially life threatening or serious scenario. A range of other devices including ICDs, biventricular devices, and implantable physiologic monitors as well as guidance of medical procedures using MRI technology will require further biomedical device design changes and testing. The development and implementation of cardiac MR conditional devices will continue to require the expertise and collaboration of multiple disciplines and will need to prove safety, effectiveness, and cost effectiveness in patient care. PMID:22032338

Pacemaker remote monitoring in the pediatric population: is it a real solution?

PubMed

Leoni, Loira; Padalino, Massimo; Biffanti, Roberta; Ferretto, Sonia; Vettor, Giulia; Corrado, Domenico; Stellin, Giovanni; Milanesi, Ornella; Iliceto, Sabino

2015-05-01

Clinical utility of remote monitoring of implantable cardiac devices has been previously demonstrated in several trials in the adult population. The aim of this study was to assess the clinical utility of remote monitoring in a pediatric population undergoing pacemakers implantation. The study population included 73 consecutive pediatric patients who received an implantable pacemaker. The remote device check was programmed for every 3 months and all patients had a yearly out-patient visit. Data on device-related events, hospitalization, and other clinical information were collected during remote checks and out-patient visits. During a mean follow-up of 18 ± 10 months, 470 remote transmissions were collected and analyzed. Two deaths were reported. Eight transmissions (1.7%) triggered an urgent out-patient visit. Twenty percent of transmissions reported evidence of significant clinical or technical events. All young patients and their families were very satisfied when using remote monitoring to replace out-patient visits. The ease in use, together with satisfaction and acceptance of remote monitoring in pediatric patients, brought very good results. The remote management of our pediatric population was safe and remote monitoring adequately replaced the periodic out-patient device checks without compromising patient safety. ©2015 Wiley Periodicals, Inc.

Use of thromboelastography to tailor dual-antiplatelet therapy in patients undergoing treatment of intracranial aneurysms with the Pipeline embolization device.

PubMed

McTaggart, Ryan A; Choudhri, Omar A; Marcellus, Mary L; Brennan, Tom; Steinberg, Gary K; Dodd, Robert L; Do, Huy M; Marks, Michael P

2015-06-01

Platelet function testing is controversial and not well studied in patients with neurovascular disease. To evaluate the performance of thromboelastography (TEG) as a platelet function test in neurovascular patients treated with the Pipeline embolization device (PED). A prospective protocol was instituted for platelet function testing in patients undergoing repair of intracranial aneurysms with the PED. All patients received dual antiplatelet therapy (DAT) and their response to both P2Y12 inhibitors and aspirin was quantified with TEG. Each patient's DAT induction strategy was tailored based on the percentage ADP-induced and percentage arachidonic acid-induced platelet inhibition reported by TEG. Data collected included clinical presentation, aneurysm characteristics, treatment details, and periprocedural events. Patients were followed up clinically and/or angiographically at 30 days, 6 months, and 1 year. Thirty-four PED procedures were performed on 31 patients. TEG results altered the DAT strategy in 35% of patients. Technical success with the Pipeline placement was 100%. Two patients had minor strokes and five had transient ischemic attacks (TIAs). There have been no hemorrhagic complications. No patient had permanent neurologic deficits. Six of eight (75%) of patients with thromboembolic/TIA events were ADP-induced hyporesponders by TEG. Our 6- and 12-month angiographic occlusion rates were 78.9% and 89.5%, respectively. The 19 major branches covered by the PED that were assessed by follow-up imaging have all remained patent. Platelet function testing with TEG altered our DAT induction strategy in a significant number of cases. No hemorrhagic or disabling thromboembolic complications were seen in this series. Future studies should compare methods of platelet function testing and, possibly, no platelet function testing in neurovascular patients undergoing flow diversion and/or stent-assisted treatment of intracranial aneurysms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Film evaporation MEMS thruster array for micropropulsion

NASA Astrophysics Data System (ADS)

Cofer, Anthony G.

Current small sat propulsion systems require a substantial mass fraction of the vehicle involving tradeoffs between useful payload mass and maneuverability. This is also an issue with available attitude control systems which are either quickly saturated reaction wheels or movable high drag surfaces with long response times. What is needed is a low mass low power self-contained propulsion unit that can be easily installed and modeled. The proposed Film-Evaporation MEMS Tunable Array (FEMTA), exploits the small scale surface tension effect in conjunction with temperature dependent vapor pressure to realize a thermal valving system. The local vapor pressure is increased by resistive film heating until it exceeds meniscus strength in the nozzle inducing vacuum boiling which provides a stagnation pressure equal to vapor pressure at that point which is used for propulsion. The heat of vaporization is drawn from the bulk fluid and is replaced by either an integrated heater or waste heat from the vehicle. Proof of concept was initially achieved with a macroscale device made possible by using ethylene glycol, which has a low vapor pressure and high surface tension, as the working fluid. Both the thermal valving effect and cooling feature were demonstrated though at reduced performance than would be expected for water. Three generations of prototype FEMTA devices have been fabricated at Birck Nanotechnology Center on 200 and 500 micrometer thick silicon wafers. Preliminary testing on first generation models had tenuously demonstrated behavior consistent with the macroscale tests but there was not enough data for solid confirmation. Some reliability issues had arisen with the integrated heaters which were only partially alleviated in the second generation of FEMTAs. This led to a third generation and two changes in heater material until a chemically resilient material was found. The third generation of microthrusters were tested on the microNewton thrust stand at Purdue's High Vacuum Lab and confirmed the thermal valving concept. The microthrusters will also undergo thermal testing at the Goddard Space Flight Centers' ThermalVac environmental testing facility whenever device lifetime can be extended to the several week time frame needed to provide reliable data.

Global Transcriptional Response of Human Liver Cells to Ethanol Stress of Different Strength Reveals Hormetic Behavior.

PubMed

Schmidt-Heck, Wolfgang; Wönne, Eva C; Hiller, Thomas; Menzel, Uwe; Koczan, Dirk; Damm, Georg; Seehofer, Daniel; Knöspel, Fanny; Freyer, Nora; Guthke, Reinhard; Dooley, Steven; Zeilinger, Katrin

2017-05-01

The liver is the major site for alcohol metabolism in the body and therefore the primary target organ for ethanol (EtOH)-induced toxicity. In this study, we investigated the in vitro response of human liver cells to different EtOH concentrations in a perfused bioartificial liver device that mimics the complex architecture of the natural organ. Primary human liver cells were cultured in the bioartificial liver device and treated for 24 hours with medium containing 150 mM (low), 300 mM (medium), or 600 mM (high) EtOH, while a control culture was kept untreated. Gene expression patterns for each EtOH concentration were monitored using Affymetrix Human Gene 1.0 ST Gene chips. Scaled expression profiles of differentially expressed genes (DEGs) were clustered using Fuzzy c-means algorithm. In addition, functional classification methods, KEGG pathway mapping and also a machine learning approach (Random Forest) were utilized. A number of 966 (150 mM EtOH), 1,334 (300 mM EtOH), or 4,132 (600 mM EtOH) genes were found to be differentially expressed. Dose-response relationships of the identified clusters of co-expressed genes showed a monotonic, threshold, or nonmonotonic (hormetic) behavior. Functional classification of DEGs revealed that low or medium EtOH concentrations operate adaptation processes, while alterations observed for the high EtOH concentration reflect the response to cellular damage. The genes displaying a hormetic response were functionally characterized by overrepresented "cellular ketone metabolism" and "carboxylic acid metabolism." Altered expression of the genes BAHD1 and H3F3B was identified as sufficient to classify the samples according to the applied EtOH doses. Different pathways of metabolic and epigenetic regulation are affected by EtOH exposition and partly undergo hormetic regulation in the bioartificial liver device. Gene expression changes observed at high EtOH concentrations reflect in some aspects the situation of alcoholic hepatitis in humans. Copyright © 2017 by the Research Society on Alcoholism.

Shape memory alloys: a state of art review

NASA Astrophysics Data System (ADS)

Naresh, C.; Bose, P. S. C.; Rao, C. S. P.

2016-09-01

Shape memory alloys (SMAs) are the special materials that have the ability to return to a predetermined shape when heated. When this alloy is in below transformation temperature it undergoes low yield strength and will deform easily into any new shape which it will retain, if this alloy is heated above its transformation temperature it changes its crystal lattice structure which returns to its real shape. SMAs are remarkably different from other materials are primarily due to shape memory effect (SME) and pseudoelasticity which are related with the specific way the phase transformation occurs, biocompatibility, high specific strength, high corrosion resistance, high wear resistance and high anti-fatigue property. SMA are used in many applications such as aerospace, medical, automobile, tubes, controllers for hot water valves in showers, petroleum industry, vibration dampers, ball bearings, sensors, actuators, miniature grippers, micro valves, pumps, landing gears, eye glass frames, Material for helicopter blades, sprinklers in fine alarm systems packaging devices for electronic materials, dental materials, etc. This paper focuses on introducing shape memory alloy and their applications in past, present and in future, also revealed the concept and mechanism of shape memory materials for a particular requirement. Properties of SMAs, behaviour and characteristics of SMA, summary of recent advances and new application opportunities are also discussed.

Cardiac transplantation after bridged therapy with continuous flow left ventricular assist devices.

PubMed

Deo, Salil V; Sung, Kiick; Daly, Richard C; Shah, Ishan K; Altarabsheh, Salah E; Stulak, John M; Joyce, Lyle D; Boilson, Barry A; Kushwaha, Sudhir S; Park, Soon J

2014-03-01

Cardiac transplantation is an effective surgical therapy for end-stage heart failure. Patients (pts) may need to be bridged with a continuous flow left ventricular assist device (CF-LVAD) while on the transplant list as logistic factors like organ availability are unknown. Cardiac transplantation post-LVAD can be a surgically challenging procedure and outcome in these pts is perceived to be poorer based on experience with earlier generation pulsatile flow pumps. Data from a single institution comparing these pts with those undergoing direct transplantation in the present era of continuous flow device therapy are limited. Evaluate results of cardiac transplantation in pts bridged with a CF-LVAD (BTx) and compare outcomes with pts undergoing direct transplantation (Tx) in a single institution. From June 2007 till January 2012, 106 pts underwent cardiac transplantation. Among these, 37 (35%) pts (51±11 years; 85% male) were bridged with a CF-LVAD (BTx), while 70 (65%) comprised the Tx group (53±12 years; 72% males). The median duration of LVAD support was 227 (153,327) days. During the period of LVAD support, 10/37 (27%) pts were upgraded to status 1A and all were successfully transplanted. Median hospital stay in the BTx (14 days) was slightly longer than the Tx group (12 days) but not statistically significant (p=0.21). In-hospital mortality in the BTx (5%) and Tx (1%) were comparable (p=0.25). Estimated late survival in the BTx cohort was 94±7, 90±10 and 83±16% at the end of one, two and three years, respectively which was comparable to 97±4%, 93±6% and 89±9% for the Tx group (p=0.50). Cardiac transplantation after LVAD implant can be performed with excellent results. Patients can be supported on the left ventricular assist device even for periods close to a year with good outcome after cardiac transplantation. Copyright © 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Alfaxalone or ketamine-medetomidine in cats undergoing ovariohysterectomy: a comparison of intra-operative parameters and post-operative pain.

PubMed

Kalchofner Guerrero, Karin S; Reichler, Iris M; Schwarz, Andrea; Jud, Rahel S; Hässig, Michael; Bettschart-Wolfensberger, Regula

2014-11-01

To compare post-operative pain in cats after alfaxalone or ketamine- medetomidine anaesthesia for ovariohysterectomy (OHE) and physiologic parameters during and after surgery. Prospective 'blinded' randomized clinical study. Twenty-one healthy cats. Cats were assigned randomly into two groups: Group A, anaesthesia was induced and maintained with alfaxalone [5 mg kg(-1) intravenously (IV) followed by boli (2 mg kg(-1) IV); Group MK, induction with ketamine (5 mg kg(-1) IV) after medetomidine (30 μg kg(-1) intramuscularly (IM)], and maintenance with ketamine (2 mg kg(-1) IV). Meloxicam (0.2 mg kg(-1) IV) was administered after surgery. Basic physiological data were collected. At time T = -2, 0, 0.5, 1, 2, 4, 6, 8, 12, 16, 20, and 24 hours post-operatively pain was assessed by three methods, a composite pain scale (CPS; 0-24 points), a visual analogue scale (VAS 0-100 mm), and a mechanical wound threshold (MWT) device. Butorphanol (0.2 mg kg(-1) IM) was administered if CPS was scored ≥13. Data were analyzed using a general linear model, Kruskal-Wallis analyses, Bonferroni-Dunn test, unpaired t-test and Fisher's exact test as relevant. Significance was set at p < 0.05. VASs were significantly higher at 0.5, 1, 2, 4, and 20 hours in group A; MWT values were significantly higher at 8 and 12 hours in group MK. Post-operative MWT decreased significantly compared to baseline in both groups. There was no difference in CPS at any time point. Five cats required rescue analgesia (four in A; one in MK). Anaesthesia with ketamine-medetomidine was found to provide better post-surgical analgesia than alfaxalone in cats undergoing OHE; however, primary hyperalgesia developed in both groups. Alfaxalone is suitable for induction and maintenance of anaesthesia in cats undergoing OHE, but administration of additional sedative and analgesic drugs is highly recommended. © 2014 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.

Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft.

PubMed

Freitas, E R F S; Soares, B G O; Cardoso, J R; Atallah, A N

2007-07-18

Following coronary artery bypass graft (CABG), the main causes of postoperative morbidity and mortality are postoperative pulmonary complications, respiratory dysfunction and arterial hypoxemia. Incentive spirometry is a treatment technique that uses a mechanical device (an incentive spirometer) to reduce such pulmonary complications during postoperative care. To assess the effects of incentive spirometry for preventing postoperative pulmonary complications in adults undergoing CABG. We searched CENTRAL on The Cochrane Library (Issue 2, 2004), MEDLINE (1966 to December 2004), EMBASE (1980 to December 2004), LILACS (1982 to December 2004), the Physiotherapy Evidence Database (PEDro) (1980 to December 2004), Allied & Complementary Medicine (AMED) (1985 to December 2004), CINAHL (1982 to December 2004), and the Database of Abstracts of Reviews of Effects (DARE) (1994 to December 2004). References were checked and authors contacted. No language restrictions were applied. Randomized controlled trials comparing incentive spirometry with any type of prophylactic physiotherapy for prevention of postoperative pulmonary complications in adults undergoing CABG. Two reviewers independently evaluated the quality of trials using the guidelines of the Cochrane Reviewers' Handbook and extracted data from included trials. Four trials with 443 participants contributed to this review. There was no significant difference in pulmonary complications (atelectasis and pneumonia) between treatment with incentive spirometry and treatment with positive pressure breathing techniques (continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP) and intermittent positive pressure breathing (IPPB)) or preoperative patient education. Patients treated with incentive spirometry had worse pulmonary function and arterial oxygenation compared with positive pressure breathing (CPAP, BiPAP, IPPB). Individual small trials suggest that there is no evidence of benefit from incentive spirometry in reducing pulmonary complications and in decreasing the negative effects on pulmonary function in patients undergoing CABG. In view of the modest number of patients studied, methodological shortcomings and poor reporting of the included trials, these results should be interpreted cautiously. An appropriately powered trial of high methodological rigour is needed to determine those patients who may derive benefit from incentive spirometry following CABG.

Prophylactic urethral stenting with Memokath® 028SW in prostate cancer patients undergoing prostate 125I seed implants: phase I/II study

PubMed Central

Chao, Samuel T.; Angermeier, Kenneth; Klein, Eric A.; Reddy, Chandana A.; Ulchaker, James C.; Stephenson, Andrew; Campbell, Steven

2011-01-01

Purpose To study the feasibility/toxicity of urethral stenting with the Memokath® 028SW stent in patients undergoing prostate implant (PI) for prostate adenocarcinoma. Material and methods An Investigational Device Exemption from the Food and Drug Administration (FDA) and institutional review board (IRB) approval were obtained. Twenty patients enrolled. Baseline American Urological Association (AUA) score was obtained prior to PI. Follow-up information was obtained with weekly phone calls for the first 12 weeks and biweekly calls for the next 12 weeks to assess toxicity and AUA score. Removal of the stent was planned at six months after PI, or earlier due to excessive toxicity/patient request. Results Median age was 66.5 years. The median prostate volume was 39 cc (range: 10-90). The median baseline AUA score was 7.5 (range: 1-21). Three patients required intermittent self-catheterization (ISC) within 3 days after PI. No patients required ISC beyond day 3 after PI. The median duration of ISC was 1 day (range: 1-2). AUA scores returned to baseline values 6 weeks after PI. The week 6 AUA score was 10 (range: 4-16). Seven patients (35%) underwent early removal because of patient preference. The reasons were: incontinence (n = 3), discomfort (n = 2), hematuria (n = 1), and obstructive symptoms (n = 1). The median time of stent removal in these patients was 13.9 weeks (range: 0.9-21.4). Thirteen patients (65%) had ISC and/or urinary catheterization post stent removal. Median time for ISC use was 10 days (range: 1-90). Conclusions Urethral stenting with Memokath® in patients undergoing PI was feasible, but resulted in relatively high rate of urinary incontinence and discomfort. Given the adverse effects experienced by patients of this study, further studies should focus only on patients with highest risk of urinary obstruction from PI or those with obstruction needing ISC. PMID:27877196

Determination of heat transfer coefficients in plastic French straws plunged in liquid nitrogen.

PubMed

Santos, M Victoria; Sansinena, M; Chirife, J; Zaritzky, N

2014-12-01

The knowledge of the thermodynamic process during the cooling of reproductive biological systems is important to assess and optimize the cryopreservation procedures. The time-temperature curve of a sample immersed in liquid nitrogen enables the calculation of cooling rates and helps to determine whether it is vitrified or undergoes phase change transition. When dealing with cryogenic liquids, the temperature difference between the solid and the sample is high enough to cause boiling of the liquid, and the sample can undergo different regimes such as film and/or nucleate pool boiling. In the present work, the surface heat transfer coefficients (h) for plastic French straws plunged in liquid nitrogen were determined using the measurement of time-temperature curves. When straws filled with ice were used the cooling curve showed an abrupt slope change which was attributed to the transition of film into nucleate pool boiling regime. The h value that fitted each stage of the cooling process was calculated using a numerical finite element program that solves the heat transfer partial differential equation under transient conditions. In the cooling process corresponding to film boiling regime, the h that best fitted experimental results was h=148.12±5.4 W/m(2) K and for nucleate-boiling h=1355±51 W/m(2) K. These values were further validated by predicting the time-temperature curve for French straws filled with a biological fluid system (bovine semen-extender) which undergoes freezing. Good agreement was obtained between the experimental and predicted temperature profiles, further confirming the accuracy of the h values previously determined for the ice-filled straw. These coefficients were corroborated using literature correlations. The determination of the boiling regimes that govern the cooling process when plunging straws in liquid nitrogen constitutes an important issue when trying to optimize cryopreservation procedures. Furthermore, this information can lead to improvements in the design of cooling devices in the cryobiology field. Copyright © 2014 Elsevier Inc. All rights reserved.

Ultra-thin, single-layer polarization rotator

DOE Office of Scientific and Technical Information (OSTI.GOV)

Son, T. V.; Truong, V. V., E-mail: Truong.Vo-Van@Concordia.Ca; Do, P. A.

We demonstrate light polarization control over a broad spectral range by a uniform layer of vanadium dioxide as it undergoes a phase transition from insulator to metal. Changes in refractive indices create unequal phase shifts on s- and p-polarization components of incident light, and rotation of linear polarization shows intensity modulation by a factor of 10{sup 3} when transmitted through polarizers. This makes possible polarization rotation devices as thin as 50 nm that would be activated thermally, optically or electrically.

[A comparison of various supraglottic airway devices for fiberoptical guided tracheal intubation].

PubMed

Metterlein, Thomas; Dintenfelder, Anna; Plank, Christoph; Graf, Bernhard; Roth, Gabriel

Fiberoptical assisted intubation via placed supraglottic airway devices has been described as safe and easy procedure to manage difficult airways. However visualization of the glottis aperture is essential for fiberoptical assisted intubation. Various different supraglottic airway devices are commercially available and might offer different conditions for fiberoptical assisted intubation. The aim of this study was to compare the best obtainable view of the glottic aperture using different supraglottic airway devices. With approval of the local ethics committee 52 adult patients undergoing elective anesthesia were randomly assigned to a supraglottic airway device (Laryngeal Tube, Laryngeal Mask Airway I-Gel, Laryngeal Mask Airway Unique, Laryngeal Mask Airway Supreme, Laryngeal Mask Airway Aura-once). After standardized induction of anaesthesia the supraglottic airway device was placed according to the manufacturers recommendations. After successful ventilation the position of the supraglottic airway device in regard to the glottic opening was examined with a flexible fiberscope. A fully or partially visible glottic aperture was considered as suitable for fiberoptical assisted intubation. Suitability for fiberoptical assisted intubation was compared between the groups (H-test, U-test; p<0.05). Demographic data was not different between the groups. Placement of the supraglottic airway device and adequate ventilation was successful in all attempts. Glottic view suitable for fiberoptical assisted intubation differed between the devices ranging from 40% for the laringeal tube (LT), 66% for the laryngeal mask airway Supreme, 70% for the Laryngeal Mask Airway I-Gel and 90% for both the Laryngeal Mask Airway Unique and the Laryngeal Mask Airway Aura-once. None of the used supraglottic airway devices offered a full or partial glottic view in all cases. However the Laryngeal Mask Airway Unique and the Laryngeal Mask Airway Aura-once seem to be more suitable for fiberoptical assisted intubation compared to other devices. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

A comparison of various supraglottic airway devices for fiberoptical guided tracheal intubation.

PubMed

Metterlein, Thomas; Dintenfelder, Anna; Plank, Christoph; Graf, Bernhard; Roth, Gabriel

Fiberoptical assisted intubation via placed supraglottic airway devices has been described as safe and easy procedure to manage difficult airways. However visualization of the glottis aperture is essential for fiberoptical assisted intubation. Various different supraglottic airway devices are commercially available and might offer different conditions for fiberoptical assisted intubation. The aim of this study was to compare the best obtainable view of the glottic aperture using different supraglottic airway devices. With approval of the local ethics committee 52 adult patients undergoing elective anesthesia were randomly assigned to a supraglottic airway device (Laryngeal Tube, Laryngeal Mask Airway I-Gel, Laryngeal Mask Airway Unique, Laryngeal Mask Airway Supreme, Laryngeal Mask Airway Aura-once). After standardized induction of anesthesia the supraglottic airway device was placed according to the manufacturers recommendations. After successful ventilation the position of the supraglottic airway device in regard to the glottic opening was examined with a flexible fiberscope. A fully or partially visible glottic aperture was considered as suitable for fiberoptical assisted intubation. Suitability for fiberoptical assisted intubation was compared between the groups (H-test, U-test; p<0.05). Demographic data was not different between the groups. Placement of the supraglottic airway device and adequate ventilation was successful in all attempts. Glottic view suitable for fiberoptical assisted intubation differed between the devices ranging from 40% for the laringeal tube (LT), 66% for the laryngeal mask airway Supreme, 70% for the Laryngeal Mask Airway I-Gel and 90% for both the Laryngeal Mask Airway Unique and the Laryngeal Mask Airway Aura-once. None of the used supraglottic airway devices offered a full or partial glottic view in all cases. However the Laryngeal Mask Airway Unique and the Laryngeal Mask Airway Aura-once seem to be more suitable for fiberoptical assisted intubation compared to other devices. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

The immediate use of a silicone sheet wound closure device in scar reduction and prevention.

PubMed

Parry, James R; Stupak, Howard D; Johnson, Calvin M

2016-02-01

Silicone has been used successfully postoperatively in the prevention of hypertrophic and other types of adverse scars. The Silicone Suture Plate (SSP) is a new, minimally invasive, sterile wound closure device that is applied intraoperatively to prevent adverse scarring. The SSP device permits immediate application of silicone while concurrently allowing for wound-edge tension redistribution. In this prospective, controlled, single-blinded clinical study, 8 consecutive patients undergoing deep-plane rhytidectomy were selected. SSP devices were placed on the patients' posterior rhytidectomy hairline incision; the mirror-image control site underwent standard suturing techniques. Three blinded, independent raters assessed the treatment and control sides at 6-week and 4-month follow-up visits, using the Objective Scar Assessment Scale (OSAS), a validated scar assessment tool. The 6-week OSAS scores revealed an 18.4% improvement on the side with the SSP device (13.3) when compared to the control side (16.3). The 4-month OSAS scores showed a 27.3% improvement on the treatment side from 12.7 (control) to 9.2 (SSP). These OSAS results were found to be statistically significant when taken as an aggregate of the observers' scores, but not when observers' scores were measured individually (p < 0.05). In our series of patients, we showed promising results with the use of the SSP device. Early silicone application and tissue tension distribution contributed to an overall more aesthetically pleasing scar compared to those seen with standard suturing techniques, although more testing is required.

Hemodialysis Reliable Outflow (HeRO) device in end-stage dialysis access: a decision analysis model.

PubMed

Dageforde, Leigh Anne; Bream, Peter R; Moore, Derek E

2012-09-01

The Hemodialysis Reliable Outflow (HeRO) dialysis access device is a permanent tunneled dialysis graft connected to a central venous catheter and is used in patients with end-stage dialysis access (ESDA) issues secondary to central venous stenosis. The safety and effectiveness of the HeRO device has previously been proven, but no study thus far has compared the cost of its use with tunneled dialysis catheters (TDCs) and thigh grafts in patients with ESDA. A decision analytic model was developed to simulate outcomes for patients with ESDA undergoing placement of a HeRO dialysis access device, TDC, or thigh graft. Outcomes of interest were infection, thrombosis, and ischemic events. Baseline values, ranges, and costs were determined from a systematic review of the literature. Total costs were based on 1 year of post-procedure outcomes. Sensitivity analyses were conducted to test model strength. The HeRO dialysis access device is the least costly dialysis access with an average 1-year cost of $6521. The 1-year cost for a TDC was $8477. A thigh graft accounted for $9567 in a 1-year time period. The HeRO dialysis access device is the least costly method of ESDA. The primary determinants of cost in this model are infection in TDCs and leg ischemia necessitating amputation in thigh grafts. Further study is necessary to incorporate patient preference and quality of life into the model. Copyright © 2012 Elsevier Inc. All rights reserved.

SdrF, a Staphylococcus epidermidis Surface Protein, Contributes to the Initiation of Ventricular Assist Device Driveline–Related Infections

PubMed Central

Arrecubieta, Carlos; Toba, Faustino A.; von Bayern, Manuel; Akashi, Hirokazu; Deng, Mario C.; Naka, Yoshifumi; Lowy, Franklin D.

2009-01-01

Staphylococcus epidermidis remains the predominant pathogen in prosthetic-device infections. Ventricular assist devices, a recently developed form of therapy for end-stage congestive heart failure, have had considerable success. However, infections, most often caused by Staphylococcus epidermidis, have limited their long-term use. The transcutaneous driveline entry site acts as a potential portal of entry for bacteria, allowing development of either localized or systemic infections. A novel in vitro binding assay using explanted drivelines obtained from patients undergoing transplantation and a heterologous lactococcal system of surface protein expression were used to identify S. epidermidis surface components involved in the pathogenesis of driveline infections. Of the four components tested, SdrF, SdrG, PIA, and GehD, SdrF was identified as the primary ligand. SdrF adherence was mediated via its B domain attaching to host collagen deposited on the surface of the driveline. Antibodies directed against SdrF reduced adherence of S. epidermidis to the drivelines. SdrF was also found to adhere with high affinity to Dacron, the hydrophobic polymeric outer surface of drivelines. Solid phase binding assays showed that SdrF was also able to adhere to other hydrophobic artificial materials such as polystyrene. A murine model of infection was developed and used to test the role of SdrF during in vivo driveline infection. SdrF alone was able to mediate bacterial adherence to implanted drivelines. Anti-SdrF antibodies reduced S. epidermidis colonization of implanted drivelines. SdrF appears to play a key role in the initiation of ventricular assist device driveline infections caused by S. epidermidis. This pluripotential adherence capacity provides a potential pathway to infection with SdrF-positive commensal staphylococci first adhering to the external Dacron-coated driveline at the transcutaneous entry site, then spreading along the collagen-coated internal portion of the driveline to establish a localized infection. This capacity may also have relevance for other prosthetic device–related infections. PMID:19412528

Effect of Levosimendan on Low Cardiac Output Syndrome in Patients With Low Ejection Fraction Undergoing Coronary Artery Bypass Grafting With Cardiopulmonary Bypass

PubMed Central

Caruba, Thibaut; Grosjean, Sandrine; Amour, Julien; Ouattara, Alexandre; Villacorta, Judith; Miguet, Bertrand; Guinet, Patrick; Lévy, François; Squara, Pierre; Aït Hamou, Nora; Carillon, Aude; Boyer, Julie; Boughenou, Marie-Fazia; Rosier, Sebastien; Robin, Emmanuel; Radutoiu, Mihail; Durand, Michel; Guidon, Catherine; Desebbe, Olivier; Charles-Nelson, Anaïs; Menasché, Philippe; Rozec, Bertrand; Girard, Claude; Fellahi, Jean-Luc; Pirracchio, Romain; Chatellier, Gilles

2017-01-01

Importance Low cardiac output syndrome after cardiac surgery is associated with high morbidity and mortality in patients with impaired left ventricular function. Objective To assess the ability of preoperative levosimendan to prevent postoperative low cardiac output syndrome. Design, Setting, and Participants Randomized, double-blind, placebo-controlled trial conducted in 13 French cardiac surgical centers. Patients with a left ventricular ejection fraction less than or equal to 40% and scheduled for isolated or combined coronary artery bypass grafting with cardiopulmonary bypass were enrolled from June 2013 until May 2015 and followed during 6 months (last follow-up, November 30, 2015). Interventions Patients were assigned to a 24-hour infusion of levosimendan 0.1 µg/kg/min (n = 167) or placebo (n = 168) initiated after anesthetic induction. Main Outcomes and Measures Composite end point reflecting low cardiac output syndrome with need for a catecholamine infusion 48 hours after study drug initiation, need for a left ventricular mechanical assist device or failure to wean from it at 96 hours after study drug initiation when the device was inserted preoperatively, or need for renal replacement therapy at any time postoperatively. It was hypothesized that levosimendan would reduce the incidence of this composite end point by 15% in comparison with placebo. Results Among 336 randomized patients (mean age, 68 years; 16% women), 333 completed the trial. The primary end point occurred in 87 patients (52%) in the levosimendan group and 101 patients (61%) in the placebo group (absolute risk difference taking into account center effect, −7% [95% CI, −17% to 3%]; P = .15). Predefined subgroup analyses found no interaction with ejection fraction less than 30%, type of surgery, and preoperative use of β-blockers, intra-aortic balloon pump, or catecholamines. The prevalence of hypotension (57% vs 48%), atrial fibrillation (50% vs 40%), and other adverse events did not significantly differ between levosimendan and placebo. Conclusions and Relevance Among patients with low ejection fraction who were undergoing coronary artery bypass grafting with cardiopulmonary bypass, levosimendan compared with placebo did not result in a significant difference in the composite end point of prolonged catecholamine infusion, use of left ventricular mechanical assist device, or renal replacement therapy. These findings do not support the use of levosimendan for this indication. Trial Registration EudraCT Number: 2012-000232-25; clinicaltrials.gov Identifier: NCT02184819 PMID:28787507

Large-Vessel Sealing in Laparoscopic Colectomy with an Ultrasonic Device

PubMed Central

Plasencia, Gustavo; Van der Speeten, Kurt; Hinoul, Piet; Batiller, Jonathan; Severin, Kimberley S.; Schwiers, Michael L.; Rockall, Tim

2016-01-01

Background and Objective: The Harmonic ACE+7 Shears with Advanced Hemostasis Mode (Ethicon, Somerville, NJ, USA) is an ultrasonic device designed to transect and seal vessels up to 7 mm in diameter. The device applies an algorithm that optimizes ultrasonic energy delivery combined with a longer sealing cycle. The purpose of this study was to assess the initial clinical experience with the Harmonic device by evaluating large-vessel sealing during laparoscopic colectomy in consecutive cases. Methods: This prospective, multicenter, observational series involved 40 adult patients who were to undergo elective laparoscopic colectomy where dissection and transection of the inferior mesenteric artery was indicated. The primary study endpoint was first-pass hemostasis, defined as a single activation of the Advanced Hemostasis Mode to transect and seal the inferior mesenteric artery. The use of any additional energy device or hemostatic product to establish or maintain hemostasis was noted. Patients were observed after surgery for ∼4 weeks for adverse events that were considered to be related to the study procedure or study device. Descriptive statistical analyses were performed for study endpoints. Results: Forty patients underwent the laparoscopic colectomy procedure. First-pass hemostasis of the inferior mesenteric artery was achieved and maintained in all 40 patients, with no required additional hemostatic measures. Exposure of the vessel was reported as skeletonized in 22 of 40 (55%) patients. Mean transection time was 21.9 ± 7.4 s. One adverse event (postoperative anemia) was considered possibly related to the study device. Conclusion: In this initial clinical consecutive series, the device demonstrated successful transection and sealing of the large mesenteric vessels during laparoscopic colorectal surgery. PMID:27186065

The potential cost-effectiveness of the Diamondback 360® Coronary Orbital Atherectomy System for treating de novo, severely calcified coronary lesions: an economic modeling approach

PubMed Central

Chambers, Jeffrey; Généreux, Philippe; Lee, Arthur; Lewin, Jack; Young, Christopher; Crittendon, Janna; Mann, Marita; Garrison, Louis P.

2015-01-01

Background: Patients who undergo percutaneous coronary intervention (PCI) for severely calcified coronary lesions have long been known to have worse clinical and economic outcomes than patients with no or mildly calcified lesions. We sought to assess the likely cost-effectiveness of using the Diamondback 360® Orbital Atherectomy System (OAS) in the treatment of de novo, severely calcified lesions from a health-system perspective. Methods and results: In the absence of a head-to-head trial and long-term follow up, cost-effectiveness was based on a modeled synthesis of clinical and economic data. A cost-effectiveness model was used to project the likely economic impact. To estimate the net cost impact, the cost of using the OAS technology in elderly (⩾ 65 years) Medicare patients with de novo severely calcified lesions was compared with cost offsets. Elderly OAS patients from the ORBIT II trial (Evaluate the Safety and Efficacy of OAS in Treating Severely Calcified Coronary Lesions) [ClinicalTrials.gov identifier: NCT01092426] were indirectly compared with similar patients using observational data. For the index procedure, the comparison was with Medicare data, and for both revascularization and cardiac death in the following year, the comparison was with a pooled analysis of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI)/Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trials. After adjusting for differences in age, gender, and comorbidities, the ORBIT II mean index procedure costs were 17% (p < 0.001) lower, approximately US$2700. Estimated mean revascularization costs were lower by US$1240 in the base case. These cost offsets in the first year, on average, fully cover the cost of the device with an additional 1.2% cost savings. Even in the low-value scenario, the use of the OAS is cost-effective with a cost per life-year gained of US$11,895. Conclusions: Based on economic modeling, the recently approved coronary OAS device is projected to be highly cost-effective for patients who undergo PCI for severely calcified lesions. PMID:26702147

The potential cost-effectiveness of the Diamondback 360® Coronary Orbital Atherectomy System for treating de novo, severely calcified coronary lesions: an economic modeling approach.

PubMed

Chambers, Jeffrey; Généreux, Philippe; Lee, Arthur; Lewin, Jack; Young, Christopher; Crittendon, Janna; Mann, Marita; Garrison, Louis P

2016-04-01

Patients who undergo percutaneous coronary intervention (PCI) for severely calcified coronary lesions have long been known to have worse clinical and economic outcomes than patients with no or mildly calcified lesions. We sought to assess the likely cost-effectiveness of using the Diamondback 360(®) Orbital Atherectomy System (OAS) in the treatment of de novo, severely calcified lesions from a health-system perspective. In the absence of a head-to-head trial and long-term follow up, cost-effectiveness was based on a modeled synthesis of clinical and economic data. A cost-effectiveness model was used to project the likely economic impact. To estimate the net cost impact, the cost of using the OAS technology in elderly (⩾ 65 years) Medicare patients with de novo severely calcified lesions was compared with cost offsets. Elderly OAS patients from the ORBIT II trial (Evaluate the Safety and Efficacy of OAS in Treating Severely Calcified Coronary Lesions) [ClinicalTrials.gov identifier: NCT01092426] were indirectly compared with similar patients using observational data. For the index procedure, the comparison was with Medicare data, and for both revascularization and cardiac death in the following year, the comparison was with a pooled analysis of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI)/Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trials. After adjusting for differences in age, gender, and comorbidities, the ORBIT II mean index procedure costs were 17% (p < 0.001) lower, approximately US$2700. Estimated mean revascularization costs were lower by US$1240 in the base case. These cost offsets in the first year, on average, fully cover the cost of the device with an additional 1.2% cost savings. Even in the low-value scenario, the use of the OAS is cost-effective with a cost per life-year gained of US$11,895. Based on economic modeling, the recently approved coronary OAS device is projected to be highly cost-effective for patients who undergo PCI for severely calcified lesions. © The Author(s), 2015.

Subclinical ischemic events in patients undergoing carotid artery stent placement: comparison of proximal and distal protection techniques.

PubMed

Aytac, Emrah; Gürkaş, Erdem; Akpinar, Cetin Kursad; Saleem, Muhammad A; Qureshi, Adnan I

2017-10-01

To determine the relative effectiveness of proximal and distal protection in prevention of cerebral ischemic events during carotid artery stent (CAS) placement using diffusion-weighted MRI (DW-MRI). We analyzed data from patients who had undergone DW-MRI before and within 24 hours of CAS for symptomatic internal carotid artery (ICA) stenosis (with last ischemic events within 3 months). The study was performed prospectively; patients were not randomized, and were treated either with a proximal balloon occlusion system (Mo.Ma; Invatec, Roncadelle, Italy) or filter-type distal protection device (Spider device; ev3, Plymouth, Minnesota, USA). Of the 45 patients (mean age±SD: 66.9±9.8 years; 73.3% were men) who underwent CAS, 19 had proximal protection and 26 distal protection. New ischemic lesions were detected in 26/45 patients on DW-MRI scans obtained within 24 hours after CAS. The proportion of patients with new lesions on DW-MRI at 24 hours was not different between the two groups (47.4% vs 65.4% for proximal and distal protection, respectively). The mean number of new ischemic lesions on post-CAS DW-MRI was non-significantly higher in patients who underwent CAS with distal protection (2.80±3.54 for proximal protection vs 4.96±5.11 for distal protection; p=0.12). The proportion of patients with new lesions >1 cm did not differ between the two groups (5.3% for proximal protection vs 11.5% for distal protection; p=0.62). There was no difference in the rates of ischemic stroke between patients who underwent CAS treatment using proximal and distal protection (5.3% vs 7.7%; p=1.000). We found a relatively high rate of new ischemic lesions in patients undergoing CAS with cerebral protection. There was no difference in the proportion of patients with new lesions between patients treated using distal protection and those treated using proximal protection. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Femoral Access PCI in a Default Radial Center Identifies High-Risk Patients With Poor Outcomes.

PubMed

Uddin, Muezz; Bundhoo, Shantu; Mitra, Rito; Ossei-Gerning, Nicholas; Morris, Keith; Anderson, Richard; Kinnaird, Tim

2015-10-01

Increasingly the trans-radial route (TRR) is preferred over the trans-femoral route (TFR) for PCI. However, even in high volume default TRR centers a cohort of patients undergo TFR PCI. We examined the demographics, procedural characteristics, and outcomes of patients undergoing PCI via the TF. The patient demographics, procedural data, and outcomes of 5,379 consecutive patients undergoing PCI at a default radial center between 2009 and 2012 were examined. Major bleeding (MB) was classified by ACUITY and BARC definitions. A total of 559 (10.4%) patients underwent PCI via the TFR and 4,820 patients via the TRR (89.6%). Baseline variables associated with TFR were shock, previous CABG, chronic total occlusion intervention, rotablation/laser use, female sex, and renal failure. Sixty-five patients of the TFR cohort (11.6%) experienced MB with 27 (41.5%) being access site related. MB was significantly more frequent than in the radial cohort. The variables independently associated with MB in the TFR cohort were renal failure, acute presentation, shock, and age. In the TFR, patients with MB mortality was high at 30 days (17.2% vs 2.6% for no MB, P < 0.0001) and at 1 year (37.6% vs 5.0%, P < 0.0001). Shock and MB were highly predictive of 30 day and 12 month mortality. In a default radial PCI center 10% of patients undergo PCI via the femoral artery. These patients have high baseline bleeding risk and undergo complex interventions. As a result the incidence of major bleeding, transfusion and death are high. Alternative strategies are required to optimize outcomes in this select group. © 2015, Wiley Periodicals, Inc.

Outcomes of Highly Sensitized Patients Undergoing Simultaneous Liver and Kidney Transplantation: A Single-Center Experience With Desensitization.

PubMed

Steggerda, J A; Kang, A; Pan, S-H; Sundaram, V; Nissen, N N; Klein, A S; Todo, T; Annamalai, A; Vo, A; Jordan, S C; Kim, I K

Preformed donor-specific human leukocyte antigen antibodies (DSAs) in patients undergoing simultaneous liver and kidney transplantation (SLKT) are an independent risk factor for poorer patient and renal allograft survival. The outcomes of patients highly sensitized (HS) against HLA antigens undergoing SLKT and select HS SLKT recipients undergoing desensitization at a high-volume desensitization center were investigated. Seventy-five patients undergoing SLKT at a high-volume desensitization center between January 1, 2001, and December 31, 2015, were retrospectively reviewed. HS patients were defined by panel-reactive antibody (PRA) >30% (n = 17 patients), 11 of whom received pre- or perioperative desensitization with high-dose intravenous immunoglobulin (IVIG) ± rituximab. HS patients had significantly higher class I and class II PRA (class I = 41.3% ± 40.0% vs 2.5% ± 6.3%; class II = 45.7% ± 36.4% vs 1.0% ± 2.9%; P < .001), were more likely to be female (P = .05), and more likely to have had a prior transplant (P = .03). HS patients demonstrated greater susceptibility to renal cell-mediated rejection (CMR) (23.5% vs 5.2%, P = .02) compared to nonsensitized patients. Higher renal antibody-mediated rejection (ABMR) was also observed in HS patients, 11.8% vs 3.4%, but did not reach significance (P = .18). Desensitization in select HS SLKT patients was well tolerated but did not improve patient and allograft survival or significantly curtail rejection. HS SLKT recipients demonstrated increased allograft rejection, particularly CMR, but patient and graft survival were not impacted in the first year post-transplant. Select HS SLKT patients tolerated desensitization with high-dose IVIG ± rituximab and may have received additional immunoprotection against ABMR but survival was not affected. Copyright © 2017 Elsevier Inc. All rights reserved.

Stability of Programmable Shunt Valve Settings with Simultaneous Use of the Optune Transducer Array: A Case Report.

PubMed

Chan, Andrew K; Birk, Harjus S; Winkler, Ethan A; Viner, Jennifer A; Taylor, Jennie W; McDermott, Michael W

2016-07-07

The Optune® transducer array (Novocure Ltd., Haifa, Israel) is an FDA-approved noninvasive regional therapy that aims to inhibit the growth of glioblastoma multiforme (GBM) cells via utilization of alternating electric fields. Some patients with GBM may develop hydrocephalus and benefit from subsequent shunt placement, but special attention must be paid to patients in whom programmable valves are utilized, given the potential effect of the magnetic fields on valve settings. We present the first case report illustrating the stability of programmable shunt valve settings in a neurosurgical patient undergoing therapy with the Optune device. In this study, shunt valve settings were stable over a period of five days despite Optune therapy. This is reassuring for patients with GBM who require simultaneous treatment with both the Optune device and a programmable shunt system.

Weather and atmosphere observation with the ATOM all-sky camera

NASA Astrophysics Data System (ADS)

Jankowsky, Felix; Wagner, Stefan

2015-03-01

The Automatic Telescope for Optical Monitoring (ATOM) for H.E.S.S. is an 75 cm optical telescope which operates fully automated. As there is no observer present during observation, an auxiliary all-sky camera serves as weather monitoring system. This device takes an all-sky image of the whole sky every three minutes. The gathered data then undergoes live-analysis by performing astrometric comparison with a theoretical night sky model, interpreting the absence of stars as cloud coverage. The sky monitor also serves as tool for a meteorological analysis of the observation site of the the upcoming Cherenkov Telescope Array. This overview covers design and benefits of the all-sky camera and additionally gives an introduction into current efforts to integrate the device into the atmosphere analysis programme of H.E.S.S.

En-masse protraction of mandibular posterior teeth into missing mandibular lateral incisor spaces using a fixed functional appliance.

PubMed

Chhibber, Aditya; Upadhyay, Madhur

2016-11-01

Protraction of mandibular posterior teeth requiring absolute anchorage has always been a challenge, especially when the space is located in the anterior region, since more teeth must be protracted. Traditionally, skeletal anchorage devices have been used for anchorage reinforcement during protraction. However, drawbacks such as requirement of a surgical step, inability to tolerate heavy forces, and patient willingness to undergo such surgical procedures can be limiting factors. Additionally, the mechanics involved can sometimes create undesirable side effects, thereby limiting their application in such situations. This report describes the use of a fixed functional appliance as an anchorage-reinforcement device for en-masse protraction of mandibular posterior teeth into a missing lateral incisor space. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Polyimide-Epoxy Composites with Superior Bendable Properties for Application in Flexible Electronics

NASA Astrophysics Data System (ADS)

Lee, Sangyoup; Yoo, Taewon; Han, Youngyu; Kim, Hanglim; Han, Haksoo

2017-08-01

The need for flexible electronics with outstanding bending properties is increasing due to the demand for wearable devices and next-generation flexible or rollable smartphones. In addition, the requirements for flexible or rigid-flexible electronics are sharply increasing to achieve the design of space-saving electronic devices. In this regard, coverlay (CL) film is a key material used in the bending area of flexible electronics, albeit infrequently. Because flexible electronics undergo folding and unfolding numerous times, CL films with superior mechanical and bending properties are required so that the bending area can endure such severe stress. However, because current CL films are only used for a designated bending area in the flexible electronics panel, their highly complicated and expensive manufacturing procedure is a disadvantage. In addition, the thickness of CL films must be decreased to satisfy the ongoing requirement for increasingly thin products. However, due to the limitations of the two-layer structure of existing CL films, the manufacturing process cannot be made more cost effective by simply applying more thin film onto the board. To address this problem, we have developed liquid coverlay inks (LCIs) with superior bendable properties, in comparison with CL films, when applied onto flexible electronics using a screen-printing method. The results show that LCIs have the potential to become one of the leading candidates to replace existing CL films because of their lower cost and faster manufacturing process.

Testing of Visual Field with Virtual Reality Goggles in Manual and Visual Grasp Modes

PubMed Central

Wroblewski, Dariusz; Francis, Brian A.; Sadun, Alfredo; Vakili, Ghazal; Chopra, Vikas

2014-01-01

Automated perimetry is used for the assessment of visual function in a variety of ophthalmic and neurologic diseases. We report development and clinical testing of a compact, head-mounted, and eye-tracking perimeter (VirtualEye) that provides a more comfortable test environment than the standard instrumentation. VirtualEye performs the equivalent of a full threshold 24-2 visual field in two modes: (1) manual, with patient response registered with a mouse click, and (2) visual grasp, where the eye tracker senses change in gaze direction as evidence of target acquisition. 59 patients successfully completed the test in manual mode and 40 in visual grasp mode, with 59 undergoing the standard Humphrey field analyzer (HFA) testing. Large visual field defects were reliably detected by VirtualEye. Point-by-point comparison between the results obtained with the different modalities indicates: (1) minimal systematic differences between measurements taken in visual grasp and manual modes, (2) the average standard deviation of the difference distributions of about 5 dB, and (3) a systematic shift (of 4–6 dB) to lower sensitivities for VirtualEye device, observed mostly in high dB range. The usability survey suggested patients' acceptance of the head-mounted device. The study appears to validate the concepts of a head-mounted perimeter and the visual grasp mode. PMID:25050326

Bending impact on the performance of a flexible Li4Ti5O12-based all-solid-state thin-film battery

PubMed Central

Vereecken, Philippe M.

2018-01-01

Abstract The growing demand of flexible electronic devices is increasing the requirements of their power sources. The effect of bending in thin-film batteries is still not well understood. Here, we successfully developed a high active area flexible all-solid-state battery as a model system that consists of thin-film layers of Li4Ti5O12, LiPON, and Lithium deposited on a novel flexible ceramic substrate. A systematic study on the bending state and performance of the battery is presented. The battery withstands bending radii of at least 14 mm achieving 70% of the theoretical capacity. Here, we reveal that convex bending has a positive effect on battery capacity showing an average increase of 5.5%, whereas concave bending decreases the capacity by 4% in contrast with recent studies. We show that the change in capacity upon bending may well be associated to the Li-ion diffusion kinetic change through the electrode when different external forces are applied. Finally, an encapsulation scheme is presented allowing sufficient bending of the device and operation for at least 500 cycles in air. The results are meant to improve the understanding of the phenomena present in thin-film batteries while undergoing bending rather than showing improvements in battery performance and lifetime. PMID:29868149

Bolt Stress Monitor

NASA Technical Reports Server (NTRS)

1978-01-01

In photo, an engineer is using a new Ultrasonic Bolt Stress Monitor developed by NASA's Langley Research Center to determine whether a bolt is properly tightened. A highly accurate device, the monitor is an important tool in construction of such structures as pressure vessels, bridges and power plants, wherein precise measurement of the stress on a tightened bolt is critical. Overtightened or undertightened bolts can fail and cause serious industrial accidents or costly equipment break-downs. There are a number of methods for measuring bolt stress. Most widely used and least costly is the torque wrench, which is inherently inaccurate; it does not take into account the friction between nut and bolt, which has an influence on stress. At the other end of the spectrum, there are accurate stress-measuring systems, but they are expensive and not portable. The battery-powered Langley monitor fills a need; it is inexpensive, lightweight, portable and extremely accurate because it is not subject to friction error. Sound waves are transmitted to the bolt and a return signal is received. As the bolt is tightened, it undergoes changes in resonance due to stress, in the manner that a violin string changes tone when it is tightened. The monitor measures the changes in resonance and provides a reading of real stress on the bolt. The device, patented by NASA, has aroused wide interest and a number of firms have applied for licenses to produce it for the commercial market.

Relationship between cognition and gait performance in older adults receiving physical therapy interventions in the home.

PubMed

Whitney, Susan L; Marchetti, Gregory F; Ellis, Jennifer; Otis, Laurie; Asiri, Faisal; Alghadir, Ahmad

2013-01-01

Persons undergoing physical therapy home services often have difficulty with mobility and gait. The purpose of this study was to determine whether there was a relationship between gait and a rating of cognitive functioning in persons undergoing home-care physical therapy services. Patients over the age of 65 (n = 11,601) seen by a home-care agency between 2007 and 2008 were included in the retrospective analysis, and 10,953 (mean +/- standard deviation age 83.2 +/- 7.1; 31%) met the criteria of being able to ambulate independently or with an assistive device. All patients attempted to perform the modified Clinical Test of Sensory Integration and Balance plus either the Performance Oriented Measurement Assessment (POMA) or the Dynamic Gait Index (DGI). Mental function was scored as part of the Outcome and Assessment Information Set. A multivariate model with adjustment for age and sex identified gait performance as measured by the DGI to be independently associated with the likelihood that a patient required cognitive prompting (p = 0.03). Both the DGI and POMA scores were independently associated with requiring assistance/dependence with cognitive tasks. There was a strong relationship between cognition and gait performance in persons undergoing physical therapy interventions in the home. Changes in gait may be related to cognitive decline.

Ticagrelor for Neuroendovascular Procedures: A Case Series.

PubMed

Davis, Kyle; Morrison, Christopher

2018-02-01

The development of thromboembolism is one of the most common complications of neuroendovascular procedures. Although several small studies have deemed clopidogrel safe and effective in the prevention of intracranial stent thrombosis, ticagrelor has yet to be assessed in this setting. The objective of this study was to retrospectively evaluate the safety and efficacy of ticagrelor in patients undergoing neuroendovascular procedures. A retrospective review of patients receiving ticagrelor following neuroendovascular aneurysm repair. A total of 5 patients undergoing neuroendovascular aneurysm repair received ticagrelor for a median of 5 days while hospitalized. Three patients were treated with stent-assisted coiling, while 2 received pipeline embolization devices. All patients received additional low-dose aspirin therapy. One patient received ticagrelor after experiencing a thrombotic event on clopidogrel, while a second patient was treated with ticagrelor after developing a dermatologic reaction to clopidogrel. Three (60%) patients were successfully treated and discharged on ticagrelor therapy. Two patients experienced cerebrovascular accidents following aneurysm repair while receiving ticagrelor, one of which was potentially due to medication omission. One (20%) patient receiving ticagrelor experienced a small retroperitoneal hematoma; however, ticagrelor therapy was continued without further complication. Therapy with ticagrelor may be a safe and effective treatment option for patients undergoing neuroendovascular aneurysm repair. However, future studies are warranted to substantiate these findings.

Radiation exposure and contrast agent use related to radial versus femoral arterial access during percutaneous coronary intervention (PCI)-Results of the FERARI study.

PubMed

Becher, Tobias; Behnes, Michael; Ünsal, Melike; Baumann, Stefan; El-Battrawy, Ibrahim; Fastner, Christian; Kuschyk, Jürgen; Papavassiliu, Theano; Hoffmann, Ursula; Mashayekhi, Kambis; Borggrefe, Martin; Akin, Ibrahim

2016-12-01

Data regarding radiation exposure related to radial versus femoral arterial access in patients undergoing percutaneous coronary intervention (PCI) remain controversial. This study aims to evaluate patients enrolled in the FERARI study regarding radiation exposure, fluoroscopy time and contrast agent use. The Femoral Closure versus Radial Compression Devices Related to Percutaneous Coronary Interventions (FERARI) study evaluated prospectively 400 patients between February 2014 and May 2015 undergoing PCI either using the radial or femoral access. In these 400 patients, baseline characteristics, procedural data such as procedural duration, fluoroscopy time, dose-area product (DAP) as well as the amount of contrast agent used were documented and analyzed. Median fluoroscopy time was not significantly different in patients undergoing radial versus femoral access (12.2 vs. 9.8min, p=0.507). Furthermore, median DAP (54.5 vs. 52.0 Gycm2, p=0.826), procedural duration (46.0 vs. 45.0min, p=0.363) and contrast agent use (185.5 vs. 199.5ml, p=0.742) were also similar in radial and femoral PCI. There was no difference regarding median fluoroscopy time, procedural duration, radiation dose or contrast agent use between radial versus femoral arterial access in PCI. Copyright © 2016 Elsevier Inc. All rights reserved.

Keratometry obtained by corneal mapping versus the IOLMaster in the prediction of postoperative refraction in routine cataract surgery.

PubMed

Dulku, Simon; Smith, Henry B; Antcliff, Richard J

2013-01-01

To establish whether simulated keratometry values obtained by corneal mapping (videokeratography) would provide a superior refractive outcome to those obtained by Zeiss IOLMaster (partial coherence interferometry) in routine cataract surgery. Prospective, non-randomized, single-surgeon study set at the The Royal United Hospital, Bath, UK, District General Hospital. Thirty-three patients undergoing routine cataract surgery in the absence of significant ocular comorbidity. Conventional biometry was recorded using the Zeiss IOLMaster. Postoperative refraction was calculated using the SRK/T formula and the most appropriate power of lens implanted. Preoperative keratometry values were also obtained using Humphrey Instruments Atlas Version A6 corneal mapping. Achieved refraction was compared with predicted refraction for the two methods of keratometry after the A-constants were optimized to obtain a mean arithmetic error of zero dioptres for each device. The mean absolute prediction error was 0.39 dioptres (standard deviation 0.29) for IOLMaster and 0.48 dioptres (standard deviation 0.31) for corneal mapping (P = 0.0015). Keratometry readings between the devices were highly correlated by Spearman correlation (0.97). The Bland-Altman plot demonstrated close agreement between keratometers, with a bias of 0.0079 dioptres and 95% limits of agreement of -0.48-0.49 dioptres. The IOLMaster was superior to Humphrey Atlas A6 corneal mapping in the prediction of postoperative refraction. This difference could not have been predicted from the keratometry readings alone. When comparing biometry devices, close agreement between readings should not be considered a substitute for actual postoperative refraction data. © 2012 The Authors. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.

Postoperative chest tube management: measuring air leak using an electronic device decreases variability in the clinical practice.

PubMed

Varela, Gonzalo; Jiménez, Marcelo F; Novoa, Nuria Maria; Aranda, José Luis

2009-01-01

Since there are no data in the literature regarding variability in the management of postoperative pleural drainages, we have designed a prospective randomized study aimed at measuring inter-observer variability in deciding when to withdraw chest tubes after lung resection and to evaluate if the use of an electronic device to measure postoperative air leak decreases clinical practice variations. Sixty-one patients undergoing pulmonary resection were randomly assigned to one of the following groups: digital group (electronic measure of pleural air leak using Millicore AB DigiVent chest drainage system) or traditional group (standard water seal pleural chamber). Chest tube withdrawal criteria were established in advance. During morning rounds, two thoracic surgeons with comparable clinical experience and blinded to the decision of their counterpart, evaluated chest tube withdrawal criteria and noted whether the tube should be withdrawn or not. Inter-observer variability kappa index and global, positive, and negative agreement rates were calculated on 2 x 2 tables. Each observation episode was considered in the calculation. Fifty-four observations were recorded in the traditional group. Kappa coefficient was 0.37 (overall agreement rate: 0.58; positive agreement rate: 0.72; and negative agreement rate: 0.64). In the digital group, 67 observations were recorded. Kappa coefficient was 0.88 (overall agreement rate: 0.94; positive agreement rate 0.94; and negative agreement rate 0.94). We have demonstrated a high rate of disagreement related to the indication to remove chest tubes after lung resection and the improvement of the agreement rate with the use of an electronic device to measure postoperative air leak and pleural pressures.

Society position statement : Canadian Cardiovascular Society/Canadian Anesthesiologists' Society/Canadian Heart Rhythm Society joint position statement on the perioperative management of patients with implanted pacemakers, defibrillators, and neurostimulating devices.

PubMed

Healey, Jeff S; Merchant, Richard; Simpson, Chris; Tang, Timothy; Beardsall, Marianne; Tung, Stanley; Fraser, Jennifer A; Long, Laurene; van Vlymen, Janet M; Manninen, Pirjo; Ralley, Fiona; Venkatraghavan, Lashmi; Yee, Raymond; Prasloski, Bruce; Sanatani, Shubhayan; Philippon, François

2012-04-01

There are more than 200,000 Canadians living with permanent pacemakers or implantable defibrillators, many of whom will require surgery or invasive procedures each year. They face potential hazards when undergoing surgery; however, with appropriate planning and education of operating room personnel, adverse device-related outcomes should be rare. This joint position statement from the Canadian Cardiovascular Society (CCS) and the Canadian Anesthesiologists' Society (CAS) has been developed as an accessible reference for physicians and surgeons, providing an overview of the key issues for the preoperative, intraoperative, and postoperative care of these patients. The document summarizes the limited published literature in this field, but for most issues, relies heavily on the experience of the cardiologists and anesthesiologists who contributed to this work. This position statement outlines how to obtain information about an individual's type of pacemaker or implantable defibrillator and its programming. It also stresses the importance of determining if a patient is highly pacemaker-dependent and proposes a simple approach for nonelective evaluation of dependency. Although the document provides a comprehensive list of the intraoperative issues facing these patients, there is a focus on electromagnetic interference resulting from electrocautery and practical guidance is given regarding the characteristics of surgery, electrocautery, pacemakers, and defibrillators which are most likely to lead to interference. The document stresses the importance of preoperative consultation and planning to minimize complications. It reviews the relative merits of intraoperative magnet use vs reprogramming of devices and gives examples of situations where one or the other approach is preferable.

Is the new Occlutech duct occluder an appropriate device for transcatheter closure of patent ductus arteriosus?

PubMed

Godart, François; Houeijeh, Ali; Domanski, Olivia; Guillaume, Marie-Paule; Brard, Mélanie; Lucron, Hugues

2018-06-15

To describe our initial experience with the Occlutech Duct Occluder (ODO) for percutaneous closure of patent ductus arteriosus (PDA). Retrospective review of patients undergoing transcatheter PDA closure with the ODO in 2 academic centers. From April 2013 to September 2017, 42 patients underwent PDA closure. Median age at implantation was 34 months (range 4 months-68 years) and median weight was 12 kg (range 4.1-57 kg). Ducts were Krichenko type A duct (n = 34), type E (n = 6), and type C (n = 2). The mean duct diameter was 3.76 mm (range 1.69 to 9.95 mm, median 3.1 mm). Implantation succeeded in all. There was neither device embolization nor hemolysis. At device release, immediate angiogram showed a small residual shunt in 54.7%. During follow-up, Doppler echocardiography demonstrated 71% of full occlusion at day one, rising to 95% at one month and 100% at one year and half after implantation. The mean maximal systolic pressure gradient in left pulmonary artery was 4.2 ± 4.3 mm and across the distal aortic arch 5.4 ± 4.7 mm Hg. No patient had any significant stenosis with clinical relevance. ODO is safe and effective in transcatheter closure of PDA including relatively large sized ducts. The results are satisfactory with a high level of full occlusion and a low rate of complications. Further evaluation with larger studies and longer follow-up will be required to confirm these preliminary good results. Copyright © 2018. Published by Elsevier B.V.

Strategy to reduce E. coli bacteraemia based on cohort data from a London teaching hospital.

PubMed

Hsu, Desmond; Melzer, Mark

2018-04-01

In 2017, National Health Service Improvement set a 10% reduction target for Escherichia coli bacteraemia by 2018, followed by a 50% reduction in healthcare-associated Gram-negative bacteraemias by 2022. We analysed consecutive cases of E. coli bacteraemia and devised a strategy to achieve these targets. From December 2012 to November 2013, demographic, clinical and microbiological data were prospectively collected on all patients with bacteraemia at the Royal London Hospital in East London, UK. There were 594 significant bacteraemic episodes and 207 (34.8%) were E. coli . Twenty-four (11.6%) of the E. coli isolates were extended spectrum beta-lactamase producers, 22 (10.6%) gentamicin resistant and 2 (1.0%) amikacin resistant. The three most common sites of infection were pyelonephritis 105 (56.7%), catheter-associated urinary tract infection 22 (10.6%), and other medical devices and procedures that cause bacteraemia 32 (15.5%). In the pyelonephritis group, trimethoprim resistance in urinary isolates was 16/47 (34.0%) compared with 3/47 (6.4%) for nitrofurantoin. Twelve months postbacteraemia, recurrent bacteraemia rates were 10/105 (9.5%). There were 44 medical device-associated E. coli bacteraemias, and 22 (50%) were urinary catheter associated. There were 10 patients with E. coli bacteraemia caused by procedures, seven genitourinary or biliary tract instrumentation and three postgastrointestinal surgery. E. coli bacteraemias related to urosepsis could have been prevented by better empirical treatment and targeted prophylaxis. Urinary catheter quality improvement programmes should contribute to a further reduction. For patients undergoing high-risk urinary or biliary tract procedures or device manipulation, we advocate single-dose amikacin prophylaxis. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Handling the procurement of prostheses for total hip replacement: description of an original value based approach and application to a real-life dataset reported in the UK

PubMed Central

Messori, Andrea; Trippoli, Sabrina; Marinai, Claudio

2017-01-01

Objectives In most European countries, innovative medical devices are not managed according to cost–utility methods, the reason being that national agencies do not generally evaluate these products. The objective of our study was to investigate the cost-utility profile of prostheses for hip replacement and to calculate a value-based score to be used in the process of procurement and tendering for these devices. Methods The first phase of our study was aimed at retrieving the studies reporting the values of QALYs, direct cost, and net monetary benefit (NMB) from patients undergoing total hip arthroplasty (THA) with different brands of hip prosthesis. The second phase was aimed at calculating, on the basis of the results of cost–utility analysis, a tender score for each device (defined according to standard tendering equations and adapted to a 0–100 scale). This allowed us to determine the ranking of each device in the simulated tender. Results We identified a single study as the source of information for our analysis. Nine device brands (cemented, cementless, or hybrid) were evaluated. The cemented prosthesis Exeter V40/Elite Plus Ogee, the cementless device Taperloc/Exceed, and the hybrid device Exeter V40/Trident had the highest NMB (£152 877, £156 356, and £156 210, respectively) and the best value-based tender score. Conclusions The incorporation of value-based criteria in the procurement process can contribute to optimising the value for money for THA devices. According to the approach described herein, the acquisition of these devices does not necessarily converge on the product with the lowest cost; in fact, more costly devices should be preferred when their increased cost is offset by the monetary value of the increased clinical benefit. PMID:29259062

Adverse Events Profile of PrePex a Non-Surgical Device for Adult Male Circumcision in a Ugandan Urban Setting

PubMed Central

Galukande, Moses; Duffy, Kevin; Bitega, Jean Paul; Rackara, Sam; Bbaale, Denis Sekavuga; Nakaggwa, Florence; Nagaddya, Teddy; Wooding, Nick; Dea, Monica; Coutinho, Alex

2014-01-01

Background Safe Male Circumcision is a proven approach for partial HIV prevention. Several sub Saharan African countries have plans to reach a prevalence of 80% of their adult males circumcised by 2015. These targets require out of ordinary organization, demand creation, timely execution and perhaps the use of SMC devices. Objective To profile Adverse Events rate and acceptance of PrePex, a non surgical device for adult male circumcision. Methods A prospective study, conducted at International Hospital Kampala, Uganda, between August and October 2012. Ethical approval was obtained from Uganda National Council of Science and Technology. Results Of 1,040 men received to undergo SMC, 678 opted for PrePex, 36 were excluded at an initial physical examination screening. 642 were enrolled and consented, and another 17 were excluded before device placement. 625 underwent the procedure. Average age was 24 years (±7). Twelve moderate AEs occurred among 10 participants 12/625, (1.9%). These were all reversible. Five had device displacement, one had an everted foreskin; five had bleeding after the device was removed and one had voiding difficulties. The majority (279 out of 300) of men interviewed complained of some pain within the week of placement. Mean pain score at device placement (using visual analogue scale) was 0.5, at device removal 4.5 and within 2 min of removal the pain score was 1.4. Over 70% of the devices were placed and removed by non-physician clinicians. Presented with a choice, 60% of men chose PrePex over surgical SMC. Close to 90% would recommend the device to their friends. Odour from the necrotic skin was a concern. Removals done 1–2 days earlier than day 7 were beneficial and conferred no extra risk. Conclusion AEs of a moderate or severe nature associated with PrePex were low and reversible. PrePex is feasible for mass safe male circumcision scaling up. PMID:24489754

Packaging of solid state devices

DOEpatents

Glidden, Steven C.; Sanders, Howard D.

2006-01-03

A package for one or more solid state devices in a single module that allows for operation at high voltage, high current, or both high voltage and high current. Low thermal resistance between the solid state devices and an exterior of the package and matched coefficient of thermal expansion between the solid state devices and the materials used in packaging enables high power operation. The solid state devices are soldered between two layers of ceramic with metal traces that interconnect the devices and external contacts. This approach provides a simple method for assembling and encapsulating high power solid state devices.

Contraindications for video capsule endoscopy

PubMed Central

Bandorski, Dirk; Kurniawan, Niehls; Baltes, Peter; Hoeltgen, Reinhard; Hecker, Matthias; Stunder, Dominik; Keuchel, Martin

2016-01-01

Video capsule endoscopy (VCE) has been applied in the last 15 years in an increasing field of applications. Although many contraindications have been put into perspective, some precautions still have to be considered. Known stenosis of the gastrointestinal tract is a clear contraindication for VCE unless surgery is already scheduled or at least has been considered as an optional treatment modality. In patients with a higher incidence of stenosis, as in an established diagnosis of Crohn’s disease, clinical signs of obstruction, prior radiation or surgical small bowel resection, a preceding test with the self-dissolving patency capsule can override this contraindication. Endoscopic placement of the capsule should be considered in patients with swallowing disorders to avoid aspiration. Esophageal or gastric motility disorders may require endoscopic capsule transport or application of prokinetics if the real-time viewer proofs delayed transit. In pregnant women, VCE should be restricted to urgent cases where diagnosis cannot be postponed after delivery, as data on safety are missing. There is theoretical and clinical evidence that patients with implanted cardiac devices such as a pacemaker, cardioverters or left heart assist devices, can safely undergo VCE in spite of still existing contraindication by manufacturers. Children from the age of 2 years have safely undergone VCE. Although video capsules are not proven safe with magnetic resonance imaging (MRI), first single cases of patients incidentally undergoing MRI with an incorporated capsule have been reported, showing susceptibility artifacts but no signs of clinical harm. PMID:28018097

Hypovitaminosis D in patients undergoing kidney transplant: the importance of sunlight exposure

PubMed Central

Vilarta, Cristiane F.; Unger, Marianna D.; dos Reis, Luciene M.; Dominguez, Wagner V.; David-Neto, Elias; Moysés, Rosa M.; Titan, Silvia; Custodio, Melani R.; Hernandez, Mariel J.; Jorgetti, Vanda

2017-01-01

OBJECTIVES: Recent studies have shown a high prevalence of hypovitaminosis D, defined as a serum 25-hydroxyvitamin D level less than 30 ng/ml, in both healthy populations and patients with chronic kidney disease. Patients undergoing kidney transplant are at an increased risk of skin cancer and are advised to avoid sunlight exposure. Therefore, these patients might share two major risk factors for hypovitaminosis D: chronic kidney disease and low sunlight exposure. This paper describes the prevalence and clinical characteristics of hypovitaminosis D among patients undergoing kidney transplant. METHODS: We evaluated 25-hydroxyvitamin D serum levels in a representative sample of patients undergoing kidney transplant. We sought to determine the prevalence of hypovitaminosis D, compare these patients with a control group, and identify factors associated with hypovitaminosis D (e.g., sunlight exposure and dietary habits). RESULTS: Hypovitaminosis D was found in 79% of patients undergoing kidney transplant, and the major associated factor was low sunlight exposure. These patients had higher creatinine and intact parathyroid hormone serum levels, with 25-hydroxyvitamin D being inversely correlated with intact parathyroid hormone serum levels. Compared with the control group, patients undergoing kidney transplant presented a higher prevalence of 25-hydroxyvitamin D deficiency and lower serum calcium, phosphate and albumin but higher creatinine and intact parathyroid hormone levels. CONCLUSIONS: Our results confirmed the high prevalence of hypovitaminosis D in patients undergoing kidney transplant. Therapeutic strategies such as moderate sunlight exposure and vitamin D supplementation should be seriously considered for this population. PMID:28793001

Hypovitaminosis D in patients undergoing kidney transplant: the importance of sunlight exposure.

PubMed

Vilarta, Cristiane F; Unger, Marianna D; Dos Reis, Luciene M; Dominguez, Wagner V; David-Neto, Elias; Moysés, Rosa M; Titan, Silvia; Custodio, Melani R; Hernandez, Mariel J; Jorgetti, Vanda

2017-07-01

Recent studies have shown a high prevalence of hypovitaminosis D, defined as a serum 25-hydroxyvitamin D level less than 30 ng/ml, in both healthy populations and patients with chronic kidney disease. Patients undergoing kidney transplant are at an increased risk of skin cancer and are advised to avoid sunlight exposure. Therefore, these patients might share two major risk factors for hypovitaminosis D: chronic kidney disease and low sunlight exposure. This paper describes the prevalence and clinical characteristics of hypovitaminosis D among patients undergoing kidney transplant. We evaluated 25-hydroxyvitamin D serum levels in a representative sample of patients undergoing kidney transplant. We sought to determine the prevalence of hypovitaminosis D, compare these patients with a control group, and identify factors associated with hypovitaminosis D (e.g., sunlight exposure and dietary habits). Hypovitaminosis D was found in 79% of patients undergoing kidney transplant, and the major associated factor was low sunlight exposure. These patients had higher creatinine and intact parathyroid hormone serum levels, with 25-hydroxyvitamin D being inversely correlated with intact parathyroid hormone serum levels. Compared with the control group, patients undergoing kidney transplant presented a higher prevalence of 25-hydroxyvitamin D deficiency and lower serum calcium, phosphate and albumin but higher creatinine and intact parathyroid hormone levels. Our results confirmed the high prevalence of hypovitaminosis D in patients undergoing kidney transplant. Therapeutic strategies such as moderate sunlight exposure and vitamin D supplementation should be seriously considered for this population.

High Pulse Wave Velocity Has a Strong Impact on Early Carotid Atherosclerosis in a Japanese General Male Population.

PubMed

Kubozono, Takuro; Miyata, Masaaki; Kawasoe, Shin; Ojima, Satoko; Yoshifuku, Shiro; Miyahara, Hironori; Maenohara, Shigeho; Ohishi, Mitsuru

2017-02-24

Although there have been several reports on the risk factors associated with intima-media thickness (IMT), many questions remain. The purpose of this study was to investigate the association between IMT and cardiovascular risk factors in a Japanese general population.Methods and Results:The study group consisted of 1,583 male subjects undergoing routine health checkups. IMT of the common carotid artery was measured by high-resolution ultrasonography. Brachial-ankle pulse wave velocity (baPWV) was measured using an automated device. Univariate analysis demonstrated that carotid IMT significantly associated with age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), baPWV, fasting glucose, low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C). Multiple logistic regression analysis for carotid atherosclerosis (carotid IMT ≥1.0 mm) was performed using obesity (BMI ≥25.0 kg/m 2 ), high BP (SBP ≥130 mmHg or DBP ≥85 mmHg), dyslipidemia (LDL-C ≥140 mg/dL, TG ≥150 mg/dL, or HDL-C <40 mg/dL), impaired fasting glucose (IFG) (fasting glucose ≥110 g/dL), and high baPWV (≥1,400 cm/s). Carotid atherosclerosis was significantly associated with only high baPWV (OR: 2.22, 95% CI: 1.24-4.17, P<0.01). High baPWV was a stronger predictor of early carotid atherosclerosis than high BP, dyslipidemia, or IFG in a Japanese general male population.

Polariton devices and quantum fluids

NASA Astrophysics Data System (ADS)

Ballarini, D.; De Giorgi, M.; Lerario, G.; Cannavale, A.; Cancellieri, E.; Bramati, A.; Gigli, G.; Laussy, F.; Sanvitto, D.

2014-02-01

Exciton-polaritons, composite particles resulting from the strong coupling between excitons and photons, have shown the capability to undergo condensation into a macroscopically coherent quantum state, demonstrating strong non-linearities and unique propagation properties. These strongly-coupled light-matter particles are promising candidates for the realization of semiconductor all-optical devices with fast time response and small energy consumption. Recently, quantum fluids of polaritons have been used to demonstrate the possibility to implement optical functionalities as spin switches, transistors or memories, but also to provide a channel for the transmission of information inside integrated circuits. In this context, the possibility to extend the range of light-matter interaction up to room temperature becomes of crucial importance. One of the most intriguing promises is to use organic Frenkel excitons, which, thanks to their huge oscillator strength, not only sustain the polariton picture at room temperature, but also bring the system into the unexplored regime of ultra-strong coupling. The combination of these materials with ad-hoc designed structures may allow the control of the propagation properties of polaritons, paving the way towards their implementation of the polariton functionalities in actual devices for opto-electronic applications.

Scaling laws for nanoFET sensors

NASA Astrophysics Data System (ADS)

Zhou, Fu-Shan; Wei, Qi-Huo

2008-01-01

The sensitive conductance change of semiconductor nanowires and carbon nanotubes in response to the binding of charged molecules provides a novel sensing modality which is generally denoted as nanoFET sensors. In this paper, we study the scaling laws of nanoplate FET sensors by simplifying nanoplates as random resistor networks with molecular receptors sitting on lattice sites. Nanowire/tube FETs are included as the limiting cases where the device width goes small. Computer simulations show that the field effect strength exerted by the binding molecules has significant impact on the scaling behaviors. When the field effect strength is small, nanoFETs have little size and shape dependence. In contrast, when the field effect strength becomes stronger, there exists a lower detection threshold for charge accumulation FETs and an upper detection threshold for charge depletion FET sensors. At these thresholds, the nanoFET devices undergo a transition between low and large sensitivities. These thresholds may set the detection limits of nanoFET sensors, while they could be eliminated by designing devices with very short source-drain distance and large width.

Radiation dominated acoustophoresis driven by surface acoustic waves.

PubMed

Guo, Jinhong; Kang, Yuejun; Ai, Ye

2015-10-01

Acoustophoresis-based particle manipulation in microfluidics has gained increasing attention in recent years. Despite the fact that experimental studies have been extensively performed to demonstrate this technique for various microfluidic applications, numerical simulation of acoustophoresis driven by surface acoustic waves (SAWs) has still been largely unexplored. In this work, a numerical model taking into account the acoustic-piezoelectric interaction was developed to simulate the generation of a standing surface acoustic wave (SSAW) field and predict the acoustic pressure field in the liquid. Acoustic radiation dominated particle tracing was performed to simulate acoustophoresis of particles with different sizes undergoing a SSAW field. A microfluidic device composed of two interdigital transducers (IDTs) for SAW generation and a microfluidic channel was fabricated for experimental validation. Numerical simulations could well capture the focusing phenomenon of particles to the pressure nodes in the experimental observation. Further comparison of particle trajectories demonstrated considerably quantitative agreement between numerical simulations and experimental results with fitting in the applied voltage. Particle switching was also demonstrated using the fabricated device that could be further developed as an active particle sorting device. Copyright © 2015 Elsevier Inc. All rights reserved.

Near-IR squaraine dye–loaded gated periodic mesoporous organosilica for photo-oxidation of phenol in a continuous-flow device

PubMed Central

Borah, Parijat; Sreejith, Sivaramapanicker; Anees, Palapuravan; Menon, Nishanth Venugopal; Kang, Yuejun; Ajayaghosh, Ayyappanpillai; Zhao, Yanli

2015-01-01

Periodic mesoporous organosilica (PMO) has been widely used for the fabrication of a variety of catalytically active materials. We report the preparation of novel photo-responsive PMO with azobenzene-gated pores. Upon activation, the azobenzene gate undergoes trans-cis isomerization, which allows an unsymmetrical near-infrared squaraine dye (Sq) to enter into the pores. The gate closure by cis-trans isomerization of the azobenzene unit leads to the safe loading of the monomeric dye inside the pores. The dye-loaded and azobenzene-gated PMO (Sq-azo@PMO) exhibits excellent generation of reactive oxygen species upon excitation at 664 nm, which can be effectively used for the oxidation of phenol into benzoquinone in aqueous solution. Furthermore, Sq-azo@PMO as the catalyst was placed inside a custom-built, continuous-flow device to carry out the photo-oxidation of phenol to benzoquinone in the presence of 664-nm light. By using the device, about 23% production of benzoquinone with 100% selectivity was achieved. The current research presents a prototype of transforming heterogeneous catalysts toward practical use. PMID:26601266

Ampoule Failure System

NASA Technical Reports Server (NTRS)

Watring, Dale A. (Inventor); Johnson, Martin L. (Inventor)

1996-01-01

An ampoule failure system for use in material processing furnaces comprising a containment cartridge and an ampoule failure sensor. The containment cartridge contains an ampoule of toxic material therein and is positioned within a furnace for processing. An ampoule failure probe is positioned in the containment cartridge adjacent the ampoule for detecting a potential harmful release of toxic material therefrom during processing. The failure probe is spaced a predetermined distance from the ampoule and is chemically chosen so as to undergo a timely chemical reaction with the toxic material upon the harmful release thereof. The ampoule failure system further comprises a data acquisition system which is positioned externally of the furnace and is electrically connected to the ampoule failure probe so as to form a communicating electrical circuit. The data acquisition system includes an automatic shutdown device for shutting down the furnace upon the harmful release of toxic material. It also includes a resistance measuring device for measuring the resistance of the failure probe during processing. The chemical reaction causes a step increase in resistance of the failure probe whereupon the automatic shutdown device will responsively shut down the furnace.

Comparison of intra-ocular pressure changes with liquid or flat applanation interfaces in a femtosecond laser platform.

PubMed

Williams, G P; Ang, H P; George, B L; Liu, Y C; Peh, G; Izquierdo, L; Tan, D T; Mehta, J S

2015-10-06

Cataract surgery is the most common surgical procedure and femtosecond laser assisted cataract surgery (FLACS) has gained increased popularity. FLACS requires the application of a suction device to stabilize the laser head and focus the laser beam accurately. This may cause a significant escalation in intra-ocular pressure (IOP), which poses potential risks for patients undergoing cataract surgery. In this study we aimed to assess the effect of the Ziemer LDV Z8 femtosecond cataract machine on IOP. We demonstrated through a porcine model that IOP was significantly higher with a flat interface but could be abrogated by reducing surgical compression and vacuum. Pressure was lower with a liquid interface, and further altering angulation of the laser arm could reduce the IOP to 36 mmHg. A pilot series in patients showed comparable pressure rises with the porcine model (30 mmHg). These strategies may improve the safety profile in patients vulnerable to high pressure when employing FLACS with the Ziemer LDV Z8.

Magnetic assembly of transparent and conducting graphene-based functional composites

PubMed Central

Le Ferrand, Hortense; Bolisetty, Sreenath; Demirörs, Ahmet F.; Libanori, Rafael; Studart, André R.; Mezzenga, Raffaele

2016-01-01

Innovative methods producing transparent and flexible electrodes are highly sought in modern optoelectronic applications to replace metal oxides, but available solutions suffer from drawbacks such as brittleness, unaffordability and inadequate processability. Here we propose a general, simple strategy to produce hierarchical composites of functionalized graphene in polymeric matrices, exhibiting transparency and electron conductivity. These are obtained through protein-assisted functionalization of graphene with magnetic nanoparticles, followed by magnetic-directed assembly of the graphene within polymeric matrices undergoing sol–gel transitions. By applying rotating magnetic fields or magnetic moulds, both graphene orientation and distribution can be controlled within the composite. Importantly, by using magnetic virtual moulds of predefined meshes, graphene assembly is directed into double-percolating networks, reducing the percolation threshold and enabling combined optical transparency and electrical conductivity not accessible in single-network materials. The resulting composites open new possibilities on the quest of transparent electrodes for photovoltaics, organic light-emitting diodes and stretchable optoelectronic devices. PMID:27354243

Biologics industry challenges for developing diagnostic tests for the National Veterinary Stockpile.

PubMed

Hardham, J M; Lamichhane, C M

2013-01-01

Veterinary diagnostic products generated ~$3 billion US dollars in global sales in 2010. This industry is poised to undergo tremendous changes in the next decade as technological advances move diagnostic products from the traditional laboratory-based and handheld immunologic assays towards highly technical, point of care devices with increased sensitivity, specificity, and complexity. Despite these opportunities for advancing diagnostic products, the industry continues to face numerous challenges in developing diagnostic products for emerging and foreign animal diseases. Because of the need to deliver a return on the investment, research and development dollars continue to be focused on infectious diseases that have a negative impact on current domestic herd health, production systems, or companion animal health. Overcoming the administrative, legal, fiscal, and technological barriers to provide veterinary diagnostic products for the National Veterinary Stockpile will reduce the threat of natural or intentional spread of foreign diseases and increase the security of the food supply in the US.

Rationalizing the light-induced phase separation of mixed halide organic–inorganic perovskites

DOE Office of Scientific and Technical Information (OSTI.GOV)

Draguta, Sergiu; Sharia, Onise; Yoon, Seog Joon

Mixed halide hybrid perovskites, CH 3NH 3Pb(I 1-xBrx) 3' represent good candidates for lowcost, high efficiency photovoltaic, and light-emitting devices. Their band gaps can be tuned from 1.6 to 2.3 eV, by changing the halide anion identity. Unfortunately, mixed halide perovskites undergo phase separation under illumination. This leads to iodide- and bromide-rich domains along with corresponding changes to the material’s optical/electrical response. Here, using combined spectroscopic measurements and theoretical modeling, we quantitatively rationalize all microscopic processes that occur during phase separation. Our model suggests that the driving force behind phase separation is the bandgap reduction of iodiderich phases. It additionallymore » explains observed non-linear intensity dependencies, as well as self-limited growth of iodide-rich domains. Most importantly, our model reveals that mixed halide perovskites can be stabilized against phase separation by deliberately engineering carrier diffusion lengths and injected carrier densities.« less

Rationalizing the light-induced phase separation of mixed halide organic–inorganic perovskites

DOE PAGES

Draguta, Sergiu; Sharia, Onise; Yoon, Seog Joon; ...

2017-08-04

Mixed halide hybrid perovskites, CH 3NH 3Pb(I 1-xBrx) 3' represent good candidates for lowcost, high efficiency photovoltaic, and light-emitting devices. Their band gaps can be tuned from 1.6 to 2.3 eV, by changing the halide anion identity. Unfortunately, mixed halide perovskites undergo phase separation under illumination. This leads to iodide- and bromide-rich domains along with corresponding changes to the material’s optical/electrical response. Here, using combined spectroscopic measurements and theoretical modeling, we quantitatively rationalize all microscopic processes that occur during phase separation. Our model suggests that the driving force behind phase separation is the bandgap reduction of iodiderich phases. It additionallymore » explains observed non-linear intensity dependencies, as well as self-limited growth of iodide-rich domains. Most importantly, our model reveals that mixed halide perovskites can be stabilized against phase separation by deliberately engineering carrier diffusion lengths and injected carrier densities.« less

Design and performance of a vacuum-bottle solid-state calorimeter

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bracken, D.S.; Biddle, R.; Cech, R.

1997-11-01

EG and G Mound Applied Technologies calorimetry personnel have developed a small, thermos-bottle solid-state calorimeter, which is now undergoing performance testing at Los Alamos National Laboratory. The thermos-bottle solid-state calorimeter is an evaluation prototype for characterizing the heat output of small heat standards and other homogeneous heat sources. The current maximum sample size is 3.5 in. long with a diameter of 0.8 in. The overall size of the thermos bottle and thermoelectric cooling device is 9.25 in. high by 3.75 in. diameter and less than 3 lb. Coupling this unit with compact electronics and a laptop computer makes this calorimetermore » easily hand carried by a single individual. This compactness was achieved by servo controlling the reference temperature below room temperature and replacing the water bath used in conventional calorimeter design with the thermos-bottle insulator. Other design features will also be discussed. The performance of the calorimeter will be presented.« less

Imaging of super-fast dynamics and flow instabilities of superconducting vortices

DOE PAGES

Embon, L.; Anahory, Y.; Jelić, Ž. L.; ...

2017-07-20

Quantized magnetic vortices driven by electric current determine key electromagnetic properties of superconductors. And while the dynamic behavior of slow vortices has been thoroughly investigated, the physics of ultrafast vortices under strong currents remains largely unexplored. Here, we use a nanoscale scanning superconducting quantum interference device to image vortices penetrating into a superconducting Pb film at rates of tens of GHz and moving with velocities of up to tens of km/s, which are not only much larger than the speed of sound but also exceed the pair-breaking speed limit of superconducting condensate. These experiments reveal formation of mesoscopic vortex channelsmore » which undergo cascades of bifurcations as the current and magnetic field increase. Our numerical simulations predict metamorphosis of fast Abrikosov vortices into mixed Abrikosov-Josephson vortices at even higher velocities. Our work offers an insight into the fundamental physics of dynamic vortex states of superconductors at high current densities, crucial for many applications.« less

Two Different Maintenance Strategies in the Hospital Environment: Preventive Maintenance for Older Technology Devices and Predictive Maintenance for Newer High-Tech Devices.

PubMed

Sezdi, Mana

2016-01-01

A maintenance program generated through the consideration of characteristics and failures of medical equipment is an important component of technology management. However, older technology devices and newer high-tech devices cannot be efficiently managed using the same strategies because of their different characteristics. This study aimed to generate a maintenance program comprising two different strategies to increase the efficiency of device management: preventive maintenance for older technology devices and predictive maintenance for newer high-tech devices. For preventive maintenance development, 589 older technology devices were subjected to performance verification and safety testing (PVST). For predictive maintenance development, the manufacturers' recommendations were used for 134 high-tech devices. These strategies were evaluated in terms of device reliability. This study recommends the use of two different maintenance strategies for old and new devices at hospitals in developing countries. Thus, older technology devices that applied only corrective maintenance will be included in maintenance like high-tech devices.

Two Different Maintenance Strategies in the Hospital Environment: Preventive Maintenance for Older Technology Devices and Predictive Maintenance for Newer High-Tech Devices

PubMed Central

Sezdi, Mana

2016-01-01

A maintenance program generated through the consideration of characteristics and failures of medical equipment is an important component of technology management. However, older technology devices and newer high-tech devices cannot be efficiently managed using the same strategies because of their different characteristics. This study aimed to generate a maintenance program comprising two different strategies to increase the efficiency of device management: preventive maintenance for older technology devices and predictive maintenance for newer high-tech devices. For preventive maintenance development, 589 older technology devices were subjected to performance verification and safety testing (PVST). For predictive maintenance development, the manufacturers' recommendations were used for 134 high-tech devices. These strategies were evaluated in terms of device reliability. This study recommends the use of two different maintenance strategies for old and new devices at hospitals in developing countries. Thus, older technology devices that applied only corrective maintenance will be included in maintenance like high-tech devices. PMID:27195666

Percutaneous assist devices in acute myocardial infarction with cardiogenic shock: Review, meta-analysis

PubMed Central

Romeo, Francesco; Acconcia, Maria Cristina; Sergi, Domenico; Romeo, Alessia; Francioni, Simona; Chiarotti, Flavia; Caretta, Quintilio

2016-01-01

AIM: To assess the impact of percutaneous cardiac support in cardiogenic shock (CS) complicating acute myocardial infarction (AMI), treated with percutaneous coronary intervention. METHODS: We selected all of the studies published from January 1st, 1997 to May 15st, 2015 that compared the following percutaneous mechanical support in patients with CS due to AMI undergoing myocardial revascularization: (1) intra-aortic balloon pump (IABP) vs Medical therapy; (2) percutaneous left ventricular assist devices (PLVADs) vs IABP; (3) complete extracorporeal life support with extracorporeal membrane oxygenation (ECMO) plus IABP vs IABP alone; and (4) ECMO plus IABP vs ECMO alone, in patients with AMI and CS undergoing myocardial revascularization. We evaluated the impact of the support devices on primary and secondary endpoints. Primary endpoint was the inhospital mortality due to any cause during the same hospital stay and secondary endpoint late mortality at 6-12 mo of follow-up. RESULTS: One thousand two hundred and seventy-two studies met the initial screening criteria. After detailed review, only 30 were selected. There were 6 eligible randomized controlled trials and 24 eligible observational studies totaling 15799 patients. We found that the inhospital mortality was: (1) significantly higher with IABP support vs medical therapy (RR = +15%, P = 0.0002); (2) was higher, although not significantly, with PLVADs compared to IABP (RR = +14%, P = 0.21); and (3) significantly lower in patients treated with ECMO plus IABP vs IABP (RR = -44%, P = 0.0008) or ECMO (RR = -20%, P = 0.006) alone. In addition, Trial Sequential Analysis showed that in the comparison of IABP vs medical therapy, the sample size was adequate to demonstrate a significant increase in risk due to IABP. CONCLUSION: Inhospital mortality was significantly higher with IABP vs medical therapy. PLVADs did not reduce early mortality. ECMO plus IABP significantly reduced inhospital mortality compared to IABP. PMID:26839661

Cost savings associated with prevention of recurrent lumbar disc herniation with a novel annular closure device: a multicenter prospective cohort study.

PubMed

Parker, Scott L; Grahovac, Gordan; Vukas, Duje; Ledic, Darko; Vilendecic, Milorad; McGirt, Matthew J

2013-09-01

Same-level recurrent disc herniation is a well-defined complication following lumbar discectomy. Reherniation results in increased morbidity and health care costs. Techniques to reduce these consequences may improve outcomes and reduce cost after lumbar discectomy. In a prospective cohort study, we set out to evaluate the cost associated with surgical management of recurrent, same-level lumbar disc herniation following primary discectomy. Forty-six consecutive European patients undergoing lumbar discectomy for a single-level herniated disc at two institutions were prospectively followed with clinical and radiographic evaluations. A second consecutive cohort of 30 patients undergoing 31 lumbar discectomies with implantation of an annular closure device was followed at the same hospitals and same follow-up intervals. Cost estimates for reherniation were modeled on Medicare national allowable payment amounts (direct cost) and patient work-day losses (indirect cost). Annular closure and control cohorts were matched at baseline. By 2 years follow-up, symptomatic recurrent same-level disc herniation occurred in three (6.5%) patients in the control cohort versus zero (0%) patients in the annular closure cohort. For patients experiencing recurrent disc herniation, mean estimated direct and indirect cost of management of recurrent disc herniation was $34,242 and $3,778, respectively. Use of an annular closure device potentially results in a cost savings of $222,573 per 100 primary discectomy procedures performed (or $2,226 per discectomy), based solely on the reduction of reoperated reherniations when modeled on U.S. Medicare costs. Recurrent disc herniation did not occur in any patients after annular closure within the 12-month follow-up. The reduction in the incidence of reherniation was associated with potentially significant cost savings. Development of novel techniques to prevent recurrent lumbar disc herniation is warranted to decrease the associated morbidity and health care costs associated with this complication. Georg Thieme Verlag KG Stuttgart · New York.

Thermal Properties of Microstrain Gauges Used for Protection of Lithium-Ion Cells of Different Designs

NASA Technical Reports Server (NTRS)

Jeevarajan, Judith

2011-01-01

The purpose of this innovation is to use microstrain gauges to monitor minute changes in temperature along with material properties of the metal cans and pouches used in the construction of lithium-ion cells. The sensitivity of the microstrain gauges to extremely small changes in temperatures internal to the cells makes them a valuable asset in controlling the hazards in lithium-ion cells. The test program on lithium-ion cells included various cell configurations, including the pouch type configurations. The thermal properties of microstrain gauges have been found to contribute significantly as safety monitors in lithium-ion cells that are designed even with hard metal cases. Although the metal cans do not undergo changes in material property, even under worst-case unsafe conditions, the small changes in thermal properties observed during charge and discharge of the cell provide an observable change in resistance of the strain gauge. Under abusive or unsafe conditions, the change in the resistance is large. This large change is observed as a significant change in slope, and this can be used to prevent cells from going into a thermal runaway condition. For flexible metal cans or pouch-type lithium-ion cells, combinations of changes in material properties along with thermal changes can be used as an indication for the initiation of an unsafe condition. Lithium-ion cells have a very high energy density, no memory effect, and almost 100-percent efficiency of charge and discharge. However, due to the presence of a flammable electrolyte, along with the very high energy density and the capability of releasing oxygen from the cathode, these cells can go into a hazardous condition of venting, fire, and thermal runaway. Commercial lithium-ion cells have current and voltage monitoring devices that are used to control the charge and discharge of the batteries. Some lithium-ion cells have internal protective devices, but when used in multi-cell configurations, these protective devices either do not protect or are themselves a hazard to the cell due to their limitations. These devices do not help in cases where the cells develop high impedance that suddenly causes them to go into a thermal runaway condition. Temperature monitoring typically helps with tracking the performance of a battery. But normal thermistors or thermal sensors do not provide the accuracy needed for this and cannot track a change in internal cell temperatures until it is too late to stop a thermal runaway.

Electroacoustic control of Rijke tube instability

NASA Astrophysics Data System (ADS)

Zhang, Yumin; Huang, Lixi

2017-11-01

Unsteady heat release coupled with pressure fluctuation triggers the thermoacoustic instability which may damage a combustion chamber severely. This study demonstrates an electroacoustic control approach of suppressing the thermoacoustic instability in a Rijke tube by altering the wall boundary condition. An electrically shunted loudspeaker driver device is connected as a side-branch to the main tube via a small aperture. Tests in an impedance tube show that this device has sound absorption coefficient up to 40% under normal incidence from 100 Hz to 400 Hz, namely over two octaves. Experimental result demonstrates that such a broadband acoustic performance can effectively eliminate the Rijke-tube instability from 94 Hz to 378 Hz (when the tube length varies from 1.8 m to 0.9 m, the first mode frequency for the former is 94 Hz and the second mode frequency for the latter is 378 Hz). Theoretical investigation reveals that the devices act as a damper draining out sound energy through a tiny hole to eliminate the instability. Finally, it is also estimated based on the experimental data that small amount of sound energy is actually absorbed when the system undergoes a transition from the unstable to stable state if the contrpaol is activated. When the system is actually stabilized, no sound is radiated so no sound energy needs to be absorbed by the control device.

Clean Water for Remote Locations

NASA Technical Reports Server (NTRS)

2006-01-01

Marshall Space Flight Center engineers are working on creating the Regenerative Environmental Control and Life Support System, a complex system of devices intended to sustain the astronauts living on the ISS and, in the future, sustain those who are blasting off to the Moon or Mars. The devices make use of the available resources, by turning wastewater from respiration, sweat, and urine into drinkable water. One of the devices that Marshall has been working on is the Water Recovery System (WRS). Marshall has teamed with long-time NASA contractor, Hamilton Sundstrand Space Systems International, Inc., of Windsor Locks, Connecticut. Hamilton Sundstrand, the original designer of the life support devices for the space suits, developed the Water Processor Assembly (WPA). It, along with the Urine Processor Assembly (UPA) developed by Marshall, combines to make up the total system, which is about the size of two refrigerators, and will support up to a six-member crew. The system is currently undergoing final testing and verification. "The Water Processor Assembly can produce up to about 28 gallons of potable recycled water each day," said Bob Bagdigian, Marshall Regenerative Environmental Control and Life Support System project manager. After the new systems are installed, annual delivered water to the ISS should decrease by approximately 15,960 pounds, or about 1,600 gallons.

Temperature Measurement Aid

NASA Technical Reports Server (NTRS)

1979-01-01

NASA's Ames Research Center has designed a simple but medically important device--one which holds temperature probes, called thermistors, to a person's skin without affecting the characteristics of the skin segment being measured. The device improves the accuracy of skin surface temperature measurements, valuable data in health evaluation. The need for such a device was recognized in the course of life science experiments at Ames. In earlier methods, the sensing head of the temperature probe was affixed to the patient's skin by tape or elastic bands. This created a heat variance which altered skin temperature readings. The Ames-developed thermistor holder is a plastic ring with tab extensions, shown in the upper photo on the chest, arm and leg of the patient undergoing examination. The ring holds the sensing head of the temperature probe and provides firm, constant pressure between the skin and the probe. The tabs help stabilize the ring and provide attachment points for the fastening tape or bands, which do not directly touch the sensor. With this new tool, it is possible to determine more accurately the physiological effects of strenuous exercise, particularly on the treadmill. The holder is commercially available from Yellow Springs Instrument Company, Inc., Yellow Springs, Ohio, which is producing the device under a NASA patent license.

Should high risk patients with concomitant severe aortic stenosis and mitral valve disease undergo double valve surgery in the TAVR era?

PubMed

Yu, Pey-Jen; Mattia, Allan; Cassiere, Hugh A; Esposito, Rick; Manetta, Frank; Kohn, Nina; Hartman, Alan R

2017-12-29

Significant mitral regurgitation in patients undergoing transcatheter aortic valve replacement (TAVR) is associated with increased mortality. The aim of this study is to determine if surgical correction of both aortic and mitral valves in high risk patients with concomitant valvular disease would offer patients better outcomes than TAVR alone. A retrospective analysis of 43 high-risk patients who underwent concomitant surgical aortic valve replacement and mitral valve surgery from 2008 to 2012 was performed. Immediate and long term survival were assessed. There were 43 high-risk patients with severe aortic stenosis undergoing concomitant surgical aortic valve replacement and mitral valve surgery. The average age was 80 ± 6 years old. Nineteen (44%) patients had prior cardiac surgery, 15 (34.9%) patients had chronic obstructive lung disease, and 39 (91%) patients were in congestive heart failure. The mean Society of Thoracic Surgeons Predicted Risk of Mortality for isolated surgical aortic valve replacement for the cohort was 10.1% ± 6.4%. Five patients (11.6%) died during the index admission and/or within thirty days of surgery. Mortality rate was 25% at six months, 35% at 1 year and 45% at 2 years. There was no correlation between individual preoperative risk factors and mortality. High-risk patients with severe aortic stenosis and mitral valve disease undergoing concomitant surgical aortic valve replacement and mitral valve surgery may have similar long term survival as that described for such patients undergoing TAVR. Surgical correction of double valvular disease in this patient population may not confer mortality benefit compared to TAVR alone.

The economic impact of battery longevity in implantable cardioverter-defibrillators for cardiac resynchronization therapy: the hospital and healthcare system perspectives.

PubMed

Landolina, Maurizio; Morani, Giovanni; Curnis, Antonio; Vado, Antonello; D'Onofrio, Antonio; Bianchi, Valter; Stabile, Giuseppe; Crosato, Martino; Petracci, Barbara; Ceriotti, Carlo; Bontempi, Luca; Morosato, Martina; Ballari, Gian Paolo; Gasparini, Maurizio

2017-08-01

Patients receiving cardiac resynchronization therapy defibrillators (CRT-Ds) are likely to undergo one or more device replacements, mainly for battery depletion. We assessed the economic impact of battery depletion on the overall cost of CRT-D treatment from the perspectives of the healthcare system and the hospital. We also compared devices of different generations and from different manufacturers in terms of therapy cost. We analysed data on 1792 CRT-Ds implanted in 1399 patients in 9 Italian centres. We calculated the replacement probability and the total therapy cost over 6 years, stratified by device generation and manufacturer. Public tariffs from diagnosis-related groups were used together with device prices and hospitalization costs. Generators were from 3 manufacturers: Boston Scientific (667, 37%), Medtronic (973, 54%), and St Jude Medical (152, 9%). The replacement probability at 6 years was 83 and 68% for earlier- and recent-generation devices, respectively. The need for replacement increased total therapy costs by more than 50% over the initial implantation cost for hospitals and by more than 30% for healthcare system. The improved longevity of recent-generation CRT-Ds reduced the therapy cost by ∼6% in both perspectives. Among recent-generation CRT-Ds, the replacement probability of devices from different manufacturers ranged from 12 to 70%. Consequently, the maximum difference in therapy cost between manufacturers was 40% for hospitals and 19% for the healthcare system. Differences in CRT-D longevity strongly affect the overall therapy cost. While the use of recent-generation devices has reduced the cost, significant differences exist among currently available systems. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.

Pacemaker Use in New Zealand - Data From the New Zealand Implanted Cardiac Device Registry (ANZACS-QI 15).

PubMed

Larsen, P D; Kerr, A J; Hood, M; Harding, S A; Hooks, D; Heaven, D; Lever, N A; Sinclair, S; Boddington, D; Tang, E W; Swampillai, J; Stiles, M K

2017-03-01

The New Zealand Cardiac Implanted Device Registry (Device) has recently been developed under the auspices of the New Zealand Branch of the Cardiac Society of Australia and New Zealand. This study describes the initial Device registry cohort of patients receiving a new pacemaker, their indications for pacing and their perioperative complications. The Device Registry was used to audit patients receiving a first pacemaker between 1 st January 2014 and 1 st June 2015. We examined 1611 patients undergoing first pacemaker implantation. Patients were predominantly male (59%), and had a median age of 70 years. The most common symptom for pacemaker implantation was syncope (39%), followed by dizziness (30%) and dyspnoea (12%). The most common aetiology for a pacemaker was a conduction tissue disorder (35%), followed by sinus node dysfunction (22%). Atrioventricular (AV) block was the most common ECG abnormality, present in 44%. Dual chamber pacemakers were most common (62%), followed by single chamber ventricular pacemakers (34%), and cardiac resynchronisation therapy - pacemakers (CRT-P) (2%). Complications within 24hours of the implant procedure were reported in 64 patients (3.9%), none of which were fatal. The most common complication was the need for reoperation to manipulate a lead, occurring in 23 patients (1.4%). This is the first description of data entered into the Device registry. Patients receiving a pacemaker were younger than in European registries, and there was a low use of CRT-P devices compared to international rates. Complications rates were low and compare favourably to available international data. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Prospective, randomized multicenter study of cervical arthroplasty versus anterior cervical discectomy and fusion: 5-year results with a metal-on-metal artificial disc.

PubMed

Coric, Domagoj; Guyer, Richard D; Nunley, Pierce D; Musante, David; Carmody, Cameron; Gordon, Charles; Lauryssen, Carl; Boltes, Margaret O; Ohnmeiss, Donna D

2018-03-01

OBJECTIVE Seven cervical total disc replacement (TDR) devices have received FDA approval since 2006. These devices represent a heterogeneous assortment of implants made from various biomaterials with different biomechanical properties. The majority of these devices are composed of metallic endplates with a polymer core. In this prospective, randomized multicenter study, the authors evaluate the safety and efficacy of a metal-on-metal (MoM) TDR (Kineflex|C) versus anterior cervical discectomy and fusion (ACDF) in the treatment of single-level spondylosis with radiculopathy through a long-term (5-year) follow-up. METHODS An FDA-regulated investigational device exemption (IDE) pivotal trial was conducted at 21 centers across the United States. Standard validated outcome measures including the Neck Disability Index (NDI) and visual analog scale (VAS) for assessing pain were used. Patients were randomized to undergo TDR using the Kineflex|C cervical artificial disc or anterior cervical fusion using structural allograft and an anterior plate. Patients were evaluated preoperatively and at 6 weeks and 3, 6, 12, 24, 36, 48, and 60 months after surgery. Serum ion analysis was performed on a subset of patients randomized to receive the MoM TDR. RESULTS A total of 269 patients were enrolled and randomly assigned to undergo either TDR (136 patients) or ACDF (133 patients). There were no significant differences between the TDR and ACDF groups in terms of operative time, blood loss, or length of hospital stay. In both groups, the mean NDI scores improved significantly by 6 weeks after surgery and remained significantly improved throughout the 60-month follow-up (both p < 0.01). Similarly, VAS pain scores improved significantly by 6 weeks and remained significantly improved through the 60-month follow-up (both p < 0.01). There were no significant changes in outcomes between the 24- and 60-month follow-ups in either group. Range of motion in the TDR group decreased at 3 months but was significantly greater than the preoperative mean value at the 12- and 24-month follow-ups and remained significantly improved through the 60-month period. There were no significant differences between the 2 groups in terms of reoperation/revision surgery or device-/surgery-related adverse events. The serum ion analysis revealed cobalt and chromium levels significantly lower than the levels that merit monitoring. CONCLUSIONS Cervical TDR with an MoM device is safe and efficacious at the 5-year follow-up. These results from a prospective randomized study support that Kineflex|C TDR as a viable alternative to ACDF in appropriately selected patients with cervical radiculopathy. Clinical trial registration no.: NCT00374413 (clinicaltrials.gov).

Impact of a theory-based video on initiation of long-acting reversible contraception after abortion.

PubMed

Davidson, AuTumn S; Whitaker, Amy K; Martins, Summer L; Hill, Brandon; Kuhn, Caroline; Hagbom-Ma, Catherine; Gilliam, Melissa

2015-03-01

Adoption of long-acting reversible contraception (LARC) (ie, the intrauterine device or the contraceptive implant) immediately after abortion is associated with high contraceptive satisfaction and reduced rates of repeat abortion. Theory-based counseling interventions have been demonstrated to improve a variety of health behaviors; data on theory-based counseling interventions for postabortion contraception are lacking. Informed by the transtheoretical model of behavioral change, a video intervention was developed to increase awareness of, and dispel misconceptions about, LARC methods. The intervention was evaluated in a randomized controlled trial among women aged 18-29 years undergoing surgical abortion at a clinic in Chicago, IL. Participants were randomized 1:1 to watch the intervention video or to watch a stress management video (control), both 7 minutes in duration. Contraceptive methods were supplied to all participants free of charge. Rates of LARC initiation immediately after abortion were compared. Rates of LARC initiation immediately after abortion were not significantly different between the 2 study arms; 59.6% in the intervention and 51.6% in the control arm chose a LARC method (P = .27). This study resulted in an unexpectedly high rate of LARC initiation immediately after abortion. High rates of LARC initiation could not be attributed to a theory-based counseling intervention. Copyright © 2015 Elsevier Inc. All rights reserved.

Concordance of Motion Sensor and Clinician-Rated Fall Risk Scores in Older Adults.

PubMed

Elledge, Julie

2017-12-01

As the older adult population in the United States continues to grow, developing reliable, valid, and practical methods for identifying fall risk is a high priority. Falls are prevalent in older adults and contribute significantly to morbidity and mortality rates and rising health costs. Identifying at-risk older adults and intervening in a timely manner can reduce falls. Conventional fall risk assessment tools require a health professional trained in the use of each tool for administration and interpretation. Motion sensor technology, which uses three-dimensional cameras to measure patient movements, is promising for assessing older adults' fall risk because it could eliminate or reduce the need for provider oversight. The purpose of this study was to assess the concordance of fall risk scores as measured by a motion sensor device, the OmniVR Virtual Rehabilitation System, with clinician-rated fall risk scores in older adult outpatients undergoing physical rehabilitation. Three standardized fall risk assessments were administered by the OmniVR and by a clinician. Validity of the OmniVR was assessed by measuring the concordance between the two assessment methods. Stability of the OmniVR fall risk ratings was assessed by measuring test-retest reliability. The OmniVR scores showed high concordance with the clinician-rated scores and high stability over time, demonstrating comparability with provider measurements.

Management of LVAD Patients for Noncardiac Surgery: A Single-Institution Study.

PubMed

Nelson, Eric W; Heinke, Timothy; Finley, Alan; Guldan, G J; Gaddy, Parker; Matthew Toole, J; Mims, Ryan; Abernathy, J H

2015-08-01

To describe the experience regarding the perioperative management of patients with left ventricular assist devices (LVADs) who require anesthesia while undergoing noncardiac surgery (NCS) at a single medical center. Retrospective chart review Academic medical center Patients with LVADs Medical records from April 1, 2009 through January 31, 2014 were reviewed for patients who underwent Heartmate II LVAD placement at this facility. Individual records were reviewed for NCS after LVAD placement, specifically investigating perioperative and anesthetic management. Seventy-one patients underwent LVAD placement during this time period. Thirty-five patients (49%) underwent a total of 101 NCS procedures. Arterial catheters were placed in 19 patients (19%), and 33 patients (33%) were intubated for their procedure. No complications or perioperative mortality occurred related to the NCS. Noncardiac surgery is becoming more common in patients with LVADs. Anesthetic management of these patients outside of the cardiac operating room is limited. Patients with Heartmate II LVADs can safely undergo noncardiac surgery. Copyright © 2015 Elsevier Inc. All rights reserved.

[Paradigm shift in the management of metastatic epidural spinal cord compression: the importance of preserving ambulation].

PubMed

Itshayek, Eyal

2013-12-01

In 2005, a Landmark study showed that direct decompressive surgery, followed by postoperative external beam radiotherapy (EBRT) is superior to EBRT alone in patients with metastatic epidural spinal cord compression (MESCC). Patients undergoing both surgery and EBRT had similar median survival but experienced longer ambulation than with EBRT alone. Additional studies have shown improvements in quality-of-life, higher cost-effectiveness, improved pain control, and higher functional status with surgery plus EBRT. Improved neurological outcome also improved the patients' ability to undergo postoperative adjuvant therapy. According to our experience, even patients over 65 or patients with aggressive primary tumors and additional metastases have benefited from surgical intervention, living longer than expected with preservation of ambulation and sphincter control until death or shortly before. Preserving ambulation is critical. With current surgical devices and techniques, patients with MESCC who present with a single area of cord compression, back pain, neurological deficit, or progressive deformity, may benefit from surgery prior to adjuvant radiation-based treatment or chemotherapy.

Informed consent needed for sterilization or research.

PubMed

Barnett, B

1998-01-01

Informed choice involves enabling family planning clients to base their decisions about contraceptive use upon adequate information. It is a process in which clients give their permission to undergo a procedure, take a medication, or participate in a study after being fully informed. Informed consent protects an individual's freedom of choice, respects his or her autonomy, is important in both family planning programs and reproductive health research, and should always be available to clients seeking health services. Although written informed consent is not needed for most reproductive health services, it should be obtained from men and women who undergo sterilization, since that involves surgery and is considered permanent. In addition, people who volunteer to participate in contraceptive studies need to be fully informed of the risks and benefits of any new drugs or devices they receive. Volunteers should understand the potential effects of methods upon their physical health and other aspects of their lives. Ethical reviews need to be conducted before research begins.

Effect of a Scalp Cooling Device on Alopecia in Women Undergoing Chemotherapy for Breast Cancer: The SCALP Randomized Clinical Trial.

PubMed

Nangia, Julie; Wang, Tao; Osborne, Cynthia; Niravath, Polly; Otte, Kristen; Papish, Steven; Holmes, Frankie; Abraham, Jame; Lacouture, Mario; Courtright, Jay; Paxman, Richard; Rude, Mari; Hilsenbeck, Susan; Osborne, C Kent; Rimawi, Mothaffar

2017-02-14

Chemotherapy may induce alopecia. Although scalp cooling devices have been used to prevent this alopecia, efficacy has not been assessed in a randomized clinical trial. To assess whether a scalp cooling device is effective at reducing chemotherapy-induced alopecia and to assess adverse treatment effects. Multicenter randomized clinical trial of women with breast cancer undergoing chemotherapy. Patients were enrolled from December 9, 2013, to September 30, 2016. One interim analysis was planned to allow the study to stop early for efficacy. Data reported are from the interim analysis. This study was conducted at 7 sites in the United States, and 182 women with breast cancer requiring chemotherapy were enrolled and randomized. Participants were randomized to scalp cooling (n = 119) or control (n = 63). Scalp cooling was done using a scalp cooling device. The primary efficacy end points were successful hair preservation assessed using the Common Terminology Criteria for Adverse Events version 4.0 scale (grade 0 [no hair loss] or grade 1 [<50% hair loss not requiring a wig] were considered to have hair preservation) at the end of 4 cycles of chemotherapy by a clinician unaware of treatment assignment, and device safety. Secondary end points included wig use and scores on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, Hospital Anxiety and Depression Scale, and a summary scale of the Body Image Scale. At the time of the interim analysis, 142 participants were evaluable. The mean (SD) age of the patients was 52.6 (10.1) years; 36% (n = 51) received anthracycline-based chemotherapy and 64% (n = 91) received taxane-based chemotherapy. Successful hair preservation was found in 48 of 95 women with cooling (50.5%; 95% CI, 40.7%-60.4%) compared with 0 of 47 women in the control group (0%; 95% CI, 0%-7.6%) (success rate difference, 50.5%; 95% CI, 40.5%-60.6%). Because the 1-tailed P value from the Fisher exact test was <.001, which crossed the superiority boundary (P = .0061), the data and safety monitoring board recommended study termination on September 26, 2016. There were no statistically significant differences in changes in any of the scales of quality of life from baseline to chemotherapy cycle 4 among the scalp cooling and control groups. Only adverse events related to device use were collected; 54 adverse events were reported in the cooling group, all grades 1 and 2. There were no serious adverse device events. Among women with stage I to II breast cancer receiving chemotherapy with a taxane, anthracycline, or both, those who underwent scalp cooling were significantly more likely to have less than 50% hair loss after the fourth chemotherapy cycle compared with those who received no scalp cooling. Further research is needed to assess longer-term efficacy and adverse effects. clinicaltrials.gov Identifier: NCT01986140.

Impact of a new cryotherapy device on early rehabilitation after primary total knee arthroplasty (TKA): a prospective randomised controlled trial.

PubMed

Sadoghi, Patrick; Hasenhütl, Sandro; Gruber, Gerald; Leitner, Lukas; Leithner, Andreas; Rumpold-Seitlinger, Gudrun; Kastner, Norbert; Poolman, Rudolf W; Glehr, Mathias

2018-06-01

The aim of this prospective, randomised and single blinded study was to evaluate the efficiency and safety of a new cryotherapy device in patients undergoing unilateral, primary total knee arthroplasty (TKA). Our hypothesis was that patients administered to the new cryotherapy device would perform better than patients receiving a conventional standard cold therapy regimen. Ninety-seven patients were randomised into two groups receiving either the cTreatment® (new cryotherapy device) or the standard cold therapy protocol (including cold pack application for six days after the surgical intervention). We evaluated the following endpoints consisting of range of motion (ROM), pain intensity, and knee girth on admission day and the second, fourth, and sixth post-operative day (POD). A statistically significant benefit of the new cryotherapy device was detected regarding the ROM on the sixth POD with an average gain of 7 degrees (p = 0.021). Pain in the numeric rating scale (NRS) score in motion was significantly lower in the cTreatment® group on the second POD (p = 0.034). There were no statistically significant differences between groups regarding the NRS in rest, patient controlled analgesia (PCA) consumption, and girth measurements. No adverse effects were observed in both study groups. The new computer-controlled cooling therapy device provides benefits in terms of early post-operative remobilisation with respect to ROM and pain, which might be attributed to a reduced inflammatory response, as well as reduced secretion and bleeding. The cTreatment® system appears to be a safe and efficient procedure.

Battery drain in daily practice and medium-term projections on longevity of cardioverter-defibrillators: an analysis from a remote monitoring database.

PubMed

Boriani, Giuseppe; Ritter, Philippe; Biffi, Mauro; Ziacchi, Matteo; Diemberger, Igor; Martignani, Cristian; Valzania, Cinzia; Valsecchi, Sergio; Padeletti, Luigi; Gadler, Fredrik

2016-09-01

The longevity of generators is a crucial determinant of the cost-effectiveness of therapy with implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-D). We evaluated the trend of device-measured residual battery capacity and longevity projections over 5-year follow-up. We also investigated possible factors associated with battery drain. Data from 4851 patients in the European LATITUDE(®) database who were followed up for a minimum of 3 years were analysed. The factors associated with battery drain (i.e. year-to-year decrease in residual battery capacity), and thus potentially impacting on device longevity, were mainly the pacing parameters in CRT-D devices and the number of shocks delivered and diverted in both ICD and CRT-D (all P < 0.01 on linear regression analysis). Over the first 5 years, the longevity estimates provided by devices showed low intra-patient variability and increased with time. The estimates exceeded 10 years for CRT-D and 13 and 12 years for single- and dual-chamber ICDs, respectively. In CRT-D patients, the expected patient age on replacement was 80 ± 12 years, and the expected probability of undergoing device replacement was 63 ± 13% for New York Heart Association (NYHA) II patients and 37 ± 16% for NYHA III patients. For comparison, the probabilities of replacing a CRT-D lasting 5 years were 78 ± 8 and 59 ± 13%, respectively (both P < 0.001). Battery drain was mainly associated with pacing output in CRT-D devices and with the number of capacitor charges in both ICD and CRT-D devices. The longevity estimates provided by the devices were consistent and conservative. According to these estimates, among CRT-D recipients a low proportion of patients should require device replacement. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.

Battery drain in daily practice and medium-term projections on longevity of cardioverter-defibrillators: an analysis from a remote monitoring database

PubMed Central

Boriani, Giuseppe; Ritter, Philippe; Biffi, Mauro; Ziacchi, Matteo; Diemberger, Igor; Martignani, Cristian; Valzania, Cinzia; Valsecchi, Sergio; Padeletti, Luigi; Gadler, Fredrik

2016-01-01

Aims The longevity of generators is a crucial determinant of the cost-effectiveness of therapy with implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-D). We evaluated the trend of device-measured residual battery capacity and longevity projections over 5-year follow-up. We also investigated possible factors associated with battery drain. Methods and results Data from 4851 patients in the European LATITUDE® database who were followed up for a minimum of 3 years were analysed. The factors associated with battery drain (i.e. year-to-year decrease in residual battery capacity), and thus potentially impacting on device longevity, were mainly the pacing parameters in CRT-D devices and the number of shocks delivered and diverted in both ICD and CRT-D (all P < 0.01 on linear regression analysis). Over the first 5 years, the longevity estimates provided by devices showed low intra-patient variability and increased with time. The estimates exceeded 10 years for CRT-D and 13 and 12 years for single- and dual-chamber ICDs, respectively. In CRT-D patients, the expected patient age on replacement was 80 ± 12 years, and the expected probability of undergoing device replacement was 63 ± 13% for New York Heart Association (NYHA) II patients and 37 ± 16% for NYHA III patients. For comparison, the probabilities of replacing a CRT-D lasting 5 years were 78 ± 8 and 59 ± 13%, respectively (both P < 0.001). Conclusion Battery drain was mainly associated with pacing output in CRT-D devices and with the number of capacitor charges in both ICD and CRT-D devices. The longevity estimates provided by the devices were consistent and conservative. According to these estimates, among CRT-D recipients a low proportion of patients should require device replacement. PMID:26847076

Development Of A Flash X-Ray Scanner For Stereoradiography And CT

NASA Astrophysics Data System (ADS)

Endorf, Robert J.; DiBianca, Frank A.; Fritsch, Daniel S.; Liu, Wen-Ching; Burns, Charles B.

1989-05-01

We are developing a flash x-ray scanner for stereoradiography and CT which will be able to produce a stereoradiograph in 30 to 70 ns and a complete CT scan in one microsecond. This type of imaging device will be valuable in studying high speed processes, high acceleration, and traumatic events. We have built a two channel flash x-ray system capable of producing stereo radiographs with stereo angles of from 15 to 165 degrees. The dynamic and static Miff 's for the flash x-ray system were measured and compared with similar MIT's measured for a conventional medical x-ray system. We have written and tested a stereo reconstruction algorithm to determine three dimensional space points from corresponding points in the two stereo images. To demonstrate the ability of the system to image traumatic events, a radiograph was obtained of a bone undergoing a fracture. The effects of accelerations of up to 600 g were examined on radiographs taken of human kidney tissue samples in a rapidly rotating centrifuge. Feasibility studies of CT reconstruction have been performed by making simulated Cr images of various phantoms for larger flash x-ray systems of from 8 to 29 flash x-ray tubes.

Point-of-service, quantitative analysis of ascorbic acid in aqueous humor for evaluating anterior globe integrity

NASA Astrophysics Data System (ADS)

Gartia, Manas R.; Misra, Santosh K.; Ye, Mao; Schwartz-Duval, Aaron; Plucinski, Lisa; Zhou, Xiangfei; Kellner, David; Labriola, Leanne T.; Pan, Dipanjan

2015-11-01

Limited training, high cost, and low equipment mobility leads to inaccuracies in decision making and is concerning with serious ocular injuries such as suspected ruptured globe or post-operative infections. Here, we present a novel point-of-service (POS) quantitative ascorbic acid (AA) assay with use of the OcuCheck Biosensor. The present work describes the development and clinical testing of the paper-based biosensor that measures the changes in electrical resistance of the enzyme-plated interdigitated electrodes to quantify the level of AA present in ocular fluid. We have demonstrated the proof-of-concept of the biosensor testing 16 clinical samples collected from aqueous humor of patients undergoing therapeutic anterior chamber paracentesis. Comparing with gold standard colorimetric assay for AA concentration, OcuCheck showed accuracy of >80%, sensitivity of >88% and specificity of >71%. At present, there are no FDA-approved POS tests that can directly measures AA concentration levels in ocular fluid. We envisage that the device can be realized as a handheld, battery powered instrument that will have high impact on glaucoma care and point-of-care diagnostics of penetrating ocular globe injuries.

Freedom from band-gap slavery: from diode lasers to quantum cascade lasers

NASA Astrophysics Data System (ADS)

Capasso, Federico

2010-02-01

Semiconductor heterostructure lasers, for which Alferov and Kromer received part of the Nobel Prize in Physics in 2000, are the workhorse of technologies such as optical communications, optical recording, supermarket scanners, laser printers and fax machines. They exhibit high performance in the visible and near infrared and rely for their operation on electrons and holes emitting photons across the semiconductor bandgap. This mechanism turns into a curse at longer wavelengths (mid-infrared) because as the bandgap, shrinks laser operation becomes much more sensitive to temperature, material defects and processing. Quantum Cascade Laser (QCL), invented in 1994, rely on a radically different process for light emission. QCLs are unipolar devices in which electrons undergo transitions between quantum well energy levels and are recycled through many stages emitting a cascade of photons. Thus by suitable tailoring of the layers' thickness, using the same heterostructure material, they can lase across the molecular fingerprint region from 3 to 25 microns and beyond into the far-infrared and submillimiter wave spectrum. High power cw room temperature QCLs and QCLs with large continuous single mode tuning range have found many applications (infrared countermeasures, spectroscopy, trace gas analysis and atmospheric chemistry) and are commercially available. )