Effects of simultaneous and optimized sequential cardiac resynchronization therapy on myocardial oxidative metabolism and efficiency.

PubMed

Christenson, Stuart D; Chareonthaitawee, Panithaya; Burnes, John E; Hill, Michael R S; Kemp, Brad J; Khandheria, Bijoy K; Hayes, David L; Gibbons, Raymond J

2008-02-01

Cardiac resynchronization therapy (CRT) can improve left ventricular (LV) hemodynamics and function. Recent data suggest the energy cost of such improvement is favorable. The effects of sequential CRT on myocardial oxidative metabolism (MVO(2)) and efficiency have not been previously assessed. Eight patients with NYHA class III heart failure were studied 196 +/- 180 days after CRT implant. Dynamic [(11)C]acetate positron emission tomography (PET) and echocardiography were performed after 1 hour of: 1) AAI pacing, 2) simultaneous CRT, and 3) sequential CRT. MVO(2) was calculated using the monoexponential clearance rate of [(11)C]acetate (k(mono)). Myocardial efficiency was expressed in terms of the work metabolic index (WMI). P values represent overall significance from repeated measures analysis. Global LV and right ventricular (RV) MVO(2) were not significantly different between pacing modes, but the septal/lateral MVO(2) ratio differed significantly with the change in pacing mode (AAI pacing = 0.696 +/- 0.094 min(-1), simultaneous CRT = 0.975 +/- 0.143 min(-1), and sequential CRT = 0.938 +/- 0.189 min(-1); overall P = 0.001). Stroke volume index (SVI) (AAI pacing = 26.7 +/- 10.4 mL/m(2), simultaneous CRT = 30.6 +/- 11.2 mL/m(2), sequential CRT = 33.5 +/- 12.2 mL/m(2); overall P < 0.001) and WMI (AAI pacing = 3.29 +/- 1.34 mmHg*mL/m(2)*10(6), simultaneous CRT = 4.29 +/- 1.72 mmHg*mL/m(2)*10(6), sequential CRT = 4.79 +/- 1.92 mmHg*mL/m(2)*10(6); overall P = 0.002) also differed between pacing modes. Compared with simultaneous CRT, additional changes in septal/lateral MVO(2), SVI, and WMI with sequential CRT were not statistically significant on post hoc analysis. In this small selected population, CRT increases LV SVI without increasing MVO(2), resulting in improved myocardial efficiency. Additional improvements in LV work, oxidative metabolism, and efficiency from simultaneous to sequential CRT were not significant.

Increased base rate of atrial pacing for prevention of atrial fibrillation after implantation of a dual-chamber pacemaker: insights from the Atrial Overdrive Pacing Study.

PubMed

Kantharia, Bharat K; Freedman, Roger A; Hoekenga, David; Tomassoni, Gery; Worley, Seth; Sorrentino, Robert; Steinhaus, David; Wolkowicz, Joel M; Syed, Zaffer A

2007-11-01

Different pacing sites and various algorithms have been utilized to prevent atrial fibrillation (AF) in pacemaker recipients. However, the optimal pacing rate settings have not yet been established. In this randomized, prospective, multicentre, single-blinded, cross over study, rate-adaptive pacing at a high base rate (BR) in patients, age 60 years or above, or a history of paroxysmal AF, who underwent dual-chamber (DDD) pacemaker implantation for standard pacing indications, was evaluated for prevention of AF. In the study cohort of 145 patients implanted with DDD pacemakers with a programmable rest rate (RR) feature, the BR/RR settings were sequentially but randomly adjusted as follows: 60 bpm/Off for the baseline quarter (initial 3 months) and then to either 'A-B-C' or 'C-B-A' settings (A = 70/65 bpm, B = 70/Off, C = 80/65 bpm) for the subsequent quarters each of 3 months duration. Data on automatic mode switch episodes, device diagnostics, and a questionnaire evaluating pacemaker awareness and palpitations were collected. Ninety-nine patients, mean age 77 +/- 10 years, who completed the study protocol and followed for 12 months did not show significant differences in the number of mode switch episodes between any settings used. The percentage of atrial pacing was lower during baseline pacing compared to settings A, B, and C (P < 0.0001). Setting C produced a higher percentage of atrial pacing than A and B (P < 0.01). Although a higher percentage of atrial pacing correlated with a lower incidence of mode switch episodes, there was no statistically significant difference in the number of mode switch episodes between settings A, B, and C. There were no significant differences in the questionnaire scores relating to pacemaker awareness or palpitation. Overdrive single-site pacing in the right atrium achieved by programming analysed settings in the present study did not reduce AF as assessed by mode switch episodes. Additionally, no change in the symptoms of arrhythmia or awareness of pacing was seen.

Merits and limitations of the mode switching rate stabilization pacing algorithms in the implantable cardioverter defibrillator.

PubMed

Dijkman, B; Wellens, H J

2001-09-01

The 7250 Jewel AF Medtronic model of ICD is the first implantable device in which both therapies for atrial arrhythmias and pacing algorithms for atrial arrhythmia prevention are available. Feasibility of that extensive atrial arrhythmia management requires correct and synergic functioning of different algorithms to control arrhythmias. The ability of the new pacing algorithms to stabilize the atrial rate following termination of treated atrial arrhythmias was evaluated in the marker channel registration of 600 spontaneously occurring episodes in 15 patients with the Jewel AF. All patients (55+/-15 years) had structural heart disease and documented atrial and ventricular arrhythmias. Dual chamber rate stabilization pacing was present in 245 (41 %) of episodes following arrhythmia termination and was a part of the mode switching operation during which pacing was provided in the dynamic DDI mode. This algorithm could function as the atrial rate stabilization pacing only when there was a slow spontaneous atrial rhythm or in presence of atrial premature beats conducted to the ventricles with a normal AV time. In case of atrial premature beats with delayed or absent conduction to the ventricles and in case of ventricular premature beats, the algorithm stabilized the ventricular rate. The rate stabilization pacing in DDI mode during sinus rhythm following atrial arrhythmia termination was often extended in time due to the device-based definition of arrhythmia termination. This was also the case in patients, in whom the DDD mode with true atrial rate stabilization algorithm was programmed. The rate stabilization algorithms in the Jewel AF applied after atrial arrhythmia termination provide pacing that is not based on the timing of atrial events. Only under certain circumstances the algorithm can function as atrial rate stabilization pacing. Adjustments in availability and functioning of the rate stabilization algorithms might be of benefit for the clinical performance of pacing as part of device therapy for atrial arrhythmias.

Comparison of DDD versus VVIR pacing modes in elderly patients with atrioventricular block.

PubMed

Kılıçaslan, Barış; Vatansever Ağca, Fahriye; Kılıçaslan, Esin Evren; Kınay, Ozan; Tigen, Kürşat; Cakır, Cayan; Nazlı, Cem; Ergene, Oktay

2012-06-01

Dual-chamber pacing is believed to have an advantage over single-chamber ventricular pacing. The aim of this study was to determine whether elderly patients who have implanted pacemakers for complete atrioventricular block gain significant benefits from dual-chamber (DDD) pacemakers compared with single chamber ventricular (VVIR) pacemakers. This study was designed as a randomized, two-period crossover study-each pacing mode was maintained for 1 month. Thirty patients (16 men, mean age 68.87 ± 6.89 years) with implanted DDD pacemakers were submitted to a standard protocol, which included an interview, pacemaker syndrome assessment, health related quality of life (HRQoL) questionnaires assessed by an SF-36 test, 6-minute walk test (6MWT), and transthoracic echocardiographic examinations. All of these parameters were obtained on both DDD and VVIR mode pacing. Paired data were compared. HRQoL scores were similar, and 6MWT results did not differ between the two groups. VVIR pacing elicited significant enlargement of the left atrium and impaired left ventricular diastolic functions as compared with DDD pacing. Two patients reported subclinical pacemaker syndrome, but this was not statistically significant. Our study revealed that in active elderly patients with complete heart block, DDD pacing and VVIR pacing yielded similar improvements in QoL and exercise performance. However, after a short follow-up period, we noted that VVIR pacing caused significant left atrial enlargement and impaired left ventricular diastolic functions.

[The use of auto mode switching in patients with sick sinus syndrome].

PubMed

Vlasínová, J

2005-01-01

At present the dual chamber pacing, originally developed for patients with AV blockades, is widely used also for patients with Sick sinus syndrome (tachycardic-bradycardic type). But these patients often cause therapeutical problems to their physicians. In these cases either antiarrhythmic therapy is necessary to prevent recurrent supraventricular tachycardias (which are cause of rapid ventricular pacing) or in the case of failure of AA therapy the pacing mode has to be changed to DDI/R, which excludes physiological VAT pacing. The Auto Mode Switching (AMS) function ensures adequate ventricular pacing rate in the time of SV arrhythmias. Effects of dual chamber pacemakers equipped with AMS were studied in a group of patients with paroxysmal atrial fibrilation and/or atrial flutter. Therapy brings effects in lower of expenses due to less frequent visits at the physician, lower rate of rehospitalizations and lower need for powerful AA therapy.

A 2:1 AV rhythm: an adverse effect of a long AV delay during DDI pacing and its prevention by the ventricular intrinsic preference algorithm in DDD mode.

PubMed

Minamiguchi, Hitoshi; Oginosawa, Yasushi; Kohno, Ritsuko; Tamura, Masahito; Takeuchi, Masaaki; Otsuji, Yutaka; Abe, Haruhiko

2012-07-01

A 91-year-old woman received a dual-chamber pacemaker for sick sinus syndrome and intermittently abnormal atrioventricular (AV) conduction. The pacemaker was set in DDI mode with a 350-ms AV delay to preserve intrinsic ventricular activity. She complained of palpitation during AV sequential pacing. The electrocardiogram showed a 2:1 AV rhythm from 1:1 ventriculoatrial (VA) conduction during ventricular pacing in DDI mode with a long AV interval. After reprogramming of the pacemaker in DDD mode with a 250-ms AV interval and additional 100-ms prolongation of the AV interval by the ventricular intrinsic preference function, VA conduction disappeared and the patient's symptom were alleviated without increasing unnecessary right ventricular pacing. ©2011, The Authors. Journal compilation ©2011 Wiley Periodicals, Inc.

Correlation between the sudden jump-like increases of the atrio-Hisian interval induced during burst atrial pacing and during programmed atrial stimulation in patients with atrioventricular nodal reentrant tachycardia.

PubMed

Bayraktarova, Iskra H; Stoyanov, Milko K; Kunev, Boyan T; Shalganov, Tchavdar N

To study the correlation between the sudden prolongations of the atrio-Hisian (AH) interval with ≥50 ms during burst and programmed atrial stimulation, and to define whether the AH jump during burst atrial pacing is a reliable diagnostic criterion for dual AV nodal physiology. Retrospective data on 304 patients with preliminary ECG diagnosis of AV nodal reentrant tachycardia (AVNRT), confirmed during electrophysiological study, was analyzed for the presence of AH jump during burst and programmed atrial stimulation, and for correlation between the pacing modes for inducing the jump. Wilcoxon signed-ranks test and Spearman's bivariate correlation coefficient were applied, significant was P-value <0.05. The population was aged 48.5 ± 15.7 (12-85) years; males were 38.5%. AH jump occurred during burst atrial pacing in 81% of the patients, and during programmed stimulation - in 78%, P = 0.366. In 63.2% AH jump was induced by both pacing modes; in 17.8% - only by burst pacing; in 14.8% - only by programmed pacing; in 4.2% there was no inducible jump. There was negative correlation between both pacing modes, ρ = -0.204, Р<0.001. Burst and programmed atrial stimulation separately prove the presence of dual AV nodal physiology in 81 and 78% of the patients with AVNRT, respectively. There is negative correlation between the two pacing modes, allowing the combination of the two methods to prove diagnostic in 95.8% of the patients. Copyright © 2017 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. All rights reserved.

Dynamic and dual-site atrial pacing in the prevention of atrial fibrillation: The STimolazione Atrial DInamica Multisito (STADIM) Study.

PubMed

De Simone, Antonio; Senatore, Gaetano; Donnici, Giovanni; Turco, Pietro; Romano, Enrico; Gazzola, Carlo; Stabile, G

2007-01-01

The impact of new algorithms to consistently pace the atrium on the prevention of atrial fibrillation (AF) remains unclear. Our randomized, crossover study compared the efficacy of single- and dual-site atrial pacing, with versus without dynamic atrial overdrive pacing in preventing AF. We studied 72 patients (mean age = 69.6 +/- 6.5 years, 34 men) with sick sinus syndrome (SSS) and paroxysmal or persistent AF, who received dual-chamber pacemakers (PM) equipped with an AF prevention algorithm and two atrial leads placed in the right atrial appendage (RAA), by passive fixation, and in the coronary sinus ostium (CS), by active fixation, respectively. At implant, the patients were randomly assigned to unipolar CS versus RAA pacing. The PM was programmed in DDDR mode 1 month after implant. Each patient underwent four study phases of equal duration: (1) unipolar, single site (CS or RAA) pacing with the AF algorithm ON (atrial lower rate = 0 ppm); (2) unipolar, single site pacing with the AF algorithm OFF (atrial lower rate = 70 bpm); (3) bipolar, dual-site pacing with AF algorithm ON; (4) bipolar, dual-site pacing with the AF algorithm OFF. Among 40 patients (56%), who completed the follow-up (15 +/- 4 months) no difference was observed in the mean number of automatic mode switch (AMS) corrected for the duration of follow-up, in unipolar (5.6 +/- 22.8 vs 2.6 +/- 5.5) or bipolar mode (3.3 +/- 12.7 vs 2.1 +/- 4.9) with, respectively, the algorithm OFF or ON. With the AF prevention algorithm ON, the percentage of atrial pacing increased significantly from 78.7 +/- 22.1% to 92.4 +/- 4.9% (P < 0.001), while the average ventricular heart rate was significantly lower with the algorithm ON (62.4 +/- 17.5 vs 79.9 +/- 3 bpm (P < 0.001). The AF prevention algorithm increased the percentage of atrial pacing significantly, regardless of the atrial pulse configuration and pacing site, while maintaining a slower ventricular heart rate. It had no impact on the number of AMS in the unipolar and bipolar modes in patients with SSS.

Sawtooth pacing by real-time auxiliary power control in a tokamak plasma.

PubMed

Goodman, T P; Felici, F; Sauter, O; Graves, J P

2011-06-17

In the standard scenario of tokamak plasma operation, sawtooth crashes are the main perturbations that can trigger performance-degrading, and potentially disruption-generating, neoclassical tearing modes. This Letter demonstrates sawtooth pacing by real-time control of the auxiliary power. It is shown that the sawtooth crash takes place in a reproducible manner shortly after the removal of that power, and this can be used to precisely prescribe, i.e., pace, the individual sawteeth. In combination with preemptive stabilization of the neoclassical tearing modes, sawtooth pacing provides a new sawtooth control paradigm for improved performance in burning plasmas.

Right atrial pacing impairs cardiac function during resynchronization therapy: acute effects of DDD pacing compared to VDD pacing.

PubMed

Bernheim, Alain; Ammann, Peter; Sticherling, Christian; Burger, Peter; Schaer, Beat; Brunner-La Rocca, Hans Peter; Eckstein, Jens; Kiencke, Stephanie; Kaiser, Christoph; Linka, Andre; Buser, Peter; Pfisterer, Matthias; Osswald, Stefan

2005-05-03

We aimed to compare the hemodynamic effects of right-atrial-paced (DDD) and right-atrial-sensed (VDD) biventricular paced rhythm on cardiac resynchronization therapy (CRT). Cardiac resynchronization therapy improves hemodynamics in patients with severe heart failure and left ventricular (LV) dyssynchrony. However, the impact of active right atrial pacing on resynchronization therapy is unknown. Seventeen CRT patients were studied 10 months (range: 1 to 46 months) after implantation. At baseline, the programmed atrioventricular delay was optimized by timing LV contraction properly at the end of atrial contraction. In both modes the acute hemodynamic effects were assessed by multiple Doppler echocardiographic parameters. Compared to DDD pacing, VDD pacing resulted in much better improvement of intraventricular dyssynchrony assessed by the septal-to-posterior wall motion delay (VDD 106 +/- 83 ms vs. DDD 145 +/- 95 ms; p = 0.001), whereas the interventricular mechanical delay (difference between onset of pulmonary and aortic outflow) did not differ (VDD 20 +/- 21 ms vs. DDD 18 +/- 17 ms; p = NS). Furthermore, VDD pacing significantly prolonged the rate-corrected LV filling period (VDD 458 +/- 123 ms vs. DDD 371 +/- 94 ms; p = 0.0001) and improved the myocardial performance index (VDD 0.60 +/- 0.18 vs. DDD 0.71 +/- 0.23; p < 0.01). Our findings suggest that avoidance of right atrial pacing results in a higher degree of LV resynchronization, in a substantial prolongation of the LV filling period, and in an improved myocardial performance. Thus, the VDD mode seems to be superior to the DDD mode in CRT patients.

Effect of right ventricular pacing on cardiac apex rotation assessed by a gyroscopic sensor.

PubMed

Marcelli, Emanuela; Cercenelli, Laura; Parlapiano, Mario; Fumero, Roberto; Bagnoli, Paola; Costantino, Maria Laura; Plicchi, Gianni

2007-01-01

To quantify cardiac apex rotation (CAR), the authors recently proposed the use of a Coriolis force sensor (gyroscope) as an alternative to other complex techniques. The aim of this study was to evaluate the effects of right ventricular (RV) pacing on CAR. A sheep heart was initially paced from the right atrium to induce a normal activation sequence at a fixed heart rate (AAI mode) and then an atrioventricular pacing was performed (DOO mode, AV delay = 60 ms). A small gyroscope was epicardially glued on the cardiac apex to measure the angular velocity (Ang V). From AAI to DOO pacing mode, an increase (+9.2%, p < 0.05) of the maximum systolic twisting velocity (Ang VMAX) and a marked decrease (-19.9%, p < 0.05) of the maximum diastolic untwisting velocity (Ang VMIN) resulted. RV pacing had negligible effects (-3.1%, p = 0.09) on the maximum angle of CAR, obtained by integrating Ang V. The hemodynamic parameters of systolic (LVdP/dtMAX) and diastolic (LVdP/dtMIN) cardiac function showed slight variations (-3.8%, p < 0.05 and +3.9%, p < 0.05, respectively). Results suggest that cardiac dyssynchrony induced by RV pacing can alter the normal physiological ventricular twist patterns, particularly affecting diastolic untwisting velocity.

Long-term outcome in patients receiving permanent pacemaker implantation for atrioventricular block

PubMed Central

Liao, Jo-Nan; Chao, Tze-Fan; Tuan, Ta-Chuan; Kong, Chi-Woon; Chen, Shih-Ann

2016-01-01

Abstract A permanent pacemaker (PPM) with dual chamber pacing (DDD) offers atrioventricular synchronization for patients with atrioventricular block (AVB). Single lead atrial synchronous ventricular pacing mode (VDD) is an alternative, but there are concerns about its efficacy and risk of atrial undersensing. Whether VDD can be a good alternative in patients with AVB remains unknown. The aim of the present study was to compare the long-term risk of mortality of VDD with DDD pacing. A total of 207 patients undergoing PPM implantations for AVB with VDD mode were enrolled from 2000 to 2013. Another 828 age- and sex-matched patients undergoing DDD implantations during the same period of time were selected as the control group in a 1 to 4 ratio. The study endpoint was mortality. A total of 1035 patients (64.3% male) were followed up for 46.5 ± 43.2 months. The mean ages were 75.0 years for VDD, and 74.9 years for DDD. The Kaplan–Meier survival analysis showed no significant difference in long-term survival between the VDD and DDD groups (log-rank P = 0.313). After adjustment for baseline characteristics, the VDD and DDD groups had a similar long-term prognosis with an adjusted hazard ratio of 0.875 (P = 0.445). Further analyses for the risk of cardiovascular and noncardiovascular deaths also showed no significant differences between the 2 groups. The long-term prognosis of VDD mode is comparable to that of DDD mode. Single lead VDD can be considered as an alternative choice in patients with AVB without sinus nodal dysfunction. PMID:27583889

Cardiac pacing for severe childhood neurally mediated syncope with reflex anoxic seizures

PubMed Central

McLeod, K; Wilson, N; Hewitt, J; Norrie, J; Stephenson, J

1999-01-01

OBJECTIVE—To determine whether permanent cardiac pacing could prevent syncope and seizures in children with frequent severe neurally mediated syncope, and if so whether dual chamber pacing was superior to single chamber ventricular pacing.
METHODS—Dual chamber pacemakers were implanted into 12 children (eight male, four female) aged 2-14 years (median 2.8 years) with frequent episodes of reflex anoxic seizures and a recorded prolonged asystole during an attack. The pacemaker was programmed to sensing only (ODO), single chamber ventricular pacing with hysteresis (VVI), and dual chamber pacing with rate drop response (DDD) for four month periods, with each patient allocated to one of the six possible sequences of these modes, according to chronological order of pacemaker implantation. The parent and patient were blinded to the pacemaker mode and asked to record all episodes of syncope or presyncope ("near miss" events). The doctor analysing the results was blinded to the patient and pacemaker mode.
RESULTS—One patient was withdrawn from the study after the pacemaker was removed because of infection. In the remaining children, both dual chamber and single chamber pacing significantly reduced the number of syncopal episodes compared with sensing only (p = 0.0078 for both). VVI was as effective as DDD for preventing syncope, but DDD was superior to VVI in reducing near miss events (p = 0.016).
CONCLUSIONS—Permanent pacing is an effective treatment for children with severe neurally mediated syncope and reflex anoxic seizures. VVI is as effective as DDD in preventing syncope and seizures, but DDD is superior in preventing overall symptoms.


Keywords: syncope; reflex anoxic seizures; pacing; paediatric cardiology PMID:10573501

Evaluation of phrenic nerve and diaphragm function with peripheral nerve stimulation and M-mode ultrasonography in potential pediatric phrenic nerve or diaphragm pacing candidates.

PubMed

Skalsky, Andrew J; Lesser, Daniel J; McDonald, Craig M

2015-02-01

Assessing phrenic nerve function in the setting of diaphragmatic paralysis in diaphragm pacing candidates can be challenging. Traditional imaging modalities and electrodiagnostic evaluations are technically difficult. Either modality alone is not a direct measure of the function of the phrenic nerve and diaphragm unit. In this article, the authors present their method for evaluating phrenic nerve function and the resulting diaphragm function. Stimulating the phrenic nerve with transcutaneous stimulation and directly observing the resulting movement of the hemidiaphragm with M-mode ultrasonography provides quantitative data for predicting the success of advancing technologies such as phrenic nerve pacing and diaphragm pacing. Copyright © 2015 Elsevier Inc. All rights reserved.

Failure of communication and capture: The perils of temporary unipolar pacing system.

PubMed

Sahinoglu, Efe; Wool, Thomas J; Wool, Kenneth J

2015-06-01

We present a case of a patient with pacemaker dependence secondary to complete heart block who developed loss of capture of her temporary pacemaker. Patient developed torsades de pointes then ventricular fibrillation, requiring CPR and external cardioversion. After patient was stabilized, it was noticed that loss of capture of pacemaker corresponded with nursing care, when the pulse generator was lifted off patient׳s chest wall, and that patient׳s temporary pacing system had been programmed to unipolar mode without knowledge of attending cardiologist. This case highlights the importance of communication ensuring all caregivers are aware of mode of the temporary pacing system.

Development of a Student-Paced Course in General Pathology Utilizing a Computer Managed Evaluation System.

ERIC Educational Resources Information Center

Kent, Thomas H.; And Others

The advantages, feasibility and problems associated with a student-paced course were investigated, and a computer managed evaluation system compared to paper and pencil testing mode. The development of a self-paced course was facilitated by explicit behavior objectives, a variety of learning materials referenced to the objectives and a large pool…

Performance of a specific algorithm to minimize right ventricular pacing: A multicenter study.

PubMed

Strik, Marc; Defaye, Pascal; Eschalier, Romain; Mondoly, Pierre; Frontera, Antonio; Ritter, Philippe; Haïssaguerre, Michel; Ploux, Sylvain; Ellenbogen, Kenneth A; Bordachar, Pierre

2016-06-01

In Boston Scientific dual-chamber devices, the RYTHMIQ algorithm aims to minimize right ventricular pacing. We evaluated the performance of this algorithm determining (1) the appropriateness of the switch from the AAI(R) mode with backup VVI pacing to the DDD(R) mode in case of suspected loss of atrioventricular (AV) conduction and (2) the rate of recorded pacemaker-mediated tachycardia (PMT) when AV hysteresis searches for restored AV conduction. In this multicenter study, we included 157 patients with a Boston Scientific dual-chamber device (40 pacemakers and 117 implantable cardioverter-defibrillators) without permanent AV conduction disorder and with the RYTHMIQ algorithm activated. We reviewed the last 10 remote monitoring-transmitted RYTHMIQ and PMT episodes. We analyzed 1266 episodes of switch in 142 patients (90%): 207 (16%) were appropriate and corresponded to loss of AV conduction, and 1059 (84%) were inappropriate, of which 701 (66%) were related to compensatory pause (premature atrial contraction, 7%; premature ventricular contraction, 597 (56%); or both, 27 (3%)) or to a premature ventricular contraction falling in the post-atrial pacing ventricular refractory period interval (219, 21%) and 94 (10%) were related to pacemaker dysfunction. One hundred fifty-four PMT episodes were diagnosed in 27 patients (17%). In 85 (69%) of correctly diagnosed episodes, the onset of PMT was directly related to the algorithm-related prolongation of the AV delay, promoting AV dissociation and retrograde conduction. This study highlights some of the limitations of the RYTHMIQ algorithm: high rate of inappropriate switch and high rate of induction of PMT. This may have clinical implications in terms of selection of patients and may suggest required changes in the algorithm architecture. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Effects of generation mode in fMRI adaptations of semantic fluency: Paced production and overt speech

PubMed Central

Basho, Surina; Palmer, Erica D.; Rubio, Miguel A.; Wulfeck, Beverly; Müller, Ralph-Axel

2007-01-01

Verbal fluency is a widely used neuropsychological paradigm. In fMRI implementations, conventional unpaced (self-paced) versions are suboptimal due to uncontrolled timing of responses, and overt responses carry the risk of motion artifact. We investigated the behavioral and neurofunctional effects of response pacing and overt speech in semantic category-driven word generation. Twelve right-handed adults (8 female) ages 21–37 were scanned in four conditions each: Paced-Overt, Paced-Covert, Unpaced-Overt, and Unpaced-Covert. There was no significant difference in the number of exemplars generated between overt versions of the paced and unpaced conditions. Imaging results for category-driven word generation overall showed left-hemispheric activation in inferior frontal cortex, premotor cortex, cingulate gyrus, thalamus, and basal ganglia. Direct comparison of generation modes revealed significantly greater activation for the paced compared to unpaced conditions in right superior temporal, bilateral middle frontal, and bilateral anterior cingulate cortex, including regions associated with sustained attention, motor planning, and response inhibition. Covert (compared to overt) conditions showed significantly greater effects in right parietal and anterior cingulate, as well as left middle temporal and superior frontal regions. We conclude that paced overt paradigms are useful adaptations of conventional semantic fluency in fMRI, given their superiority with regard to control over and monitoring of behavioral responses. However, response pacing is associated with additional non-linguistic effects related to response inhibition, motor preparation, and sustained attention. PMID:17292926

An evaluation of the use of new Doppler methods for detecting longitudinal function abnormalities in a pacing-induced heart failure model

NASA Technical Reports Server (NTRS)

Tabata, Tomotsugu; Cardon, Lisa A.; Armstrong, Guy P.; Fukamach, Kiyotaka; Takagaki, Masami; Ochiai, Yoshie; McCarthy, Patrick M.; Thomas, James D.

2003-01-01

BACKGROUND: Doppler tissue echocardiography and color M-mode Doppler flow propagation velocity have proven useful in evaluating cross-sections of patients with left ventricular (LV) dysfunction, but experience with serial changes is limited. Purpose and methods: We tested their use by evaluating the temporal changes of LV function in a pacing-induced congestive heart failure model. Rapid ventricular pacing was initiated and maintained in 20 dogs for 4 weeks. Echocardiography was performed at baseline and weekly during brief pacing cessation. RESULTS: With rapid pacing, LV volume significantly increased and ejection fraction (57%-28%), stroke volume (37-18 mL), and mitral annulus systolic velocity (16.1-6.6 cm/s) by Doppler tissue echocardiography significantly decreased, with ejection fraction and mitral annulus systolic velocity closely correlated (r = 0.706, P <.0001). In contrast to the mitral inflow velocities, mitral annulus early diastolic velocity decreased steadily (12.3-7.3 cm/s) resulting in a dramatic decrease in mitral annulus early/late (1.22-0.57) diastolic velocity with no tendency toward pseudonormalization. The color M-mode Doppler flow propagation velocity also showed significant steady decrease (57-24 cm/s) throughout the pacing period. Multiple regression analysis chose mitral annulus systolic velocity (r = 0.895, P <.0001) and propagation velocity (r = 0.782, P <.0001) for the most important factor predicting LV systolic and diastolic function, respectively. CONCLUSIONS: Doppler tissue echocardiography and color M-mode Doppler flow could evaluate the serial deterioration in LV dysfunction throughout the pacing period. These were more useful in quantifying progressive LV dysfunction than conventional ehocardiographic techniques, and were probably relatively independent of preload. These techniques could be suitable for longitudinal evaluation in addition to the cross-sectional study.

[Management of surgery patients with implanted cardiac pacemakers].

PubMed

Ugljen, R; Dadić, D; Ferek-Petrić, B; Jelić, I; Letica, D; Anić, D; Husar, J

1995-01-01

Patients having cardiac pacemaker implanted may be subjected to various general surgery procedures. Application of electrosurgery for the purpose of resection and coagulation, provides a high frequency electric field which produces electric voltage on the electrodes of the pacing system. This voltage may be detected within the pacing system, and various arrhythmias can be provoked in correlation with underlying rhythm and mode of pacing. Preoperative patient control and proper pacemaker programming can prevent the pacing malfunctions due to the electrosurgery application. Appropriate positioning of the neutral electrode in relation to the pacing system avoids the electric fields intersection and decreases their interference.

Long-term follow-up of DDD pacing mode.

PubMed

Ulman, Mateusz; Dębski, Maciej; Ząbek, Andrzej; Haberka, Kazimierz; Lelakowski, Jacek; Małecka, Barbara

2014-01-01

The aim of this study was to determine the long-term survival of DDD pacing and identify the main reasons for its loss. The study group consisted of 496 patients in whom a DDD pacing system was implanted between October 1984 and March 2002 and who were followed up until July 2010. The follow-up period was 152.1 ± 35.5 months. The patients' mean age at the time of implantation was 59.5 ± 12.5 years, and 53.5% were male; 58% had sick sinus syndrome (SSS), 26% had atrioventricular block (AVB), 15% had both of these indications simultaneously, and 1% had other indications. The incidence of lead malfunction, progression to chronic atrial fibrillation (AF), and the rate of infective complications was analysed. During the follow-up, 369 patients remained in DDD mode stimulation. DDD mode survival rate at one, five, ten and 15 years was, respectively, 96%, 86%, 77% and 72%. The most common reason for reprogramming out of DDD mode was the development of permanent AF in 65 (13.1%) patients. The occurrence of chronic AF was associated with a prior history of paroxysmal AF (p = 0.0001), SSS (p = 0.0215), and older age at time of implantation (p = 0.0068) compared to patients who remained in sinus rhythm. Lead malfunction caused loss of DDD mode pacing in 56 (11.3%) patients. Atrial leads were damaged in 37 patients, ventricular in 12 patients, and both leads in seven patients. The subclavian vein puncture was correlated with the mechanical damage of the atrial lead (p = 0.02935) compared to cephalic vein access. At the moment of complication, the patients with a dysfunctional lead were significantly younger than those who progressed to chronic AF(p = 0.0019). Infective complications which caused temporary loss of DDD pacing were observed in six patients: five had pocket infection and one had lead-dependent infective endocarditis. 1. Effective DDD pacing from the originally implanted system was noted in a high percentage (72%) of patients in long-term observation (15 years). 2. Progression to permanent AF is the most common reason for loss of DDD pacing;a history of paroxysmal AF and old age are the risk factors. 3. Subclavian vein puncture is associated with a higher rate of atrial lead damage.

Feasibility and safety of adenosine cardiovascular magnetic resonance in patients with MR conditional pacemaker systems at 1.5 Tesla.

PubMed

Klein-Wiele, Oliver; Garmer, Marietta; Urbien, Rhyan; Busch, Martin; Kara, Kaffer; Mateiescu, Serban; Grönemeyer, Dietrich; Schulte-Hermes, Michael; Garbrecht, Marc; Hailer, Birgit

2015-12-22

Cardiovascular Magnetic Resonance (CMR) with adenosine stress is a valuable diagnostic tool in coronary artery disease (CAD). However, despite the development of MR conditional pacemakers CMR is not yet established in clinical routine for pacemaker patients with known or suspected CAD. A possible reason is that adenosine stress perfusion for ischemia detection in CMR has not been studied in patients with cardiac conduction disease requiring pacemaker therapy. Other than under resting conditions it is unclear whether MR safe pacing modes (paused pacing or asynchronous mode) can be applied safely because the effect of adenosine on heart rate is not precisely known in this entity of patients. We investigate for the first time feasibility and safety of adenosine stress CMR in pacemaker patients in clinical routine and evaluate a pacing protocol that considers heart rate changes under adenosine. We retrospectively analyzed CMR scans of 24 consecutive patients with MR conditional pacemakers (mean age 72.1 ± 11.0 years) who underwent CMR in clinical routine for the evaluation of known or suspected CAD. MR protocol included cine imaging, adenosine stress perfusion and late gadolinium enhancement. Pacemaker indications were sinus node dysfunction (n = 18) and second or third degree AV block (n = 6). Under a pacing protocol intended to avoid competitive pacing on the one hand and bradycardia due to AV block on the other no arrhythmia occurred. Pacemaker stimulation was paused to prevent competitive pacing in sinus node dysfunction with resting heart rate >45 bpm. Sympatho-excitatory effect of adenosine led to a significant acceleration of heart rate by 12.3 ± 8.3 bpm (p < 0.001), no bradycardia occurred. On the contrary in AV block heart rate remained constant; asynchronous pacing above resting heart rate did not interfere with intrinsic rhythm. Adenosine stress CMR appears to be feasible and safe in patients with MR conditional pacemakers. Heart rate response to adenosine has to be considered for the choice of pacing modes during CMR.

Long-term follow-up of DDD and VDD pacing: a prospective non-randomized single-centre comparison of patients with symptomatic atrioventricular block.

PubMed

Marchandise, Sébastien; Scavée, Christophe; le Polain de Waroux, Jean-Benoit; de Meester, Christophe; Vanoverschelde, Jean-Louis; Debbas, Nadia

2012-04-01

This prospective non-randomized single-centre registry compared clinical outcome, pacing parameters, and long-term survival in patients receiving VDD or DDD pacemaker (PMs) for symptomatic atrioventricular (AV) block. Single-lead VDD (n= 166) and DDD (n= 254) PMs were implanted in 420 successive patients with isolated AV block between January 2001 and December 2009. At the end of the follow-up period [median 25 (1-141) months], there was no difference in the incidence of atrial fibrillation [11.2% in the VDD group; 11.4% in the DDD group (P= 0.95)], myocardial infarction [31.1% in the VDD group; 25.2% in the DDD group (P= 0.20)], or dilated cardiomyopathy [9.9% in the VDD group; 8.9% in the DDD group (P= 0.74)]. At last follow-up, 65.9% of the VDD PMs and 89.3% of the DDD PMs were still programmed in their original mode with good atrial sensing. Due to permanent atrial fibrillation, 7.9% patients out of the VDD group had been switched to VVIR mode and 8.7% patients out of the DDD group to VVIR or DDIR mode. The P-wave amplitude was poor (sensed P-wave <0.5 mV) in 19.1% of the VDD PM and 1.6% of the DDD PM (P< 0.001) and 7.1% of the VDD patients and 0.4% of the DDD patients had been switched to VVIR pacing mode due to P-wave undersensing and AV dissociation (P= 0.003). Symptomatic atrial undersensing requiring upgrading was similar in both groups. The overall survival, adjusted for age, was not significantly different in the VDD and the DDD group (log rank: 0.26). Moreover, Cox survival analysis excluded the pacing mode as a significant predictor of mortality [hazard ratio (HR) = 0.79, confidence interval (CI) (0.46-1.35), P= 0.39]. Comparing VDD and DDD pacing, a significantly larger number of VDD-paced patients developed poor atrial signal detection without clinical impact. However, atrial under sensing did not influence the incidence of atrial fibrillation, myocardial infarction, dilated cardiomyopathy, or mortality.

Effect of monopolar radiofrequency energy on pacemaker function.

PubMed

Govekar, Henry R; Robinson, Thomas N; Varosy, Paul D; Girard, Guillaume; Montero, Paul N; Dunn, Christina L; Jones, Edward L; Stiegmann, Greg V

2012-10-01

This study aimed to quantify the clinical parameters of mono- and bipolar instruments that inhibit pacemaker function. The specific aims were to quantify pacer inhibition resulting from the monopolar instrument by altering the generator power setting, the generator mode, the distance between the active electrode and the pacemaker, and the location of the dispersive electrode. A transvenous ventricular lead pacemaker overdrive paced the native heart rate of an anesthetized pig. The primary outcome variable was pacer inhibition quantified as the number of beats dropped by the pacemaker during 5 s of monopolar active electrode activation. Lowering the generator power setting from 60 to 30 W decreased the number of dropped paced events (2.3 ± 1.2 vs 1.6 ± 0.8 beats; p = 0.045). At 30 W of power, use of the cut mode decreased the number of dropped paced beats compared with the coagulation mode (0.6 ± 0.5 vs 1.6 ± 0.8; p = 0.015). At 30 W coagulation, firing the active electrode at different distances from the pacemaker generator (3.75, 7.5, 15, and 30 cm) did not change the number of dropped paced beats (p = 0.314, analysis of variance [ANOVA]). The dispersive electrode was placed in four locations (right/left gluteus, right/left shoulder). More paced beats were dropped when the current vector traveled through the pacemaker/leads than when it did not (1.5 ± 1.0 vs 0.2 ± 0.4; p < 0.001). Clinical parameters that reduce the inhibition of a pacemaker by monopolar instruments include lowering the generator power setting, using cut (vs coagulation) mode, and locating the dispersive electrode so the current vector does not traverse the pacemaker generator or leads.

Long-Term Outcome of Single-Chamber Atrial Pacing Compared with Dual-Chamber Pacing in Patients with Sinus-Node Dysfunction and Intact Atrioventricular Node Conduction

PubMed Central

Kim, Won Ho; Joung, Boyoung; Shim, Jaemin; Park, Jong Sung; Hwang, Eui-Seock; Pak, Hui-Nam; Kim, Sungsoon

2010-01-01

Purpose The optimal pacing mode with either single chamber atrial pacemaker (AAI or AAIR) or dual chamber pacemaker (DDD or DDDR) is still not clear in sinus-node dysfunction (SND) and intact atrioventricular (AV) conduction. Materials and Methods Patients who were implanted with permanent pacemaker using AAI(R) (n = 73) or DDD(R) (n = 113) were compared. Results The baseline characteristics were comparable between the two groups, with a mean follow-up duration of 69 months. The incidence of death did not show statistical difference. However, the incidence of hospitalization for congestive heart failure (CHF) was significantly lower in the AAI(R) group (0%) than the DDD(R) group (8.8%, p = 0.03). Also, atrial fibrillation (AF) was found in 2.8% in the AAI(R) group, which was statistically different from 15.2% of patients in the DDD(R) group (p = 0.01). Four patients (5.5%) with AAI(R) developed AV block, and subsequently switched to DDD(R) pacing. The risk of AF was lower in the patients implanted with AAI(R) than those with DDD(R) [hazard ratio (HR), 0.84; 95% confidence interval, 0.72 to 0.97, p = 0.02]. Conclusion In patients with SND and intact AV conduction, AAI(R) pacing can achieve a better clinical outcome in terms of occurrence of CHF and AF than DDD(R) pacing. These findings support AAI(R) pacing as the preferred pacing mode in patients with SND and intact AV conduction. PMID:20879047

Right heart failure due to loss of right ventricular capture in a patient with atrioventricular junction ablation and biventricular pacing.

PubMed

Raffa, Santi; Fantoni, Cecilia; Restauri, Luigia; Auricchio, Angelo

2005-10-01

We describe the case of a patient with atrioventricular (AV) junction ablation and chronic biventricular pacing in which intermittent dysfunction of the right ventricular (RV) lead resulted in left ventricular (LV) stimulation alone and onset of severe right heart failure. Restoration of biventricular pacing by increasing device output and then performing lead revision resolved the issue. This case provides evidence that LV pacing alone in patients with AV junction ablation may lead to severe right heart failure, most likely as a result of iatrogenic mechanical dyssynchrony within the RV. Thus, probably this pacing mode should be avoided in pacemaker-dependent patients with heart failure.

Minimal invasive epicardial lead implantation: optimizing cardiac resynchronization with a new mapping device for epicardial lead placement.

PubMed

Maessen, J G; Phelps, B; Dekker, A L A J; Dijkman, B

2004-05-01

To optimize resynchronization in biventricular pacing with epicardial leads, mapping to determine the best pacing site, is a prerequisite. A port access surgical mapping technique was developed that allowed multiple pace site selection and reproducible lead evaluation and implantation. Pressure-volume loops analysis was used for real time guidance in targeting epicardial lead placement. Even the smallest changes in lead position revealed significantly different functional results. Optimizing the pacing site with this technique allowed functional improvement up to 40% versus random pace site selection.

A pacemaker magnet check alone is sufficient for the majority of patients postpacemaker implant.

PubMed

Jones, Michael A; Wong, Kelvin C K; Qureshi, Norman; Rajappan, Kim; Bashir, Yaver; Betts, Timothy R

2014-12-01

Patients postpacemaker implant can undergo a full assessment by pacing system programmer (PSP) or a magnet check. The former takes longer, but provides more detailed information; a magnet-mode assessment is faster, but provides only capture data in an asynchronous pacing mode. A magnet-mode assessment alone may be sufficient in most cases, and current clinical practice varies considerably. A retrospective single-center assessment of all pacemaker implants receiving PSP and magnet checks between September 2009 and April 2010. Patient records were reviewed. The results of PSP and magnet checks and any subsequent device-related management were noted. A total of 168 patients underwent pacemaker implantation, magnet-mode assessment, and then PSP interrogation during this period. Magnet-mode assessment revealed a problem in only one patient-failure of atrial capture, leading to subsequent atrial lead repositioning. None of the remaining 167 patients have a serious problem at PSP interrogation; six had minor issues at PSP check, none of which required repeat surgical intervention. The magnet-mode test only provides information on lead capture in an asynchronous pacing mode, which is the most essential data postoperatively. Our study has suggested that a magnet-mode assessment without PSP interrogation may be sufficient in the immediate postimplant assessment of these patients. Routine postimplant PSP interrogation is time consuming, labor intensive, and adds only minimal additional benefit to the safe management of these patients above and beyond a magnet check, coupled with informed assessment of the associated electrocardiogram/rhythm strip, clinical examination, and chest x-ray. ©2014 Wiley Periodicals, Inc.

Safety and efficiency of ventricular pacing prevention with an AAI-DDD changeover mode in patients with sinus node disease or atrioventricular block: impact on battery longevity—a sub-study of the ANSWER trial

PubMed Central

Stockburger, Martin; Defaye, Pascal; Boveda, Serge; Stancak, Branislav; Lazarus, Arnaud; Sipötz, Johann; Nardi, Stefano; Rolando, Mara; Moreno, Javier

2016-01-01

Abstract Aims This ANSWER (EvaluAtioN of the SafeR mode in patients With a dual chambER pacemaker indication) sub-study assesses safety and effectiveness of SafeR™ and the impact of ventricular pacing (VP) prevention on anticipated device longevity and replacement rate. Methods and results Patients implanted for atrioventricular block (AVB, n = 310) or sinus node dysfunction (SND, n = 336) were randomly assigned to SafeR (n = 314) or DDD (n = 318) and followed for 36 months. Safety, median VP, estimated device longevity (mean difference, 95% confidence interval [CI]), and anticipated replacement rates were analysed by pacing mode and implant indication. No difference in mortality, syncope, or mode intolerance was observed between randomization groups regardless of the indication. Ventricular pacing on SafeR vs. DDD was 11.5 vs. 93.6% in the overall population (P < 0.001), 89.2 vs. 83.8% in permanent AVB (P = 0.944), 53.5 vs. 98.2% in intermittent AVB (P < 0.001), and 2.2 vs. 84.7% in SND (P < 0.001). Anticipated median device longevity increased on SafeR by 14 [Q1 10; Q3 17] months [10; 17] (P < 0.001) in the overall population, 9 months [−5; 22] (P = 0.193) in permanent AVB, 14 months [8; 19] (P < 0.001) in intermittent AVB, and 14 months [9; 19] (P < 0.001) in SND. In intermittent AVB and SND, prolonged estimated battery longevity translated into the prevention of one anticipated replacement in at least 23% of patients. Conclusion SafeR was effective in reducing VP in intermittent AVB and in SND. No effect was observed in permanent AVB. No safety issue was observed. Ventricular pacing reduction by SafeR translated into relevant estimated prolongation of device longevity and anticipated reduction of required replacements. PMID:26612882

A delivery mode study: The effect of self-paced video learning on first-year college students' achievement in calculus

NASA Astrophysics Data System (ADS)

Oktaviyanthi, Rina; Herman, Tatang

2016-10-01

In this paper, the effect of two different modes of deliver are proposed. The use of self-paced video learning and conventional learning methods in mathematics are compared. The research design classified as a quasi-experiment. The participants were 80 students in the first-year college and divided into two groups. One group as an experiment class received self-paced video learning method and the other group as a control group taught by conventional learning method. Pre and posttest were employed to measure the students' achievement, while questionnaire and interviews were applied to support the pre and posttest data. Statistical analysis included the independent samples t-test showed differences (p < 0.05) in posttest between the experimental and control groups, it means that the use of self-paced video contributed on students' achievement and students' attitudes. In addition, related to corresponding to the students' answer, there are five positive gains in using self-paced video in learning Calculus, such as appropriate learning for both audio and visual of students' characteristics, useful to learn Calculus, assisting students to be more engaging and paying attention in learning, helping students in making the concepts of Calculus are visible, interesting media and motivating students to learn independently.

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

PubMed

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

2018-05-30

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

[TRENDS OF PERMANENT PACEMAKER IMPLANTATION IN A SINGLE CENTER OVER A 20-YEAR PERIOD].

PubMed

Antonelli, Dante; Ilan, Limor Bushar; Freedberg, Nahum A; Feldman, Alexander; Turgeman, Yoav

2015-05-01

To review the changes in permanent pacemaker implantation indications, pacing modes and patients' demographics over a 20-year period. We retrospectively retrieved data on patients who underwent first implantation of the pacemaker between 1-1-1991 and 31-12-2010. One thousand and nine (1,009) patients underwent a first pacemaker implantation during that period; 535 were men (53%), their mean age was 74.6±19.5 years; the highest rate of implanted pacemaker was in patients ranging in age from 70-79 years, however there was an increasing number of patients aged over 80 years. The median survival time after initial pacemaker implantation was 8 years. Syncope was the most common symptom (62.5%) and atrioventricular block was the most common electrocardiographic indication (56.4%) leading to pacemaker implantation. There was increased utilization of dual chamber and rate responsive pacemakers over the years. There was no difference regarding mode selection between genders. Pacemaker implantation rates have increased over a 20-year period. Dual chamber replaced most of the single ventricular chamber pacemaker and rate responsive pacemakers became the norm. The data of a small volume center are similar to those reported in pacemaker surveys of high volume pacemaker implantation centers. They confirm adherence to the published guidelines for pacing.

Clinically oriented device programming in bradycardia patients: part 1 (sinus node disease). Proposals from AIAC (Italian Association of Arrhythmology and Cardiac Pacing).

PubMed

Ziacchi, Matteo; Palmisano, Pietro; Biffi, Mauro; Ricci, Renato P; Landolina, Maurizio; Zoni-Berisso, Massimo; Occhetta, Eraldo; Maglia, Giampiero; Botto, Gianluca; Padeletti, Luigi; Boriani, Giuseppe

2018-04-01

: Modern pacemakers have an increasing number of programable parameters and specific algorithms designed to optimize pacing therapy in relation to the individual characteristics of patients. When choosing the most appropriate pacemaker type and programing, the following variables must be taken into account: the type of bradyarrhythmia at the time of pacemaker implantation; the cardiac chamber requiring pacing, and the percentage of pacing actually needed to correct the rhythm disorder; the possible association of multiple rhythm disturbances and conduction diseases; the evolution of conduction disorders during follow-up. The goals of device programing are to preserve or restore the heart rate response to metabolic and hemodynamic demands; to maintain physiological conduction; to maximize device longevity; to detect, prevent, and treat atrial arrhythmia. In patients with sinus node disease, the optimal pacing mode is DDDR. Based on all the available evidence, in this setting, we consider appropriate the activation of the following algorithms: rate responsive function in patients with chronotropic incompetence; algorithms to maximize intrinsic atrioventricular conduction in the absence of atrioventricular blocks; mode-switch algorithms; algorithms for autoadaptive management of the atrial pacing output; algorithms for the prevention and treatment of atrial tachyarrhythmias in the subgroup of patients with atrial tachyarrhythmias/atrial fibrillation. The purpose of this two-part consensus document is to provide specific suggestions (based on an extensive literature review) on appropriate pacemaker setting in relation to patients' clinical features.

Extraction of SelectSecure leads compared to conventional pacing leads in patients with congenital heart disease and congenital atrioventricular block.

PubMed

Shepherd, Emma; Stuart, Graham; Martin, Rob; Walsh, Mark A

2015-06-01

SelectSecure™ pacing leads (Medtronic Inc) are increasingly being used in pediatric patients and adults with structural congenital heart disease. The 4Fr lead is ideal for patients who may require lifelong pacing and can be advantageous for patients with complex anatomy. The purpose of this study was to compare the extraction of SelectSecure leads with conventional (stylette-driven) pacing leads in patients with structural congenital heart disease and congenital atrioventricular block. The data on lead extractions from pediatric and adult congenital heart disease (ACHD) patients from August 2004 to July 2014 at Bristol Royal Hospital for Children and the Bristol Heart Institute were reviewed. Multivariable regression analysis was used to determine whether conventional pacing leads were associated with a more difficult extraction process. A total of 57 patients underwent pacemaker lead extractions (22 SelectSecure, 35 conventional). No deaths occurred. Mean age at the time of extraction was 17.6 ± 10.5 years, mean weight was 47 ± 18 kg, and mean lead age was 5.6 ± 2.6 years (range 1-11 years). Complex extraction (partial extraction/femoral extraction) was more common in patients with conventional pacing leads at univariate (P < .01) and multivariate (P = .04) levels. Lead age was also a significant predictor of complex extraction (P < .01). SelectSecure leads can be successfully extracted using techniques that are used for conventional pacing leads. They are less likely to be partially extracted and are less likely to require extraction using a femoral approach compared with conventional pacing leads. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Implantable cardiac arrhythmia devices--part I: pacemakers.

PubMed

Kusumoto, Fred M; Goldschlager, Nora

2006-05-01

Implantable cardiac devices have become firmly entrenched as important therapeutic tools for a variety of cardiac conditions. The first part of this two-part review will discuss the contemporary use and follow-up of pacemakers, while the second part will address the use of implantable cardioverter defibrillators and implantable loop recorders. Pacemakers are the only available treatment for symptomatic bradycardia not due to reversible causes. Large randomized studies have demonstrated a small but statistically significant reduction in atrial fibrillation associated with pacing modes that maintain atrioventricular synchrony. In contrast, pacing mode appears to have a less dramatic effect in patients with atrioventricular block. Cardiac resynchronization with specialized left ventricular leads has been shown to reduce symptoms and improve survival in patients with symptomatic heart failure, systolic dysfunction, and widened QRS complexes. For all patients, careful follow-up is necessary to ensure optimal therapeutic benefit of pacing systems.

[Analysis of pacemaker ECGs].

PubMed

Israel, Carsten W; Ekosso-Ejangue, Lucy; Sheta, Mohamed-Karim

2015-09-01

The key to a successful analysis of a pacemaker electrocardiogram (ECG) is the application of the systematic approach used for any other ECG without a pacemaker: analysis of (1) basic rhythm and rate, (2) QRS axis, (3) PQ, QRS and QT intervals, (4) morphology of P waves, QRS, ST segments and T(U) waves and (5) the presence of arrhythmias. If only the most obvious abnormality of a pacemaker ECG is considered, wrong conclusions can easily be drawn. If a systematic approach is skipped it may be overlooked that e.g. atrial pacing is ineffective, the left ventricle is paced instead of the right ventricle, pacing competes with intrinsic conduction or that the atrioventricular (AV) conduction time is programmed too long. Apart from this analysis, a pacemaker ECG which is not clear should be checked for the presence of arrhythmias (e.g. atrial fibrillation, atrial flutter, junctional escape rhythm and endless loop tachycardia), pacemaker malfunction (e.g. atrial or ventricular undersensing or oversensing, atrial or ventricular loss of capture) and activity of specific pacing algorithms, such as automatic mode switching, rate adaptation, AV delay modifying algorithms, reaction to premature ventricular contractions (PVC), safety window pacing, hysteresis and noise mode. A systematic analysis of the pacemaker ECG almost always allows a probable diagnosis of arrhythmias and malfunctions to be made, which can be confirmed by pacemaker control and can often be corrected at the touch of the right button to the patient's benefit.

A Study of Instructional Methods Used in Fast-Paced Classes

ERIC Educational Resources Information Center

Lee, Seon-Young; Olszewski-Kubilius, Paula

2006-01-01

This study involved 15 secondary-level teachers who taught fast-paced classes at a university based summer program and similar regularly paced classes in their local schools in order to examine how teachers differentiate or modify instructional methods and content selections for fast-paced classes. Interviews were conducted with the teachers…

Rational Design of a Highly Potent and Selective Peptide Inhibitor of PACE4 by Salt Bridge Interaction with D160 at Position P3.

PubMed

Dianati, Vahid; Shamloo, Azar; Kwiatkowska, Anna; Desjardins, Roxane; Soldera, Armand; Day, Robert; Dory, Yves L

2017-08-08

PACE4, a member of the proprotein convertases (PCs) family of serine proteases, is a validated target for prostate cancer. Our group has developed a potent and selective PACE4 inhibitor: Ac-LLLLRVKR-NH 2 . In seeking for modifications to increase the selectivity of this ligand toward PACE4, we replaced one of its P3 Val methyl groups with a basic group capable of forming a salt bridge with D160 of PACE4. The resulting inhibitor is eight times more potent than the P3 Val parent inhibitor and two times more selective over furin, because the equivalent salt bridge with furin E257 is not optimal. Moreover, the β-branched nature of the new P3 residue favors the extended β-sheet conformation usually associated with substrates of proteases. This work provides new insight for better understanding of β-sheet backbone-backbone interactions between serine proteases and their peptidic ligands. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Myopotential inhibition of a bipolar pacemaker caused by electrode insulation defect.

PubMed Central

Amikam, S; Peleg, H; Lemer, J; Riss, E

1977-01-01

A patient is described in whom myopotentials orginating from the anterior abdominal wall muscle suppressed the implanted demand pacemaker despite its bipolar mode of action. This phenomenon was shown by simultaneous recording of the electrocardiogram the electromyogram. At operation, a defect in the insulation of a previously repaired epicardial electrode was found lying in close proximity to these muscles. After repair of the insulation defect, normal pacemaker function was restored. It is suggested that the myopotentials leaked into the pacing system through the insulation defect, thereby suppressing the demand unit, which maintained its bipolar mode of pacing throughout. Images PMID:145229

Electrocardiograms with pacemakers: accuracy of computer reading.

PubMed

Guglin, Maya E; Datwani, Neeta

2007-04-01

We analyzed the accuracy with which a computer algorithm reads electrocardiograms (ECGs) with electronic pacemakers (PMs). Electrocardiograms were screened for the presence of electronic pacing spikes. Computer-derived interpretations were compared with cardiologists' readings. Computer-drawn interpretations required revision by cardiologists in 61.3% of cases. In 18.4% of cases, the ECG reading algorithm failed to recognize the presence of a PM. The misinterpretation of paced beats as intrinsic beats led to multiple secondary errors, including myocardial infarctions in varying localization. The most common error in computer reading was the failure to identify an underlying rhythm. This error caused frequent misidentification of the PM type, especially when the presence of normal sinus rhythm was not recognized in a tracing with a DDD PM tracking the atrial activity. The increasing number of pacing devices, and the resulting number of ECGs with pacing spikes, mandates the refining of ECG reading algorithms. Improvement is especially needed in the recognition of the underlying rhythm, pacing spikes, and mode of pacing.

Validation of criteria for selective his bundle and para-hisian permanent pacing.

PubMed

Cantù, F; De Filippo, P; Cardano, P; De Luca, A; Gavazzi, A

2006-12-01

His Bundle (HB) pacing is a valid alternative to right ventricular pacing for patients with preserved His-ventricle conduction who are candidates for permanent stimulation. Permanent pacing in the HB area enables Selective HB pacing (SHBP) or para-Hisian pacing (PHP) to be achieved. The aim of our study was to draw up a set of easy criteria to differentiate and validate the two kinds of stimulations according to the pacing output and the ECG/EKG signals. From February to July 2005, 17 patients eligible for a pacemaker (PM) procedure underwent implantation with the Medtronic SelectSecure lead (Medtronic, Minneapolis, MN, USA) screwed into the HB area.SHBP was defined when the intrinsic QRS was equal, in both duration and morphology, to the paced QRS, the His-Ventricular (H-V) interval was equal to Pace-Ventricular interval (Vp-V) and, at low output, only the HB was captured, while increasing the output resulted in both the HB and right ventricular (RV) being captured (widening of QRS at high output). Conversely, PHP was defined when the intrinsic QRS differed from the paced one, either in morphology or in duration and, at high output, both the RV and HB were captured (non-SHBP), while decreasing the output resulted in losing HB capture (widening of QRS at low output). According to these criteria, SHBP was achieved in 11 patients, while in the remaining 6, PHP was obtained. No adverse events were reported. The above criteria enabled SHBP and PHP to be validated easily and clearly. A longer follow-up will be needed in order to ascertain whether the clinical outcome of these two approaches differs.

Safety and efficiency of ventricular pacing prevention with an AAI-DDD changeover mode in patients with sinus node disease or atrioventricular block: impact on battery longevity-a sub-study of the ANSWER trial.

PubMed

Stockburger, Martin; Defaye, Pascal; Boveda, Serge; Stancak, Branislav; Lazarus, Arnaud; Sipötz, Johann; Nardi, Stefano; Rolando, Mara; Moreno, Javier

2016-05-01

This ANSWER (EvaluAtioN of the SafeR mode in patients With a dual chambER pacemaker indication) sub-study assesses safety and effectiveness of SafeR™ and the impact of ventricular pacing (VP) prevention on anticipated device longevity and replacement rate. Patients implanted for atrioventricular block (AVB, n = 310) or sinus node dysfunction (SND, n = 336) were randomly assigned to SafeR (n = 314) or DDD (n = 318) and followed for 36 months. Safety, median VP, estimated device longevity (mean difference, 95% confidence interval [CI]), and anticipated replacement rates were analysed by pacing mode and implant indication. No difference in mortality, syncope, or mode intolerance was observed between randomization groups regardless of the indication. Ventricular pacing on SafeR vs. DDD was 11.5 vs. 93.6% in the overall population (P < 0.001), 89.2 vs. 83.8% in permanent AVB (P = 0.944), 53.5 vs. 98.2% in intermittent AVB (P < 0.001), and 2.2 vs. 84.7% in SND (P < 0.001). Anticipated median device longevity increased on SafeR by 14 [Q1 10; Q3 17] months [10; 17] (P < 0.001) in the overall population, 9 months [-5; 22] (P = 0.193) in permanent AVB, 14 months [8; 19] (P < 0.001) in intermittent AVB, and 14 months [9; 19] (P < 0.001) in SND. In intermittent AVB and SND, prolonged estimated battery longevity translated into the prevention of one anticipated replacement in at least 23% of patients. SafeR was effective in reducing VP in intermittent AVB and in SND. No effect was observed in permanent AVB. No safety issue was observed. Ventricular pacing reduction by SafeR translated into relevant estimated prolongation of device longevity and anticipated reduction of required replacements. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Step Detection Robust against the Dynamics of Smartphones

PubMed Central

Lee, Hwan-hee; Choi, Suji; Lee, Myeong-jin

2015-01-01

A novel algorithm is proposed for robust step detection irrespective of step mode and device pose in smartphone usage environments. The dynamics of smartphones are decoupled into a peak-valley relationship with adaptive magnitude and temporal thresholds. For extracted peaks and valleys in the magnitude of acceleration, a step is defined as consisting of a peak and its adjacent valley. Adaptive magnitude thresholds consisting of step average and step deviation are applied to suppress pseudo peaks or valleys that mostly occur during the transition among step modes or device poses. Adaptive temporal thresholds are applied to time intervals between peaks or valleys to consider the time-varying pace of human walking or running for the correct selection of peaks or valleys. From the experimental results, it can be seen that the proposed step detection algorithm shows more than 98.6% average accuracy for any combination of step mode and device pose and outperforms state-of-the-art algorithms. PMID:26516857

The Search for Learning Community in Learner Paced Distance Education: Or, "Having Your Cake and Eating It, Too!"

ERIC Educational Resources Information Center

Anderson, Terry; Annand, David; Wark, Norine

2005-01-01

University distance and e-learning programs generally follow one of two models. Most dual mode institutions and some open universities follow a model of cohort learning. Students start and terminate each course at the same time, and proceed at the same pace. This model allows for occasional or regular group based activities. The second model,…

Mitigation of divertor heat flux by high-frequency ELM pacing with non-fuel pellet injection in DIII-D

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

Bortolon, A.; Maingi, R.; Mansfield, D. K.

Experiments have been conducted on DIII-D investigating high repetition rate injection of non-fuel pellets as a tool for pacing Edge Localized Modes (ELMs) and mitigating their transient divertor heat loads. Effective ELM pacing was obtained with injection of Li granules in different H-mode scenarios, at frequencies 3–5 times larger than the natural ELM frequency, with subsequent reduction of strike-point heat flux. However, in scenarios with high pedestal density (~6 × 10 19 m –3), the magnitude of granule triggered ELMs shows a broad distribution, in terms of stored energy loss and peak heat flux, challenging the effectiveness of ELM mitigation.more » Furthermore, transient heat-flux deposition correlated with granule injections was observed far from the strike-points. As a result, field line tracing suggest this phenomenon to be consistent with particle loss into the mid-plane far scrape-off layer, at toroidal location of the granule injection.« less

Mitigation of divertor heat flux by high-frequency ELM pacing with non-fuel pellet injection in DIII-D

DOE PAGES

Bortolon, A.; Maingi, R.; Mansfield, D. K.; ...

2017-03-23

Experiments have been conducted on DIII-D investigating high repetition rate injection of non-fuel pellets as a tool for pacing Edge Localized Modes (ELMs) and mitigating their transient divertor heat loads. Effective ELM pacing was obtained with injection of Li granules in different H-mode scenarios, at frequencies 3–5 times larger than the natural ELM frequency, with subsequent reduction of strike-point heat flux. However, in scenarios with high pedestal density (~6 × 10 19 m –3), the magnitude of granule triggered ELMs shows a broad distribution, in terms of stored energy loss and peak heat flux, challenging the effectiveness of ELM mitigation.more » Furthermore, transient heat-flux deposition correlated with granule injections was observed far from the strike-points. As a result, field line tracing suggest this phenomenon to be consistent with particle loss into the mid-plane far scrape-off layer, at toroidal location of the granule injection.« less

"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.

Coronal View Ultrasound Imaging of Movement in Different Segments of the Tongue during Paced Recital: Findings from Four Normal Speakers and a Speaker with Partial Glossectomy

ERIC Educational Resources Information Center

Bressmann, Tim; Flowers, Heather; Wong, Willy; Irish, Jonathan C.

2010-01-01

The goal of this study was to quantitatively describe aspects of coronal tongue movement in different anatomical regions of the tongue. Four normal speakers and a speaker with partial glossectomy read four repetitions of a metronome-paced poem. Their tongue movement was recorded in four coronal planes using two-dimensional B-mode ultrasound…

Continuous directed evolution of aminoacyl-tRNA synthetases

PubMed Central

Bryson, David I.; Fan, Chenguang; Guo, Li-Tao; Miller, Corwin; Söll, Dieter; Liu, David R.

2017-01-01

Directed evolution of orthogonal aminoacyl-tRNA synthetases (AARSs) enables site-specific installation of non-canonical amino acids (ncAAs) into proteins. Traditional evolution techniques typically produce AARSs with greatly reduced activity and selectivity compared to their wild-type counterparts. We designed phage-assisted continuous evolution (PACE) selections to rapidly produce highly active and selective orthogonal AARSs through hundreds of generations of evolution. PACE of a chimeric Methanosarcina spp. pyrrolysyl-tRNA synthetase (PylRS) improved its enzymatic efficiency (kcat/KMtRNA) 45-fold compared to the parent enzyme. Transplantation of the evolved mutations into other PylRS-derived synthetases improved yields of proteins containing non-canonical residues up to 9.7-fold. Simultaneous positive and negative selection PACE over 48 h greatly improved the selectivity of a promiscuous Methanocaldococcus jannaschii tyrosyl-tRNA synthetase variant for site-specific incorporation of p-iodo-L-phenylalanine. These findings offer new AARSs that increase the utility of orthogonal translation systems and establish the capability of PACE to efficiently evolve orthogonal AARSs with high activity and amino acid specificity. PMID:29035361

Atrial septal pacing in small dogs: a pilot study.

PubMed

Jones, Ashley E; Estrada, Amara H; Pariaut, Romain; Sosa-Samper, Ivan; Shih, Andre C; Mincey, Brandy D; Moïse, N Sydney

2014-09-01

To determine the feasibility of atrial septal pacing via a delivery catheter-guided small non-retracting helix pacing lead. Six healthy beagles (8.3-12.9 kg). Using single plane fluoroscopic guidance, Medtronic(®) 3830 SelectSecure leads were connected to the atrial septum via Medtronic® Attain Select® II standard 90 Left Heart delivery catheter. Pacing threshold and lead impedance were measured at implantation. The Wenckebach point was tested via atrial pacing up to 220 paced pulses per minute (ppm). Thoracic radiographs were performed following implantation to identify the lead position, and repeated at 24 h, 1 month, and 3 months post-operatively. Macro-lead dislodgement occurred in two dogs at 24 h and in three dogs at one-month post-implantation. Lead impedance, measured at the time of implantation, ranged from 583 to 1421 Ω. The Wenckebach point was >220 ppm in four of the six dogs. The remaining two dogs had Wenckebach points of 120 and 190 ppm. This pilot study suggests the selected implantation technique and lead system were inadequate for secure placement in the atrial septum of these dogs. The possible reasons for inadequate stability include unsuitable lead design for this location, inadequate lead slack at the time of implantation and inadequate seating of the lead as evidenced by low impedance at the time of implantation. Other implantation techniques and/or pacing leads should be investigated to determine the optimal way of pacing the atria in small breed dogs that are prone to sinus node dysfunction. Copyright © 2014 Elsevier B.V. All rights reserved.

Interatrial septum pacing guided by three-dimensional intracardiac echocardiography.

PubMed

Szili-Torok, Tamas; Kimman, Geert Jan P; Scholten, Marcoen F; Ligthart, Jurgen; Bruining, Nico; Theuns, Dominic A M J; Klootwijk, Peter J; Roelandt, Jos R T C; Jordaens, Luc J

2002-12-18

Currently, the interatrial septum (IAS) pacing site is indirectly selected by fluoroscopy and P-wave analysis. The aim of the present study was to develop a novel approach for IAS pacing using intracardiac echocardiography (ICE). Interatrial septum pacing may be beneficial for the prevention of paroxysmal atrial fibrillation. Cross-sectional images are acquired during a pull-back of the ICE transducer from the superior vena cava into the inferior vena cava by an electrocardiogram- and respiration-gated technique. Both atria are then reconstructed using three-dimensional (3D) imaging. Using an "en face" view of the IAS, the desired pacing site is selected. Following lead placement and electrical testing, another 3D reconstruction is performed to verify the final lead position. Twelve patients were included in this study. The IAS pacing was achieved in all patients including six suprafossal (SF) and six infrafossal (IF) lead locations all confirmed by 3D imaging. The mean duration times of atrial lead implantation and fluoroscopy were 70 +/- 48.9 min and 23.7 +/- 20.6 min, respectively. The IAS pacing resulted in a significant reduction of the P-wave duration as compared to sinus rhythm (98.9 +/- 19.3 ms vs. 141.3 +/- 8.6 ms; p < 0.002). The SF pacing showed a greater reduction of the P-wave duration than IF pacing (59.4 +/- 6.6 ms vs. 30.2 +/- 13.6 ms; p < 0.004). Three-dimensional ICE is a feasible tool for guiding IAS pacing.

Higher sympathetic nerve activity during ventricular (VVI) than during dual-chamber (DDD) pacing

NASA Technical Reports Server (NTRS)

Taylor, J. A.; Morillo, C. A.; Eckberg, D. L.; Ellenbogen, K. A.

1996-01-01

OBJECTIVES: We determined the short-term effects of single-chamber ventricular pacing and dual-chamber atrioventricular (AV) pacing on directly measured sympathetic nerve activity. BACKGROUND: Dual-chamber AV cardiac pacing results in greater cardiac output and lower systemic vascular resistance than does single-chamber ventricular pacing. However, it is unclear whether these hemodynamic advantages result in less sympathetic nervous system outflow. METHODS: In 13 patients with a dual-chamber pacemaker, we recorded the electrocardiogram, noninvasive arterial pressure (Finapres), respiration and muscle sympathetic nerve activity (microneurography) during 3 min of underlying basal heart rate and 3 min of ventricular and AV pacing at rates of 60 and 100 beats/min. RESULTS: Arterial pressure was lowest and muscle sympathetic nerve activity was highest at the underlying basal heart rate. Arterial pressure increased with cardiac pacing and was greater with AV than with ventricular pacing (change in mean blood pressure +/- SE: 10 +/- 3 vs. 2 +/- 2 mm Hg at 60 beats/min; 21 +/- 5 vs. 14 +/- 2 mm Hg at 100 beats/min; p < 0.05). Sympathetic nerve activity decreased with cardiac pacing and the decline was greater with AV than with ventricular pacing (60 beats/min -40 +/- 11% vs. -17 +/- 7%; 100 beats/min -60 +/- 9% vs. -48 +/- 10%; p < 0.05). Although most patients showed a strong inverse relation between arterial pressure and muscle sympathetic nerve activity, three patients with severe left ventricular dysfunction (ejection fraction < or = 30%) showed no relation between arterial pressure and sympathetic activity. CONCLUSIONS: Short-term AV pacing results in lower sympathetic nerve activity and higher arterial pressure than does ventricular pacing, indicating that cardiac pacing mode may influence sympathetic outflow simply through arterial baroreflex mechanisms. We speculate that the greater incidence of adverse outcomes in patients treated with single-chamber ventricular rather than dual-chamber pacing may be due in part to increased sympathetic nervous outflow.

[Magnets, pacemaker and defibrillator: fatal attraction?].

PubMed

Bergamin, C; Graf, D

2015-05-27

This article aims at clarifying the effects of a clinical magnet on pacemakers and Implantable Cardioverter Defibrillators. The effects of electromagnetic interferences on such devices, including interferences linked to electrosurgery and magnetic resonance imaging are also discussed. In general, a magnet provokes a distinctive effect on a pacemaker by converting it into an asynchronous mode of pacing, and on an Implantable Cardioverter Defibrillator by suspending its own antitachyarythmia therapies without affecting the pacing. In the operating room, the magnet has to be used cautiously with precisely defined protocols which respect the type of the device used, the type of intervention planned, the presence or absence of EMI and the pacing-dependency of the patient.

Is there a right place to pace the right ventricle? Evaluation of apical and septal positions in a pacemaker population: study protocol for a prospective intervention-control trial.

PubMed

Muto, Carmine; Calvi, Valeria; Botto, Giovanni Luca; Pecora, Domenico; Ciaramitaro, Gianfranco; Valsecchi, Sergio; Malacrida, Maurizio; Maglia, Giampiero

2014-11-01

The main objective of research in pacemaker therapy has been to provide the best physiologic way to pace the heart. Despite the good results provided by right ventricular pacing minimization and by biventricular pacing in specific subsets of heart failure patients, these options present many limitations for standard pacemaker recipients. In these patients, pacing the right ventricle at alternative sites could result in a lower degree of left intraventricular dyssynchrony. Despite the lack of strong evidence and the difficulty in placing and accurately classifying the final lead position, pacing at alternative right ventricular sites seems to have become a standard procedure at many implanting centers. The RIGHT PACE study is a multi-center, prospective, single-blind, double-arm, intervention-control trial comparing right ventricular pacing from the apex and from the septal site in terms of left intraventricular dyssynchrony. A total of 408 patients with indications for cardiac pacing but without indications for ICD and/or CRT will be enrolled. Investigators will be divided on the basis of their prior experience of selective site pacing lead implantation and patients will be treated according to the clinical practice of the centers. After device implantation, they will be followed up for 24 months through evaluation of clinical, echocardiographic and safety/system-performance variables. This study might provide important information about the impact of the right ventricular pacing on the left ventricular dyssynchrony, and about acute and chronic responses to selective site pacing, as adopted in current clinical practice. This trial is registered at ClinicalTrials.gov (ID:NCT01647490). Right Ventricular Lead Placement in a Pacemaker Population: Evaluation of apical and alternative position. ClinicalTrials.gov: NCT01647490. Copyright © 2014 Elsevier Inc. All rights reserved.

A research project to develop and evaluate a technical education component on materials technology for orientation to space-age technology

NASA Technical Reports Server (NTRS)

Jacobs, J. A.

1976-01-01

A project was initiated to develop, implement, and evaluate a prototype component for self-pacing, individualized instruction on basic materials science. Results of this project indicate that systematically developed, self-paced instruction provides an effective means for orienting nontraditional college students and secondary students, especially minorities, to both engineering technology and basic materials science. In addition, students using such a system gain greater chances for mastering subject matter than with conventional modes of instruction.

Sensors for rate responsive pacing

PubMed Central

Dell'Orto, Simonetta; Valli, Paolo; Greco, Enrico Maria

2004-01-01

Advances in pacemaker technology in the 1980s have generated a wide variety of complex multiprogrammable pacemakers and pacing modes. The aim of the present review is to address the different rate responsive pacing modalities presently available in respect to physiological situations and pathological conditions. Rate adaptive pacing has been shown to improve exercise capacity in patients with chronotropic incompetence. A number of activity and metabolic sensors have been proposed and used for rate control. However, all sensors used to optimize pacing rate metabolic demands show typical limitations. To overcome these weaknesses the use of two sensors has been proposed. Indeed an unspecific but fast reacting sensor is combined with a more specific but slower metabolic one. Clinical studies have demonstrated that this methodology is suitable to reproduce normal sinus behavior during different types and loads of exercise. Sensor combinations require adequate sensor blending and cross checking possibly controlled by automatic algorithms for sensors optimization and simplicity of programming. Assessment and possibly deactivation of some automatic functions should be also possible to maximize benefits from the dual sensor system in particular conditions. This is of special relevance in patient whose myocardial contractility is limited such as in subjects with implantable defibrillators and biventricular pacemakers. The concept of closed loop pacing, implementing a negative feedback relating pacing rate and the control signal, will provide new opportunities to optimize dual-sensors system and deserves further investigation. The integration of rate adaptive pacing into defibrillators is the natural consequence of technical evolution. PMID:16943981

Permanent epicardial pacing in pediatric patients: 12-year experience at a single center.

PubMed

Kwak, Jae Gun; Kim, Soo-Jin; Song, Jin Young; Choi, Eun Young; Lee, Sang Yoon; Shim, Woo Sup; Lee, Chang-Ha; Lee, Cheul; Park, Chun Soo

2012-02-01

Permanent cardiac pacing is not often done in children, and when done is usually accomplished through epicardial pacing. We reviewed a 12-year experience with the implantation of epicardial pacemakers by our clinical group. Fifty-three patients who underwent their first implantation of an epicardial pacemaker before the age of 18 years and between 1997 and 2009 were included in our study. The mean age of the patients at the time of first pacemaker implantation was 5.7±4.8 years. Indications for pacemaker implantation included postoperative or congenital atrioventricular block and sinus node dysfunction. The patients underwent 105 operations for the replacement of pacemaker pulse generators and 75 operations for the replacement of pacemaker leads. The most commonly used generator mode was the rate-responsive accelerometer-based (DDDR) mode, which was used in 40.9% of the patients. We used more non-steroid-eluting leads (70.1%) than steroid-eluting leads (29.1%). The overall duration of follow-up in the study was 8.0±4.5 years (range, 2.1 months to approximately 17.0 years). Freedom from the need for generator replacement was 98.0%, 60.7%, and 11.1% at 1, 5, and 8 years, respectively. A tendency toward early generator exhaustion was observed among younger patients (p=0.058). The generator mode used for pacing did not significantly affect generator longevity. Freedom from the need for lead replacement was 98.3%, 83.8%, and 63.6% at 1, 5, and 10 years, respectively. The mean longevity of the leads used in the study was 10.8±0.8 years. Neither patient age at the time of lead implantation nor type of lead significantly affected lead longevity. Lead longevity was sufficiently long and did not vary significantly according to type of lead. Generator longevity was not affected by lead type, generator mode, or patient age at the time of pacemaker implantation. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Pacing for neurally mediated syncope: is placebo powerless?

PubMed

Brignole, M; Sutton, R

2007-01-01

After two recent controlled trials failed to prove superiority of cardiac pacing over placebo in patients affected by neurally mediated syncope, a widely accepted opinion is that cardiac pacing therapy is not very effective and that a strong placebo effect exists. To measure the effect of placebo pacing therapy. We compared the recurrence rate of syncope during placebo vs. no treatment in controlled trials of drug or pacing therapy. Syncope recurred in 38% of 252 patients randomized to placebo pooled from five trials vs. 34% of 881 patients randomized to no treatment pooled from eight trials. The corresponding recurrence rate with active cardiac pacing was 15% in 203 patients from six trials. Placebo is not an effective therapy for neurally mediated syncope. Different selection criteria in patients who are candidates for cardiac pacing-for example, presence, absence, or severity of the cardioinhibitory reflex may separate positive from negative trials.

The effect of atrial-based pacing on exercise capacity as measured by the 6-minute walk test: a substudy of the Canadian Trial of Physiological Pacing (CTOPP).

PubMed

Baranchuk, Adrian; Healey, Jeff S; Thorpe, Kevin E; Morillo, Carlos A; Nair, Girish; Crystal, Eugene; Kerr, Charles R; Connolly, Stuart J

2007-08-01

Although several randomized trials have detected no reduction in major cardiovascular events with the routine use of dual-chamber as opposed to ventricular pacemakers, many individuals continue to advocate their use as a means of improving exercise capacity. The Canadian Trial of Physiological Pacing (CTOPP) trial is the largest trial comparing ventricular pacing to atrial-based pacing (atrial or dual-chamber) in patients with bradycardia. All patients in this trial were asked to complete a 6-minute hall walk test (6MWT) at the time of their first study follow-up. The distance walked in 6 minutes and the patient's heart rate before and immediately after the walk were recorded. Of the 2568 patients in the CTOPP, 76% completed the 6MWT. The mean distance walked was 350 +/- 127 m in the ventricular pacing group and 356 +/- 127 m in the atrial-based group (P = NS). Similarly, there was no difference in the change in heart rate between the two groups (17 +/- 13 vs. 18 +/- 12 bpm: P = NS). However, among patients with an unpaced heart rate of

DDD(R)-pacing, but not AAI(R)-pacing induces left ventricular desynchronization in patients with sick sinus syndrome: tissue-Doppler and 3D echocardiographic evaluation in a randomized controlled comparison.

PubMed

Albertsen, Andi Eie; Nielsen, Jens Cosedis; Poulsen, Steen Hvitfeldt; Mortensen, Peter Thomas; Pedersen, Anders Kirstein; Hansen, Peter Steen; Jensen, Henrik Kjaerulf; Egeblad, Henrik

2008-02-01

Increasing evidence from randomized trials and experimental studies indicates that right ventricular (RV) pacing may induce congestive heart failure. We studied regional left ventricular (LV) dyssynchrony and global LV function in 50 consecutive patients with sick sinus syndrome (SSS) randomized to either atrial pacing [AAI(R)] or dual chamber RV-pacing [DDD(R)]. Fifty consecutive patients were randomized to AAI(R) or DDD(R)-pacing. Tissue-Doppler imaging was used to quantify LV dyssynchrony in terms of number of segments with delayed longitudinal contraction (DLC). Left ventricular ejection fraction (LVEF) was measured using three-dimensional echocardiography. Dyssynchrony was more pronounced in the DDD(R)-group than in the AAI(R)-group at the 12 months follow-up (P < 0.05). This reflected a significant increase of dyssynchrony in the DDD(R)-group from baseline to the 12 months follow-up (1.3 +/- 1 to 2.1 +/- 1 segments displaying DLC per patient), P < 0.05. No change was observed in the AAI(R)-group (1.6 +/- 2 to 1.3 +/- 2 segments displaying DLC per patient, NS). No difference in LVEF, NYHA or NT-proBNP was observed between AAI(R)- and DDD(R)-mode after 12 months of pacing although LVEF decreased significantly in the DDD(R)-group from baseline (63.1 +/- 8%) to the 12 months follow-up (59.3 +/- 8%, P < 0.05), while LVEF remained unchanged in the AAI(R)-group (61.5 +/- 11% at baseline vs. 62.3 +/- 7% after 12 months, NS. In patients with SSS, DDD(R)-pacing but not AAI(R)-pacing induces significant LV desynchronization and reduction of LVEF.

Synchronous ventricular pacing with direct capture of the atrioventricular conduction system: Functional anatomy, terminology, and challenges.

PubMed

Mulpuru, Siva K; Cha, Yong-Mei; Asirvatham, Samuel J

2016-11-01

Right ventricular apical pacing is associated with an increased incidence of heart failure, atrial fibrillation, and overall mortality. As a result, pacing the ventricles in a manner that closely mimics normal AV conduction with an intact His-Purkinje system has been explored. Recently, the sustainable benefits of selective His-bundle stimulation have been demonstrated and proposed as the preferred method of ventricular stimulation for appropriate patients. Ideally, conduction system pacing should be selective without myocardial capture, overcome distal bundle branch block when present, and not compromise tricuspid valve function. Contemporary literature on conduction system pacing is confusing largely because of inconsistent terminology and, at times, anatomically inaccurate terms used interchangeably for nonsynonymous anatomic sites. In this review, we discuss the functional anatomy of AV conduction access with specific emphasis on terminology, relationship to the membranous septum, tricuspid valve tissue, and proximity to atrial or ventricular myocardium. The potential benefits of each specific site as well as associated unique difficulties with those sites are described. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Temporary epicardial cardiac resynchronisation versus conventional right ventricular pacing after cardiac surgery: study protocol for a randomised control trial.

PubMed

Russell, Stuart J; Tan, Christine; O'Keefe, Peter; Ashraf, Saeed; Zaidi, Afzal; Fraser, Alan G; Yousef, Zaheer R

2012-02-20

Heart failure patients with stable angina, acute coronary syndromes and valvular heart disease may benefit from revascularisation and/or valve surgery. However, the mortality rate is increased- 5-30%. Biventricular pacing using temporary epicardial wires after surgery is a potential mechanism to improve cardiac function and clinical endpoints. A multi-centred, prospective, randomised, single-blinded, intervention-control trial of temporary biventricular pacing versus standard pacing. Patients with ischaemic cardiomyopathy, valvular heart disease or both, an ejection fraction ≤ 35% and a conventional indication for cardiac surgery will be recruited from 2 cardiac centres. Baseline investigations will include: an electrocardiogram to confirm sinus rhythm and measure QRS duration; echocardiogram to evaluate left ventricular function and markers of mechanical dyssynchrony; dobutamine echocardiogram for viability and blood tests for renal function and biomarkers of myocardial injury- troponin T and brain naturetic peptide. Blood tests will be repeated at 18, 48 and 72 hours. The principal exclusions will be subjects with permanent atrial arrhythmias, permanent pacemakers, infective endocarditis or end-stage renal disease.After surgery, temporary pacing wires will be attached to the postero-lateral wall of the left ventricle, the right atrium and right ventricle and connected to a triple chamber temporary pacemaker. Subjects will be randomised to receive either temporary biventricular pacing or standard pacing (atrial inhibited pacing or atrial-synchronous right ventricular pacing) for 48 hours.The primary endpoint will be the duration of level 3 care. In brief, this is the requirement for invasive ventilation, multi-organ support or more than one inotrope/vasoconstrictor. Haemodynamic studies will be performed at baseline, 6, 18 and 24 hours after surgery using a pulmonary arterial catheter. Measurements will be taken in the following pacing modes: atrial inhibited; right ventricular only; atrial synchronous-right ventricular; atrial synchronous-left ventricular and biventricular pacing. Optimisation of the atrioventricular and interventricular delay will be performed in the biventricular pacing group at 18 hours. The effect of biventricular pacing on myocardial injury, post operative arrhythmias and renal function will also be quantified. ClinicalTrials.gov: NCT01027299.

Improving pacemaker therapy in congenital heart disease: contractility and resynchronization.

PubMed

Karpawich, Peter P

2015-01-01

Designed as effective therapy for patients with symptomatic bradycardia, implantable cardiac pacemakers initially served to improve symptoms and survival. With initial applications to the elderly and those with severe myocardial disease, extended longevity was not a major concern. However, with design technology advances in leads and generators since the 1980s, pacemaker therapy is now readily applicable to all age patients, including children with congenital heart defects. As a result, emphasis and clinical interests have advanced beyond simply quantity to quality of life. Adverse cardiac effects of pacing from right ventricular apical or epicardial sites with resultant left bundle branch QRS configurations have been recognized. As a result, and with the introduction of newer catheter-delivered pacing leads, more recent studies have focused on alternative or select pacing sites such as septal, outflow tract, and para-bundle of His. This is especially important in dealing with pacemaker therapy among younger patients and those with congenital heart disease, with expected decades of artificial cardiac stimulation, in which adverse myocellular changes secondary to pacing itself have been reported. As a correlate to these alternate or select pacing sites, applications of left ventricular pacing, either via the coronary sinus, intraseptal or epicardial, alone or in combination with right ventricular pacing, have gained interest for patients with heart failure. Although cardiac resynchronization pacing has, to date, had limited clinical applications among patients with congenital heart disease, the few published reports do indicate potential benefits as a bridge to cardiac transplant. Copyright © 2015 Elsevier Inc. All rights reserved.

Repetitive nonreentrant ventriculoatrial synchrony: An underrecognized cause of pacemaker-related arrhythmia.

PubMed

Sharma, Parikshit S; Kaszala, Karoly; Tan, Alex Y; Koneru, Jayanthi N; Shepard, Richard; Ellenbogen, Kenneth A; Huizar, Jose F

2016-08-01

Similar to endless loop tachycardia (ELT), repetitive nonreentrant ventriculoatrial synchrony (RNRVAS) is a ventriculoatrial (VA) synchrony pacemaker-mediated arrhythmia. RNRVAS was first described in 1990 and can only occur in the presence of retrograde VA conduction and dual-chamber or cardiac resynchronization devices with tracking (P-synchronous ventricular pacing such as DDD, DDDR) or nontracking pacing modes that allow AV-sequential pacing (DDI, DDIR). RNRVAS is promoted by (1) high lower rate limit or any feature that allows rapid pacing, (2) long AV intervals, or (3) long postventricular atrial refractory period (PVARP). In contrast to ELT, RNRVAS is a less well-recognized form of pacemaker-mediated arrhythmia; thus, unlike ELT, there are no specific device algorithms to prevent, recognize, and terminate RNRVAS. However, RNRVAS has been recently shown to occur frequently. We present a series of cases, some of which were found fortuitously. Owing to its clinical implications, we propose that algorithms should be developed to prevent, identify, and terminate RNRVAS. Published by Elsevier Inc.

The association between left ventricular twisting motion and mechanical dyssynchrony: a three-dimensional speckle tracking study.

PubMed

Fujiwara, Shohei; Komamura, Kazuo; Nakabo, Ayumi; Masaki, Mitsuru; Fukui, Miho; Sugahara, Masataka; Itohara, Kanako; Soyama, Yuko; Goda, Akiko; Hirotani, Shinichi; Mano, Toshiaki; Masuyama, Tohru

2016-02-01

Left ventricular (LV) dyssynchrony is a causal factor in LV dysfunction and thought to be associated with LV twisting motion. We tested whether three-dimensional speckle tracking (3DT) can be used to evaluate the relationship between LV twisting motion and dyssynchrony. We examined 25 patients with sick sinus syndrome who had received dual chamber pacemakers. The acute effects of ventricular pacing on LV wall motion after the switch from atrial to ventricular pacing were assessed. LV twisting motion and dyssynchrony during each pacing mode were measured using 3DT. LV dyssynchrony was calculated from the time to the minimum peak systolic area strain of 16 LV imaging segments. Ventricular pacing increased LV dyssynchrony and decreased twist and torsion. A significant correlation was observed between changes in LV dyssynchrony and changes in torsion (r = -0.65, p < 0.01). Evaluation of LV twisting motion can potentially be used for diagnosing LV dyssynchrony.

Critical evaluation of monitoring strategy for the multi-residue determination of 90 chiral and achiral micropollutants in effluent wastewater.

PubMed

Petrie, Bruce; Proctor, Kathryn; Youdan, Jane; Barden, Ruth; Kasprzyk-Hordern, Barbara

2017-02-01

It is essential to monitor the release of organic micropollutants from wastewater treatment plants (WWTPs) for developing environmental risk assessment and assessing compliance with legislative regulation. In this study the impact of sampling strategy on the quantitative determination of micropollutants in effluent wastewater was investigated. An extended list of 90 chiral and achiral micropollutants representing a broad range of biological and physico-chemical properties were studied simultaneously for the first time. During composite sample collection micropollutants can degrade resulting in the under-estimation of concentration. Cooling collected sub-samples to 4°C stabilised ≥81 of 90 micropollutants to acceptable levels (±20% of the initial concentration) in the studied effluents. However, achieving stability for all micropollutants will require an integrated approach to sample collection (i.e., multi-bottle sampling with more than one stabilisation method applied). Full-scale monitoring of effluent revealed time-paced composites attained similar information to volume-paced composites (influent wastewater requires a sampling mode responsive to flow variation). The option of monitoring effluent using time-paced composite samplers is advantageous as not all WWTPs have flow controlled samplers or suitable sites for deploying portable flow meters. There has been little research to date on the impact of monitoring strategy on the determination of chiral micropollutants at the enantiomeric level. Variability in wastewater flow results in a dynamic hydraulic retention time within the WWTP (and upstream sewerage system). Despite chiral micropollutants being susceptible to stereo-selective degradation, no diurnal variability in their enantiomeric distribution was observed. However, unused medication can be directly disposed into the sewer network creating short-term (e.g., daily) changes to their enantiomeric distribution. As enantio-specific toxicity is observed in the environment, similar resolution of enantio-selective analysis to more routinely applied achiral methods is needed throughout the monitoring period for accurate risk assessment. Copyright © 2016 British Geological Survey, NERC. Published by Elsevier B.V. All rights reserved.

Exercise, Affect, and Adherence: An Integrated Model and a Case for Self-Paced Exercise

PubMed Central

Williams, David M.

2014-01-01

This paper reviews research relevant to a proposed conceptual model of exercise adherence that integrates the dual mode model and hedonic theory. Exercise intensity is posited to influence affective response to exercise via interoceptive (e.g., ventilatory drive) and cognitive (e.g., perceived autonomy) pathways; affective response to exercise is posited to influence exercise adherence via anticipated affective response to future exercise. The potential for self-paced exercise to enhance exercise adherence is examined in the context of the proposed model and suggestions are given for future research. Further evidence in support of self-paced exercise could have implications for exercise prescription, especially among overweight, sedentary adults, who are most in need of interventions that enhance adherence to exercise programs. PMID:18971508

Variables affecting the manifestation of and intensity of pacing behavior: A preliminary case study in zoo-housed polar bears.

PubMed

Cless, Isabelle T; Lukas, Kristen E

2017-09-01

High-speed video analysis was used to quantify two aspects of gait in 10 zoo-housed polar bears. These two variables were then examined as to how they differed in the conditions of pacing versus locomoting for each bear. Percent difference calculations measured the difference between pacing and locomoting data for each bear. We inferred that the higher the percent difference between pacing and locomoting in a given subject, the more intense the pacing may be. The percent difference values were analyzed alongside caregiver survey data defining the locations, frequency, and anticipatory nature of pacing in each bear, as well as each bear's age and sex, to determine whether any variables were correlated. The frequency and intensity of pacing behavior were not correlated. However, location of pacing was significantly correlated both with the subjects' age and whether or not the subject was classified as an anticipatory pacer. Bears appeared to select specific spots within their exhibits to pace, and the location therefore seemed tied to underlying motivation for the behavior. Additionally, bears that were classified in the survey as pacing anticipatorily displayed significantly more intense pacing behavior as quantified by gait analysis. © 2017 Wiley Periodicals, Inc.

Effect of 1. 5 tesla nuclear magnetic resonance imaging scanner on implanted permanent pacemakers

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

Hayes, D.L.; Holmes, D.R. Jr.; Gray, J.E.

1987-10-01

Patients with a permanent pacemaker are currently restricted from diagnostic nuclear magnetic resonance (NMR) imaging because of potential adverse effects on the pacemaker by the magnet. Previous work has shown that NMR imaging will result in asynchronous pacing of the pulse generator within a given distance of the magnet. The radiofrequency signal generated by the system may also result in rapid cardiac pacing, which may have deleterious effects. This study utilized a 1.5 tesla unit in an in vivo laboratory animal to evaluate the unit's effects on eight different pulse generators from two manufacturers. All pacemakers functioned in an asynchronousmore » mode when placed within a certain distance of the magnet. In addition, transient reed switch inhibition was observed. Seven of the eight pulse generators paced rapidly when exposed to the radiofrequency signal and there was a dramatic decrease in arterial blood pressure. Whether effective rapid cardiac pacing would occur could not be predicted before exposure to the magnetic resonance unit. Nuclear magnetic resonance imaging with high magnetic fields in patients with a pacemaker should continue to be avoided until the mechanism of the rapid cardiac pacing can be further delineated and either predicted or prevented.« less

The Manipulation of Pace within Endurance Sport

PubMed Central

Skorski, Sabrina; Abbiss, Chris R.

2017-01-01

In any athletic event, the ability to appropriately distribute energy is essential to prevent premature fatigue prior to the completion of the event. In sport science literature this is termed “pacing.” Within the past decade, research aiming to better understand the underlying mechanisms influencing the selection of an athlete's pacing during exercise has dramatically increased. It is suggested that pacing is a combination of anticipation, knowledge of the end-point, prior experience and sensory feedback. In order to better understand the role each of these factors have in the regulation of pace, studies have often manipulated various conditions known to influence performance such as the feedback provided to participants, the starting strategy or environmental conditions. As with all research there are several factors that should be considered in the interpretation of results from these studies. Thus, this review aims at discussing the pacing literature examining the manipulation of: (i) energy expenditure and pacing strategies, (ii) kinematics or biomechanics, (iii) exercise environment, and (iv) fatigue development. PMID:28289392

The Platform-Aware Compilation Environment (PACE)

DTIC Science & Technology

2012-09-01

The PACE Project provided full or partial support for the following graduate students: 1. Raj Barik (Rice) 2. Thomas Barr (Rice) 3...University, Houston, TX, Technical Report CS TR11-03, October 20, 2011. [7] Rajkishore Barik , Jisheng Zhao, and Vivek Sarkar, "Efficient Selection

Optimizing local capture of atrial fibrillation by rapid pacing: study of the influence of tissue dynamics.

PubMed

Uldry, Laurent; Virag, Nathalie; Jacquemet, Vincent; Vesin, Jean-Marc; Kappenberger, Lukas

2010-12-01

While successful termination by pacing of organized atrial tachycardias has been observed in patients, rapid pacing of AF can induce a local capture of the atrial tissue but in general no termination. The purpose of this study was to perform a systematic evaluation of the ability to capture AF by rapid pacing in a biophysical model of the atria with different dynamics in terms of conduction velocity (CV) and action potential duration (APD). Rapid pacing was applied during 30 s at five locations on the atria, for pacing cycle lengths in the range 60-110% of the mean AF cycle length (AFCL(mean)). Local AF capture could be achieved using rapid pacing at pacing sites located distal to major anatomical obstacles. Optimal pacing cycle lengths were found in the range 74-80% AFCL(mean) (capture window width: 14.6 ± 3% AFCL(mean)). An increase/decrease in CV or APD led to a significant shrinking/stretching of the capture window. Capture did not depend on AFCL, but did depend on the atrial substrate as characterized by an estimate of its wavelength, a better capture being achieved at shorter wavelengths. This model-based study suggests that a proper selection of the pacing site and cycle length can influence local capture results and that atrial tissue properties (CV and APD) are determinants of the response to rapid pacing.

Prolonged self-paced exercise in the heat – environmental factors affecting performance

PubMed Central

Junge, Nicklas; Jørgensen, Rasmus; Flouris, Andreas D.; Nybo, Lars

2016-01-01

ABSTRACT In this review we examine how self-paced performance is affected by environmental heat stress factors during cycling time trial performance as well as considering the effects of exercise mode and heat acclimatization. Mean power output during prolonged cycling time trials in the heat (≥30°C) was on average reduced by 15% in the 14 studies that fulfilled the inclusion criteria. Ambient temperature per se was a poor predictor of the integrated environmental heat stress and 2 of the prevailing heat stress indices (WBGT and UTCI) failed to predict the environmental influence on performance. The weighing of wind speed appears to be too low for predicting the effect for cycling in trained acclimatized subjects, where performance may be maintained in outdoor time trials at ambient temperatures as high as 36°C (36°C UTCI; 28°C WBGT). Power output during indoor trials may also be maintained with temperatures up to at least 27°C when humidity is modest and wind speed matches the movement speed generated during outdoor cycling, whereas marked reductions are observed when air movement is minimal. For running, representing an exercise mode with lower movement speed and higher heat production for a given metabolic rate, it appears that endurance is affected even at much lower ambient temperatures. On this basis we conclude that environmental heat stress impacts self-paced endurance performance. However, the effect is markedly modified by acclimatization status and exercise mode, as the wind generated by the exercise (movement speed) or the environment (natural or fan air movement) exerts a strong influence. PMID:28090557

Efficacy of Precordial Percussion Pacing Assessed in a Cardiac Standstill Microminipig Model.

PubMed

Wada, Takeshi; Ohara, Hiroshi; Nakamura, Yuji; Cao, Xin; Izumi-Nakaseko, Hiroko; Ando, Kentaro; Honda, Mitsuru; Yoshihara, Katsunori; Nakazato, Yuji; Lurie, Keith G; Sugiyama, Atsushi

2017-07-25

Potential cardiovascular benefits of precordial percussion pacing (PPP) during cardiac standstill are unknown.Methods and Results:A cardiac standstill model in amicrominipigwas created by inducing complete atrioventricular block with a catheter ablation technique (n=7). Next, the efficacy of cardiopulmonary resuscitation by standard chest compressions (S-CPR), PPP and ventricular electrical pacing in this model were analyzed in series (n=4). To assess the mechanism of PPP, a non-selective, stretch-activated channel blocker, amiloride, was administered during PPP (n=3). Peak systolic and diastolic arterial pressures during S-CPR, PPP and ventricular electrical pacing were statistically similar. However, the duration of developed arterial pressure with PPP was comparable to that with ventricular electrical pacing, and significantly greater than that with S-CPR. Amiloride decreased the induction rate of ventricular electrical activity by PPP in a dose-related manner. Each animal survived without any neurological deficit at 24, 48 h and 1 week, even with up to 2 h of continuous PPP. In amicrominipigmodel of cardiac standstill, PPP can become a novel means to significantly improve physiological outcomes after cardiac standstill or symptomatic bradyarrhythmias in the absence of cardiac pacing. Activation of the non-selective stretch-activated channels may mediate some of the mechanophysiological effects of PPP. Further study of PPP by itself and together with S-CPR is warranted using cardiac arrest models of atrioventricular block and asystole.

Longevity of implantable cardioverter defibrillators: a comparison among manufacturers and over time.

PubMed

von Gunten, Simon; Schaer, Beat A; Yap, Sing-Chien; Szili-Torok, Tamas; Kühne, Michael; Sticherling, Christian; Osswald, Stefan; Theuns, Dominic A M J

2016-05-01

Longevity of implantable cardioverter defibrillators (ICDs) is crucial for patients and healthcare systems as replacements impact on infection rates and cost-effectiveness. Aim was to determine longevity using very large databases of two teaching hospitals with a high number of replacements and a rather homogeneous distribution among manufacturers. The study population consists of all patients in whom an ICD was inserted in. All ICD manufacturers operating in Switzerland and the Netherlands and all implanted ICDs were included. Implantable cardioverter defibrillator replacements due to normal battery depletion were considered events, and other replacements were censored. Longevity was assessed depending on manufacturers, pacing mode, implant before/after 2006, and all parameters combined. We analysed data from 3436 patients in whom 4881 ICDs [44.2% VVI-ICDs, 27.4% DDD-ICDs, 26.3% cardiac resynchronization therapy (CRT)-ICDs, 2.0% subcutaneous ICDs] were implanted. The four major manufacturers had implant shares between 18.4 and 31.5%. Replacement due to battery depletion (27.4%) was performed for 1339 ICDs. Patient survival at 5 years was 80.1%. Longevity at 5 years improved in contemporary compared with elderly ICDs [63.9-80.6% across all ICDs, of 73.7-92.1% in VVIs, 58.2-76.1% in DDDs, and of 47.1-66.3% in CRT defibrillators, all P value < 0.05]. Remarkable differences were seen among manufacturers, and those with better performance in elderly ICDs were not those with better performance in contemporary ones. Implantable cardioverter defibrillator longevity increased in contemporary models independent of manufacturer and pacing mode. Still, significant differences exist among manufacturers. These results might impact on device selection. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

Effects of septal pacing on P wave characteristics: the value of three-dimensional echocardiography.

PubMed

Szili-Torok, Tamas; Bruining, Nico; Scholten, Marcoen; Kimman, Geert-Jan; Roelandt, Jos; Jordaens, Luc

2003-01-01

Interatrial septum (IAS) pacing has been proposed for the prevention of paroxysmal atrial fibrillation. IAS pacing is usually guided by fluoroscopy and P wave analysis. The authors have developed a new approach for IAS pacing using intracardiac echocardiography (ICE), and examined its effects on P wave characteristics. Cross-sectional images are acquired during pullback of the ICE transducer from the superior vena cava into the inferior vena cava by an electrocardiogram- and respiration-gated technique. The right atrium and IAS are then three-dimensionally reconstructed, and the desired pacing site is selected. After lead placement and electrical testing, another three-dimensional reconstruction is performed to verify the final lead position. The study included 14 patients. IAS pacing was achieved at seven suprafossal (SF) and seven infrafossal (IF) lead locations, all confirmed by three-dimensional imaging. IAS pacing resulted in a significant reduction of P wave duration as compared to sinus rhythm (99.7 +/- 18.7 vs 140.4 +/- 8.8 ms; P < 0.01). SF pacing was associated with a greater reduction of P wave duration than IF pacing (56.1 +/- 9.9 vs 30.2 +/- 13.6 ms; P < 0.01). P wave dispersion remained unchanged during septal pacing as compared to sinus rhythm (21.4 +/- 16.1 vs 13.5 +/- 13.9 ms; NS). Three-dimensional intracardiac echocardiography can be used to guide IAS pacing. SF pacing was associated with a greater decrease in P wave duration, suggesting that it is a preferable location to decrease interatrial conduction delay.

Keeping Pace

ERIC Educational Resources Information Center

Henderson, Nancy

2008-01-01

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

Epicardial left ventricular lead placement for cardiac resynchronization therapy: optimal pace site selection with pressure-volume loops.

PubMed

Dekker, A L A J; Phelps, B; Dijkman, B; van der Nagel, T; van der Veen, F H; Geskes, G G; Maessen, J G

2004-06-01

Patients in heart failure with left bundle branch block benefit from cardiac resynchronization therapy. Usually the left ventricular pacing lead is placed by coronary sinus catheterization; however, this procedure is not always successful, and patients may be referred for surgical epicardial lead placement. The objective of this study was to develop a method to guide epicardial lead placement in cardiac resynchronization therapy. Eleven patients in heart failure who were eligible for cardiac resynchronization therapy were referred for surgery because of failed coronary sinus left ventricular lead implantation. Minithoracotomy or thoracoscopy was performed, and a temporary epicardial electrode was used for biventricular pacing at various sites on the left ventricle. Pressure-volume loops with the conductance catheter were used to select the best site for each individual patient. Relative to the baseline situation, biventricular pacing with an optimal left ventricular lead position significantly increased stroke volume (+39%, P =.01), maximal left ventricular pressure derivative (+20%, P =.02), ejection fraction (+30%, P =.007), and stroke work (+66%, P =.006) and reduced end-systolic volume (-6%, P =.04). In contrast, biventricular pacing at a suboptimal site did not significantly change left ventricular function and even worsened it in some cases. To optimize cardiac resynchronization therapy with epicardial leads, mapping to determine the best pace site is a prerequisite. Pressure-volume loops offer real-time guidance for targeting epicardial lead placement during minimal invasive surgery.

Implantation of active fixation leads in coronary veins for left ventricular stimulation: report of five cases.

PubMed

Hansky, Bert; Vogt, Juergen; Gueldner, Holger; Schulte-Eistrup, Sebastian; Lamp, Barbara; Heintze, Johannes; Horstkotte, Dieter; Koerfer, Reiner

2007-01-01

Securing transvenous left ventricular (LV) pacing leads without an active fixation mechanism in proximal coronary vein (CV) segments is usually challenging and frequently impossible. We investigated how active fixation leads can be safely implanted in this location, how to avoid perforating the free wall of the CV, and how to recognize and respond to perforations. In five patients with no alternative to LV pacing from proximal CV segments, 4 Fr SelectSecure (Medtronic, Minneapolis, MN, USA) leads, which have a fixed helix, were implanted through a modified 6 Fr guide catheter with a pre-shaped tip (Launcher, Medtronic). Active fixation leads were successfully implanted in proximal CVs in five patients. There were no complications. Acute and chronic pacing thresholds were comparable to those of conventional CV leads. The pre-shaped guide catheter tip remains in close proximity to the myocardial aspect of the CV, directing the lead helix toward a safe implantation site. If only proximal CV pacing sites are available, 4 Fr SelectSecure leads can be safely implanted through a modified Launcher guide catheter, avoiding more invasive implantation techniques. Other than venous stenting or implantation of leads with retractable tines, SelectSecure leads are expected to remain extractable.

Major League Baseball pace-of-play rules and their influence on predicted muscle fatigue during simulated baseball games.

PubMed

Sonne, Michael W L; Keir, Peter J

2016-11-01

Major League Baseball (MLB) has proposed rule changes to speed up baseball games. Reducing the time between pitches may impair recovery from fatigue. Fatigue is a known precursor to injury and may jeopardise joint stability. This study examined how fatigue accumulated during baseball games and how different pace of play initiatives may influence fatigue. Pitcher data were retrieved from a public database. A predictive model of muscle fatigue estimated muscle fatigue in 8 arm muscles. A self-selected pace (22.7 s), 12 s pace (Rule 8.04 from the MLB) and a 20 s rest (a pitch clock examined in the 2014 Arizona Fall League (AFL)) were examined. Significantly more muscle fatigue existed in both the AFL and Rule 8.04 conditions, when compared to the self-selected pace condition (5.01 ± 1.73%, 3.95 ± 1.20% and 3.70 ± 1.10% MVC force lost, respectively). Elevated levels of muscle fatigue are predicted in the flexor-pronator mass, which is responsible for providing elbow stability. Reduced effectiveness of the flexor-pronator mass may reduce the active contributions to joint rotational stiffness, increasing strain on the ulnar collateral ligament (UCL) and possibly increasing injury risk.

Non-selective His bundle pacing with a biphasic waveform: enhancing septal resynchronization.

PubMed

Ortega, Daniel F; Barja, Luis D; Logarzo, Emilio; Mangani, Nicolas; Paolucci, Analia; Bonomini, Maria P

2018-05-01

His bundle pacing has shown to prevent detrimental effects from right ventricular apical pacing (RVA) and proved to resynchronize many conduction disturbances cases. However, the extent of His bundle pacing resynchronization is limited. An optimized stimulation waveform could expand this limit when implemented in His bundle pacing sets. In this work, we temporarily implemented RVA and Non-selective His bundle pacing with a biphasic anodal-first waveform (AF-nHB) and compared their effects against sinus rhythm (SR). Fifteen patients referred for electrophysiologic study with conduction disturbances, cardiomyopathy and ejection fraction below 35% were enrolled for the study. The following acute parameters were measured: QRS duration, left ventricular activation (RLVT), time of isovolumic contraction (IVCT), ejection fraction (EF), and dP/dtmax. QRS duration and RLVT decreased markedly under AF-nHB (SR: 169 ± 34 ms vs. nHB: 116 ± 31 ms, P < 0.0005) while RVA significantly increased QRS duration (SR: 169 ms vs. RVA: 198 ms, P < 0.05) and did not change RLVT (P = NS). Consistently, IVCT moderately decreased under AF-nHB (SR: 238 ms vs. RVA: 184 ms, P < 0.05 vs. SR) and dP/dtmax showed a 93.35 [mmHg] average increase under AF-nHB against SR. Also, T-wave inversions were observed during AF-nHB immediately after SR and RVA pacing suggesting the occurrence of cardiac memory. AF-nHB corrected bundle branch blocks in patients with severe conduction disturbances, even in those with dilated cardiomiopathy, outstanding from RVA. Also, the occurrence of cardiac memory during AF-nHB turned up as an observational finding of this study.

The effect of pacing strategy on physiological, kinetic and performance variables during simulated rowing ergometer.

PubMed

Dimakopoulou, Eleni; Zacharogiannis, Elias; Chairopoulou, Chrysoula; Kaloupsis, Socratis; Platanou, Theodoros

2017-02-21

This study compared the effects of self selected (SSP), negative (NPS) and even (EPS) pacing strategy on performance time, kinetic and physiological variables in overall 2km rowing and in first and second 1km. Fifteen male rowers (15.37 ± 1.34 yrs) realized four tests: an incremental test on a rowing ergometer to determine their VO2peak and three experimental 2 km rowing race, where first 1km was manipulated. From SSP a negative pacing strategy, 4% slower than the mean velocity of SSP, and an even pacing strategy (EPS) with mean velocity of SSP, were developed. High stroke rate and better performance time was observed in SSP. Fstr and Fpeak decreased, whereas performance time increased, in SSP and EPS from first to second 1km.Unlike, performance time, stroke rate and Pst in NPS presented better values (p=0.001) with the exception of decreased stroke length (p=0.03). There was an increase in physiological responses in all pacing strategies from first to second 1km (p=0.001). Performance time, stroke rate and Fstr were better in SSP and EPS compared to NPS in first 1km (p=0.001). VE, VE/VO2, VCO2 were better in SSP and EPS compared to NPS (p=0.001) in both first and second 1km. Stroke length was smaller in SSP compared to NPS and EPS in second 1km (p=0.001). Self selected pacing (parabolic-shaped profile) allowed rowers to cover the 2 km distance in higher stroke rate and in shorter performance time compared to negative and even pacing strategies presenting same physiological responses.

Active Self-Paced Learning for Cost-Effective and Progressive Face Identification.

PubMed

Lin, Liang; Wang, Keze; Meng, Deyu; Zuo, Wangmeng; Zhang, Lei

2018-01-01

This paper aims to develop a novel cost-effective framework for face identification, which progressively maintains a batch of classifiers with the increasing face images of different individuals. By naturally combining two recently rising techniques: active learning (AL) and self-paced learning (SPL), our framework is capable of automatically annotating new instances and incorporating them into training under weak expert recertification. We first initialize the classifier using a few annotated samples for each individual, and extract image features using the convolutional neural nets. Then, a number of candidates are selected from the unannotated samples for classifier updating, in which we apply the current classifiers ranking the samples by the prediction confidence. In particular, our approach utilizes the high-confidence and low-confidence samples in the self-paced and the active user-query way, respectively. The neural nets are later fine-tuned based on the updated classifiers. Such heuristic implementation is formulated as solving a concise active SPL optimization problem, which also advances the SPL development by supplementing a rational dynamic curriculum constraint. The new model finely accords with the "instructor-student-collaborative" learning mode in human education. The advantages of this proposed framework are two-folds: i) The required number of annotated samples is significantly decreased while the comparable performance is guaranteed. A dramatic reduction of user effort is also achieved over other state-of-the-art active learning techniques. ii) The mixture of SPL and AL effectively improves not only the classifier accuracy compared to existing AL/SPL methods but also the robustness against noisy data. We evaluate our framework on two challenging datasets, which include hundreds of persons under diverse conditions, and demonstrate very promising results. Please find the code of this project at: http://hcp.sysu.edu.cn/projects/aspl/.

Primary prevention of atrial fibrillation: does the atrial lead position influence the incidence of atrial arrhythmias in patients with sinus node dysfunction? Results from the PASTA Trial.

PubMed

Spitzer, Stefan G; Wacker, Petra; Gazarek, Steffen; Malinowski, Klaus; Schibgilla, Volker

2009-12-01

PASTA (pacing of the atria in sinus node disease) is a prospective and randomized trial, assessing the effect of different atrial lead positions on the atrial fibrillation (AF) incidence in patients with sinus node disease (SND). The atrial lead position is randomized to: (a) free right atrial wall, (b) right atrial appendage (RAA), (c) coronary sinus ostium (CS-Os), or (d) dual site right atrial pacing (CS-Os + RAA). The pacemakers (Vitatron Selection 9000 or Prevent AF, Vitatron B.V., Arnhem, The Netherlands) are programmed in DDDR 70 mode and the total follow-up duration is 24 months. To describe the atrial rhythm state, pacemaker-derived data (arrhythmia counter) were assessed for AF episodes. AF was considered as evident, if the AF burden (time in AF related to follow-up interval) was >1% (i.e., 15 min/d). Follow-up data after 24 months were evaluated. The analysis evaluates 142 patients (77 male, 74.5 +/- 7.8 years). There was no statistical significant difference with respect to the occurrence of AF between the four groups after 24 months (A: 36%; B: 38%, C: 32%, D: 48%). The percentage of atrial/ventricular pacing was in A: 78/76%, in B: 84/81%, in C: 70/65%, and in D: 79/69%. These differences were not significant. The evaluation of the AF burden >1% and the total AF burden after 24 months did not show differences in the incidence of AF in patients with dual chamber pacemaker therapy for SND. We were not able to demonstrate a significant influence of right atrial lead position on the incidence of AF recurrence.

Effects of Reduced Strength on Self-Selected Pacing for Long-Duration Activities

NASA Technical Reports Server (NTRS)

Buxton, Roxanne E.; Ryder, Jeffrey W.; English, Kirk E.; Guined, Jamie R.; Ploutz-Snyder, Lori L.

2015-01-01

Strength and aerobic capacity are predictors of astronaut performance for extravehicular activities (EVA) during exploration missions. It is expected that astronauts will self-select a pace below their ventilatory threshold (VT). PURPOSE: To determine the percentage of VT that subjects self-select for prolonged occupational tasks. METHODS: Maximal aerobic capacity and a variety of lower-body strength and power variables were assessed in 17 subjects who climbed 480 rungs on a ladder ergometer and then completed 10 km on a treadmill as quickly as possible using a self-selected pace. The tasks were performed on 4 days, with a weighted suit providing 0% (suit fabric only), 40%, 60%, and 80% of additional bodyweight (BW), thereby altering the strength to BW ratio. Oxygen consumption and heart rate were continuously measured. Repeated measures ANOVA and post-hoc comparisons were performed on the percent of VT values under each suited condition. RESULTS: Subjects consistently self-paced at or below VT for both tasks and the pace was related to suit weight. At the midpoint for the ladder climb the 80% BW condition elicited the lowest metabolic cost (-19+/-14% below VT), significantly different than the 0% BW (-3+/-16%, P=0.002) and the 40% BW conditions (-5+/-22%, P=0.023). The 60% BW condition (-13+/-19%) was different than the 40% BW condition (P=0.034). Upon completion of the ladder task there were no differences among the conditions (0%BW: 3+/-18%; 40%BW: 3+/-21%; 60%BW: - 8+/-25%; 80%BW: -10+/-18%). All subjects failed to complete 5km at 80%BW. At the midpoint of the treadmill test the three remaining conditions were all significantly different (0%BW: -20+/-15%; 40%BW: - 33+/-15%; 60%BW: -41+/-19%). Upon completion of the treadmill test the 60% BW condition (-38+/-12%) was significantly different than the 40% BW (-28+/-15%, P=0.024). CONCLUSIONS: Decreasing relative strength results in progressive and disproportionate decreases (relative to VT) in self-selected pacing during long-duration activities. Thus, during prolonged, endurance-type activities, large reductions in strength cause notable performance decrements despite no changes in aerobic capacity. These data highlight the importance of both aerobic capacity and muscle strength to the performance of prolonged EVA in exploration mission scenarios.

The Post-Myocardial Infarction Pacing Remodeling Prevention Therapy (PRomPT) Trial: Design and Rationale.

PubMed

Chung, Eugene S; Fischer, Trent M; Kueffer, Fred; Anand, Inder S; Bax, Jeroen J; Gold, Michael R; Gorman, Robert C; Theres, Heinz; Udelson, James E; Stancak, Branislav; Svendsen, Jesper H; Stone, Gregg W; Leon, Angel

2015-07-01

Despite considerable improvements in the medical management of patients with myocardial infarction (MI), patients with large MI still have substantial risk of developing heart failure. In the early post-MI setting, implantable cardioverter defibrillators have reduced arrhythmic deaths but have no impact on overall mortality. Therefore, additional interventions are required to further reduce the overall morbidity and mortality of patients with large MI. The Pacing Remodeling Prevention Therapy (PRomPT) trial is designed to study the effects of peri-infarct pacing in preventing adverse post-MI remodeling. Up to 120 subjects with peak creatine phosphokinase >3,000 U/L (or troponin T >10 μg/L) at time of MI will be randomized to either dual-site or single-site biventricular pacing with the left ventricular lead implanted in a peri-infarct region or to a nonimplanted control group. Those randomized to a device will be blinded to the pacing mode, but randomization to a device or control cannot be blinded. Subjects randomized to pacing will have the device implanted within 10 days of MI. The primary objective is to assess the change in left ventricular end-diastolic volume from baseline to 18 months. Secondary objectives are to assess changes in clinical and mechanistic parameters between the groups, including rates of hospitalization for heart failure and cardiovascular events, the incidence of sudden cardiac death and all-cause mortality, New York Heart Association functional class, 6-minute walking distance, and quality of life. The PRomPT trial will provide important evidence regarding the potential of peri-infarct pacing to interrupt adverse remodeling in patients with large MI. Copyright © 2015 Elsevier Inc. All rights reserved.

Sound Effects for Children's Comprehension of Variably-Paced Television Programs.

ERIC Educational Resources Information Center

Calvert, Sandra L.; Scott, M. Catherine

In this study, children's selective attention to, and comprehension of, variably-paced television programs were examined as a function of sound effects. Sixty-four children, equally distributed by sex and by preschool and fourth grades, were randomly assigned to one of four treatment conditions which crossed two levels of sound effects (presence…

Bachmann bundle pacing reduces atrial electromechanical delay in type 1 myotonic dystrophy patients.

PubMed

Russo, Vincenzo; Rago, Anna; Papa, Andrea Antonio; Arena, Giulia; Politano, Luisa; Nigro, Gerardo

2018-04-01

Atrial electromechanical delay (AEMD) is an echocardiographic parameter correlated with the onset of supraventricular arrhythmias in several clinical conditions. Inter-atrial septal pacing in the region of Bachmann's bundle (BB) has been shown to be safe and feasible in myotonic dystrophy type 1 (DM1) patients, with a low rate of sensing and pacing defects. The aim of this study was to assess the impact of temporary BB pacing compared with right atrial appendage (RAA) pacing on AEMD in DM1 patients undergoing pacemaker (PM) implantation for cardiac rhythm abnormalities. The study enrolled 70 consecutive DM1 patients undergoing PM implantation for cardiac rhythm abnormalities in accordance with the current guidelines. Seventy age- and sex-matched non-DM1 patients undergoing dual-chamber PM implantation for cardiac rhythm abnormalities were used as controls. The atrial pacing lead was temporarily positioned in the RAA and on the right side of the inter-atrial septum in the region of Bachmann's bundle. For each site (BB and RAA), temporary atrial pacing in the AAI mode was established at 10 beats per minute above the sinus rate and a detailed trans-thoracic echocardiogram with tissue Doppler (TDI) analysis was recorded after at least 10 min of atrial pacing to evaluate AEMD. Temporary RAA pacing did not show statistically significant differences in inter-AEMD (48.2 ± 17.8 vs 50.5 ± 16.5 ms; P = 0.8), intra-left AEMD (43.3 ± 15.5 vs 44.6 ± 15.8 ms; P = 0.1), or intra-right-AEMD (14.1 ± 4.2 vs 15.4 ± 5.8 ms; P = 0.9), in comparison with sinus rhythm. Temporary BB pacing determined a significantly lower inter-AEMD (36.1 ± 17.1 vs 50.5 ± 16.5 ms; P = 0.001) and intra-left AEMD (32.5 ± 15.2 vs 44.6 ± 15.8 ms; P = 0.001) values in comparison with temporary RAA pacing. No statistically significant difference was found in intra-right AEMD (12.2 ± 4.6 vs 15.4 ± 5.8 ms; P = 0.2). In the control group, neither temporary RAA pacing nor temporary BB pacing showed statistically significant differences in inter-AEMD, intra-left AEMD, or intra-right AEMD values in comparison with sinus rhythm. In DM1 patients undergoing dual-chamber PM implantation, atrial pacing in the Bachmann bundle region is associated with significantly lower echocardiographic indices of atrial electromechanical delay (inter-AEMD and intra-left AEMD) in comparison with RAA pacing.

PubMed Central

RUSSO, VINCENZO; NIGRO, GERARDO; RAGO, ANNA; ANTONIO PAPA, ANDREA; PROIETTI, RICCARDO; DELLA CIOPPA, NADIA; CRISTIANO, ANNA; PALLADINO, ALBERTO; CALABRÒ, RAFFAELE; POLITANO, LUISA

2013-01-01

The role that atrial pacing therapy plays on the atrial fibrillation (AF) burden is still unclear. Aim of the study was to evaluate the effect of the atrial preference pacing algorithm on AF burden in patients affected by Myotonic Dystrophy type 1 (DM1) followed for a long follow up period. Sixty DM1 patients were -implanted with a dual chamber pacemaker (PM) for first degree or symptomatic type 1/type 2 second degree atrio-ventricular blocks- were followed for 2-years after implantation, by periodical examination. After 1 month of stabilization, they were randomized into two groups: 1) Patients implanted with conventional dual-chamber pacing mode (DDDR group) and 2) Patients implanted with DDDR plus Atrial Preference Pacing (APP) algorithm (APP ON group). The results showed that atrial tachycardia (AT)/AF burden was significantly reduced at 1 year follow up in the APP ON group (2122 ± 428 minutes vs 4127 ± 388 minutes, P = 0.03), with a further reduction at the end of the 2 year follow up period (4652 ± 348 minutes vs 7564 ± 638 minutes, P = 0.005). The data here reported show that the APP is an efficient algorithm to reduce AT/AF burden in DM1 patients implanted with dual chamber pacemaker. PMID:24803841

Frequency of pacemaker malfunction associated with monopolar electrosurgery during pulse generator replacement or upgrade surgery.

PubMed

Lin, Yun; Melby, Daniel P; Krishnan, Balaji; Adabag, Selcuk; Tholakanahalli, Venkatakrishna; Li, Jian-Ming

2017-08-01

The aim of this study is to investigate the frequency of electrosurgery-related pacemaker malfunction. A retrospective study was conducted to investigate electrosurgery-related pacemaker malfunction in consecutive patients undergoing pulse generator (PG) replacement or upgrade from two large hospitals in Minneapolis, MN between January 2011 and January 2014. The occurrence of this pacemaker malfunction was then studied by using MAUDE database for all four major device vendors. A total of 1398 consecutive patients from 2 large tertiary referral centers in Minneapolis, MN undergoing PG replacement or upgrade surgery were retrospectively studied. Four patients (0.3% of all patients), all with pacemakers from St Jude Medical (2.8%, 4 of 142) had output failure or inappropriately low pacing rate below 30 bpm during electrosurgery, despite being programmed in an asynchronous mode. During the same period, 1174 cases of pacemaker malfunctions were reported on the same models in MAUDE database, 37 of which (3.2%) were electrosurgery-related. Twenty-four cases (65%) had output failure or inappropriate low pacing rate. The distribution of adverse events was loss of pacing (59.5%), reversion to backup pacing (32.4%), inappropriate low pacing rate (5.4%), and ventricular fibrillation (2.7%). The majority of these (78.5%) occurred during PG replacement at ERI or upgrade surgery. No electrosurgery-related malfunction was found in MAUDE database on 862 pacemaker malfunction cases during the same period from other vendors. Electrosurgery during PG replacement or upgrade surgery can trigger output failure or inappropriate low pacing rate in certain models of modern pacemakers. Cautions should be taken for pacemaker-dependent patients.

Percutaneous Epicardial Pacing using a Novel Insulated Multi-electrode Lead.

PubMed

Syed, Faisal F; DeSimone, Christopher V; Ebrille, Elisa; Gaba, Prakriti; Ladewig, Dorothy J; Mikell, Susan B; Suddendorf, Scott H; Gilles, Emily J; Danielsen, Andrew J; Lukášová, Markéta; Wolf, Jiří; Leinveber, Pavel; Novák, Miroslav; Stárek, Zdeněk; Kara, Tomas; Bruce, Charles J; Friedman, Paul A; Asirvatham, Samuel J

2015-08-01

Epicardial cardiac resynchronization therapy (CRT) permits unrestricted electrode positioning. However, this requires surgical placement of device leads and the risk of unwanted phrenic nerve stimulation. We hypothesized that shielded electrodes can capture myocardium without extracardiac stimulation. In 6 dog and 5 swine experiments, we used a percutaneous approach to access the epicardial surface of the heart, and deploy novel leads housing multiple electrodes with selective insulation. Bipolar pacing thresholds at prespecified sites were tested compare electrode threshold data both facing towards and away from the epicardial surface. In 151 paired electrode recordings (70 in 6 dogs; 81 in 5 swine), thresholds facing myocardium were lower than facing away (median [IQR] mA: dogs 0.9 [0.4-1.6] vs 4.6 [2.1 to >10], p<0.0001; swine 0.5 [0.2-1] vs 2.5 [0.5-6.8], p<0.0001). Myocardial capture was feasible without extracardiac stimulation at all tested sites, with mean ± SE threshold margin 3.6±0.7 mA at sites of high output extracardiac stimulation (p=0.004). Selective electrode insulation confers directional pacing to a multielectrode epicardial pacing lead. This device has the potential for a novel percutaneous epicardial resynchronization therapy that permits placement at an optimal pacing site, irrespective of the anatomy of the coronary veins or phrenic nerves.

The effects of presentation pace and modality on learning a multimedia science lesson

NASA Astrophysics Data System (ADS)

Chung, Wen-Hung

Working memory is a system that consists of multiple components. The visuospatial sketchpad is the main entrance for visual and spatial information, whereas acoustic and verbal information is processed in the phonological loop. The central executive works as a coordinator of information from these two subsystems. Numerous studies have shown that working memory has a very limited capacity. Based on these characteristics of working memory, theories such as cognitive load theory and the cognitive theory of multimedia learning provide multimedia design principles. One of these principles is that when verbal information accompanying pictures is presented in audio mode instead of visually, learning can be more effective than if both text and pictures are presented visually. This is called the modality effect. However, some studies have found that the modality effect does not occur in some situations. In most experiments examining the modality effect, the multimedia is presented as system-paced. If learners are able to repeat listening as many times as they need, the superiority of spoken text over visual text seems lessened. One aim of this study was to examine the modality effect in a learner-controlled condition. This study also used the one-word-at-a-time technique to investigate whether the modality effect would still occur if both reading and listening rates were equal. There were 182 college students recruited for this study. Participants were randomly assigned to seven groups: a self-paced listening group, a self-paced reading group, a self text-block reading group, a general-paced listening group, a general-paced reading group, a fast-paced listening group, and a fast-paced reading group. The experimental material was a cardiovascular multimedia module. A three-by-two between-subjects design was used to test the main effect. Results showed that modality effect was still present but not between the self-paced listening group and the self text-block reading group. A post-study survey showed participants' different responses to the two modalities and their preferences as well. Results and research limitations are discussed and applications and future directions are also addressed.

Space shuttle environmental control/life support systems

NASA Technical Reports Server (NTRS)

1972-01-01

This study analyzes and defines a baseline Environmental Control/Life Support System (EC/LSS) for a four-man, seven-day orbital shuttle. In addition, the impact of various mission parameters, crew size, mission length, etc. are examined for their influence on the selected system. Pacing technology items are identified to serve as a guide for application of effort to enhance the total system optimization. A fail safe-fail operation philosophy was utilized in designing the system. This has resulted in a system that requires only one daily routine operation. All other critical item malfunctions are automatically resolved by switching to redundant modes of operation. As a result of this study, it is evident that a practical, flexible, simple and long life, EC/LSS can be designed and manufactured for the shuttle orbiter within the time phase required.

The Biomechanical and Energetic Advantages of a Mediolaterally Wide Pelvis in Women.

PubMed

Wall-Scheffler, Cara M; Myers, Marcella J

2017-04-01

Here, we argue that two key shifts in thinking are required to more clearly understand the selection pressures shaping pelvis evolution in female hominins: (1) the primary locomotor mode of female hominins was loaded walking in the company of others, and (2) the periodic gait of human walking is most effectively explained as a biomechanically controlled process related to heel-strike collisions that is tuned for economy and stability by properly-timed motor inputs (a model called dynamic walking). In the light of these two frameworks, the evidence supports differences between female and male upper-pelvic morphology being the result of the unique reproductive role of female hominins, which involved moderately paced, loaded walking in groups. Anat Rec, 300:764-775, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Introducing GIS across Levels: Designing for Diversity

ERIC Educational Resources Information Center

Barros, Joana

2017-01-01

The paper proposes a strategy for designing introductory GIS modules at Birkbeck, University of London. Seven design aspects or elements (content, practical exercises, assessment, pace, mode, level of support, and level of difficulty) for tailoring modules at appropriate levels and for diversity are introduced and their application in Birkbeck's…

Biology Needs a Modern Assessment System for Professional Productivity

ERIC Educational Resources Information Center

McDade, Lucinda A.; Maddison, David R.; Guralnick, Robert; Piwowar, Heather A.; Jameson, Mary Liz; Helgen, Kristofer M.; Herendeen, Patrick S.; Hill, Andrew; Vis, Morgan L.

2011-01-01

Stimulated in large part by the advent of the Internet, research productivity in many academic disciplines has changed dramatically over the last two decades. However, the assessment system that governs professional success has not kept pace, creating a mismatch between modes of scholarly productivity and academic assessment criteria. In this…

Predictors of temporary epicardial pacing wires use after valve surgery

PubMed Central

2014-01-01

Background Although temporary cardiac pacing is infrequently needed, temporary epicardial pacing wires are routinely inserted after valve surgery. As they are associated with infrequent, but life threatening complications, and the decreased need for postoperative pacing in a group of low risk patients; this study aims to identify the predictors of temporary cardiac pacing after valve surgery. Methods A retrospective analysis of data collected prospectively on 400 consecutive valve surgery patients between May 2002 and December 2012 was performed. Patients were grouped according to avoidance or insertion of temporary pacing wires, and were further subdivided according to temporary cardiac pacing need. Multiple logistic regression was used to determine the predictors of temporary cardiac pacing. Results 170 (42.5%) patients did not have insertion of temporary pacing wires and none of them needed temporary pacing. 230 (57.5%) patients had insertion of temporary pacing wires and among these, only 55 (23.9%) required temporary pacing who were compared with the remaining 175 (76.1%) patients in the main analysis. The determinants of temporary cardiac pacing (adjusted odds ratios; 95% confidence interval) were as follows: increased age (1.1; 1.1, 1.3, p = 0.002), New York Heart Association class III- IV (5.6; 1.6, 20.2, p = 0.008) , pulmonary artery pressure ≥ 50 mmHg (22.0; 3.4, 142.7, p = 0.01), digoxin use (8.0; 1.3, 48.8, p = 0.024), multiple valve surgery (13.5; 1.5, 124.0, p = 0.021), aorta cross clamp time ≥ 60 minutes (7.8; 1.6, 37.2, p = 0.010), and valve annulus calcification (7.9; 2.0, 31.7, p = 0.003). Conclusion Although limited by sample size, the present results suggest that routine use of temporary epicardial pacing wires after valve surgery is only necessary for high risk patients. Preoperative identification and aggressive management of predictors of temporary cardiac pacing and the possible modulation of intraoperative techniques can decrease the need of temporary cardiac pacing. Prospective randomized controlled studies on a larger number of patients are necessary to draw solid conclusions regarding the selective use of temporary epicardial pacing wires in valve surgery. PMID:24521215

Locating the Business. PACE Revised. Level 2. Unit 7. Research & Development Series No. 240BB7.

ERIC Educational Resources Information Center

Ashmore, M. Catherine; Pritz, Sandra G.

This unit on selecting a site for a small business, the seventh in a series of 18 modules, is on the second level of the revised PACE (Program for Acquiring Competence in Entrepreneurship) comprehensive curriculum. Geared to advanced secondary and beginning postsecondary or adult students, the modules provide an opportunity to learn about and try…

Urban sparrows respond to a sexually selected trait with increased aggression in noise.

PubMed

Phillips, Jennifer N; Derryberry, Elizabeth P

2018-05-14

Animals modify acoustic communication signals in response to noise pollution, but consequences of these modifications are unknown. Vocalizations that transmit best in noise may not be those that best signal male quality, leading to potential conflict between selection pressures. For example, slow paced, narrow bandwidth songs transmit better in noise but are less effective in mate choice and competition than fast paced, wide bandwidth songs. We test the hypothesis that noise affects response to song pace and bandwidth in the context of competition using white-crowned sparrows (Zonotrichia leucophrys). We measure male response to song variation along a gradient of ambient noise levels in San Francisco, CA. We find that males discriminate between wide and narrow bandwidth songs but not between slow and fast paced songs. These findings are biologically relevant because songs in noisy areas tend to have narrow bandwidths. Therefore, this song phenotype potentially increases transmission distance in noise, but elicits weaker responses from competitors. Further, we find that males respond more strongly to stimuli in noisier conditions, supporting the 'urban anger' hypothesis. We suggest that noise affects male responsiveness to song, possibly leading to more territorial conflict in urban areas.

Efficacy of low interatrial septum and right atrial appendage pacing for prevention of permanent atrial fibrillation in patients with sinus node disease: results from the electrophysiology-guided pacing site selection (EPASS) study.

PubMed

Verlato, Roberto; Botto, Giovanni Luca; Massa, Riccardo; Amellone, Claudia; Perucca, Antonello; Bongiorni, Maria Grazia; Bertaglia, Emanuele; Ziacchi, Vigilio; Piacenti, Marcello; Del Rosso, Attilio; Russo, Giovanni; Baccillieri, Maria Stella; Turrini, Pietro; Corbucci, Giorgio

2011-12-01

The role of pacing sites and atrial electrophysiology on the progression of atrial fibrillation (AF) to the permanent form in patients with sinus node dysfunction (SND) has never been investigated. The aim of the study was to investigate the relationship between atrial electrophysiology and the efficacy of atrial pacing at the low interatrial septum (IAS) or at the right atrial appendage (RAA) to prevent persistent/permanent AF in patients with SND. The Electrophysiology-Guided Pacing Site Selection (EPASS) Study was a prospective, controlled, randomized study. Atrial refractoriness, basal and incremental conduction times from the RAA to the coronary sinus ostium were measured before implantation, and the difference (ΔCTos) was calculated. Patients with ΔCTos ≥ 50 ms (study group) and those with ΔCTos <50 ms (control group) were randomly assigned to RAA or IAS with algorithms for continuous atrial stimulation "on." The primary end point was time to development of permanent or persistent AF within a 2-year follow-up in the study group, IAS versus RAA. Data were analyzed by intention to treat. One hundred two patients (77 ± 7 years, 44 mol/L) were enrolled, 69 (68%) in the study group and 33 (32%) in the control group. Of these, 97 ended the study, respectively, randomly assigned: 29 IAS versus 36 RAA and 18 IAS versus 14 RAA. After a mean follow-up of 15 ± 7 (median, 17) months, 11 (16.6%) patients in the study group met the primary end point: 2 IAS versus 9 RAA (log rank=3.93, P=0.047). In patients with SND and intra-atrial conduction delay, low IAS pacing was superior to RAA pacing in preventing progression to persistent or permanent AF. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00239226.

A proteomic approach reveals transient association of reticulocalbin-3, a novel member of the CREC family, with the precursor of subtilisin-like proprotein convertase, PACE4

PubMed Central

Tsuji, Akihiko; Kikuchi, Yayoi; Sato, Yukimi; Koide, Shizuyo; Yuasa, Keizo; Nagahama, Masami; Matsuda, Yoshiko

2006-01-01

SPCs (subtilisin-like proprotein convertases) are a family of seven structurally related serine endoproteases that are involved in the proteolytic activation of proproteins. In an effort to examine the substrate protein for PACE4 (paired basic amino-acid-cleaving enzyme-4), an SPC, a potent protein inhibitor of PACE4, an α1-antitrypsin RVRR (Arg-Val-Arg-Arg) variant, was expressed in GH4C1 cells. Ectopic expression of the RVRR variant caused accumulation of the 48 kDa protein in cells. Sequence analysis indicates that the 48 kDa protein is a putative Ca2+-binding protein, RCN-3 (reticulocalbin-3), which had previously been predicted by bioinformatic analysis of cDNA from the human hypothalamus. RCN-3 is a member of the CREC (Cab45/reticulocalbin/ERC45/calumenin) family of multiple EF-hand Ca2+-binding proteins localized to the secretory pathway. The most interesting feature of the RCN-3 sequence is the presence of five Arg-Xaa-Xaa-Arg motifs, which represents the target sequence of SPCs. Biosynthetic studies showed that RCN-3 is transiently associated with proPACE4, but not with mature PACE4. Inhibition of PACE4 maturation by a Ca2+ ionophore resulted in accumulation of the proPACE4–RCN-3 complex in cells. Furthermore, autoactivation and secretion of PACE4 was increased upon co-expression with RCN-3. Our findings suggest that selective and transient association of RCN-3 with the precursor of PACE4 plays an important role in the biosynthesis of PACE4. PMID:16433634

Performance vs. Paper-And-Pencil Estimates of Cognitive Abilities.

ERIC Educational Resources Information Center

Arima, James K.

Arima's Discrimination Learning Test (DLT) was reconfigured, made into a self-paced mode, and administered to potential recruits in order to determine if: (1) a previous study indicating a lack of difference in learning performance between white and nonwhites would hold up; and (2) the correlations between scores attained on the DLT and scores…

Online, Instructional Television and Traditional Delivery: Student Characteristics and Success Factors in Business Statistics

ERIC Educational Resources Information Center

Dotterweich, Douglas P.; Rochelle, Carolyn F.

2012-01-01

Distance education has surged in recent years while research on student characteristics and factors leading to successful outcomes has not kept pace. This study examined characteristics of regional university students in undergraduate Business Statistics and factors linked to their success based on three modes of delivery - Online, Instructional…

Lithium granule ablation and penetration during ELM pacing experiments at DIII-D

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

Lunsford, R.; Bortolon, A.; Roquemore, A. L.

At DIII-D, lithium granules were radially injected into the plasma at the outer midplane to trigger and pace edge localized modes (ELMs). Granules ranging in size from 300 to 1000 microns were horizontally launched into H-mode discharges with velocities near 100 m/s, and granule to granule injection frequencies less than 500 Hz. While the smaller granules were only successful in triggering ELMs approximately 20% of the time, the larger granules regularly demonstrated ELM triggering efficiencies of greater than 80%. A fast visible camera looking along the axis of injection observed the ablation of the lithium granules. We used the durationmore » of ablation as a benchmark for a neutral gas shielding calculation, and approximated the ablation rate and mass deposition location for the various size granules, using measured edge plasma profiles as inputs. In conclusion, this calculation suggests that the low triggering efficiency of the smaller granules is due to the inability of these granules to traverse the steep edge pressure gradient region and reach the top of the pedestal prior to full ablation.« less

Lithium granule ablation and penetration during ELM pacing experiments at DIII-D

DOE PAGES

Lunsford, R.; Bortolon, A.; Roquemore, A. L.; ...

2016-05-25

At DIII-D, lithium granules were radially injected into the plasma at the outer midplane to trigger and pace edge localized modes (ELMs). Granules ranging in size from 300 to 1000 microns were horizontally launched into H-mode discharges with velocities near 100 m/s, and granule to granule injection frequencies less than 500 Hz. While the smaller granules were only successful in triggering ELMs approximately 20% of the time, the larger granules regularly demonstrated ELM triggering efficiencies of greater than 80%. A fast visible camera looking along the axis of injection observed the ablation of the lithium granules. We used the durationmore » of ablation as a benchmark for a neutral gas shielding calculation, and approximated the ablation rate and mass deposition location for the various size granules, using measured edge plasma profiles as inputs. In conclusion, this calculation suggests that the low triggering efficiency of the smaller granules is due to the inability of these granules to traverse the steep edge pressure gradient region and reach the top of the pedestal prior to full ablation.« less

Prognosis of super-elderly healthy Japanese patients after pacemaker implantation for bradycardia.

PubMed

Yamaguchi, Tetsuo; Miyamoto, Takamichi; Iwai, Takamasa; Yamaguchi, Junji; Hijikata, Sadahiro; Miyazaki, Ryoichi; Miwa, Naoyuki; Sekigawa, Masahiro; Hara, Nobuhiro; Nagata, Yasutoshi; Nozato, Toshihiro; Yamauchi, Yasuteru; Obayashi, Toru; Isobe, Mitsuaki

2017-07-01

The prognosis of super-elderly patients (age≥85 years) who undergo bradycardia pacemaker (PM) implantation remains unknown. We retrospectively enrolled 868 patients (men 49.0%, 76.6±10.6 years) who could walk unassisted and whose expected life expectancy was more than 1 year, receiving their first bradycardia PM implantation between January 1, 2006, and June 30, 2013. Clinical outcomes were compared between super-elderly patients (n=201, mean age 88.6±3.2 years) and younger patients (n=667, 73.0±9.3 years). At the end of a median 1285-day follow-up, 128 patients (14.7%) died, of which 54 were cardiac deaths (42.2%). Mortality rates were similar between the groups (16.4% vs. 14.2%, log-rank p=0.56) and across different indications for implantation (atrio-ventricular conduction disturbance or sick sinus syndrome, p=0.59), initial rhythms (sinus rhythm or persistent atrial fibrillation, p=0.62), pacing modes (dual chamber pacing or VVI pacing, p=0.26), and ventricular lead positions (septum or apex, p=0.52). On Cox proportional hazard model analysis, hypertension [hazard ratio (HR)=1.74, 95% confidence interval (CI)=1.19-2.54, p=0.004], diabetes mellitus (HR=2.18, 95% CI=1.51-3.14, p<0.001), history of myocardial infarction (HR=3.59, 95% CI=2.49-5.16, p<0.001), and history of stroke (HR=2.26, 95% CI=1.51-3.37, p<0.001) were independent predictors for mortality. The mortality rate of super-elderly patients who had no critical illnesses and were healthy enough to walk unassisted at the time of PM implantation was not inferior to that of younger patients. Prognosis was determined by comorbidities, but not by age, PM indication, initial rhythm, pacing leads, or mode. Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Clinically oriented device programming in bradycardia patients: part 2 (atrioventricular blocks and neurally mediated syncope). Proposals from AIAC (Italian Association of Arrhythmology and Cardiac Pacing).

PubMed

Palmisano, Pietro; Ziacchi, Matteo; Biffi, Mauro; Ricci, Renato P; Landolina, Maurizio; Zoni-Berisso, Massimo; Occhetta, Eraldo; Maglia, Giampiero; Botto, Gianluca; Padeletti, Luigi; Boriani, Giuseppe

2018-04-01

: The purpose of this two-part consensus document is to provide specific suggestions (based on an extensive literature review) on appropriate pacemaker setting in relation to patients' clinical features. In part 2, criteria for pacemaker choice and programming in atrioventricular blocks and neurally mediate syncope are proposed. The atrioventricular blocks can be paroxysmal or persistent, isolated or associated with sinus node disease. Neurally mediated syncope can be related to carotid sinus syndrome or cardioinhibitory vasovagal syncope. In sinus rhythm, with persistent atrioventricular block, we considered appropriate the activation of mode-switch algorithms, and algorithms for auto-adaptive management of the ventricular pacing output. If the atrioventricular block is paroxysmal, in addition to algorithms mentioned above, algorithms to maximize intrinsic atrioventricular conduction should be activated. When sinus node disease is associated with atrioventricular block, the activation of rate-responsive function in patients with chronotropic incompetence is appropriate. In permanent atrial fibrillation with atrioventricular block, algorithms for auto-adaptive management of the ventricular pacing output should be activated. If the atrioventricular block is persistent, the activation of rate-responsive function is appropriate. In carotid sinus syndrome, adequate rate hysteresis should be programmed. In vasovagal syncope, specialized sensing and pacing algorithms designed for reflex syncope prevention should be activated.

Influence of digital and analogue cellular telephones on implanted pacemakers.

PubMed

Altamura, G; Toscano, S; Gentilucci, G; Ammirati, F; Castro, A; Pandozi, C; Santini, M

1997-10-01

The aim of this study was to find out whether digital and analogue cellular 'phones affect patients with pacemakers. The study comprised continuous ECG monitoring of 200 pacemaker patients. During the monitoring certain conditions caused by interference created by the telephone were looked for: temporary or prolonged pacemaker inhibition; a shift to asynchronous mode caused by electromagnetic interference; an increase in ventricular pacing in dual chamber pacemakers, up to the programmed upper rate. The Global System for Mobile Communications system interfered with pacing 97 times in 43 patients (21.5%). During tests on Total Access of Communication System telephones, there were 60 cases of pacing interference in 35 patients (17.5%). There were 131 interference episodes during ringing vs 26 during the on/off phase; (P < 0.0001); 106 at maximum sensitivity level vs 51 at the 'base' value; P < 0.0001). Prolonged pacing inhibition (> 4 s) was seen at the pacemaker 'base' sensing value in six patients using the Global system but in only one patient using Total Access. Cellular 'phones may be dangerous for pacemaker patients. However, they can be used safely if patients do not carry the 'phone close to the pacemaker, which is the only place where high risk interference has been observed.

Long-term clinical effects of ventricular pacing reduction with a changeover mode to minimize ventricular pacing in a general pacemaker population

PubMed Central

Stockburger, Martin; Boveda, Serge; Moreno, Javier; Da Costa, Antoine; Hatala, Robert; Brachmann, Johannes; Butter, Christian; Garcia Seara, Javier; Rolando, Mara; Defaye, Pascal

2015-01-01

Aim Right ventricular pacing (VP) has been hypothesized to increase the risk in heart failure (HF) and atrial fibrillation (AF). The ANSWER study evaluated, whether an AAI-DDD changeover mode to minimize VP (SafeR) improves outcome compared with DDD in a general dual-chamber pacemaker population. Methods and results ANSWER was a randomized controlled multicentre trial assessing SafeR vs. standard DDD in sinus node disease (SND) or AV block (AVB) patients. After a 1-month run-in period, they were randomized (1 : 1) and followed for 3 years. Pre-specified co-primary end-points were VP and the composite of hospitalization for HF, AF, or cardioversion. Pre-specified secondary end-points were cardiac death or HF hospitalizations and cardiovascular hospitalizations. ANSWER enrolled 650 patients (52.0% SND, 48% AVB) at 43 European centres and randomized in SafeR (n = 314) or DDD (n = 318). The SafeR mode showed a significant decrease in VP compared with DDD (11.5 vs. 93.6%, P < 0.0001 at 3 years). Deaths and syncope did not differ between randomization arms. No significant difference between groups [HR = 0.78; 95% CI (0.48–1.25); P = 0.30] was found in the time to event of the co-primary composite of hospitalization for HF, AF, or cardioversion, nor in the individual components. SafeR showed a 51% risk reduction (RR) in experiencing cardiac death or HF hospitalization [HR = 0.49; 95% CI (0.27–0.90); P = 0.02] and 30% RR in experiencing cardiovascular hospitalizations [HR = 0.70; 95% CI (0.49–1.00); P = 0.05]. Conclusion SafeR safely and significantly reduced VP in a general pacemaker population though had no effect on hospitalization for HF, AF, or cardioversion, when compared with DDD. PMID:25179761

[Multi-channel data collection and visualization system for intramyocardial electrograms].

PubMed

Kastner, P; Wimmer, W; Hutten, H

2000-11-01

The aim of the project was to develop a multichannel data acquisition system for the recording and visualisation of intramyocardial electrograms (IEGM) from both the spontaneously beating and the artificially paced heart. Signal processing comprises multi-step amplification, filtering (0.05-800 Hz), and AD conversion (12 Bit max. 6.25 kHz). IEGMs can be obtained either in unipolar or bipolar mode. Stimulation of the heart is achieved by an incorporated programmable dual-chamber pacemaker that can be selectively switched to the input channels. A LabView-based graphical user interface permits the programming of all system parameters via a microcontroller, and supports data acquisition and visualisation. The system can be used in animal experiments to monitor the spread of excitation across the heart, to measure propagation velocity, or to measure the impact of drugs and pathological changes on the morphology of IEGMs.

Visitor reaction to pacing behavior: influence on the perception of animal care and interest in supporting zoological institutions.

PubMed

Miller, Lance J

2012-01-01

Many publications within the field of zoo animal welfare have stated the importance of decreasing stereotypic behavior (e.g., pacing) to help ensure a positive visitor experience. The idea behind these statements is that visitors want to see animals engaged in natural behavior. Additionally, it is thought that watching an animal exhibit species-appropriate behavior could help increase a visitor's connection to wildlife and ultimately their interest in conservation. However, until recently, no information was available to validate such statements. The purpose of this research was to examine people's reaction to viewing an animal engaged in pacing behavior. Participants were randomly selected to fill out a survey after watching a short video of either a tiger pacing or resting (control). Results indicate that having viewed a tiger pacing significantly decreases people's perception of the level of care animals receive at that facility. In addition, people's interest in supporting zoos decreased as a result of viewing this behavior. Results are discussed from an animal welfare, business, and conservation perspective. © 2011 Wiley Periodicals, Inc.

Design of a Motivational Scaffold for the Malaysian e-Learning Environment

ERIC Educational Resources Information Center

Alias, Nor Aziah

2012-01-01

With a structure that provides control and choice over time, place, and pace, e-learning has emerged as a viable mode for working adults who wish to upgrade their knowledge. However, such flexibility provides leeway for these adults to procrastinate and for their motivation to dwindle. After all, many adults, especially Malaysian adults, are used…

Lecturer e-Training Program to Support University Teaching

ERIC Educational Resources Information Center

Chang-Tik, Chan

2017-01-01

This article attempts to explore the extent to which Lecturer e-Training Program (LeP) supports lecturers in their preparation for student-centred teaching. LeP was conducted in a blended mode, that is, it involved an online self-paced learning module followed by an interactive online discussion and ended with a face-to-face action learning. It…

Neural representation of cost-benefit selections in rat anterior cingulate cortex in self-paced decision making.

PubMed

Wang, Shuai; Shi, Yi; Li, Bao-Ming

2017-03-01

The anterior cingulate cortex (ACC) is crucial for decision making which involves the processing of cost-benefit information. Our previous study has shown that ACC is essential for self-paced decision making. However, it is unclear how ACC neurons represent cost-benefit selections during the decision-making process. In the present study, we trained rats on the same "Do More Get More" (DMGM) task as in our previous work. In each trial, the animals stand upright and perform a sustained nosepoke of their own will to earn a water reward, with the amount of reward positively correlated to the duration of the nosepoke (i.e., longer nosepokes earn larger rewards). We then recorded ACC neuronal activity on well-trained rats while they were performing the DMGM task. Our results show that (1) approximately 3/5 ACC neurons (296/496, 59.7%) exhibited changes in firing frequency that were temporally locked with the main events of the DMGM task; (2) about 1/5 ACC neurons (101/496, 20.4%) or 1/3 of the event-modulated neurons (101/296, 34.1%) showed differential firing rate changes for different cost-benefit selections; and (3) many ACC neurons exhibited linear encoding of the cost-benefit selections in the DMGM task events. These results suggest that ACC neurons are engaged in encoding cost-benefit information, thus represent the selections in self-paced decision making. Copyright © 2016 Elsevier Inc. All rights reserved.

Pacing in Swimming: A Systematic Review.

PubMed

McGibbon, Katie E; Pyne, D B; Shephard, M E; Thompson, K G

2018-03-20

Pacing strategy, or how energy is distributed during exercise, can substantially impact athletic performance and is considered crucial for optimal performance in many sports. This is particularly true in swimming given the highly resistive properties of water and low mechanical efficiency of the swimming action. The aim of this systematic review was to determine the pacing strategies utilised by competitive swimmers in competition and their reproducibility, and to examine the impact of different pacing strategies on kinematic, metabolic and performance variables. This will provide valuable and practical information to coaches and sports science practitioners. The databases Web of Science, Scopus, SPORTDiscus and PubMed were searched for published articles up to 1 August 2017. A total of 23 studies examining pool-based swimming competitions or experimental trials in English-language and peer-reviewed journals were included in this review. In short- and middle-distance swimming events maintenance of swimming velocity is critical, whereas in long-distance events a low lap-to-lap variability and the ability to produce an end spurt in the final lap(s) are key. The most effective strategy in the individual medley (IM) is to conserve energy during the butterfly leg to optimise performance in subsequent legs. The pacing profiles of senior swimmers remain relatively stable irrespective of opponents, competition stage or type, and performance time. Implementing event-specific pacing strategies should benefit the performance of competitive swimmers. Given differences between swimmers, there is a need for greater individualisation when considering pacing strategy selection across distances and strokes.

Safety of Magnetic Resonance Imaging in Patients with Cardiac Devices.

PubMed

Nazarian, Saman; Hansford, Rozann; Rahsepar, Amir A; Weltin, Valeria; McVeigh, Diana; Gucuk Ipek, Esra; Kwan, Alan; Berger, Ronald D; Calkins, Hugh; Lardo, Albert C; Kraut, Michael A; Kamel, Ihab R; Zimmerman, Stefan L; Halperin, Henry R

2017-12-28

Patients who have pacemakers or defibrillators are often denied the opportunity to undergo magnetic resonance imaging (MRI) because of safety concerns, unless the devices meet certain criteria specified by the Food and Drug Administration (termed "MRI-conditional" devices). We performed a prospective, nonrandomized study to assess the safety of MRI at a magnetic field strength of 1.5 Tesla in 1509 patients who had a pacemaker (58%) or an implantable cardioverter-defibrillator (42%) that was not considered to be MRI-conditional (termed a "legacy" device). Overall, the patients underwent 2103 thoracic and nonthoracic MRI examinations that were deemed to be clinically necessary. The pacing mode was changed to asynchronous mode for pacing-dependent patients and to demand mode for other patients. Tachyarrhythmia functions were disabled. Outcome assessments included adverse events and changes in the variables that indicate lead and generator function and interaction with surrounding tissue (device parameters). No long-term clinically significant adverse events were reported. In nine MRI examinations (0.4%; 95% confidence interval, 0.2 to 0.7), the patient's device reset to a backup mode. The reset was transient in eight of the nine examinations. In one case, a pacemaker with less than 1 month left of battery life reset to ventricular inhibited pacing and could not be reprogrammed; the device was subsequently replaced. The most common notable change in device parameters (>50% change from baseline) immediately after MRI was a decrease in P-wave amplitude, which occurred in 1% of the patients. At long-term follow-up (results of which were available for 63% of the patients), the most common notable changes from baseline were decreases in P-wave amplitude (in 4% of the patients), increases in atrial capture threshold (4%), increases in right ventricular capture threshold (4%), and increases in left ventricular capture threshold (3%). The observed changes in lead parameters were not clinically significant and did not require device revision or reprogramming. We evaluated the safety of MRI, performed with the use of a prespecified safety protocol, in 1509 patients who had a legacy pacemaker or a legacy implantable cardioverter-defibrillator system. No long-term clinically significant adverse events were reported. (Funded by Johns Hopkins University and the National Institutes of Health; ClinicalTrials.gov number, NCT01130896 .).

Sustainable Use of Technology in Teaching: A Principled Approach

ERIC Educational Resources Information Center

Karanfil, Talip; Neufeld, Steve

2014-01-01

The bewildering pace of change in technology has had a polarizing effect on the teaching profession. Teachers tend to cope in two ways, either by finding the least invasive ways to use technology without interfering with their standard mode of practice, or by embracing technology at every step and turn in new and innovative ways. The former does a…

Pacing strategies during the swim, cycle and run disciplines of sprint, Olympic and half-Ironman triathlons.

PubMed

Wu, Sam Shi Xuan; Peiffer, Jeremiah J; Brisswalter, Jeanick; Nosaka, Kazunori; Lau, Wing Yin; Abbiss, Chris R

2015-05-01

This study investigated the influence of distance on self-selected pacing during the swim, cycle and run disciplines of sprint, Olympic and half-Ironman (HIM) distance triathlon races. Eight trained male triathletes performed the three individual races in <2 months. Participants' bikes were fitted with Schoberer Rad Meßtechnik to monitor speed, power output and heart rate during the cycle discipline. Global positioning system was worn to determine speed and heart rate during the swim and run disciplines. An even swim pacing strategy was adopted across all distances. A more stochastic pacing was observed during the HIM cycle [standard deviation of exposure variation analysis (EVASD) = 3.21 ± 0.61] when compared with the sprint cycle discipline (EVASD = 3.84 ± 0.44, p = 0.018). Only 20.9 ± 4.1 % of the cycling time was spent more than 10 % above the mean power output in the HIM, compared with 43.8 ± 2.9 % (p = 0.002) and 37.7 ± 11.1 % (p = 0.039) during the sprint and Olympic distance triathlons, respectively. Conversely, 13.6 ± 5.1 % of the cycling time was spent 5-10 % below the mean power output during the HIM, compared with 5.9 ± 1.2 % (p = 0.034) and 8.0 ± 5.1 % (p = 0.045) during the sprint and Olympic distance triathlons, respectively. A negative pacing strategy was adopted during the sprint distance run, compared with positive pacing strategy during the Olympic and HIM. Results of this study suggest that pacing strategies during triathlon are highly influenced by distance and discipline, and highlight the importance of developing pacing strategies based on distance, strengths and individual fitness.

Re-use of explanted DDD pacemakers as VDD- clinical utility and cost effectiveness.

PubMed

Namboodiri, K K N; Sharma, Y P; Bali, H K; Grover, A

2004-01-01

Re-use of DDD pulse generators explanted from patients died of unrelated causes is associated with an additional cost of two transvenous leads if implanted as DDD itself, and high rate of infection according to some studies. We studied the clinical and economical aspects of reutilization of explanted DDD pacemakers programmed to VDD mode. Out of 28 patients who received VDD pacemaker during the period, October 2000- September 2001 in the Department of Cardiology, PGIMER, Chandigarh, 5 poor patients were implanted with explanted DDD pulse generators programmed to VDD mode. Each implantation was planned and carried out according to a standard protocol. The age ranged from 45 to 75 (mean-61) years. The indications for pacing were complete heart block (4) and second degree AV block (1). The clinical profile, costs and complications, if any were noted and followed up at regular intervals. The results were compared with patients who received new DDD pulse generators during this period. The additional cost for the atrial lead was not required in these patients. None of these patients had any local site infection. Compared to the two-lead system, the single lead system provided more rapid implantation and minimized complications associated with placement of an atrial lead. The explanted DDD pacemaker can be safely reused as VDD mode with same efficacy in selected patient population. This is associated with lower cost and complications compared to reimplantation as DDD itself.

Object Localization Does Not Imply Awareness of Object Category at the Break of Continuous Flash Suppression

PubMed Central

Kobylka, Florian; Persike, Malte; Meinhardt, Günter

2017-01-01

In continuous flash suppression (CFS), a dynamic noise masker, presented to one eye, suppresses conscious perception of a test stimulus, presented to the other eye, until the suppressed stimulus comes to awareness after few seconds. But what do we see breaking the dominance of the masker in the transition period? We addressed this question with a dual-task in which observers indicated (i) whether the test object was left or right of the fixation mark (localization) and (ii) whether it was a face or a house (categorization). As done recently Stein et al. (2011a), we used two experimental varieties to rule out confounds with decisional strategy. In the terminated mode, stimulus and masker were presented for distinct durations, and the observers were asked to give both judgments at the end of the trial. In the self-paced mode, presentation lasted until the observers responded. In the self-paced mode, b-CFS durations for object categorization were about half a second longer than for object localization. In the terminated mode, correct categorization rates were consistently lower than correct detection rates, measured at five duration intervals ranging up to 2 s. In both experiments we observed an upright face advantage compared to inverted faces and houses, as concurrently reported in b-CFS studies. Our findings reveal that more time is necessary to enable observers judging the nature of the object, compared to judging that there is “something other” than the noise which can be localized, but not recognized. This suggests gradual transitions in the first break of CFS. Further, the results imply that suppression is such that no cues to object identity are conveyed in potential “leaks” of CFS (Gelbard-Sagiv et al., 2016). PMID:28663728

Effects of interventions on normalizing step width during self-paced dual-belt treadmill walking with virtual reality, a randomised controlled trial.

PubMed

Oude Lansink, I L B; van Kouwenhove, L; Dijkstra, P U; Postema, K; Hijmans, J M

2017-10-01

Step width is increased during dual-belt treadmill walking, in self-paced mode with virtual reality. Generally a familiarization period is thought to be necessary to normalize step width. The aim of this randomised study was to analyze the effects of two interventions on step width, to reduce the familiarization period. We used the GRAIL (Gait Real-time Analysis Interactive Lab), a dual-belt treadmill with virtual reality in the self-paced mode. Thirty healthy young adults were randomly allocated to three groups and asked to walk at their preferred speed for 5min. In the first session, the control-group received no intervention, the 'walk-on-the-line'-group was instructed to walk on a line, projected on the between-belt gap of the treadmill and the feedback-group received feedback about their current step width and were asked to reduce it. Interventions started after 1min and lasted 1min. During the second session, 7-10days later, no interventions were given. Linear mixed modeling showed that interventions did not have an effect on step width after the intervention period in session 1. Initial step width (second 30s) of session 1 was larger than initial step width of session 2. Step width normalized after 2min and variation in step width stabilized after 1min. Interventions do not reduce step width after intervention period. A 2-min familiarization period is sufficient to normalize and stabilize step width, in healthy young adults, regardless of interventions. A standardized intervention to normalize step width is not necessary. Copyright © 2017 Elsevier B.V. All rights reserved.

The pacemaker-twiddler's syndrome: an infrequent cause of pacemaker failure.

PubMed

Salahuddin, Mohammad; Cader, Fathima Aaysha; Nasrin, Sahela; Chowdhury, Mashhud Zia

2016-01-20

The pacemaker-twiddler's syndrome is an uncommon cause of pacemaker malfunction. It occurs due to unintentional or deliberate manipulation of the pacemaker pulse generator within its skin pocket by the patient. This causes coiling of the lead and its dislodgement, resulting in failure of ventricular pacing. More commonly reported among elderly females with impaired cognition, the phenomenon usually occurs in the first year following pacemaker implantation. Treatment involves repositioning of the dislodged leads and suture fixation of the lead and pulse generator within its pocket. An 87 year old Bangladeshi lady who underwent a single chamber ventricular pacemaker (VVI mode: i.e. ventricle paced, ventricle sensed, inhibitory mode) implantation with the indication of complete heart block, and presented to us again 7 weeks later, with syncopal attacks. She admitted to repeatedly manipulating the pacemaker generator in her left pectoral region. Physical examination revealed a heart rate of 42 beats/minute, blood pressure 140/80 mmHg and bilateral crackles on lung auscultation. She had no cognitive deficit. An immediate electrocardiogram showed complete heart block with pacemaker spikes and failure to capture. Chest X-ray showed coiled and retracted right ventricular lead and rotated pulse generator. An emergent temporary pace maker was set at a rate of 60 beats per minute. Subsequently, she underwent successful lead repositioning with strong counselling to avoid further twiddling. Twiddler's syndrome should be considered as a cause of pacemaker failure in elderly patients presenting with bradyarrythmias following pacemaker implantation. Chest X-ray and electrocardiograms are simple and easily-available first line investigations for its diagnosis. Lead repositioning is required, however proper patient education and counselling against further manipulation is paramount to long-term management.

Dynamics of energetic particle driven modes and MHD modes in wall-stabilized high-β plasmas on JT-60U and DIII-D

NASA Astrophysics Data System (ADS)

Matsunaga, G.; Okabayashi, M.; Aiba, N.; Boedo, J. A.; Ferron, J. R.; Hanson, J. M.; Hao, G. Z.; Heidbrink, W. W.; Holcomb, C. T.; In, Y.; Jackson, G. L.; Liu, Y. Q.; Luce, T. C.; McKee, G. R.; Osborne, T. H.; Pace, D. C.; Shinohara, K.; Snyder, P. B.; Solomon, W. M.; Strait, E. J.; Turnbull, A. D.; Van Zeeland, M. A.; Watkins, J. G.; Zeng, L.; the DIII-D Team; the JT-60 Team

2013-12-01

In the wall-stabilized high-β plasmas in JT-60U and DIII-D, interactions between energetic particle (EP) driven modes (EPdMs) and edge localized modes (ELMs) have been observed. The interaction between the EPdM and ELM are reproducibly observed. Many EP diagnostics indicate a strong correlation between the distorted waveform of the EPdM and the EP transport to the edge. The waveform distortion is composed of higher harmonics (n ⩾ 2) and looks like a density snake near the plasma edge. According to statistical analyses, ELM triggering by the EPdMs requires a finite level of waveform distortion and pedestal recovery. ELM pacing by the EPdMs occurs when the repetition frequency of the EPdMs is higher than the natural ELM frequency. EPs transported by EPdMs are thought to contribute to change the edge stability.

Moving On/Keeping Pace: Youth's Literate Identities and Multimodal Digital Texts

ERIC Educational Resources Information Center

Alvermann, Donna E.

2011-01-01

"We're not in Kansas anymore, Toto"--a statement Dorothy made to her dog, Toto, in "The Wizard of Oz"--sums up reasonably well the point the author wants to make in this article. That is, as literacy educators no longer constrained (or protected) by older, more familiar 20th-century print-centric modes of communicating, educators may at times feel…

A Solution to the Small Enrollment Problem in Aerospace Engineering--Self-Paced Materials Used in an Independent Studies Mode.

ERIC Educational Resources Information Center

Fowler, Wallace T.; Watkins, R. D.

With the decline in enrollment in the early 1970's, many aerospace engineering departments had too few students to offer some required courses. At the University of Texas at Austin, a set of personalized system of instruction (PSI) materials for the aircraft performance, stability, and control course was developed. The paper includes a description…

Intermittent pacemaker dysfunction caused by digital mobile telephones.

PubMed

Naegeli, B; Osswald, S; Deola, M; Burkart, F

1996-05-01

This study was designed to evaluate possible interactions between digital mobile telephones and implanted pacemakers. Electromagnetic fields may interfere with normal pacemaker function. Development of bipolar sensing leads and modern noise filtering techniques have lessened this problem. However, it remains unclear whether these features also protect from high frequency noise arising from digital cellular phones. In 39 patients with an implanted pacemaker (14 dual-chamber [DDD], 8 atrial-synchronized ventricular-inhibited [VDD(R)] and 17 ventricular-inhibited [VVI(R)] pacemakers), four mobile phones with different levels of power output (2 and 8 W) were tested in the standby, dialing and operating mode. During continuous electrocardiographic monitoring, 672 tests were performed in each mode with the phones positioned over the pulse generator, the atrial and the ventricular electrode tip. The tests were carried out at different sensitivity settings and, where possible, in the unipolar and bipolar pacing modes as well. In 7 (18%) of 39 patients, a reproducible interference was induced during 26 (3.9%) of 672 tests with the operating phones in close proximity (<10 cm) to the pacemaker. In 22 dual-chamber (14 DDD, 8 VDD) pacemakers, atrial triggering occurred in 7 (2.8%) of 248 and ventricular inhibition in 5 (2.8%) of 176 tests. In 17 VVI(R) systems, pacemaker inhibition was induced in 14 (5.6%) of 248 tests. Interference was more likely to occur at higher power output of the phone and at maximal sensitivity of the pacemakers (maximal vs. nominal sensitivity, 6% vs. 1.8% positive test results, p = 0.009). When the bipolar and unipolar pacing modes were compared in the same patients, ventricular inhibition was induced only in the unipolar mode (12.5% positive test results, p = 0.0003). Digital mobile phones in close proximity to implanted pacemakers may cause intermittent pacemaker dysfunction with inappropriate ventricular tracking and potentially dangerous pacemaker inhibition.

Time-Resolved Transposon Insertion Sequencing Reveals Genome-Wide Fitness Dynamics during Infection.

PubMed

Yang, Guanhua; Billings, Gabriel; Hubbard, Troy P; Park, Joseph S; Yin Leung, Ka; Liu, Qin; Davis, Brigid M; Zhang, Yuanxing; Wang, Qiyao; Waldor, Matthew K

2017-10-03

Transposon insertion sequencing (TIS) is a powerful high-throughput genetic technique that is transforming functional genomics in prokaryotes, because it enables genome-wide mapping of the determinants of fitness. However, current approaches for analyzing TIS data assume that selective pressures are constant over time and thus do not yield information regarding changes in the genetic requirements for growth in dynamic environments (e.g., during infection). Here, we describe structured analysis of TIS data collected as a time series, termed pattern analysis of conditional essentiality (PACE). From a temporal series of TIS data, PACE derives a quantitative assessment of each mutant's fitness over the course of an experiment and identifies mutants with related fitness profiles. In so doing, PACE circumvents major limitations of existing methodologies, specifically the need for artificial effect size thresholds and enumeration of bacterial population expansion. We used PACE to analyze TIS samples of Edwardsiella piscicida (a fish pathogen) collected over a 2-week infection period from a natural host (the flatfish turbot). PACE uncovered more genes that affect E. piscicida 's fitness in vivo than were detected using a cutoff at a terminal sampling point, and it identified subpopulations of mutants with distinct fitness profiles, one of which informed the design of new live vaccine candidates. Overall, PACE enables efficient mining of time series TIS data and enhances the power and sensitivity of TIS-based analyses. IMPORTANCE Transposon insertion sequencing (TIS) enables genome-wide mapping of the genetic determinants of fitness, typically based on observations at a single sampling point. Here, we move beyond analysis of endpoint TIS data to create a framework for analysis of time series TIS data, termed pattern analysis of conditional essentiality (PACE). We applied PACE to identify genes that contribute to colonization of a natural host by the fish pathogen Edwardsiella piscicida. PACE uncovered more genes that affect E. piscicida 's fitness in vivo than were detected using a terminal sampling point, and its clustering of mutants with related fitness profiles informed design of new live vaccine candidates. PACE yields insights into patterns of fitness dynamics and circumvents major limitations of existing methodologies. Finally, the PACE method should be applicable to additional "omic" time series data, including screens based on clustered regularly interspaced short palindromic repeats with Cas9 (CRISPR/Cas9). Copyright © 2017 Yang et al.

Making time for soil: Technoscientific futurity and the pace of care.

PubMed

de la Bellacasa, Maria Puig

2015-10-01

The dominant drive for understanding soil has been to pace its fertility with human demand. Today, warnings about soil's exhaustion and endangered ecology raise concerns marked by fears of gloomy environmental futures, prompting scientists and soil practitioners urgently to develop better ways of taking care of soils. Yet the pace required by ecological soil care could be at odds with the predominant temporal orientation of technoscientific intervention, which is driven by an inherently progressivist, productionist and restless mode of futurity. Through a conceptual and historical approach to the soil sciences and other domains of soil knowledge, this article looks for soil ontologies and relations to soil care that are obscured by the predominant timescape. Contemporary discussions of the future of the soil sciences expose tensions between 'progress as usual'--by intensifying productivity--and the need to protect the pace of soil renewal. The intimate relation of soil science with productionism is being interrogated, as ecology attempts to engage with soil as a living community rather than a receptacle for crops. In this context, and beyond science, the 'foodweb' model of soil ecology has become a figure of alternative human-soil relations that involve environmental practitioners in the soil community. Reading these ways of making time for soil as a form of 'care time' helps to reveal a diversity of more-than-human interdependent temporalities, disrupting the anthropocentric appeal of predominant timescales of technoscientific futurity and their reductive notion of innovation.

Recent approaches in design of peptidomimetics for antimicrobial drug discovery research.

PubMed

Lohan, Sandeep; Bisht, Gopal Singh

2013-06-01

Resistant pathogenic microbial strains are emerging at a rate that far exceeds the pace of new anti-infective drug development. In order to combat resistance development, there is pressing need to develop novel class of antibiotics having different mechanism of action in comparison to existing antibiotics. Antimicrobial peptides (AMPs) have been identified as ubiquitous components of innate immune system and widely regarded as a potential source of future antibiotics owing to a remarkable set of advantageous properties ranging from broad spectrum of activity to low propensity of resistance development. However, AMPs present several drawbacks that strongly limit their clinical applicability as ideal drug candidates such as; poor bioavailability, potential immunogenicity and high production cost. Thus, to overcome the limitations of native peptides, peptidomimetic becomes an important and promising approach. The different research groups worldwide engaged in antimicrobial drug discovery over the past decade have paid tremendous effort to design peptidomimetics. This review will focus on recent approaches in design of antimicrobial peptidomimetics their structure-activity relationship studies, mode of action, selectivity & toxicity.

The design of a tactical situation display

NASA Astrophysics Data System (ADS)

Kuperman, Gilbert G.; Wilson, Denise L.

The design and demonstration of a dynamic tactical situation display applicable to an advanced conceptual bomber crew system is discussed. The display is the primary source of mission pacing and situational awareness information in the Strategic Avionics Battle-Management Evaluation and Research (SABER) simulator. Aspects of the display design are described, including primary data items, horizontal situation display, point of interest indication, terrain data, graphics overlay, text window, and presentation modes.

Investigation of a novel algorithm for synchronized left-ventricular pacing and ambulatory optimization of cardiac resynchronization therapy: results of the adaptive CRT trial.

PubMed

Martin, David O; Lemke, Bernd; Birnie, David; Krum, Henry; Lee, Kathy Lai-Fun; Aonuma, Kazutaka; Gasparini, Maurizio; Starling, Randall C; Milasinovic, Goran; Rogers, Tyson; Sambelashvili, Alex; Gorcsan, John; Houmsse, Mahmoud

2012-11-01

In patients with sinus rhythm and normal atrioventricular conduction, pacing only the left ventricle with appropriate atrioventricular delays can result in superior left ventricular and right ventricular function compared with standard biventricular (BiV) pacing. To evaluate a novel adaptive cardiac resynchronization therapy ((aCRT) algorithm for CRT pacing that provides automatic ambulatory selection between synchronized left ventricular or BiV pacing with dynamic optimization of atrioventricular and interventricular delays. Patients (n = 522) indicated for a CRT-defibrillator were randomized to aCRT vs echo-optimized BiV pacing (Echo) in a 2:1 ratio and followed at 1-, 3-, and 6-month postrandomization. The study met all 3 noninferiority primary objectives: (1) the percentage of aCRT patients who improved in their clinical composite score at 6 months was at least as high in the aCRT arm as in the Echo arm (73.6% vs 72.5%, with a noninferiority margin of 12%; P = .0007); (2) aCRT and echo-optimized settings resulted in similar cardiac performance, as demonstrated by a high concordance correlation coefficient between aortic velocity time integrals at aCRT and Echo settings at randomization (concordance correlation coefficient = 0.93; 95% confidence interval 0.91-0.94) and at 6-month postrandomization (concordance correlation coefficient = 0.90; 95% confidence interval 0.87-0.92); and (3) aCRT did not result in inappropriate device settings. There were no significant differences between the arms with respect to heart failure events or ventricular arrhythmia episodes. Secondary end points showed similar benefit, and right-ventricular pacing was reduced by 44% in the aCRT arm. The aCRT algorithm is safe and at least as effective as BiV pacing with comprehensive echocardiographic optimization. Copyright © 2012 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Leadless Pacing: Current State and Future Direction.

PubMed

Merkel, Matthias; Grotherr, Philipp; Radzewitz, Andrea; Schmitt, Claus

2017-12-01

Leadless pacing is now an established alternative to conventional pacing with subcutaneous pocket and transvenous lead for patients with class I or II single-chamber pacing indication. Available 12-month follow-up data shows a 48% fewer major complication rate in patients with Micra™ compared to a historical control group in a nonrandomized study [1]. There is one system with Food and Drug Administration (FDA) approval and two with the Communauté Européenne (CE) mark. The OPS code for the implantation is 8-83d.3 and the procedure has recently been rated as a "new Examination and Treatment Method (NUB)" in the German DRG system, meaning adequate reimbursement is negotiable with health insurance providers. The systems offer similar generator longevity and programming possibilities as conventional pacemaker systems, including rate response, remote monitoring, and MRI safety. The biggest downsides to date are limitations to single-chamber stimulation, lack of long-time data, and concerns of handling of the system at the end of its life span. However, implant procedure complication rates and procedure times do not exceed conventional pacemaker operations, and proper training and patient selection is provided.

Self-Paced Prioritized Curriculum Learning With Coverage Penalty in Deep Reinforcement Learning.

PubMed

Ren, Zhipeng; Dong, Daoyi; Li, Huaxiong; Chen, Chunlin; Zhipeng Ren; Daoyi Dong; Huaxiong Li; Chunlin Chen; Dong, Daoyi; Li, Huaxiong; Chen, Chunlin; Ren, Zhipeng

2018-06-01

In this paper, a new training paradigm is proposed for deep reinforcement learning using self-paced prioritized curriculum learning with coverage penalty. The proposed deep curriculum reinforcement learning (DCRL) takes the most advantage of experience replay by adaptively selecting appropriate transitions from replay memory based on the complexity of each transition. The criteria of complexity in DCRL consist of self-paced priority as well as coverage penalty. The self-paced priority reflects the relationship between the temporal-difference error and the difficulty of the current curriculum for sample efficiency. The coverage penalty is taken into account for sample diversity. With comparison to deep Q network (DQN) and prioritized experience replay (PER) methods, the DCRL algorithm is evaluated on Atari 2600 games, and the experimental results show that DCRL outperforms DQN and PER on most of these games. More results further show that the proposed curriculum training paradigm of DCRL is also applicable and effective for other memory-based deep reinforcement learning approaches, such as double DQN and dueling network. All the experimental results demonstrate that DCRL can achieve improved training efficiency and robustness for deep reinforcement learning.

Assessing patients' experiences with communication across the cancer care continuum.

PubMed

Mazor, Kathleen M; Street, Richard L; Sue, Valerie M; Williams, Andrew E; Rabin, Borsika A; Arora, Neeraj K

2016-08-01

To evaluate the relevance, performance and potential usefulness of the Patient Assessment of cancer Communication Experiences (PACE) items. Items focusing on specific communication goals related to exchanging information, fostering healing relationships, responding to emotions, making decisions, enabling self-management, and managing uncertainty were tested via a retrospective, cross-sectional survey of adults who had been diagnosed with cancer. Analyses examined response frequencies, inter-item correlations, and coefficient alpha. A total of 366 adults were included in the analyses. Relatively few selected Does Not Apply, suggesting that items tap relevant communication experiences. Ratings of whether specific communication goals were achieved were strongly correlated with overall ratings of communication, suggesting item content reflects important aspects of communication. Coefficient alpha was ≥.90 for each item set, indicating excellent reliability. Variations in the percentage of respondents selecting the most positive response across items suggest results can identify strengths and weaknesses. The PACE items tap relevant, important aspects of communication during cancer care, and may be useful to cancer care teams desiring detailed feedback. The PACE is a new tool for eliciting patients' perspectives on communication during cancer care. It is freely available online for practitioners, researchers and others. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Self-paced model learning for robust visual tracking

NASA Astrophysics Data System (ADS)

Huang, Wenhui; Gu, Jason; Ma, Xin; Li, Yibin

2017-01-01

In visual tracking, learning a robust and efficient appearance model is a challenging task. Model learning determines both the strategy and the frequency of model updating, which contains many details that could affect the tracking results. Self-paced learning (SPL) has recently been attracting considerable interest in the fields of machine learning and computer vision. SPL is inspired by the learning principle underlying the cognitive process of humans, whose learning process is generally from easier samples to more complex aspects of a task. We propose a tracking method that integrates the learning paradigm of SPL into visual tracking, so reliable samples can be automatically selected for model learning. In contrast to many existing model learning strategies in visual tracking, we discover the missing link between sample selection and model learning, which are combined into a single objective function in our approach. Sample weights and model parameters can be learned by minimizing this single objective function. Additionally, to solve the real-valued learning weight of samples, an error-tolerant self-paced function that considers the characteristics of visual tracking is proposed. We demonstrate the robustness and efficiency of our tracker on a recent tracking benchmark data set with 50 video sequences.

Disturbed jaw behavior in whiplash-associated disorders during rhythmic jaw movements.

PubMed

Häggman-Henrikson, B; Zafar, H; Eriksson, P-O

2002-11-01

As shown previously, "functional jaw movements" are the result of coordinated activation of jaw as well as neck muscles, leading to simultaneous movements in the temporomandibular, atlanto-occipital, and cervical spine joints. In this study, the effect of neck trauma on natural jaw function was evaluated in 12 individuals suffering from whiplash-associated disorders (WAD). Spatiotemporal characteristics of mandibular and concomitant head movements were evaluated for three different modes of rhythmic jaw activities: self-paced continuous maximal jaw-opening/-closing movements, paced continuous maximal jaw-opening/-closing movements at 50 cycles/minute, and unilateral chewing. Compared with healthy subjects, the WAD group showed smaller magnitude and altered coordination pattern (a change in temporal relations) of mandibular and head movements. In conclusion, these results show that neck trauma can derange integrated jaw and neck behavior, and underline the functional coupling between the jaw and head-neck motor systems.

Effects of closed-loop stimulation vs. DDD pacing on haemodynamic variations and occurrence of syncope induced by head-up tilt test in older patients with refractory cardioinhibitory vasovagal syncope: the Tilt test-Induced REsponse in Closed-loop Stimulation multicentre, prospective, single blind, randomized study.

PubMed

Palmisano, Pietro; Dell'Era, Gabriele; Russo, Vincenzo; Zaccaria, Maria; Mangia, Rolando; Bortnik, Miriam; De Vecchi, Federica; Giubertoni, Ailia; Patti, Fabiana; Magnani, Andrea; Nigro, Gerardo; Rago, Anna; Occhetta, Eraldo; Accogli, Michele

2018-05-01

Closed-loop stimulation (CLS) seemed promising in preventing the recurrence of vasovagal syncope (VVS) in patients with a cardioinhibitory response to head-up tilt test (HUTT) compared with conventional pacing. We hypothesized that the better results of this algorithm are due to its quick reaction in high-rate pacing delivered in the early phase of vasovagal reflex, which increase the cardiac output and the blood pressure preventing loss of consciousness. This prospective, randomized, single-blind, multicentre study was designed as an intra-patient comparison and enrolled 30 patients (age 62.2 ± 13.5 years, males 60.0%) with cardioinhibitory VVS, carrying a dual-chamber pacemaker incorporating CLS algorithm. Two HUTTs were performed one week apart: one during DDD-CLS 60-130/min pacing and the other during DDD 60/min pacing; patients were randomly and blindly assigned to two groups: in one the first HUTT was performed in DDD-CLS (n = 15), in the other in DDD (n = 15). Occurrence of syncope and haemodynamic variations induced by HUTT was recorded during the tests. Compared with DDD, DDD-CLS significantly reduced the occurrence of syncope induced by HUTT (30.0% vs. 76.7%; P < 0.001). In the patients who had syncope in both DDD and DDD-CLS mode, DDD-CLS significantly delayed the onset of syncope during HUTT (from 20.8 ± 3.9 to 24.8 ± 0.9 min; P = 0.032). The maximum fall in systolic blood pressure recorded during HUTT was significantly lower in DDD-CLS compared with DDD (43.2 ± 30.3 vs. 65.1 ± 25.8 mmHg; P = 0.004). In patients with cardioinhibitory VVS, CLS reduces the occurrence of syncope induced by HUTT, compared with DDD pacing. When CLS is not able to abort the vasovagal reflex, it seems to delay the onset of syncope.

Accuracy of computer-calculated and manual QRS duration assessments: Clinical implications to select candidates for cardiac resynchronization therapy.

PubMed

De Pooter, Jan; El Haddad, Milad; Stroobandt, Roland; De Buyzere, Marc; Timmermans, Frank

2017-06-01

QRS duration (QRSD) plays a key role in the field of cardiac resynchronization therapy (CRT). Computer-calculated QRSD assessments are widely used, however inter-manufacturer differences have not been investigated in CRT candidates. QRSD was assessed in 377 digitally stored ECGs: 139 narrow QRS, 140 LBBB and 98 ventricular paced ECGs. Manual QRSD was measured as global QRSD, using digital calipers, by two independent observers. Computer-calculated QRSD was assessed by Marquette 12SL (GE Healthcare, Waukesha, WI, USA) and SEMA3 (Schiller, Baar, Switzerland). Inter-manufacturer differences of computer-calculated QRSD assessments vary among different QRS morphologies: narrow QRSD: 4 [2-9] ms (median [IQR]), p=0.010; LBBB QRSD: 7 [2-10] ms, p=0.003 and paced QRSD: 13 [6-18] ms, p=0.007. Interobserver differences of manual QRSD assessments measured: narrow QRSD: 4 [2-6] ms, p=non-significant; LBBB QRSD: 6 [3-12] ms, p=0.006; paced QRSD: 8 [4-18] ms, p=0.001. In LBBB ECGs, intraclass correlation coefficients (ICCs) were comparable for inter-manufacturer and interobserver agreement (ICC 0.830 versus 0.837). When assessing paced QRSD, manual measurements showed higher ICC compared to inter-manufacturer agreement (ICC 0.902 versus 0.776). Using guideline cutoffs of 130ms, up to 15% of the LBBB ECGs would be misclassified as <130ms or ≥130ms by at least one method. Using a cutoff of 150ms, this number increases to 33% of ECGs being misclassified. However, by combining LBBB-morphology and QRSD, the number of misclassified ECGs can be decreased by half. Inter-manufacturer differences in computer-calculated QRSD assessments are significant and may compromise adequate selection of individual CRT candidates when using QRSD as sole parameter. Paced QRSD should preferentially be assessed by manual QRSD measurements. Copyright © 2017 Elsevier B.V. All rights reserved.

North Pole Marathon Laboratory Lessons and Field Success.

PubMed

Barwood, Martin J; Burrows, Holly; Cessford, Jessica

2016-05-01

This case study documents the training, laboratory preparation, and in-race performance data from Great Britain's top finisher in the 13(th) edition of the UVU North Pole Marathon. We report data from a preparatory laboratory test in simulated cold conditions (-15°C) with and without wind chill during high- and low-intensity expected 'race pace' running. These tests examined the adequacy of the selected clothing assembly and provided recommendations for the race. The tests established that there was no risk of hypothermia, as the clothing assembly provided too much insulation; terminal rectal temperature was 39.25°C. Skin temperature (Tsk) data revealed no impending risk of frostbite; nadir Tsk was 20.2°C at the hamstring. Oxygen consumption data revealed the self-selected high intensity was potentially not sustainable based on estimates of substrate utilization. We recommended: 1) a maximum running speed; 2) some of the clothing base layers could be removed pre-race; 3) vents and/or zips could be used to offload or retain heat; and 4) an even pacing profile should be adopted. The participant completed the race in 6:55:24 (h:mm:ss) in temperatures of -41°C. GPS data revealed a positive pacing template (i.e., marginally quicker in the first half). Neither hypothermia nor frostbite occurred. Peak pace from the laboratory tests was not consistently exceeded. Marathon performance can be undertaken in one of the world's most inhospitable environments when careful consideration is given to clothing insulation and exercise intensity by planning for the dynamic thermal changes that may occur as the race ensues.

First results from the US-PRC PMI collaboration on EAST

NASA Astrophysics Data System (ADS)

Maingi, R.; Lunsford, R.; Mansfield, D.; Diallo, A.; Hu, J.; Sun, Z.; Zuo, G.; Gong, X.; Tritz, K.; Canik, J.; Osborne, T.; EAST Team

2017-10-01

A US-PRC collaboration was formed to understand the plasma-material interface for improved long pulse discharge performance in EAST, with an emphasis on Li conditioning techniques. The US multi-institutional team consists of participants from PPPL, UI-UC, UT-K, ORNL, MIT, LANL, and JHU. In Dec. 2016, this team co-led experiments on the use of Li aerosol injection to mitigate ELMs, Li granule injection to pace ELMs, and a flowing liquid Li limiter to serve as a primary plasma-facing component. Li aerosol injection was shown to eliminate ELMs using the upper ITER-like W divertor, extending previous results of ELM suppression in the lower cabon divertor (J.S. Hu, PRL 2015). In addition Li granule injection was shown to trigger and even pace ELMs, although the paced ELM frequency was slower than the natural ELM frequency in this set of experiments; previously paced ELM frequency was comparable to natural ELMs frequency (D.K. Mansfield, NF 2013). Finally a second generation flowing liquid Li limiter was shown to be compatible with ELMy H-mode plasmas, pushed within 1 cm of the separatrix. The surface showed no damage to PMI and improved wetting as compared to the first generation limiter experiments (J.S. Hu, NF 2016 and G.Z. Zuo, NF 2017). US scientists supported in part by US DoE contracts DE-AC02-09CH11466, DE-FG02-09ER55012, DE-AC05-00OR22725, and DE-FC02-04ER54698, and ASIPP scientists by Contract No. 11625524, No. 11075185, No. 11021565, and No. 2013GB114004.

Typewriting Instruction for Diverse Preparation Levels

ERIC Educational Resources Information Center

Crowell, Mary Alice; Young, Marlin

1976-01-01

The advanced typewriting course (for college students) effectively provided for individual differences through the use of proficiency tests, pretests, learning assignment units at three student-selected levels, timed tests, and individual pacing. (MS)

The PACE evaluation: initial findings.

PubMed

Branch, L G; Coulam, R F; Zimmerman, Y A

1995-06-01

As of mid-1994 there were nine replications of the On Lok model operating under dual capitation payments as sites in the Program of All-inclusive Care for the Elderly (PACE). A tenth site had begun operating under capitation, but was unable to remain viable. The present descriptive study documents the growth and development of the first seven of these sites, all that had been operating under capitation during 1992. Comparisons among these sites and with On Lok are presented in the areas of organizational structure, client characteristics, approaches to case management, service delivery options, and financing. There is considerable variability in the implementation of the PACE model. Combined Medicare and Medicaid capitation monthly payments range from $2,147 to $5,973. These seven PACE sites (excluding On Lok) served a total of 888 current clients at the end of 1992, after a cumulative 136 months of experience under capitation. The very slow enrollment rates may imply that the target clients are less enthusiastic about this model than are its architects. The client selection process may suggest niche-marketing or skimming, but not the full representation of the nursing home population in their states. Given both the slow enrollment and the niche-marketing (the benevolent term) or skimming (the pejorative term) that has occurred, caution about the long-term viability of the PACE model may be warranted.

Successful Reinnervation of the Diaphragm After Intercostal to Phrenic Nerve Neurotization in Patients With High Spinal Cord Injury.

PubMed

Nandra, Kulvir S; Harari, Martin; Price, Thea P; Greaney, Patrick J; Weinstein, Michael S

2017-08-01

Our objective in this study was to extend diaphragmatic pacing therapy to include paraplegic patients with high cervical spinal cord injuries between C3 and C5. Diaphragmatic pacing has been used in patients experiencing ventilator-dependent respiratory failure due to spinal cord injury as a means to reduce or eliminate the need for mechanical ventilation. However, this technique relies on intact phrenic nerve function. Recently, phrenic nerve reconstruction with intercostal nerve grafting has expanded the indications for diaphragmatic pacing. Our study aimed to evaluate early outcomes and efficacy of intercostal nerve transfer in diaphragmatic pacing. Four ventilator-dependent patients with high cervical spinal cord injuries were selected for this study. Each patient demonstrated absence of phrenic nerve function via external neck stimulation and laparoscopic diaphragm mapping. Each patient underwent intercostal to phrenic nerve grafting with implantation of a phrenic nerve pacer. The patients were followed, and ventilator dependence was reassessed at 1 year postoperatively. Our primary outcome was measured by the amount of time our patients tolerated off the ventilator per day. We found that all 4 patients have tolerated paced breathing independent of mechanical ventilation, with 1 patient achieving 24 hours of tracheostomy collar. From this study, intercostal to phrenic nerve transfer seems to be a promising approach in reducing or eliminating ventilator support in patients with C3 to C5 high spinal cord injury.

The effect of single engine fixed wing air transport on rate-responsive pacemakers.

PubMed

De Rotte, A A; Van Der Kemp, P

1999-09-01

Insufficient information exists about the safety of patients with accelerometer-based rate-responsive pacemakers in air transport by general aviation aircraft. The response in pacing rate of two types of accelerometer-based rate-responsive pacemakers with data logging capabilities was studied during test flights with single engine fixed wing aircraft. Results were compared with the rate-response of these pacemakers during transportation by car and were also interpreted in respect to physiological heart rate response of aircrew during flights in single engine fixed wing aircraft. In addition, a continuous accelerometer readout was recorded during a turbulent phase of flight. This recording was used for a pacemaker-simulator experiment with maximal sensitive motion-sensor settings. Only a minor increase in pacing rate due to aircraft motion could be demonstrated during all phases of flight at all altitudes with the pacemakers programmed in the normal mode. This increase was of the same magnitude as induced during transport by car and would be of negligible influence on the performance of the individual pacemaker patient equipped with such a pacemaker. Moreover, simultaneous Holter monitoring of the pilots during these flights showed a similar rate-response in natural heart rate compared with the increase in pacing rate induced by aircraft motion in accelerometer-based rate-responsive pacemakers. No sensor-mediated pacemaker tachycardia was seen during any of these recordings. However, a 15% increase in pacing rate was induced by severe air turbulence. Programming the maximal sensitivity of the motion sensor into the pacemaker could, on the other hand, induce a significant increase in pacing rate as was demonstrated by the simulation experiments. These results seem to rule out potentially dangerous or adverse effects from motional or vibrational influences during transport in single engine fixed wing aircraft on accelerometer-based rate-responsive pacemakers with normal activity sensor settings.

Next-generation pacemakers: from small devices to biological pacemakers.

PubMed

Cingolani, Eugenio; Goldhaber, Joshua I; Marbán, Eduardo

2018-03-01

Electrogenesis in the heart begins in the sinoatrial node and proceeds down the conduction system to originate the heartbeat. Conduction system disorders lead to slow heart rates that are insufficient to support the circulation, necessitating implantation of electronic pacemakers. The typical electronic pacemaker consists of a subcutaneous generator and battery module attached to one or more endocardial leads. New leadless pacemakers can be implanted directly into the right ventricular apex, providing single-chamber pacing without a subcutaneous generator. Modern pacemakers are generally reliable, and their programmability provides options for different pacing modes tailored to specific clinical needs. Advances in device technology will probably include alternative energy sources and dual-chamber leadless pacing in the not-too-distant future. Although effective, current electronic devices have limitations related to lead or generator malfunction, lack of autonomic responsiveness, undesirable interactions with strong magnetic fields, and device-related infections. Biological pacemakers, generated by somatic gene transfer, cell fusion, or cell transplantation, provide an alternative to electronic devices. Somatic reprogramming strategies, which involve transfer of genes encoding transcription factors to transform working myocardium into a surrogate sinoatrial node, are furthest along in the translational pipeline. Even as electronic pacemakers become smaller and less invasive, biological pacemakers might expand the therapeutic armamentarium for conduction system disorders.

BCI Competition IV – Data Set I: Learning Discriminative Patterns for Self-Paced EEG-Based Motor Imagery Detection

PubMed Central

Zhang, Haihong; Guan, Cuntai; Ang, Kai Keng; Wang, Chuanchu

2012-01-01

Detecting motor imagery activities versus non-control in brain signals is the basis of self-paced brain-computer interfaces (BCIs), but also poses a considerable challenge to signal processing due to the complex and non-stationary characteristics of motor imagery as well as non-control. This paper presents a self-paced BCI based on a robust learning mechanism that extracts and selects spatio-spectral features for differentiating multiple EEG classes. It also employs a non-linear regression and post-processing technique for predicting the time-series of class labels from the spatio-spectral features. The method was validated in the BCI Competition IV on Dataset I where it produced the lowest prediction error of class labels continuously. This report also presents and discusses analysis of the method using the competition data set. PMID:22347153

Overview of recent and current research on the TCV tokamak

NASA Astrophysics Data System (ADS)

S. Codathe TCV Team

2013-10-01

Through a diverse research programme, the Tokamak à Configuration Variable (TCV) addresses physics issues and develops tools for ITER and for the longer term goals of nuclear fusion, relying especially on its extreme plasma shaping and electron cyclotron resonance heating (ECRH) launching flexibility and preparing for an ECRH and NBI power upgrade. Localized edge heating was unexpectedly found to decrease the period and relative energy loss of edge localized modes (ELMs). Successful ELM pacing has been demonstrated by following individual ELM detection with an ECRH power cut before turning the power back up to trigger the next ELM, the duration of the cut determining the ELM period. Negative triangularity was also seen to reduce the ELM energy release. H-mode studies have focused on the L-H threshold dependence on the main ion species and on the divertor leg length. Both L- and H-modes have been explored in the snowflake configuration with emphasis on edge measurements, revealing that the heat flux to the strike points on the secondary separatrix increases as the X-points approach each other, well before they coalesce. In L-mode, a systematic scan of the auxiliary power deposition profile, with no effect on confinement, has ruled it out as the cause of confinement degradation. An ECRH power absorption observer based on transmitted stray radiation was validated for eventual polarization control. A new profile control methodology was introduced, relying on real-time modelling to supplement diagnostic information; the RAPTOR current transport code in particular has been employed for joint control of the internal inductance and central temperature. An internal inductance controller using the ohmic transformer has also been demonstrated. Fundamental investigations of neoclassical tearing mode (NTM) seed island formation by sawtooth crashes and of NTM destabilization in the absence of a sawtooth trigger were carried out. Both stabilizing and destabilizing agents (electron cyclotron current drive on or inside the q = 1 surface, respectively) were used to pace sawtooth oscillations, permitting precise control of their period. Locking of the sawtooth period to a pre-defined ECRH modulation period was also demonstrated. Sawtooth control has permitted nearly failsafe NTM prevention when combined with backup NTM stabilization by ECRH.

Plausibility assessment of a 2-state self-paced mental task-based BCI using the no-control performance analysis.

PubMed

Faradji, Farhad; Ward, Rabab K; Birch, Gary E

2009-06-15

The feasibility of having a self-paced brain-computer interface (BCI) based on mental tasks is investigated. The EEG signals of four subjects performing five mental tasks each are used in the design of a 2-state self-paced BCI. The output of the BCI should only be activated when the subject performs a specific mental task and should remain inactive otherwise. For each subject and each task, the feature coefficient and the classifier that yield the best performance are selected, using the autoregressive coefficients as the features. The classifier with a zero false positive rate and the highest true positive rate is selected as the best classifier. The classifiers tested include: linear discriminant analysis, quadratic discriminant analysis, Mahalanobis discriminant analysis, support vector machine, and radial basis function neural network. The results show that: (1) some classifiers obtained the desired zero false positive rate; (2) the linear discriminant analysis classifier does not yield acceptable performance; (3) the quadratic discriminant analysis classifier outperforms the Mahalanobis discriminant analysis classifier and performs almost as well as the radial basis function neural network; and (4) the support vector machine classifier has the highest true positive rates but unfortunately has nonzero false positive rates in most cases.

Pacing during an ultramarathon running event in hilly terrain

PubMed Central

Cole-Hunter, Tom; Wiegand, Aaron N.; Solomon, Colin

2016-01-01

Purpose The dynamics of speed selection as a function of distance, or pacing, are used in recreational, competitive, and scientific research situations as an indirect measure of the psycho-physiological status of an individual. The purpose of this study was to determine pacing on level, uphill and downhill sections of participants in a long (>80 km) ultramarathon performed on trails in hilly terrain. Methods Fifteen ultramarathon runners competed in a  173 km event (five finished at  103 km) carrying a Global-Positioning System (GPS) device. Using the GPS data, we determined the speed, relative to average total speed, in level (LEV), uphill (UH) and downhill (DH) gradient categories as a function of total distance, as well as the correlation between overall performance and speed variability, speed loss, and total time stopped. Results There were no significant differences in normality, variances or means in the relative speed in 173-km and 103-km participants. Relative speed decreased in LEV, UH and DH. The main component of speed loss occurred between 5% and 50% of the event distance in LEV, and between 5% and 95% in UH and DH. There were no significant correlations between overall performance and speed loss, the variability of speed, or total time stopped. Conclusions Positive pacing was observed at all gradients, with the main component of speed loss occurring earlier (mixed pacing) in LEV compared to UH and DH. A speed reserve (increased speed in the last section) was observed in LEV and UH. The decrease in speed and variability of speed were more important in LEV and DH than in UH. The absence of a significant correlation between overall performance and descriptors of pacing is novel and indicates that pacing in ultramarathons in trails and hilly terrain differs to other types of running events. PMID:27812406

Implantable defibrillators configured for hybrid therapy of persistent and permanent atrial fibrillation: initial clinical experience with a novel lead system.

PubMed

Rao, Hygriv B; Saksena, Sanjeev

2005-08-01

Hybrid therapy strategies have combined antiarrhythmic drugs (AAD) with pacemakers, atrio-ventricular defibrillators (AV ICD) or atrial ablation individually. The feasibility combining AAD with dual site RA pacing (DAP) in an AV ICD has not been examined. We used an AV ICD with a novel lead configuration permitting DAP, antitachycardia pacing (ATP) or atrial shocks (ADF) in patients (pts) with refractory persistent or permanent AF. Hybrid therapy included linear RA ablation and/or focal ablation. Continuous DAP and automatic ATP with patient or physician activated ADF. 24 pts, mean age 66 +/- 10 yrs, with cardiac disease (22 pts), underwent insertion of an AVICD with dual RA leads. 20 patients had concomitant ablative procedures (RA only = 19, RA + LA = 1) and all pts continued previously ineffective AAD. During a follow-up of 2-36 months (mean 17 +/- 8 mos), rhythm control was restored in all pts & maintained long-term in 19 (83%) pts. 8 pts used AF termination therapies successfully. Device datalogs showed no episodes of AF in 6 pts, asymptomatic brief arrhythmias in 4 pts, infrequent paroxysmal AF in 9 pts & persistent AF recurred in 5 pts. AV ICD detection algorithms reliably detected AF or AT in the DAP mode in all pts. Intermittent brief P wave double counting occurred during AT in selected pts. No pt received inappropriate ADF therapy. 1. DAP can be safely incorporated in an AVICD devices for use in an hybrid therapy strategy for AF pts. 2. These devices can be effective for both AF prevention & termination. 3. Long term rhythm control can be achieved and documented by device datalogs in persistent and permanent AF.

Long-term thresholds of nonsteroidal permanent pacing leads: a 5-year study.

PubMed

Gumbrielle, T P; Bourke, J P; Sinkovic, M; Tynan, M; Kittpawong, P; Gold, R G

1996-05-01

The present commercial market supports many nonsteroidal endocardial pacing leads of differing construction. In order to compare the performance of these configurations, we studied the long-term pacing properties of three representative lead types by randomized clinical trial in 99 patients undergoing a first elective VVI implant. Thirty-one patients received sintered platinum leads, 36 activated pyrolytic carbon leads, and 32 vitreous carbon leads. All received generators capable of noninvasive threshold testing. Acute sensing parameters were R wave amplitude and ST segment elevation measured from the endocardial electrogram. Noninvasive voltage thresholds were measured at implantation, 2 days, 1, 3, and 6 months, and yearly thereafter for 5 years. There were no significant differences between leads in pacing or sensing capabilities at implantation. All three demonstrated similar increases in thresholds, peaking at 1 month, then falling to a plateau by 6 months and did not vary significantly thereafter. There were no significant differences in thresholds between leads during 5 years of follow-up. The lowest mean threshold at 5 years was 0.93 V at 0.5 ms. This study suggests that: (1) although these lead types all perform well, none offers any particular clinical advantage over another; (2) the degree of early threshold peaking precludes immediate postimplant output reduction, but later thresholds are sufficiently low to enable reductions in pacing output; (3) safe low energy pacing requires greater attention to the lead-generator combinations; (4) data obtained at subsequent annual follow-up provided no additional useful clinical information to that obtained at 1 year; and (5) in the absence of other differences, cost can be the deciding factor in lead selection.

Peak fat oxidation during self-paced activities of daily life: influence of sex and body composition.

PubMed

Grams, Lena; Kück, Momme; Haufe, Sven; Tegtbur, Uwe; Nelius, Anne-Katrin; Kerling, Arno

2017-05-01

Increasing physical activity is a cornerstone in the treatment of overweight individuals and self-selected exercise intensity leads to higher adherence to physical activity. However, information on differences in energy expenditure and fat oxidation between sexes regarding common self-paced activities of daily living are rare. We divided 33 subjects into normal weight (NW, N.=21) and overweight (OW, N.=12). Energy expenditure and substrate oxidation was measured during six self-paced physical activities of daily living using a portable spirometric system. We also determined maximum aerobic capacity (VO2max) and estimated free-living physical activity with a multi-sensor device. For all six activities, total energy expenditure was not different between NW and OW subjects in both sexes. The peak fat oxidation during physical activities was reached at higher intensities for women (NW 57±15%; OW 53±8% of VO2max) compared to men (NW 41±8%; OW 42±9% of VO2max) with no differences between NW and OW subjects. The majority of OW (92%) but not NW (42%) subjects reached their highest fat oxidation during walking. The self-selected walking speed was not significantly different between NW and OW men (NW 5.25±0.48 km/h, OW 5.52±0.42 km/h) and NW and OW women (NW 5.16±0.89 km/h, OW 5.01±0.42 km/h). When physical activity aims to maximizing fat oxidation, women should exercise at higher relative intensities than men, regardless of being normal weight or overweight. Self-paced walking is a suitable activity for overweight subjects to achieve high rates of both total energy expenditure and fat oxidation.

Treadmill Adaptation and Verification of Self-Selected Walking Speed: A Protocol for Children

ERIC Educational Resources Information Center

Amorim, Paulo Roberto S.; Hills, Andrew; Byrne, Nuala

2009-01-01

Walking is a common activity of daily life and researchers have used the range 3-6 km.h[superscript -1] as reference for walking speeds habitually used for transportation. The term self-selected (i.e., individual or comfortable walking pace or speed) is commonly used in the literature and is identified as the most efficient walking speed, with…

Tailor-made heart simulation predicts the effect of cardiac resynchronization therapy in a canine model of heart failure.

PubMed

Panthee, Nirmal; Okada, Jun-ichi; Washio, Takumi; Mochizuki, Youhei; Suzuki, Ryohei; Koyama, Hidekazu; Ono, Minoru; Hisada, Toshiaki; Sugiura, Seiryo

2016-07-01

Despite extensive studies on clinical indices for the selection of patient candidates for cardiac resynchronization therapy (CRT), approximately 30% of selected patients do not respond to this therapy. Herein, we examined whether CRT simulations based on individualized realistic three-dimensional heart models can predict the therapeutic effect of CRT in a canine model of heart failure with left bundle branch block. In four canine models of failing heart with dyssynchrony, individualized three-dimensional heart models reproducing the electromechanical activity of each animal were created based on the computer tomographic images. CRT simulations were performed for 25 patterns of three ventricular pacing lead positions. Lead positions producing the best and the worst therapeutic effects were selected in each model. The validity of predictions was tested in acute experiments in which hearts were paced from the sites identified by simulations. We found significant correlations between the experimentally observed improvement in ejection fraction (EF) and the predicted improvements in ejection fraction (P<0.01) or the maximum value of the derivative of left ventricular pressure (P<0.01). The optimal lead positions produced better outcomes compared with the worst positioning in all dogs studied, although there were significant variations in responses. Variations in ventricular wall thickness among the dogs may have contributed to these responses. Thus CRT simulations using the individualized three-dimensional heart models can predict acute hemodynamic improvement, and help determine the optimal positions of the pacing lead. Copyright © 2016 Elsevier B.V. All rights reserved.

In-hive patterns of temporal polyethism in strains of honey bees (Apis mellifera) with distinct genetic backgrounds.

PubMed

Siegel, Adam J; Fondrk, M Kim; Amdam, Gro V; Page, Robert E

2013-01-01

Honey bee workers exhibit an age-based division of labor (temporal polyethism, DOL). Younger bees transition through sets of tasks within the nest; older bees forage outside. Components of temporal polyethism remain unrevealed. Here, we investigate the timing and pattern of pre-foraging behavior in distinct strains of bees to (1) determine if a general pattern of temporal DOL exists in honey bees, (2) to demonstrate a direct genetic impact on temporal pacing, and (3) to further elucidate the mechanisms controlling foraging initiation. Honey bees selected for differences in stored pollen demonstrate consistent differences in foraging initiation age. Those selected for increased pollen storage (high pollen hoarding strain, HSBs) initiate foraging earlier in life than those selected for decreased pollen storage (low pollen hoarding strain, LSBs). We found that HSBs both initiate and terminate individual pre-foraging tasks earlier than LSBs when housed in a common hive environment. Unselected commercial bees (wild type) generally demonstrated intermediate behavioral timing. There were few differences between genotypes for the proportion of pre-foraging effort dedicated to individual tasks, though total pre-foraging effort differences differed dramatically. This demonstrates that behavioral pacing can be accelerated or slowed, but the pattern of behavior is not fundamentally altered, suggesting a general pattern of temporal behavior in honey bees. This also demonstrates direct genetic control of temporal pacing. Finally, our results suggest that earlier HSB protein (pollen) consumption termination compared to LSBs may contribute to an earlier decline in hemolymph vitellogenin protein titers, which would explain their earlier onset of foraging.

Position paper for management of elderly patients with pacemakers and implantable cardiac defibrillators Groupe de rythmologie et stimulation cardiaque de la Société française de cardiologie et Société française de gériatrie et gérontologie.

PubMed

Fauchier, Laurent; Alonso, Christine; Anselme, Frédéric; Blangy, Hugues; Bordachar, Pierre; Boveda, Serge; Clementy, Nicolas; Defaye, Pascal; Deharo, Jean-Claude; Friocourt, Patrick; Gras, Daniel; Halimi, Franck; Klug, Didier; Mansourati, Jacques; Obadia, Benjamin; Pasquié, Jean-Luc; Pavin, Dominique; Sadoul, Nicolas; Taieb, Jérôme; Piot, Olivier; Hanon, Olivier

2016-09-01

Despite the increasingly high rate of implantation of pacemakers (PM) and cardioverter-defibrillators (ICD) in elderly patients, data supporting their clinical and cost-effectiveness in this age stratum are ambiguous and contradictory. We reviewed the data regarding the applicability, safety, and effectiveness of the conventional pacing, ICD and cardiac resynchronization therapy (CRT) in elderly patients. Although peri-procedural risk may be slightly higher in the elderly, the procedure of implantation of PMs and ICDs is still relatively safe in this age group. In older patients with sinus node disease, a general consensus is that dual chamber pacing, along with the programming of an algorithm to minimise ventricular pacing is preferred. In very old patients presenting with intermittent or suspected AV block, VVI pacing may be appropriate. In terms of correcting potentially life-threatening arrhythmias, the effectiveness of ICD therapy is comparable in older and younger individuals. However, the assumption of persistent ICD benefit in the elderly population is questionable, as any advantage of the device on arrhythmic death may be attenuated by a higher total non-arrhythmic mortality. While septuagenarians and octogenarians have higher annual all-cause mortality rates, ICD therapy may remain effective in selected patients at high risk of arrhythmic death and with minimum comorbidities despite advanced age. ICD implantation among the elderly, as a group, may not be cost-effective, but the procedure may reach cost-effectiveness in those expected to live >5-7 years after implantation. The elderly patients usually experience a significant functional improvement after CRT, similar to that observed in middle-aged patients. Management of CRT non responders remains globally the same, while considering a less aggressive approach in terms of re interventions (revision of LV lead placement, addition of a RV or LV lead, LV endocardial pacing configuration). Overall, age, comorbidities and comprehensive geriatric assessment should be the decisive factor in making a decision on device implantation selection for survival and well-being benefit in elderly patients.

[Diaphragm pacing for the ventilatory support of the quadriplegic patients with respiratory paralysis].

PubMed

Cheng, H; Wang, L S; Pan, H C; Shoung, H M; Lee, L S

1992-02-01

Electrical stimulation of the phrenic nerve to pace the diaphragm in patients with chronic ventilatory insufficiency has been an established therapeutic modality since William W.L. Glenn first described using radiofrequency signals in 1978 to stimulate the phrenic nerves. Before this event, patients who were ventilator-dependent and thus bedridden because of respiratory paralysis associated with quadriplegia usually anticipated little chance for physical or psychosocial rehabilitation. Two cases of C1-C2 subluxtion with cord injury and chronic ventilatory insufficiency were implanted at VGH-Taipei with diaphragm pacemaker in 1988. Postoperative phrenic nerve stimulation was given according to individual training schedule. One case with total phrenic paralysis received bilateral phrenic nerve stimulation and became weaned from the ventilator 6 months later. The other case with partially active ventilatory function received unilateral phrenic nerve stimulation to compensate the ventilation. However, its final outcome still showed the necessity of a bilateral mode to achieve adequate ventilation irrespective of strenuous training for 2 years.

Longitudinal mode selection in a delay-line homogeneously broadened oscillator with a fast saturable amplifier.

PubMed

Fleyer, Michael; Horowitz, Moshe

2017-05-01

Homogeneously broadened delay-line oscillators such as lasers or optoelectronic oscillators (OEOs) can potentially oscillate in a large number of cavity modes that are supported by their amplifier bandwidth. In a continuous wave operating mode, the oscillating mode is selected between one or few cavity modes that experience the highest small-signal gain. In this manuscript, we show that the oscillation mode of a homogeneously broadened oscillator can be selected from a large number of modes in a frequency region that can be broader than the full width at half maximum of the effective cavity filter. The mode is selected by a short-time injection of an external signal into the oscillator. After the external signal is turned off, the oscillation is maintained in the selected mode even if this mode has a significantly lower small-signal gain than that of other cavity modes. The stability of the oscillation is obtained due to nonlinear saturation effect in the oscillator amplifier. We demonstrate, experimentally and theoretically, mode selection in a long cavity OEO. We could select any desired mode between 400 cavity modes while maintaining ultra-low phase noise in the selected mode and in the non-oscillating modes. No mode-hopping was observed during our maximum measurement duration of about 24 hours.

Self-paced versus fixed speed walking and the effect of virtual reality in children with cerebral palsy.

PubMed

Sloot, Lizeth H; Harlaar, Jaap; van der Krogt, Marjolein M

2015-10-01

While feedback-controlled treadmills with a virtual reality could potentially offer advantages for clinical gait analysis and training, the effect of self-paced walking and the virtual environment on the gait pattern of children and different patient groups remains unknown. This study examined the effect of self-paced (SP) versus fixed speed (FS) walking and of walking with and without a virtual reality (VR) in 11 typically developing (TD) children and nine children with cerebral palsy (CP). We found that subjects walked in SP mode with twice as much between-stride walking speed variability (p<0.01), fluctuating over multiple strides. There was no main effect of SP on kinematics or kinetics, but small interaction effects between SP and group (TD versus CP) were found for five out of 33 parameters. This suggests that children with CP might need more time to familiarize to SP walking, however, these differences were generally too small to be clinically relevant. The VR environment did not affect the kinematic or kinetic parameters, but walking with VR was rated as more similar to overground walking by both groups (p=0.02). The results of this study indicate that both SP and FS walking, with and without VR, can be used interchangeably for treadmill-based clinical gait analysis in children with and without CP. Copyright © 2015 Elsevier B.V. All rights reserved.

The Multi-Leu Peptide Inhibitor Discriminates Between PACE4 and Furin And Exhibits Antiproliferative Effects On Prostate Cancer Cells

PubMed Central

2012-01-01

The proprotein convertases (PCs) play an important role in protein precursor activation through processing at paired basic residues. However, significant substrate cleavage redundancy has been reported between PCs. The question remains whether specific PC inhibitors can be designed. This study describes the identification of the sequence LLLLRVKR, named Multi-Leu (ML)-peptide, that displayed a 20-fold selectivity on PACE4 over furin, two enzymes with similar structural characteristics. We have previously demonstrated that PACE4 plays an important role in prostate cancer and could be a druggable target. The present study demonstrates that the ML-peptide significantly reduced the proliferation of DU145 and LNCaP prostate cancer-derived cell lines and induced G0/G1 cell cycle arrest. However, the ML-peptide must enter the cell to inhibit proliferation. It is concluded that peptide-based inhibitors can yield specific PC inhibitors and that the ML-peptide is an important lead compound that could potentially have applications in prostate cancer. PMID:23126600

Let's Walk Outdoors! Self-Paced Walking Outdoors Improves Future Intention to Exercise in Women With Obesity.

PubMed

Krinski, Kleverton; Machado, Daniel G S; Lirani, Luciana S; DaSilva, Sergio G; Costa, Eduardo C; Hardcastle, Sarah J; Elsangedy, Hassan M

2017-04-01

In order to examine whether environmental settings influence psychological and physiological responses of women with obesity during self-paced walking, 38 women performed two exercise sessions (treadmill and outdoors) for 30 min, where oxygen uptake, heart rate, ratings of perceived exertion, affect, attentional focus, enjoyment, and future intentions to walk were analyzed. Physiological responses were similar during both sessions. However, during outdoor exercise, participants displayed higher externally focused attention, positive affect, and lower ratings of perceived exertion, followed by greater enjoyment and future intention to participate in outdoor walking. The more externally focused attention predicted greater future intentions to participate in walking. Therefore, women with obesity self-selected an appropriate exercise intensity to improve fitness and health in both environmental settings. Also, self-paced outdoor walking presented improved psychological responses. Health care professionals should consider promoting outdoor forms of exercise to maximize psychological benefits and promote long-term adherence to a physically active lifestyle.

The Self-Paced Graz Brain-Computer Interface: Methods and Applications

PubMed Central

Scherer, Reinhold; Schloegl, Alois; Lee, Felix; Bischof, Horst; Janša, Janez; Pfurtscheller, Gert

2007-01-01

We present the self-paced 3-class Graz brain-computer interface (BCI) which is based on the detection of sensorimotor electroencephalogram (EEG) rhythms induced by motor imagery. Self-paced operation means that the BCI is able to determine whether the ongoing brain activity is intended as control signal (intentional control) or not (non-control state). The presented system is able to automatically reduce electrooculogram (EOG) artifacts, to detect electromyographic (EMG) activity, and uses only three bipolar EEG channels. Two applications are presented: the freeSpace virtual environment (VE) and the Brainloop interface. The freeSpace is a computer-game-like application where subjects have to navigate through the environment and collect coins by autonomously selecting navigation commands. Three subjects participated in these feedback experiments and each learned to navigate through the VE and collect coins. Two out of the three succeeded in collecting all three coins. The Brainloop interface provides an interface between the Graz-BCI and Google Earth. PMID:18350133

Two-year process evaluation of a pilot program to increase elementary children's physical activity during school.

PubMed

Webster, Collin A; Weaver, R Glenn; Egan, Cate A; Brian, Ali; Vazou, Spyridoula

2018-04-01

The purpose of this study was to examine implementation processes in elementary classrooms during a 2-year (Fall 2014 to Spring 2016) pilot intervention program, Partnerships for Active Children in Elementary Schools (PACES). We examined (a) the effect of PACES on the extent of movement integration (MI) and (b) changes in teachers' perceptions regarding MI. Purposively selected classrooms (grades 1-3) across four schools (3 intervention, 1 control) participated in the study. The sample included classroom teachers (N = 12) in Fall 2014 and Spring 2015, but the number of participants dropped to eight in Fall 2015 and Spring 2016. PACES consisted of three partnership approaches (a virtual community of practice, community-based participatory research, and university service learning) intended to increase the extent of MI in the intervention classrooms. We collected process data using the System for Observing Student Movement in Academic Routines and Transitions (SOSMART) and teacher interviews. PACES did not significantly impact the extent of observed MI. Interviews indicated that the intervention had both strengths and limitations. Building interpersonal support for teachers is important to their use of MI. A different measurement schedule (e.g., collecting MI data each day of the school week) may be required to more thoroughly capture MI instances. Copyright © 2018 Elsevier Ltd. All rights reserved.

[Biomechanics study during march with different military equipment of equal carrying load].

PubMed

Lang, Y Y

1992-03-01

The purpose of the study is to select the best military equipment of equal carrying load by the index of biomechanics. Six healthy young men whose age varied between 19 and 25 years were volunteered, in the experiment. They were required to march 1.5 h, carried with different military equipment of equal weight, 25 kg, at a speed of 5 km/h. The centre of gravity of the body and its kinesic parameters were measured before and after the march. The frequency and length of pace were measured during the march. The results of the study indicated that the displacement of the body's centre of gravity carrying equipment I was the most evident, whereas the least displacement of centre of gravity of the body was that carrying equipment II. The frequency of pace during the march was reduced in all three carrying different kinds of equipment, the most evident being that carrying equipment I; the length of pace became bigger with those carrying equipment II and III; the speed of pace was decelerated using equipment I, but it was quickened with equipment II. The change of kinesic parameters have no significant difference among the three. In summary; equipment II conforms best to biomechanical principles, whereas equipment I is the worst.

A Brief Review of Biodata History, Research, and Applications

DTIC Science & Technology

2007-01-01

scrutiny, via interpretation of the Uniform Guidelines on Employee Selection Procedures ( EEOC , 1978). Pace and Schoenfeldt (1977) point out that...classification test batteries. American Psychologist, 5, 279. Ledvinka, J., & Scarpello, V. G. (1992). Federal regulation of personnel and human resource

The metabolic pace-of-life model: incorporating ectothermic organisms into the theory of vertebrate ecoimmunology.

PubMed

Sandmeier, Franziska C; Tracy, Richard C

2014-09-01

We propose a new heuristic model that incorporates metabolic rate and pace of life to predict a vertebrate species' investment in adaptive immune function. Using reptiles as an example, we hypothesize that animals with low metabolic rates will invest more in innate immunity compared with adaptive immunity. High metabolic rates and body temperatures should logically optimize the efficacy of the adaptive immune system--through rapid replication of T and B cells, prolific production of induced antibodies, and kinetics of antibody--antigen interactions. In current theory, the precise mechanisms of vertebrate immune function oft are inadequately considered as diverse selective pressures on the evolution of pathogens. We propose that the strength of adaptive immune function and pace of life together determine many of the important dynamics of host-pathogen evolution, namely, that hosts with a short lifespan and innate immunity or with a long lifespan and strong adaptive immunity are expected to drive the rapid evolution of their populations of pathogens. Long-lived hosts that rely primarily on innate immune functions are more likely to use defense mechanisms of tolerance (instead of resistance), which are not expected to act as a selection pressure for the rapid evolution of pathogens' virulence. © The Author 2014. Published by Oxford University Press on behalf of the Society for Integrative and Comparative Biology. All rights reserved. For permissions please email: journals.permissions@oup.com.

Herbicide-Resistant Crops: Utilities and Limitations for Herbicide-Resistant Weed Management

PubMed Central

2010-01-01

Since 1996, genetically modified herbicide-resistant (HR) crops, particularly glyphosate-resistant (GR) crops, have transformed the tactics that corn, soybean, and cotton growers use to manage weeds. The use of GR crops continues to grow, but weeds are adapting to the common practice of using only glyphosate to control weeds. Growers using only a single mode of action to manage weeds need to change to a more diverse array of herbicidal, mechanical, and cultural practices to maintain the effectiveness of glyphosate. Unfortunately, the introduction of GR crops and the high initial efficacy of glyphosate often lead to a decline in the use of other herbicide options and less investment by industry to discover new herbicide active ingredients. With some exceptions, most growers can still manage their weed problems with currently available selective and HR crop-enabled herbicides. However, current crop management systems are in jeopardy given the pace at which weed populations are evolving glyphosate resistance. New HR crop technologies will expand the utility of currently available herbicides and enable new interim solutions for growers to manage HR weeds, but will not replace the long-term need to diversify weed management tactics and discover herbicides with new modes of action. This paper reviews the strengths and weaknesses of anticipated weed management options and the best management practices that growers need to implement in HR crops to maximize the long-term benefits of current technologies and reduce weed shifts to difficult-to-control and HR weeds. PMID:20586458

Third-generation mobile phones (UMTS) do not interfere with permanent implanted pacemakers.

PubMed

Ismail, Mohamed M; Badreldin, Akmal M A; Heldwein, Matthias; Hekmat, Khosro

2010-07-01

Third-generation mobile phones, UMTS (Universal Mobile Telecommunication System), were recently introduced in Europe. The safety of these devices with regard to their interference with implanted pacemakers is as yet unknown and is the point of interest in this study. The study comprised 100 patients with permanent pacemaker implantation between November 2004 and June 2005. Two UMTS cellular phones (T-Mobile, Vodafone) were tested in the standby, dialing, and operating mode with 23 single-chamber and 77 dual-chamber pacemakers. Continuous surface electrocardiograms (ECGs), intracardiac electrograms, and marker channels were recorded when calls were made by a stationary phone to cellular phone. All pacemakers were tested under a "worst-case scenario," which includes a programming of the pacemaker to unipolar sensing and pacing modes and inducing of a maximum sensitivity setting during continuous pacing of the patient. Patients had pacemaker implantation between June 1990 and April 2005. The mean age was 68.4 +/- 15.1 years. Regardless of atrial and ventricular sensitivity settings, both UMTS mobile phones (Nokia 6650 and Motorola A835) did not show any interference with all tested pacemakers. In addition, both cellular phones did not interfere with the marker channels and the intracardiac ECGs of the pacemakers. Third-generation mobile phones are safe for patients with permanent pacemakers. This is due to the high-frequency band for this system (1,800-2,200 MHz) and the low power output between 0.01 W and 0.25 W.

The nuclear pacemaker: Is renewed interest warranted

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

Parsonnet, V.; Berstein, A.D.; Perry, G.Y.

1990-10-01

From 1973 through 1987, 155 radioisotope-powered nuclear pacemakers were implanted in 132 patients at the Newark Beth Israel Medical Center. The longevity of the first 15 devices, all of which were fixed-rate (VOO) pacemakers, was significantly better than that of 15 lithium-chemistry demand (VVI) pacemakers used as control devices (p = 0.0002). Of the entire cohort of 155 nuclear pacemakers, 136 were VVI devices and 19 were VOO units. The patients with VOO pacemakers needed reoperations more often than did those with VVI pacemakers, chiefly for mode change (p less than 0.001). Power-source failure was observed in only 1 case,more » but 47 nuclear pacemakers were removed for other reasons, including component malfunction (15 units), mode change (12 units), high pacing thresholds (8 units) and lead or connector problems (5 units). The actuarial survival at 15 years was 99% for power sources and 82% for the entire pacing systems (pulse generators plus leads). The frequency of malignancy was similar to that of the population at large and primary tumor sites were randomly distributed. Deaths most commonly were due to cardiac causes (68%). Thus, nuclear pacemakers are safe and reliable and their greater initial cost appears to be offset by their longevity and the resulting decrease in the frequency of reoperations. It is reasonable to suggest that further use be made of long-lasting nuclear power sources for modern pacemakers and other implantable rhythm-management devices.« less

A novel predictive pharmacokinetic/pharmacodynamic model of repolarization prolongation derived from the effects of terfenadine, cisapride and E-4031 in the conscious chronic av node--ablated, His bundle-paced dog.

PubMed

Nolan, Emily R; Feng, Meihua Rose; Koup, Jeffrey R; Liu, Jing; Turluck, Daniel; Zhang, Yiqun; Paulissen, Jerome B; Olivier, N Bari; Miller, Teresa; Bailie, Marc B

2006-01-01

Terfenadine, cisapride, and E-4031, three drugs that prolong ventricular repolarization, were selected to evaluate the sensitivity of the conscious chronic atrioventricular node--ablated, His bundle-paced Dog for defining drug induced cardiac repolarization prolongation. A novel predictive pharmacokinetic/pharmacodynamic model of repolarization prolongation was generated from these data. Three male beagle dogs underwent radiofrequency AV nodal ablation, and placement of a His bundle-pacing lead and programmable pacemaker under anesthesia. Each dog was restrained in a sling for a series of increasing dose infusions of each drug while maintained at a constant heart rate of 80 beats/min. RT interval, a surrogate for QT interval in His bundle-paced dogs, was recorded throughout the experiment. E-4031 induced a statistically significant RT prolongation at the highest three doses. Cisapride resulted in a dose-dependent increase in RT interval, which was statistically significant at the two highest doses. Terfenadine induced a dose-dependent RT interval prolongation with a statistically significant change occurring only at the highest dose. The relationship between drug concentration and RT interval change was described by a sigmoid E(max) model with an effect site. Maximum RT change (E(max)), free drug concentration at half of the maximum effect (EC(50)), and free drug concentration associated with a 10 ms RT prolongation (EC(10 ms)) were estimated. A linear correlation between EC(10 ms) and HERG IC(50) values was identified. The conscious dog with His bundle-pacing detects delayed cardiac repolarization related to I(Kr) inhibition, and detects repolarization change induced by drugs with activity at multiple ion channels. A clinically relevant sensitivity and a linear correlation with in vitro HERG data make the conscious His bundle-paced dog a valuable tool for detecting repolarization effect of new chemical entities.

Setting the pace: the 2011 Australasian Podiatry Council conference

PubMed Central

2011-01-01

The 2011 Australasian Podiatry Council conference was held from April 26 to 29 in Melbourne, Victoria, Australia. This commentary provides a brief overview of the conference, including the speakers and topic areas covered, selected original research highlights, and award winning presentations. PMID:21762520

The Business of Academic Support

ERIC Educational Resources Information Center

Potacco, Donna R.; De Young, Sandra

2007-01-01

Academia has traditionally avoided adopting the fast-paced, profit-oriented operational style that accompanies corporate culture. However, a business model can be successfully adapted to the unique needs of an academic institution, discipline, faculty, and students through the selective adoption of business principles. A classic marketing mix…

A Brief Review of Biodata History, Research, and Applications

DTIC Science & Technology

2007-01-01

interpretation of the Uniform Guidelines on Employee Selection Procedures ( EEOC , 1978). Pace and Schoenfeldt (1977) point out that although the usual...Ledvinka, J., & Scarpello, V. G. (1992). Federal regulation of personnel and human resource management (3rd ed.). Belmont CA: Wadsworth. Levine, A. S

Activity Monitors Step Count Accuracy in Community-Dwelling Older Adults.

PubMed

Johnson, Marquell

2015-01-01

Objective: To examine the step count accuracy of activity monitors in community-dwelling older adults. Method : Twenty-nine participants aged 67.70 ± 6.07 participated. Three pedometers and the Actical accelerometer step count functions were compared with actual steps taken during a 200-m walk around an indoor track and during treadmill walking at three different speeds. Results : There was no statistical difference between activity monitors step counts and actual steps during self-selected pace walking. During treadmill walking at 0.67 m∙s -1 , all activity monitors step counts were significantly different from actual steps. During treadmill walking at 0.894m∙s -1 , the Omron HJ-112 pedometer step counts were not significantly different from actual steps. During treadmill walking at 1.12 m∙s -1 , the Yamax SW-200 pedometer steps were significantly different from actual steps. Discussion : Activity monitor selection should be deliberate when examining the walking behaviors of community-dwelling older adults, especially for those who walk at a slower pace.

Activity Monitors Step Count Accuracy in Community-Dwelling Older Adults

PubMed Central

2015-01-01

Objective: To examine the step count accuracy of activity monitors in community-dwelling older adults. Method: Twenty-nine participants aged 67.70 ± 6.07 participated. Three pedometers and the Actical accelerometer step count functions were compared with actual steps taken during a 200-m walk around an indoor track and during treadmill walking at three different speeds. Results: There was no statistical difference between activity monitors step counts and actual steps during self-selected pace walking. During treadmill walking at 0.67 m∙s−1, all activity monitors step counts were significantly different from actual steps. During treadmill walking at 0.894m∙s−1, the Omron HJ-112 pedometer step counts were not significantly different from actual steps. During treadmill walking at 1.12 m∙s−1, the Yamax SW-200 pedometer steps were significantly different from actual steps. Discussion: Activity monitor selection should be deliberate when examining the walking behaviors of community-dwelling older adults, especially for those who walk at a slower pace. PMID:28138464

From Oedipus to PACE, using the concepts of shame and guilt as golden thread.

PubMed

Beckmann, Klaus Martin

2016-02-01

To demonstrate that antiquity's concepts of shame and guilt developed in their meaning over the centuries and can still have practical applicability in psychological therapies these days. To review shame and guilt in philosophy, history, ethics and psychiatry contexts. Within limitations, a narrative is presented, starting with Oedipus in antiquity, visiting several important philosophical theories and ending in the present time with, for example, Dan Hughes' PACE model for therapy. The first part expands on selected ideas presented in Melvyn Bragg's 2007 BBC radio programme entitled 'Guilt'; the second part adds selected therapeutic models where concepts of shame and guilt play a role. Shame and guilt are archaic but quintessential concepts that already occupied thinkers in antiquity. Shame and guilt are concepts that preoccupied science and art over the millennia and continue as useful concepts to the present day. Moreover, shame and guilt, as concepts, continue to play a salient role in recent and contemporary psychiatry. © The Royal Australian and New Zealand College of Psychiatrists 2015.

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

ERIC Educational Resources Information Center

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

2011-01-01

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

Assessment of hemodynamic load components affecting optimization of cardiac resynchronization therapy by lumped parameter mode.

PubMed

Xu, Ke; Butlin, Mark; Avolio, Alberto P

2012-01-01

Timing of biventricular pacing devices employed in cardiac resynchronization therapy (CRT) is a critical determinant of efficacy of the procedure. Optimization is done by maximizing function in terms of arterial pressure (BP) or cardiac output (CO). However, BP and CO are also determined by the hemodynamic load of the pulmonary and systemic vasculature. This study aims to use a lumped parameter circulatory model to assess the influence of the arterial load on the atrio-ventricular (AV) and inter-ventricular (VV) delay for optimal CRT performance.

Applied Music Teaching Behavior as a Function of Selected Personality Variables.

ERIC Educational Resources Information Center

Schmidt, Charles P.

1989-01-01

Investigates the relationships among applied music teaching behaviors and personality variables as measured by the Myers-Briggs Type Indicator (MBTI). Suggests that personality variables may be important factors underlying four applied music teaching behaviors: approvals, rate of reinforcement, teacher model/performance, and pace. (LS)

Selective phenotyping traits related to multiple stress and drought response in dry bean

USDA-ARS?s Scientific Manuscript database

Dry bean (Phaseolus vulgaris L.) tolerance to stressful environments is not well understood. Moreover, the increasing population sizes necessary for improving genomic resolution of QTL conditioning stress response has made it difficult for phenotyping to keep pace with high throughput genotyping. ...

The Italian subcutaneous implantable cardioverter-defibrillator survey: S-ICD, why not?

PubMed

Botto, Giovanni Luca; Forleo, Giovanni B; Capucci, Alessandro; Solimene, Francesco; Vado, Antonello; Bertero, Giovanni; Palmisano, Pietro; Pisanò, Ennio; Rapacciuolo, Antonio; Infusino, Tommaso; Vicentini, Alessandro; Viscusi, Miguel; Ferrari, Paola; Talarico, Antonello; Russo, Giovanni; Boriani, Giuseppe; Padeletti, Luigi; Lovecchio, Mariolina; Valsecchi, Sergio; D'Onofrio, Antonio

2017-11-01

A recommendation for a subcutaneous-implantable cardioverter-defibrillator (S-ICD) has been added to recent European Society of Cardiology Guidelines. However, the S-ICD is not ideally suitable for patients who need pacing. The aim of this survey was to analyse the current practice of ICD implantation and to evaluate the actual suitability of S-ICD. The survey 'S-ICD Why Not?' was an independent initiative taken by the Italian Heart Rhythm Society (AIAC). Clinical characteristics, selection criteria, and factors guiding the choice of ICD type were collected in consecutive patients who underwent ICD implantation in 33 Italian centres from September to December 2015. A cardiac resynchronization therapy (CRT) device was implanted in 39% (369 of 947) of patients undergoing de novo ICD implantation. An S-ICD was implanted in 12% of patients with no CRT indication (62 of 510 with available data). S-ICD patients were younger than patients who received transvenous ICD, more often had channelopathies, and more frequently received their device for secondary prevention of sudden death. More frequently, the clinical reason for preferring a transvenous ICD over an S-ICD was the need for pacing (45%) or for antitachycardia pacing (36%). Nonetheless, only 7% of patients fulfilled conditions for recommending permanent pacing, and 4% of patients had a history of monomorphic ventricular tachycardia that might have been treatable with antitachycardia pacing. The vast majority of patients needing ICD therapy are suitable candidates for S-ICD implantation. Nevertheless, it currently seems to be preferentially adopted for secondary prevention of sudden death in young patients with channelopathies. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.

ELM mitigation techniques

NASA Astrophysics Data System (ADS)

Evans, T. E.

2013-07-01

Large edge-localized mode (ELM) control techniques must be developed to help ensure the success of burning and ignited fusion plasma devices such as tokamaks and stellarators. In full performance ITER tokamak discharges, with QDT = 10, the energy released by a single ELM could reach ˜30 MJ which is expected to result in an energy density of 10-15 MJ/m2on the divertor targets. This will exceed the estimated divertor ablation limit by a factor of 20-30. A worldwide research program is underway to develop various types of ELM control techniques in preparation for ITER H-mode plasma operations. An overview of the ELM control techniques currently being developed is discussed along with the requirements for applying these techniques to plasmas in ITER. Particular emphasis is given to the primary approaches, pellet pacing and resonant magnetic perturbation fields, currently being considered for ITER.

Temporary atrial epicardial pacing as prophylaxis against atrial fibrillation after heart surgery: a meta-analysis.

PubMed

Daoud, Emile G; Snow, Rick; Hummel, John D; Kalbfleisch, Steven J; Weiss, Raul; Augostini, Ralph

2003-02-01

Recent studies have reported the use of temporary epicardial atrial pacing as prophylaxis for postoperative atrial fibrillation (AF). The aim of this study was to assess the effect of pacing therapies for prevention of postoperative AF using meta-analysis. Using a computerized MEDLINE search, eight pacing prophylaxis trials with 776 patients were included in the meta-analysis. Trials compared control patients to patients randomized to right atrial, left atrial, or biatrial pacing used in conjunction with either fixed high-rate pacing or overdrive pacing. Overdrive biatrial pacing (OR 2.6, CI 1.4-4.8), overdrive right atrial pacing (OR 1.8, CI 1.1-2.7), and fixed high-rate biatrial pacing (OR 2.5, CI 1.3-5.1) demonstrated a significant antiarrhythmic effect for prevention of AF after open heart surgery. Furthermore, studies investigating overdrive left atrial pacing and fixed high-rate right atrial pacing have been underpowered to assess efficacy. Biatrial overdrive and fixed high-rate pacing and right atrial fixed high-rate pacing reduced the risk of new-onset AF after open heart surgery, and the relative risk reduction is approximately 2.5-fold. These results imply that various pacing algorithms are useful as a nonpharmacologic method to prevent postoperative AF.

Position paper for management of elderly patients with pacemakers and implantable cardiac defibrillators: Groupe de Rythmologie et Stimulation Cardiaque de la Société Française de Cardiologie and Société Française de Gériatrie et Gérontologie.

PubMed

Fauchier, Laurent; Alonso, Christine; Anselme, Frederic; Blangy, Hugues; Bordachar, Pierre; Boveda, Serge; Clementy, Nicolas; Defaye, Pascal; Deharo, Jean-Claude; Friocourt, Patrick; Gras, Daniel; Halimi, Franck; Klug, Didier; Mansourati, Jacques; Obadia, Benjamin; Pasquié, Jean-Luc; Pavin, Dominique; Sadoul, Nicolas; Taieb, Jerome; Piot, Olivier; Hanon, Olivier

2016-10-01

Despite the increasingly high rate of implantation of pacemakers (PMs) and implantable cardioverter defibrillators (ICDs) in elderly patients, data supporting their clinical and cost-effectiveness in this age stratum are ambiguous and contradictory. We reviewed the data regarding the applicability, safety and effectiveness of conventional pacing, ICDs and cardiac resynchronization therapy (CRT) in elderly patients. Although periprocedural risk may be slightly higher in the elderly, the implantation procedure for PMs and ICDs is still relatively safe in this age group. In older patients with sinus node disease, the general consensus is that DDD pacing with the programming of an algorithm to minimize ventricular pacing is preferred. In very old patients presenting with intermittent or suspected atrioventricular block, VVI pacing may be appropriate. In terms of correcting potentially life-threatening arrhythmias, the effectiveness of ICD therapy is similar in older and younger individuals. However, the assumption of persistent ICD benefit in the elderly population is questionable, as any advantageous effect of the device on arrhythmic death may be attenuated by higher total non-arrhythmic mortality. While septuagenarians and octogenarians have higher annual all-cause mortality rates, ICD therapy may remain effective in selected patients at high risk of arrhythmic death and with minimum comorbidities despite advanced age. ICD implantation among the elderly, as a group, may not be cost-effective, but the procedure may reach cost-effectiveness in those expected to live more than 5-7years after implantation. Elderly patients usually experience significant functional improvement after CRT, similar to that observed in middle-aged patients. Management of CRT non-responders remains globally the same, while considering a less aggressive approach in terms of reinterventions (revision of left ventricular [LV] lead placement, addition of a right ventricular or LV lead, LV endocardial pacing configuration). Overall, physiological age, general status and comorbidities rather than chronological age per se should be the decisive factors in making a decision about device implantation selection for survival and well-being benefit in elderly patients. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

42 CFR 460.60 - PACE organizational structure.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false PACE organizational structure. 460.60 Section 460.60 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... ELDERLY (PACE) PACE Administrative Requirements § 460.60 PACE organizational structure. (a) A PACE...

Engagement with Young Adult Literature: Outcomes and Processes

ERIC Educational Resources Information Center

Ivey, Gay; Johnston, Peter H.

2013-01-01

This study examines students' perceptions of the outcomes and processes of engaged reading in classrooms prioritizing engagement through self-selected, self-paced reading of compelling young adult literature. The primary data were 71 end-of-year student interviews, supported by end-of-year teacher interviews, biweekly observational data,…

Engaged Reading as a Collaborative Transformative Practice

ERIC Educational Resources Information Center

Ivey, Gay; Johnston, Peter H.

2015-01-01

The context of this study is a voluntary modification in teaching focus by four eighth-grade teachers who shifted their instructional focus toward student engagement. They abandoned assigned readings in favor of student-selected, self-paced reading within a collection of high interest materials--primarily young adult fiction that students found…

The 1981-82 Student Services Fee Survey.

ERIC Educational Resources Information Center

Matross, Ron; And Others

1981-01-01

Student perceptions and usage of selected services and organizations that receive student services fee support at the University of Minnesota Twin Cities campus were surveyed. Respondents were 417 continuing, fee-paying, nonforeign, day students. Key findings include: 60 percent said the fee should be increased enough to keep pace with inflation;…

The Texas saltwater angler population: a longitudinal perspective (1989-2005)

Treesearch

Yung-Ping (Emilio) Tseng; Robert B. Ditton

2007-01-01

This paper focuses on selected human dimensions indicators of the Texas recreational fishery using the Index of Qualitative Variation (IQV) and Spearman Rank-Order Correlation Coefficient. Minority (Hispanic, Spanish, and females) participation and the overall participation rate in saltwater fishing did not keep pace with a dramatic population...

Is Your LPN Program Keeping P.A.C.E.?

ERIC Educational Resources Information Center

Miller, George; Schill, William John

High demand for admission to Licensed Practical Nursing (LPN) programs and limited state resource allocations for LPN training programs in Washington, have forced North Seattle Community College (NSCC) to utilize a selective admissions policy for its LPN program. Currently, prospective LPN students are required to obtain satisfactory scores on…

Computer-Assisted Instruction: One Aid for Teachers of Reading.

ERIC Educational Resources Information Center

Rauch, Margaret; Samojeden, Elizabeth

Computer assisted instruction (CAI), an instructional system with direct interaction between the student and the computer, can be a valuable aid for presenting new concepts, for reinforcing of selective skills, and for individualizing instruction. The advantages CAI provides include self-paced learning, more efficient allocation of classroom time,…

Selections from the ABC 2009 Annual Convention, Portsmouth, Virginia

ERIC Educational Resources Information Center

Whalen, D. Joel

2010-01-01

The "My Favorite Assignment" Session at the 2009 Association for Business Communication (ABC) annual convention in Portsmouth, Virginia, featured over a dozen teachers sharing pedagogical innovations in a fast-paced, 4-minute format designed by Dan Dietrich. The wide variety of ideas and techniques presented makes these sessions popular…

High-power, cladding-pumped all-fiber laser with selective transverse mode generation property.

PubMed

Li, Lei; Wang, Meng; Liu, Tong; Leng, Jinyong; Zhou, Pu; Chen, Jinbao

2017-06-10

We demonstrate, to the best of our knowledge, the first cladding-pumped all-fiber oscillator configuration with selective transverse mode generation based on a mode-selective fiber Bragg grating pair. Operating in the second-order (LP 11 ) mode, maximum output power of 4.2 W is obtained with slope efficiency of about 38%. This is the highest reported output power of single higher-order transverse mode generation in an all-fiber configuration. The intensity distribution profile and spectral evolution have also been investigated in this paper. Our work suggests the potential of realizing higher power with selective transverse mode operation based on a mode-selective fiber Bragg grating pair.

Selective heart rate reduction with ivabradine slows ischaemia-induced electrophysiological changes and reduces ischaemia–reperfusion-induced ventricular arrhythmias

PubMed Central

Ng, Fu Siong; Shadi, Iqbal T.; Peters, Nicholas S.; Lyon, Alexander R.

2013-01-01

Heart rates during ischaemia and reperfusion are possible determinants of reperfusion arrhythmias. We used ivabradine, a selective If current inhibitor, to assess the effects of heart rate reduction (HRR) during ischaemia–reperfusion on reperfusion ventricular arrhythmias and assessed potential anti-arrhythmic mechanisms by optical mapping. Five groups of rat hearts were subjected to regional ischaemia by left anterior descending artery occlusion for 8 min followed by 10 min of reperfusion: (1) Control n = 10; (2) 1 μM of ivabradine perfusion n = 10; (3) 1 μM of ivabradine + 5 Hz atrial pacing throughout ischaemia–reperfusion n = 5; (4) 1 μM of ivabradine + 5 Hz pacing only at reperfusion; (5) 100 μM of ivabradine was used as a 1 ml bolus upon reperfusion. For optical mapping, 10 hearts (ivabradine n = 5; 5 Hz pacing n = 5) were subjected to global ischaemia whilst transmembrane voltage transients were recorded. Epicardial activation was mapped, and the rate of development of ischaemia-induced electrophysiological changes was assessed. HRR observed in the ivabradine group during both ischaemia (195 ± 11 bpm vs. control 272 ± 14 bpm, p < 0.05) and at reperfusion (168 ± 13 bpm vs. 276 ± 14 bpm, p < 0.05) was associated with reduced reperfusion ventricular fibrillation (VF) incidence (20% vs. 90%, p < 0.05). Pacing throughout ischaemia–reperfusion abolished the protective effects of ivabradine (100% VF), whereas pacing at reperfusion only partially attenuated this effect (40% VF). Ivabradine, given as a bolus at reperfusion, did not significantly affect VF incidence (80% VF). Optical mapping experiments showed a delay to ischaemia-induced conduction slowing (time to 50% conduction slowing: 10.2 ± 1.3 min vs. 5.1 ± 0.7 min, p < 0.05) and to loss of electrical excitability in ivabradine-perfused hearts (27.7 ± 4.3 min vs. 14.5 ± 0.6 min, p < 0.05). Ivabradine administered throughout ischaemia and reperfusion reduced reperfusion VF incidence through HRR. Heart rate during ischaemia is a major determinant of reperfusion arrhythmias. Heart rate at reperfusion alone was not a determinant of reperfusion VF, as neither a bolus of ivabradine nor pacing immediately prior to reperfusion significantly altered reperfusion VF incidence. This anti-arrhythmic effect of heart rate reduction during ischaemia may reflect slower development of ischaemia-induced electrophysiological changes. PMID:23402927

42 CFR 460.6 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Basis... enrolled in a PACE program. PACE stands for programs of all-inclusive care for the elderly. PACE center is... care for the elderly that is operated by an approved PACE organization and that provides comprehensive...

42 CFR 460.6 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Basis... enrolled in a PACE program. PACE stands for programs of all-inclusive care for the elderly. PACE center is... care for the elderly that is operated by an approved PACE organization and that provides comprehensive...

42 CFR 460.180 - Medicare payment to PACE organizations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Medicare payment to PACE organizations. 460.180... FOR THE ELDERLY (PACE) Payment § 460.180 Medicare payment to PACE organizations. (a) Principle of payment. Under a PACE program agreement, CMS makes a prospective monthly payment to the PACE organization...

Randomized placebo controlled blinded study to assess valsartan efficacy in preventing left ventricle remodeling in patients with dual chamber pacemaker--Rationale and design of the trial.

PubMed

Tomasik, Andrzej; Jacheć, Wojciech; Wojciechowska, Celina; Kawecki, Damian; Białkowska, Beata; Romuk, Ewa; Gabrysiak, Artur; Birkner, Ewa; Kalarus, Zbigniew; Nowalany-Kozielska, Ewa

2015-05-01

Dual chamber pacing is known to have detrimental effect on cardiac performance and heart failure occurring eventually is associated with increased mortality. Experimental studies of pacing in dogs have shown contractile dyssynchrony leading to diffuse alterations in extracellular matrix. In parallel, studies on experimental ischemia/reperfusion injury have shown efficacy of valsartan to inhibit activity of matrix metalloproteinase-9, to increase the activity of tissue inhibitor of matrix metalloproteinase-3 and preserve global contractility and left ventricle ejection fraction. To present rationale and design of randomized blinded trial aimed to assess whether 12 month long administration of valsartan will prevent left ventricle remodeling in patients with preserved left ventricle ejection fraction (LVEF ≥ 40%) and first implantation of dual chamber pacemaker. A total of 100 eligible patients will be randomized into three parallel arms: placebo, valsartan 80 mg/daily and valsartan 160 mg/daily added to previously used drugs. The primary endpoint will be assessment of valsartan efficacy to prevent left ventricle remodeling during 12 month follow-up. We assess patients' functional capacity, blood plasma activity of matrix metalloproteinases and their tissue inhibitors, NT-proBNP, tumor necrosis factor alpha, and Troponin T. Left ventricle function and remodeling is assessed echocardiographically: M-mode, B-mode, tissue Doppler imaging. If valsartan proves effective, it will be an attractive measure to improve long term prognosis in aging population and increasing number of pacemaker recipients. ClinicalTrials.org (NCT01805804). Copyright © 2015 Elsevier Inc. All rights reserved.

Direct His bundle pacing post AVN ablation.

PubMed

Lakshmanadoss, Umashankar; Aggarwal, Ashim; Huang, David T; Daubert, James P; Shah, Abrar

2009-08-01

Atrioventricular nodal (AVN) ablation with concomitant pacemaker implantation is one of the strategies that reduce symptoms in patients with atrial fibrillation (AF). However, the long-term adverse effects of right ventricular (RV) apical pacing have led to the search for alternating sites of pacing. Biventricular pacing produces a significant improvement in functional capacity over RV pacing in patients undergoing AVN ablation. Another alternative site for pacing is direct His bundle to reduce the adverse outcome of RV pacing. Here, we present a case of direct His bundle pacing using steerable lead delivery system in a patient with symptomatic paroxysmal AF with concurrent AVN ablation.

42 CFR 460.34 - Duration of PACE program agreement.

Code of Federal Regulations, 2011 CFR

2011-10-01

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

42 CFR 460.34 - Duration of PACE program agreement.

Code of Federal Regulations, 2010 CFR

2010-10-01

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

Bachmann's Bundle Pacing not Only Improves Interatrial Conduction but Also Reduces the Need for Ventricular Pacing.

PubMed

Sławuta, Agnieszka; Kliś, Magdalena; Skoczyński, Przemysław; Bańkowski, Tomasz; Moszczyńska-Stulin, Joanna; Gajek, Jacek

2016-01-01

Patients treated for sick sinus syndrome may have interatrial conduction disorder leading to atrial fibrillation. This study was aimed to assess the influence of the atrial pacing site on interatrial and atrioventricular conduction as well as the percentage of ventricular pacing in patients with sick sinus syndrome implanted with atrioventricular pacemaker. The study population: 96 patients (58 females, 38 males) aged 74.1 ± 11.8 years were divided in two groups: Group 1 (n = 44) with right atrial appendage pacing and group 2 (n = 52) with Bachmann's area pacing. We assessed the differences in atrioventricular conduction in sinus rhythm and atrial 60 and 90 bpm pacing, P-wave duration and percentage of ventricular pacing. No differences in baseline P-wave duration in sinus rhythm between the groups (102.4 ± 17 ms vs. 104.1 ± 26 ms, p = ns.) were noted. Atrial pacing 60 bpm resulted in longer P-wave in group 1 vs. group 2 (138.3 ± 21 vs. 106.1 ± 15 ms, p < 0.01). The differences between atrioventricular conduction time during sinus rhythm and atrial pacing at 60 and 90 bpm were significantly longer in patients with right atrial appendage vs. Bachmann's pacing (44.1 ± 17 vs. 9.2 ± 7 ms p < 0.01 and 69.2 ± 31 vs. 21.4 ± 12 ms p < 0.05, respectively). The percentage of ventricular pacing was higher in group 1 (21 vs. 4%, p < 0.01). Bachmann's bundle pacing decreases interatrial and atrioventricular conduction delay. Moreover, the frequency-dependent atrioventricular conduction lengthening is much less pronounced during Bachmann's bundle pacing. Right atrial appendage pacing in sick sinus syndrome patients promotes a higher percentage of ventricular pacing.

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

Code of Federal Regulations, 2011 CFR

2011-10-01

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

42 CFR 460.90 - PACE benefits under Medicare and Medicaid.

Code of Federal Regulations, 2011 CFR

2011-10-01

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

Multi-Leu PACE4 Inhibitor Retention within Cells Is PACE4 Dependent and a Prerequisite for Antiproliferative Activity

PubMed Central

Ly, Kévin; Levesque, Christine; Kwiatkowska, Anna; Ait-Mohand, Samia; Desjardins, Roxane; Guérin, Brigitte; Day, Robert

2015-01-01

The overexpression as well as the critical implication of the proprotein convertase PACE4 in prostate cancer progression has been previously reported and supported the development of peptide inhibitors. The multi-Leu peptide, a PACE4-specific inhibitor, was further generated and its capability to be uptaken by tumor xenograft was demonstrated with regard to its PACE4 expression status. To investigate whether the uptake of this inhibitor was directly dependent of PACE4 levels, uptake and efflux from cancer cells were evaluated and correlations were established with PACE4 contents on both wild type and PACE4-knockdown cell lines. PACE4-knockdown associated growth deficiencies were established on the knockdown HepG2, Huh7, and HT1080 cells as well as the antiproliferative effects of the multi-Leu peptide supporting the growth capabilities of PACE4 in cancer cells. PMID:26114115

Influence of music on maximal self-paced running performance and passive post-exercise recovery rate.

PubMed

Lee, Sam; Kimmerly, Derek S

2016-01-01

The purpose of this study was to examine the influence of fast tempo music (FM) on self-paced running performance (heart rate, running speed, ratings of perceived exertion), and slow tempo music (SM) on post-exercise heart rate and blood lactate recovery rates. Twelve participants (5 women) completed three randomly assigned conditions: static noise (control), FM and SM. Each condition consisted of self-paced treadmill running, and supine postexercise recovery periods (20 min each). Average running speed, heart rate (HR) and ratings of perceived exertion (RPE) were measured during the treadmill running period, while HR and blood lactate were measured during the recovery period. Listening to FM during exercise resulted in a faster self-selected running speed (10.8±1.7 vs. 9.9±1.4 km•hour-1, P<0.001) and higher peak HR (184±12 vs. 177±17 beats•min-1, P<0.01) without a corresponding difference in peak RPE (FM, 16.8±1.8 vs. SM 15.7±1.9, P=0.10). Listening to SM during the post-exercise period resulted in faster HR recovery throughout (main effect P<0.001) and blood lactate at the end of recovery (2.8±0.4 vs. 4.7±0.8 mmol•L-1, P<0.05). Listening to FM during exercise can increase self-paced intensity without altering perceived exertion levels while listening to SM after exercise can accelerate the recovery rate back to resting levels.

Influence of music on maximal self-paced running performance and passive post-exercise recovery rate.

PubMed

Lee, S; Kimmerly, D

2014-10-30

The purpose of this study was to examine the influence of fast tempo music (FM) on self--paced running performance (heart rate, running speed, ratings of perceived exertion), and slow tempo music (SM) on post--exercise heart rate and blood lactate recovery rates. Twelve participants (5 Women) completed three randomly assigned conditions: static noise (control), FM and SM. Each condition consisted of self--paced treadmill running, and supine post--exercise recovery periods (20 min each). Average running speed, heart rate (HR) and ratings of perceived exertion (RPE) were measured during the treadmill running period, while HR and blood lactate were measured during the recovery period. Listening to FM during exercise resulted in a faster self--selected running speed (10.8 ± 1.7 vs. 9.9 ± 1.4 km•hour--1, p<0.001) and higher peak HR (184 ± 12 vs. 177 ± 17 beats•min--1, p< 0.01) without a corresponding difference in peak RPE (FM, 16.8 ± 1.8 vs. SM 15.7 ± 1.9, p= 0.10). Listening to SM during the post--exercise period reduced HR throughout (main effect p<0.001) and blood lactate at the end of recovery (2.8 ± 0.4 vs. 4.7 ± 0.8 mmol•L--1, p<0.05). Listening to FM during exercise can increase self--paced intensity without altering perceived exertion levels while listening to SM after exercise can accelerate the recovery rate back to resting levels.

Influence of automatic frequent pace-timing adjustments on effective left ventricular pacing during cardiac resynchronization therapy.

PubMed

Varma, Niraj; Stadler, Robert W; Ghosh, Subham; Kloppe, Axel

2017-05-01

Cardiac resynchronization therapy (CRT) requires effective left ventricular (LV) pacing (i.e. sufficient energy and appropriate timing to capture). The AdaptivCRT™ (aCRT) algorithm serves to maintain ventricular fusion during LV or biventricular pacing. This function was tested by comparing the morphological consistency of ventricular depolarizations and percentage effective LV pacing in CRT patients randomized to aCRT vs. echo-optimization. Continuous recordings (≥20 h) of unipolar LV electrograms from aCRT (n = 38) and echo-optimized patients (n = 22) were analysed. Morphological consistency was determined by the correlation coefficient between each beat and a template beat. Effective LV pacing of paced beats was assessed by algorithmic analysis of negative initial EGM deflection in each evoked response. The %CRT pacing delivered, %effective LV pacing (i.e. % of paced beats with effective LV pacing), and overall %effective CRT (i.e. product of %CRT pacing and %effective LV pacing) were compared between aCRT and echo-optimized patients. Demographics were similar between groups. The mean correlation coefficient between individual beats and template was greater for aCRT (0.96 ± 0.03 vs. 0.91 ± 0.13, P = 0.07). Although %CRT pacing was similar for aCRT and echo-optimized (median 97.4 vs. 98.6%, P = 0.14), %effective LV pacing was larger for aCRT [99.6%, (99.1%, 99.9%) vs. 94.3%, (24.3%, 99.8%), P=0.03]. For aCRT vs. echo-optimized groups, the proportions of patients with ≥90% effective LV pacing was 92 vs. 55% (P = 0.002), and with ≥90% effective CRT was 79 vs. 45%, respectively (P = 0.018). AdaptivCRT™ significantly increased effective LV pacing over echo-optimized CRT. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

Children's On-Line Processing of Scrambling in Japanese

ERIC Educational Resources Information Center

Suzuki, Takaaki

2013-01-01

This study investigates the on-line processing of scrambled sentences in Japanese by preschool children and adults using a combination of self-paced listening and speeded picture selection tasks. The effects of a filler-gap dependency, reversibility, and case markers were examined. The results show that both children and adults had difficulty in…

Military Curriculum Materials for Vocational and Technical Education. Weather Specialist 15-4. AFSC 25150.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. National Center for Research in Vocational Education.

These individualized, self-paced student materials for a postsecondary-adult level course for weather specialist are one of a number of military-developed curriculum packages selected for adaptation to vocational instruction and curriculum development in a civilian setting. The three-volume course offers weather personnel knowledge needed to…

Boating Safety, 15-6. Military Curriculum Materials for Vocational and Technical Education.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. National Center for Research in Vocational Education.

This coursebook and training manual for a secondary/postsecondary level course on boating safety comprises one of a number of military-developed curriculum packages selected for adaptation to vocational instruction and curriculum development in a civilian setting. The purpose stated for the individualized, self-paced course is to establish policy…

Deckwatch Officer Navigation Rules, 15-5. Military Curriculum Materials for Vocational and Technical Education.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. National Center for Research in Vocational Education.

This coursebook and textbook for a secondary/postsecondary level course in navigation rules comprise one of a number of military-developed curriculum packages selected for adaptation to vocational instruction and curriculum development in a civilian setting. The individualized, self-paced course discusses the international regulations for…

What's App with that? Selecting Educational Apps for Young Children with Disabilities

ERIC Educational Resources Information Center

More, Cori M.; Travers, Jason C.

2013-01-01

Educational research will likely never be able to keep pace with technological innovation. It therefore will become increasingly important that early childhood professionals rely on existing knowledge to effectively evaluate and integrate emerging technology in the natural environment rather than waiting for a broad platform of research to inform…

WHY STUDENTS SELECT AGRICULTURE AS A MAJOR COURSE OF STUDY.

ERIC Educational Resources Information Center

JOHNSON, CECIL H.; MACK, KINSLER B.

BECAUSE AGRICULTURAL COLLEGE ENROLLMENTS WERE NOT KEEPING PACE WITH THE DEMANDS FOR AGRICULTURAL GRADUATES, A STUDY WAS UNDERTAKEN TO DETERMINE FACTORS WHICH INFLUENCE SCHOOL OF AGRICULTURE ENROLLMENT AT CLEMSON UNIVERSITY AND REASONS FOR THE HIGH PERCENTAGE OF MAJOR COURSE CHANGES. A FOUR-SECTION SCHEDULE, ADMINISTERED IN CLASSES TO 159 SCHOOL OF…

On Beyond Veatch.

ERIC Educational Resources Information Center

Blatt, Gloria T.

This paper discusses the thematic unit as a series of activities including reading, discussions, drama sessions, art workshops, games, writing, and movies, all revolving around a single topic. Students are free to seek and select their own books or stories within the topic and to read at their own pace. The thematic unit also includes a heightened…

Distance Education within the 21st Century and Its Application to Rehabilitation Education

ERIC Educational Resources Information Center

Dziekan, Kathryn; Main, Doug

2012-01-01

Historically, distance education applications served a select group of students through self-paced technical short courses that required scant to little interaction with their instructors. Today's 21st century distance education focuses on a) reaching underserved prospective students within a social justice framework, b) global recruitment, and c)…

An Exploration of Note-Taking in an Online Calculus Course

ERIC Educational Resources Information Center

van de Sande, Carla; Abramson, Jay; Judson-Garcia, Julia

2017-01-01

Taking notes is a popular activity for students attending instructional lectures and has been linked to achievement. Research on note-taking has shown that the contents and usefulness of student notes depends on several factors, including the pace of the lecture and the presence of organizational and selection cues. However, this research has…

The Role of CREB in CML

DTIC Science & Technology

2008-02-01

Feng YQ et al. Anti-beta s- ribozyme reduces beta s mRNA levels in transgenic mice: Potential application to the gene therapy of sickle cell anemia... ribozymes . RNA 2003;9:1254–1263. 13 Pace BS, Qian X, Ofori-Acquah SF. Selective inhibition of beta-globin RNA transcripts by antisense RNA molecules. Cell

77 FR 60732 - PACE Select Advisors Trust and UBS Global Asset Management (Americas) Inc.; Notice of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-04

... Hutchins Asset Management, Inc., Investment Company Act Release Nos. 24823 (Jan. 11, 2001) (notice) and... Management Inc., Investment Company Act Release Nos. 21590 (Dec. 11, 1995) (notice) and 21666 (Jan. 11, 1996... Investment Management, Office of Investment Company Regulation). SUPPLEMENTARY INFORMATION: The following is...

Communications Technician, 5-3A. Military Curriculum Materials for Vocational and Technical Education.

ERIC Educational Resources Information Center

Naval Education and Training Command, Pensacola, FL.

These assignments and text for a secondary-postsecondary level correspondence course in electronic communications comprise one of a number of military-developed curriculum packages selected for adaptation to vocational instruction and curriculum development in a civilian setting. Purpose of the individualized, self-paced course is to provide…

Military Curricula for Vocational & Technical Education. Telephone Equipment Installer-Repairman, 5-4.

ERIC Educational Resources Information Center

Bureau of Occupational and Adult Education (DHEW/OE), Washington, DC.

These individualized, self-paced student texts and workbooks for a secondary-postsecondary-level course in telephone equipment installation and repair is one of a number of military-developed curriculum packages selected for adaptation to vocational instruction and curriculum development in a civilian setting. Purpose stated for the course is to…

Assessing Patients’ Experiences with Communication Across the Cancer Care Continuum

PubMed Central

Mazor, Kathleen M.; Street, Richard L.; Sue, Valerie M.; Williams, Andrew E.; Rabin, Borsika A.; Arora, Neeraj K.

2016-01-01

Objective To evaluate the relevance, performance and potential usefulness of the Patient Assessment of cancer Communication Experiences (PACE) items. Methods Items focusing on specific communication goals related to exchanging information, fostering healing relationships, responding to emotions, making decisions, enabling self-management, and managing uncertainty were tested via a retrospective, cross-sectional survey of adults who had been diagnosed with cancer. Analyses examined response frequencies, inter-item correlations, and coefficient alpha. Results A total of 366 adults were included in the analyses. Relatively few selected “Does Not Apply”, suggesting that items tap relevant communication experiences. Ratings of whether specific communication goals were achieved were strongly correlated with overall ratings of communication, suggesting item content reflects important aspects of communication. Coefficient alpha was ≥.90 for each item set, indicating excellent reliability. Variations in the percentage of respondents selecting the most positive response across items suggest results can identify strengths and weaknesses. Conclusion The PACE items tap relevant, important aspects of communication during cancer care, and may be useful to cancer care teams desiring detailed feedback. PMID:26979476

Runaway pacemaker: a forgotten phenomenon?

PubMed

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

2005-11-01

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

New-Onset Left Bundle Branch Block Induced by Transcutaneous Aortic Valve Implantation.

PubMed

Massoullié, Grégoire; Bordachar, Pierre; Ellenbogen, Kenneth A; Souteyrand, Géraud; Jean, Frédéric; Combaret, Nicolas; Vorilhon, Charles; Clerfond, Guillaume; Farhat, Mehdi; Ritter, Philippe; Citron, Bernard; Lusson, Jean-R; Motreff, Pascal; Ploux, Sylvain; Eschalier, Romain

2016-03-01

New-onset left bundle branch block (LBBB) is a specific concern of transcutaneous aortic valve implantation (TAVI) given its estimated incidence ranging from 5% to 65%. This high rate of occurrence is dependent on the type of device used (size and shape), implantation methods, and patient co-morbidities. The appearance of an LBBB after TAVI reflects a very proximal lesion of the left bundle branch as it exits the bundle of His. At times transient, its persistence can lead to permanent pacemaker implantation in 15% to 20% of cases, most often for high-degree atrioventricular block. The management of LBBB after TAVI is currently not defined by international societies resulting in individual centers developing their own management strategy. The potential consequences of LBBB are dysrhythmias (atrioventricular block, syncope, and sudden death) and functional (heart failure) complications. Prompt postprocedural recognition and management (permanent pacemaker implantation) of patients prevents the occurrence of potential complications and may constitute the preferred approach in this frail and elderly population despite additional costs and complications of cardiac pacing. Moreover, the expansion of future indications for TAVI necessitates better identification of the predictive factors for the development of LBBB. Indeed, long-term right ventricular pacing may potentially increase the risk of developing heart failure in this population. In conclusion, it is thus imperative to not only develop new aortic prostheses with a less-deleterious impact on the conduction system but also to prescribe appropriate pacing modes in this frail population. Copyright © 2016 Elsevier Inc. All rights reserved.

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

PubMed Central

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

2016-01-01

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

Ancestrality and evolution of trait syndromes in finches (Fringillidae).

PubMed

Ponge, Jean-François; Zuccon, Dario; Elias, Marianne; Pavoine, Sandrine; Henry, Pierre-Yves; Théry, Marc; Guilbert, Éric

2017-12-01

Species traits have been hypothesized by one of us (Ponge, 2013) to evolve in a correlated manner as species colonize stable, undisturbed habitats, shifting from "ancestral" to "derived" strategies. We predicted that generalism, r-selection, sexual monomorphism, and migration/gregariousness are the ancestral states (collectively called strategy A) and evolved correlatively toward specialism, K-selection, sexual dimorphism, and residence/territoriality as habitat stabilized (collectively called B strategy). We analyzed the correlated evolution of four syndromes, summarizing the covariation between 53 traits, respectively, involved in ecological specialization, r-K gradient, sexual selection, and dispersal/social behaviors in 81 species representative of Fringillidae, a bird family with available natural history information and that shows variability for all these traits. The ancestrality of strategy A was supported for three of the four syndromes, the ancestrality of generalism having a weaker support, except for the core group Carduelinae (69 species). It appeared that two different B-strategies evolved from the ancestral state A, both associated with highly predictable environments: one in poorly seasonal environments, called B1, with species living permanently in lowland tropics, with "slow pace of life" and weak sexual dimorphism, and one in highly seasonal environments, called B2, with species breeding out-of-the-tropics, migratory, with a "fast pace of life" and high sexual dimorphism.

Selective excitation of LP01 and LP02 in dual-concentric cores fiber using an adiabatically tapered microstructured mode converter

NASA Astrophysics Data System (ADS)

Sammouda, Marwa; Taher, Aymen Belhadj; Bahloul, Faouzi; Bin, Philippe Di

2016-09-01

We propose to connect a single-mode fiber (SMF) to a dual-concentric cores fiber (DCCF) using an adiabatically tapered microstructured mode converter, and to evaluate the SMF LP01 mode and the DCCF LP01 and LP02 modes selective excitations performances. We theoretically and numerically study this selective excitation method by calculating the effective indices of the propagated modes, the adiabaticity criteria, the coupling loss, and the modes amplitudes along the tapered structure. This study shows that this method is able to achieve excellent selective excitations of the first two linearly polarized modes (LP01 and LP02) among the five guided modes in the DCCF with a negligible loss. The part of the LP01 and LP02 modes from the total power are 99% and 84% corresponding to 0.1 and 0.8 dB losses, respectively.

Influence of Pacing by Periodic Auditory Stimuli on Movement Continuation: Comparison with Self-regulated Periodic Movement

PubMed Central

Ito, Masanori; Kado, Naoki; Suzuki, Toshiaki; Ando, Hiroshi

2013-01-01

[Purpose] The purpose of this study was to investigate the influence of external pacing with periodic auditory stimuli on the control of periodic movement. [Subjects and Methods] Eighteen healthy subjects performed self-paced, synchronization-continuation, and syncopation-continuation tapping. Inter-onset intervals were 1,000, 2,000 and 5,000 ms. The variability of inter-tap intervals was compared between the different pacing conditions and between self-paced tapping and each continuation phase. [Results] There were no significant differences in the mean and standard deviation of the inter-tap interval between pacing conditions. For the 1,000 and 5,000 ms tasks, there were significant differences in the mean inter-tap interval following auditory pacing compared with self-pacing. For the 2,000 ms syncopation condition and 5,000 ms task, there were significant differences from self-pacing in the standard deviation of the inter-tap interval following auditory pacing. [Conclusion] These results suggest that the accuracy of periodic movement with intervals of 1,000 and 5,000 ms can be improved by the use of auditory pacing. However, the consistency of periodic movement is mainly dependent on the inherent skill of the individual; thus, improvement of consistency based on pacing is unlikely. PMID:24259932

Functional characteristics of left ventricular synchronization via right ventricular outflow-tract pacing detected by two-dimensional strain echocardiography.

PubMed

Hirayama, Yasutaka; Kawamura, Yuichiro; Sato, Nobuyuki; Saito, Tatsuya; Tanaka, Hideichi; Saijo, Yasuaki; Kikuchi, Kenjiro; Ohori, Katsumi; Hasebe, Naoyuki

2017-02-01

Recently, due to the detrimental effects on the ventricular function associated with right ventricular apical (RVA) pacing, right ventricular septal (RVS) pacing has become the preferred pacing method. However, the term RVS pacing refers to both right ventricular outflow-tract (RVOT) and mid-septal (RVMS) pacing, leading to a misinterpretation of the results of clinical studies. The purpose of this study, therefore, was to elucidate the functional differences of RVA, RVOT, and RVMS pacing in patients with atrioventricular block. We compared the QRS duration, global longitudinal strain (GLS), and left ventricular (LV) synchronization parameters at the three pacing sites in 47 patients. The peak systolic strain (PSS) time delay between the earliest and latest segments among the 18 LV segments and standard deviation (SD) of the time to the PSS were also calculated for the 18 LV segments at each pacing site using two-dimensional (2D) strain echocardiography. RVMS pacing was associated with a significantly shorter QRS duration compared with RVA and RVOT pacing (154.4±21.4 vs 186.5±19.9 and 171.1±21.5 ms, P <0.001). In contrast, RVOT pacing revealed a greater GLS (-14.69±4.92 vs -13.12±4.76 and -13.51±4.81%, P <0.001), shorter PSS time delay between the earliest and latest segments (236.0±87.9 vs 271.3±102.9 and 281.9±126.6%, P =0.007), and shorter SD of the time to the PSS (70.8±23.8 vs 82.7±30.8 and 81.5±33.7 ms, P =0.002) compared with RVA and RVMS pacing. These results suggest that the functional characteristics of RVOT pacing may be a more optimal pacing site than RVMS, regardless of the pacing QRS duration, in patients with atrioventricular conduction disorders.

A Prospective Evaluation of a Protocol for Magnetic Resonance Imaging of Patients With Implanted Cardiac Devices

PubMed Central

Nazarian, Saman; Hansford, Rozann; Roguin, Ariel; Goldsher, Dorith; Zviman, Menekhem M.; Lardo, Albert C.; Caffo, Brian S.; Frick, Kevin D.; Kraut, Michael A.; Kamel, Ihab R.; Calkins, Hugh; Berger, Ronald D.; Bluemke, David A.; Halperin, Henry R.

2015-01-01

Background Magnetic resonance imaging (MRI) is avoided in most patients with implanted cardiac devices because of safety concerns. Objective To define the safety of a protocol for MRI at the commonly used magnetic strength of 1.5 T in patients with implanted cardiac devices. Design Prospective nonrandomized trial. (ClinicalTrials.gov registration number: NCT01130896) Setting One center in the United States (94% of examinations) and one in Israel. Patients 438 patients with devices (54% with pacemakers and 46% with defibrillators) who underwent 555 MRI studies. Intervention Pacing mode was changed to asynchronous for pacemaker-dependent patients and to demand for others. Tachy-arrhythmia functions were disabled. Blood pressure, electrocardiography, oximetry, and symptoms were monitored by a nurse with experience in cardiac life support and device programming who had immediate backup from an electrophysiologist. Measurements Activation or inhibition of pacing, symptoms, and device variables. Results In 3 patients (0.7% [95% CI, 0% to 1.5%]), the device reverted to a transient back-up programming mode without long-term effects. Right ventricular (RV) sensing (median change, 0 mV [interquartile range {IQR}, −0.7 to 0 V]) and atrial and right and left ventricular lead impedances (median change, −2 Ω[IQR, −13 to 0 Ω], −4 Ω [IQR, −16 to 0 Ω], and −11 Ω [IQR, −40 to 0 Ω], respectively) were reduced immediately after MRI. At long-term follow-up (61% of patients), decreased RV sensing (median, 0 mV, [IQR, −1.1 to 0.3 mV]), decreased RV lead impedance (median, −3 Ω, [IQR, −29 to 15 Ω]), increased RV capture threshold (median, 0 V, IQR, [0 to 0.2 Ω]), and decreased battery voltage (median, −0.01 V, IQR, −0.04 to 0 V) were noted. The observed changes did not require device revision or reprogramming. Limitations Not all available cardiac devices have been tested. Long-term in-person or telephone follow-up was unavailable in 43 patients (10%), and some data were missing. Those with missing long-term capture threshold data had higher baseline right atrial and right ventricular capture thresholds and were more likely to have undergone thoracic imaging. Defibrillation threshold testing and random assignment to a control group were not performed. Conclusion With appropriate precautions, MRI can be done safely in patients with selected cardiac devices. Because changes in device variables and programming may occur, electrophysiologic monitoring during MRI is essential. Primary Funding Source National Institutes of Health. PMID:21969340

Constitutive innate immunity is a component of the pace-of-life syndrome in tropical birds.

PubMed

Irene Tieleman, B; Williams, Joseph B; Ricklefs, Robert E; Klasing, Kirk C

2005-08-22

We studied the relationship between one component of immune function and basal metabolic rate (BMR), an indicator of the 'pace-of-life syndrome', among 12 tropical bird species and among individuals of the tropical house wren (Troglodytes aedon), to gain insights into functional connections between life history and physiology. To assess constitutive innate immunity we introduced a new technique in the field of ecological and evolutionary immunology that quantifies the bactericidal activity of whole blood. This in vitro assay utilises a single blood sample to provide a functional, integrated measure of constitutive innate immunity. We found that the bactericidal activity of whole blood varied considerably among species and among individuals within a species. This variation was not correlated with body mass or whole-organism BMR. However, among species, bacteria killing activity was negatively correlated with mass-adjusted BMR, suggesting that species with a slower pace-of-life have evolved a more robust constitutive innate immune capability. Among individuals of a single species, the house wren, bacteria killing activity was positively correlated with mass-adjusted BMR, pointing to physiological differences in individual quality on which natural selection potentially could act.

Hybrid Therapy in the Management of Atrial Fibrillation

PubMed Central

Stárek, Zdeněk; Lehar, František; Jež, Jiří; Wolf, Jiří; Novák, Miroslav

2015-01-01

Atrial fibrillation is the most common sustained arrhythmia. Because of the sub-optimal outcomes and associated risks of medical therapy as well as the recent advances in non-pharmacologic strategies, a multitude of combined (hybrid) algorithms have been introduced that improve efficacy of standalone therapies while maintaining a high safety profile. Antiarrhythmic administration enhances success rate of electrical cardioversion. Catheter ablation of antiarrhythmic drug-induced typical atrial flutter may prevent recurrent atrial fibrillation. Through simple ablation in the right atrium, suppression of atrial fibrillation may be achieved in patients with previously ineffective antiarrhythmic therapy. Efficacy of complex catheter ablation in the left atrium is improved with antiarrhythmic drugs. Catheter ablation followed by permanent pacemaker implantation is an effective and safe treatment option for selected patients. Additional strategies include pacing therapies such as atrial pacing with permanent pacemakers, preventive pacing algorithms, and/or implantable dual-chamber defibrillators are available. Modern hybrid strategies combining both epicardial and endocardial approaches in order to create a complex set of radiofrequency lesions in the left atrium have demonstrated a high rate of success and warrant further research. Hybrid therapy for atrial fibrillation reviews history of development of non-pharmacological treatment strategies and outlines avenues of ongoing research in this field. PMID:25028165

Synchronized personalized music audio-playlists to improve adherence to physical activity among patients participating in a structured exercise program: a proof-of-principle feasibility study.

PubMed

Alter, David A; O'Sullivan, Mary; Oh, Paul I; Redelmeier, Donald A; Marzolini, Susan; Liu, Richard; Forhan, Mary; Silver, Michael; Goodman, Jack M; Bartel, Lee R

2015-01-01

Preference-based tempo-pace synchronized music has been shown to reduce perceived physical activity exertion and improve exercise performance. The extent to which such strategies can improve adherence to physical activity remains unknown. The objective of the study is to explore the feasibility and efficacy of tempo-pace synchronized preference-based music audio-playlists on adherence to physical activity among cardiovascular disease patients participating in a cardiac rehabilitation. Thirty-four cardiac rehabilitation patients were randomly allocated to one of two strategies: (1) no music usual-care control and (2) tempo-pace synchronized audio-devices with personalized music playlists + usual-care. All songs uploaded onto audio-playlist devices took into account patient personal music genre and artist preferences. However, actual song selection was restricted to music whose tempos approximated patients' prescribed exercise walking/running pace (steps per minute) to achieve tempo-pace synchrony. Patients allocated to audio-music playlists underwent further randomization in which half of the patients received songs that were sonically enhanced with rhythmic auditory stimulation (RAS) to accentuate tempo-pace synchrony, whereas the other half did not. RAS was achieved through blinded rhythmic sonic-enhancements undertaken manually to songs within individuals' music playlists. The primary outcome consisted of the weekly volume of physical activity undertaken over 3 months as determined by tri-axial accelerometers. Statistical methods employed an intention to treat and repeated-measures design. Patients randomized to personalized audio-playlists with tempo-pace synchrony achieved higher weekly volumes of physical activity than did their non-music usual-care comparators (475.6 min vs. 370.2 min, P  < 0.001). Improvements in weekly physical activity volumes among audio-playlist recipients were driven by those randomized to the RAS group which attained weekly exercise volumes that were nearly twofold greater than either of the two other groups (average weekly minutes of physical activity of 631.3 min vs. 320 min vs. 370.2 min, personalized audio-playlists with RAS vs. personalized audio-playlists without RAS vs. non-music usual-care controls, respectively, P  < 0.001). Patients randomized to music with RAS utilized their audio-playlist devices more frequently than did non-RAS music counterparts ( P  < 0.001). The use of tempo-pace synchronized preference-based audio-playlists was feasibly implemented into a structured exercise program and efficacious in improving adherence to physical activity beyond the evidence-based non-music usual standard of care. Larger clinical trials are required to validate these findings. ClinicalTrials.gov ID (NCT01752595).

Improved Frame Mode Selection for AMR-WB+ Based on Decision Tree

NASA Astrophysics Data System (ADS)

Kim, Jong Kyu; Kim, Nam Soo

In this letter, we propose a coding mode selection method for the AMR-WB+ audio coder based on a decision tree. In order to reduce computation while maintaining good performance, decision tree classifier is adopted with the closed loop mode selection results as the target classification labels. The size of the decision tree is controlled by pruning, so the proposed method does not increase the memory requirement significantly. Through an evaluation test on a database covering both speech and music materials, the proposed method is found to achieve a much better mode selection accuracy compared with the open loop mode selection module in the AMR-WB+.

All-fiber-based selective mode multiplexer and demultiplexer for weakly-coupled mode-division multiplexed systems

NASA Astrophysics Data System (ADS)

Igarashi, Koji; Park, Kyung Jun; Tsuritani, Takahiro; Morita, Itsuro; Kim, Byoung Yoon

2018-02-01

We show all-fiber-based selective mode multiplexers and demultiplexers for weakly-coupled mode-division multiplexed systems. We fabricate a set of six-mode multiplexer and demultiplexer based on fiber mode selective couplers, and experimentally evaluate the performance for the six-mode dual-polarization (DP) quadrature phase shift keying (QPSK) optical signals. In the mode multiplexer and demultiplexer, the mode couplings between the lower three modes and the higher three modes are suppressed to be less than -20 dB, which enables us to apply partial 6 ×6 MIMO equalizers even for the six-mode demultiplexing. For the six-mode DP-QPSK signals, the penalty of optical signal-to-noise ratio by replacing the full 12 ×12MIMO to the partial 6 ×6 MIMO is suppressed by less than 1 dB.

[Role of cyclic adenosine monophosphate response element binding protein in ventricular pacing induced cardiac electrical remodeling in a canine model].

PubMed

Chen, Xuesi; Chen, Xingxing; Cheng, Junhua; Hong, Jun; Zheng, Cheng; Zhao, Jinglin; Li, Jin; Lin, Jiafeng

2015-04-01

This project is designed to explore the potential role of cyclic adenosine monophosphate (cAMP) response element binding protein (CREB) in cardiac electrical remodeling induced by pacing at different ventricular positions in dogs. An animal model by implanting the pacemakers in beagles was established. According to the different pacing positions, the animals were divided into 4 groups:conditional control group (n=6), left ventricle pacing group (n=6), right ventricle pacing group (n=6) and bi-ventricle pacing group (n=6). Cardiac and electrical remodeling were observed by echocardiography, electrocardiogram and plasma BNP. Myocardial pathology and protein expression of extracellular regulated protein kinases1/2 (ERK1/2), P38 mitogen activated protein kinases (P38 MAPK) and CREB were examined at 4 weeks post pacing. Cardiac structure and plasma BNP level were similar among 4 groups (all P>0.05). Electrocardiogram derived Tp-Te interval was significantly prolonged post pacing (92±11, 91±10, and 79±13 ms vs. 60±12 ms), and the Tp-Te interval in bi-ventricle pacing group was shorter than in left or right ventricle pacing group (P < 0.05). Western blot results showed that the expression of p-ERK1/2 in left ventricular myocardium of left ventricle pacing group, right ventricular myocardium of right ventricle pacing group and bi-ventricular myocardium of bi-ventricle pacing group was 2.7±0.4, 2.4±0.2, 1.7±0.1 and 1.9±0.2, respectively, the expression of p-P38 MAPK was 1.9±0.3, 1.7±0.2, 0.8±0.1 and 1.1±0.1, respectively, and the expression of p-CREB was 2.1±0.2, 2.0±0.2, 2.7±0.4 and 2.6±0.3, respectively. The p-ERK1/2 and p-P38 MAPK expression of bi-ventricle pacing group was lower,but the p-CREB expression was higher compared to the other pacing groups (P < 0.05). Ventricular pacing could induce electrical remodeling evidenced by prolonged Tp-Te interval and increased phosphorylation of ERK1/2 and p38 MAPK and reduced phosphorylation of CREB. Compared with single ventricle pacing, bi-ventricle pacing could attenuate electrical remodeling in this model.

Altering Pace Control and Pace Regulation: Attentional Focus Effects during Running.

PubMed

Brick, Noel E; Campbell, Mark J; Metcalfe, Richard S; Mair, Jacqueline L; Macintyre, Tadhg E

2016-05-01

To date, there are no published studies directly comparing self-controlled (SC) and externally controlled (EC) pace endurance tasks. However, previous research suggests pace control may impact on cognitive strategy use and effort perceptions. The primary aim of this study was to investigate the effects of manipulating perception of pace control on attentional focus, physiological, and psychological outcomes during running. The secondary aim was to determine the reproducibility of self-paced running performance when regulated by effort perceptions. Twenty experienced endurance runners completed four 3-km time trials on a treadmill. Subjects completed two SC pace trials, one perceived exertion clamped (PE) trial, and one EC pace time trial. PE and EC were completed in a counterbalanced order. Pacing strategy for EC and perceived exertion instructions for PE replicated the subjects' fastest SC time trial. Subjects reported a greater focus on cognitive strategies such as relaxing and optimizing running action during EC than during SC. The mean HR was 2% lower during EC than that during SC despite an identical pacing strategy. Perceived exertion did not differ between the three conditions. However, increased internal sensory monitoring coincided with elevated effort perceptions in some subjects during EC and a 10% slower completion time for PE (13.0 ± 1.6 min) than that for SC (11.8 ± 1.2 min). Altering pace control and pace regulation impacted on attentional focus. External control over pacing may facilitate performance, particularly when runners engage attentional strategies conducive to improved running efficiency. However, regulating pace based on effort perceptions alone may result in excessive monitoring of bodily sensations and a slower running speed. Accordingly, attentional focus interventions may prove beneficial for some athletes to adopt task-appropriate attentional strategies to optimize performance.

Accelerated graft dysfunction in heart transplant patients with persistent atrioventricular conduction block.

PubMed

Lee, William; Tay, Andre; Walker, Bruce D; Kuchar, Dennis L; Hayward, Christopher S; Spratt, Phillip; Subbiah, Rajesh N

2016-12-01

Bradyarrhythmia following heart transplantation is common-∼7.5-24% of patients require permanent pacemaker (PPM) implantation. While overall mortality is similar to their non-paced counterparts, the effects of chronic right ventricular pacing (CRVP) in heart transplant patients have not been studied. We aim to examine the effects of CRVP on heart failure and mortality in heart transplant patients. Records of heart transplant recipients requiring PPM at St Vincent's Hospital, Sydney, Australia between January 1990 and January 2015 were examined. Patient's without a right ventricular (RV) pacing lead or a follow-up time of <1 year were excluded. Patients with pre-existing abnormal left ventricular function (<50%) were analysed separately. Patients were grouped by pacing dependence (100% pacing dependent vs. non-pacing dependent). The primary endpoint was clinical or echocardiographic heart failure (<35%) in the first 5 years post-PPM. Thirty-three of 709 heart transplant recipients were studied. Two patients had complete RV pacing dependence, and the remaining 31 patients had varying degrees of pacing requirement, with an underlying ventricular escape rhythm. The primary endpoint occurred significantly more in the pacing-dependent group; 2 (100%) compared with 2 (6%) of the non pacing dependent group (P < 0.0001 by log-rank analysis, HR = 24.58). Non-pacing-dependent patients had reversible causes for heart failure, unrelated to pacing. In comparison, there was no other cause of heart failure in the pacing-dependent group. Permanent atrioventricular block is rare in the heart transplant population. We have demonstrated CRVP as a potential cause of accelerated graft failure in pacing-dependent heart transplant patients. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

Prospective randomized study to assess the efficacy of site and rate of atrial pacing on long-term progression of atrial fibrillation in sick sinus syndrome: Septal Pacing for Atrial Fibrillation Suppression Evaluation (SAFE) Study.

PubMed

Lau, Chu-Pak; Tachapong, Ngarmukos; Wang, Chun-Chieh; Wang, Jing-Feng; Abe, Haruhiko; Kong, Chi-Woon; Liew, Reginald; Shin, Dong-Gu; Padeletti, Luigi; Kim, You-Ho; Omar, Razali; Jirarojanakorn, Kreingkrai; Kim, Yoon-Nyun; Chen, Mien-Cheng; Sriratanasathavorn, Charn; Munawar, Muhammad; Kam, Ruth; Chen, Jan-Yow; Cho, Yong-Keun; Li, Yi-Gang; Wu, Shu-Lin; Bailleul, Christophe; Tse, Hung-Fat

2013-08-13

Atrial-based pacing is associated with lower risk of atrial fibrillation (AF) in sick sinus syndrome compared with ventricular pacing; nevertheless, the impact of site and rate of atrial pacing on progression of AF remains unclear. We evaluated whether long-term atrial pacing at the right atrial (RA) appendage versus the low RA septum with (ON) or without (OFF) a continuous atrial overdrive pacing algorithm can prevent the development of persistent AF. We randomized 385 patients with paroxysmal AF and sick sinus syndrome in whom a pacemaker was indicated to pacing at RA appendage ON (n=98), RA appendage OFF (n=99), RA septum ON (n=92), or RA septum OFF (n=96). The primary outcome was the occurrence of persistent AF (AF documented at least 7 days apart or need for cardioversion). Demographic data were homogeneous across both pacing site (RA appendage/RA septum) and atrial overdrive pacing (ON/OFF). After a mean follow-up of 3.1 years, persistent AF occurred in 99 patients (25.8%; annual rate of persistent AF, 8.3%). Alternative site pacing at the RA septum versus conventional RA appendage (hazard ratio=1.18; 95% confidence interval, 0.79-1.75; P=0.65) or continuous atrial overdrive pacing ON versus OFF (hazard ratio=1.17; 95% confidence interval, 0.79-1.74; P=0.69) did not prevent the development of persistent AF. In patients with paroxysmal AF and sick sinus syndrome requiring pacemaker implantation, an alternative atrial pacing site at the RA septum or continuous atrial overdrive pacing did not prevent the development of persistent AF. URL: http://www.clinicaltrials.gov. UNIQUE IDENTIFIER: NCT00419640.

Constant DI pacing suppresses cardiac alternans formation in numerical cable models

NASA Astrophysics Data System (ADS)

Zlochiver, S.; Johnson, C.; Tolkacheva, E. G.

2017-09-01

Cardiac repolarization alternans describe the sequential alternation of the action potential duration (APD) and can develop during rapid pacing. In the ventricles, such alternans may rapidly turn into life risking arrhythmias under conditions of spatial heterogeneity. Thus, suppression of alternans by artificial pacing protocols, or alternans control, has been the subject of numerous theoretical, numerical, and experimental studies. Yet, previous attempts that were inspired by chaos control theories were successful only for a short spatial extent (<2 cm) from the pacing electrode. Previously, we demonstrated in a single cell model that pacing with a constant diastolic interval (DI) can suppress the formation of alternans at high rates of activation. We attributed this effect to the elimination of feedback between the pacing cycle length and the last APD, effectively preventing restitution-dependent alternans from developing. Here, we extend this idea into cable models to study the extent by which constant DI pacing can control alternans during wave propagation conditions. Constant DI pacing was applied to ventricular cable models of up to 5 cm, using human kinetics. Our results show that constant DI pacing significantly shifts the onset of both cardiac alternans and conduction blocks to higher pacing rates in comparison to pacing with constant cycle length. We also demonstrate that constant DI pacing reduces the propensity of spatially discordant alternans, a precursor of wavebreaks. We finally found that the protective effect of constant DI pacing is stronger for increased electrotonic coupling along the fiber in the sense that the onset of alternans is further shifted to higher activation rates. Overall, these results support the potential clinical applicability of such type of pacing in improving protocols of implanted pacemakers, in order to reduce the risk of life-threatening arrhythmias. Future research should be conducted in order to experimentally validate these promising results.

42 CFR 460.90 - PACE benefits under Medicare and Medicaid.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false PACE benefits under Medicare and Medicaid. 460.90 Section 460.90 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... FOR THE ELDERLY (PACE) PACE Services § 460.90 PACE benefits under Medicare and Medicaid. If a Medicare...

Variation of Antarctic circumpolar current and its intensification in relation to the southern annular mode detected in the time-variable gravity signals by GRACE satellite

NASA Astrophysics Data System (ADS)

Liau, Jen-Ru; Chao, Benjamin F.

2017-07-01

The southern annular mode (SAM) in the atmosphere and the Antarctic circumpolar current (ACC) in the ocean play decisive roles in the climatic system of the mid- to high-latitude southern hemisphere. Using the time-variable gravity data from the GRACE satellite mission, we find the link between the space-time variabilities of the ACC and the SAM. We calculate the empirical orthogonal functions (EOF) of the non-seasonal ocean bottom pressure (OBP) field in the circum-Antarctic seas from the GRACE data for the period from 2003 to 2015. We find that the leading EOF mode of the non-seasonal OBP represents a unison OBP oscillation around Antarctica with time history closely in pace with that of the SAM Index with a high correlation of 0.77. This OBP variation gives rise to a variation in the geostrophic flow field; the result for the same EOF mode shows heightened variations in the zonal velocity that resides primarily in the eastern hemispheric portion of the ACC and coincided geographically with the southernmost boundary of the ACC's main stream. Confirming previous oceanographic studies, these geodetic satellite results provide independent information toward better understanding of the ACC-SAM process.

Measurement Error Calibration in Mixed-Mode Sample Surveys

ERIC Educational Resources Information Center

Buelens, Bart; van den Brakel, Jan A.

2015-01-01

Mixed-mode surveys are known to be susceptible to mode-dependent selection and measurement effects, collectively referred to as mode effects. The use of different data collection modes within the same survey may reduce selectivity of the overall response but is characterized by measurement errors differing across modes. Inference in sample surveys…

A Co-Adaptive Brain-Computer Interface for End Users with Severe Motor Impairment

PubMed Central

Faller, Josef; Scherer, Reinhold; Costa, Ursula; Opisso, Eloy; Medina, Josep; Müller-Putz, Gernot R.

2014-01-01

Co-adaptive training paradigms for event-related desynchronization (ERD) based brain-computer interfaces (BCI) have proven effective for healthy users. As of yet, it is not clear whether co-adaptive training paradigms can also benefit users with severe motor impairment. The primary goal of our paper was to evaluate a novel cue-guided, co-adaptive BCI training paradigm with severely impaired volunteers. The co-adaptive BCI supports a non-control state, which is an important step toward intuitive, self-paced control. A secondary aim was to have the same participants operate a specifically designed self-paced BCI training paradigm based on the auto-calibrated classifier. The co-adaptive BCI analyzed the electroencephalogram from three bipolar derivations (C3, Cz, and C4) online, while the 22 end users alternately performed right hand movement imagery (MI), left hand MI and relax with eyes open (non-control state). After less than five minutes, the BCI auto-calibrated and proceeded to provide visual feedback for the MI task that could be classified better against the non-control state. The BCI continued to regularly recalibrate. In every calibration step, the system performed trial-based outlier rejection and trained a linear discriminant analysis classifier based on one auto-selected logarithmic band-power feature. In 24 minutes of training, the co-adaptive BCI worked significantly (p = 0.01) better than chance for 18 of 22 end users. The self-paced BCI training paradigm worked significantly (p = 0.01) better than chance in 11 of 20 end users. The presented co-adaptive BCI complements existing approaches in that it supports a non-control state, requires very little setup time, requires no BCI expert and works online based on only two electrodes. The preliminary results from the self-paced BCI paradigm compare favorably to previous studies and the collected data will allow to further improve self-paced BCI systems for disabled users. PMID:25014055

Apprentice Cook, 9-2. Military Curriculum Materials for Vocational and Technical Education.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. National Center for Research in Vocational Education.

These student materials in a two-volume format for a secondary-postsecondary level course in food service/cook comprise one of a number of military-developed curriculum packages selected for adaptation to vocational instruction and curriculum development in a civilian setting. The stated purpose for the individualized, self-paced course is to…

Basic Principles of Marine Diesel Engines, 8-2. Military Curriculum Materials for Vocational and Technical Education.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. National Center for Research in Vocational Education.

This volume of student materials for a secondary/postsecondary level course in principles of marine diesel engines is one of a number of military-developed curriculum packages selected for adaptation to vocational instruction and curriculum development in a civilian setting. The purpose of the individualized, self-paced course is to acquaint…

Assisted migration: What it means to nursery managers and tree planters

Treesearch

Mary I. Williams; R. Kasten Dumroese

2014-01-01

Projections indicate that natural plant adaptation and migration may not keep pace with climate changes. This mismatch in rates will pose significant challenges for practitioners that select, grow, and outplant native tree species. Populations of native tree species planted today must be able to meet the climatic challenges they will face during this century. One...

Some Considerations in Combining Traditional and Non-Traditional Methods of Instruction in a Mathematics Program.

ERIC Educational Resources Information Center

Gormley, Tyrone D.

Based on the assumption that each student learns in a unique way, this paper outlines the factors to be considered before selecting the methods of instruction for particular mathematics courses and their students. The advantages and disadvantages of the lecture/textbook and question/answer method, individualized instruction, self-pacing,…

Occupational Safety. Hand Tools. Pre-Apprenticeship Phase 1 Training.

ERIC Educational Resources Information Center

Lane Community Coll., Eugene, OR.

This self-paced student training module on safety when using hand tools is one of a number of modules developed for Pre-apprenticeship Phase 1 Training. Purpose of the module is to teach students the correct safety techniques for operating common hand- and arm-powered tools, including selection, maintenance, technique, and uses. The module may…

Apprentice Baker, 9-1. Military Curriculum Materials for Vocational and Technical Education.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. National Center for Research in Vocational Education.

This volume of student materials for a secondary/post-secondary level course in food service/baking comprises one of a number of military-developed curriculum packages selected for adaptation to vocational instruction and curriculum development in a civilian setting. The purpose stated for the individualized, self-paced course is to assist the…

My Favorite Assignment: Selections from the ABC 2008 Annual Convention, Lake Tahoe, Nevada

ERIC Educational Resources Information Center

Whalen, D. Joel, Ed.

2009-01-01

At the 2008 Association for Business Communication (ABC) annual convention in Lake Tahoe, Nevada, many attendees stood at the back of a crowded room to hear over a dozen teachers describe "My Favorite Assignment." As is customary in these lively sessions, the chair, Dan Dieterich, orchestrated a fast, efficient presentation pace; each…

Military Curriculum Materials for Vocational and Technical Education. Telephone Switching Equipment Repairman 5-6. (Electromechanical) CDC36251.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. National Center for Research in Vocational Education.

These individualized, self-paced student texts for a secondary-postsecondary level course for telephone switching equipment repairman are one of a number of military-developed curriculum packages selected for adaptation to vocational instruction and curriculum development in a civilian setting. The five-volume course is designed to provide…

Military Curriculum Materials for Vocational and Technical Education. Meatcutter 1-6. AFSC 61151, Volume 1.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. National Center for Research in Vocational Education.

These individualized self-paced student materials for a high school/postsecondary-level course for meatcutters are one of a number of military-developed curriculum packages selected for adaptation to vocational instruction and curriculum development in a civilian setting. The five-chapter course discusses the knowledge required of meatcutters to…

How Do the German and Dutch Curriculum Contexts Influence (the Use of) Geography Textbooks?

ERIC Educational Resources Information Center

Krause, Uwe; Béneker, Tine; van Tartwijk, Jan; Uhlenwinkel, Anke; Bolhuis, Sanneke

2017-01-01

Bernstein describes a curriculum context as a system context that is regulated by strong and weak framing, which refers to the "degree of control teachers and pupils possess over the selection, organisation, pacing and timing of the knowledge transmitted and received in the pedagogical relationship" (1975, p. 89). In this article, we…

Pharmacy Research Online. A Guide for Faculty.

ERIC Educational Resources Information Center

Parkin, Derral; And Others

This document is a self-paced training packet developed for a pilot project at the University of Houston-University Park to teach pharmacy faculty members to do their own online searching. The training begins with general topics such as the kinds of searches that can be done effectively online, the selection of appropriate databases to search, and…

Art Research Online. A Guide for Faculty.

ERIC Educational Resources Information Center

Parkin, Derral; And Others

This document is a self-paced training packet developed for a pilot project at the University of Houston-University Park to teach art faculty members to do their own online searching. The training begins with general topics such as the kinds of searches that can be done most effectively online, the selection of appropriate databases to search, and…

42 CFR 460.122 - PACE organization's appeals process.

Code of Federal Regulations, 2011 CFR

2011-10-01

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

42 CFR 460.122 - PACE organization's appeals process.

Code of Federal Regulations, 2010 CFR

2010-10-01

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

42 CFR 460.170 - Reinstatement in PACE.

Code of Federal Regulations, 2011 CFR

2011-10-01

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

42 CFR 460.170 - Reinstatement in PACE.

Code of Federal Regulations, 2010 CFR

2010-10-01

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

Acute psychological benefits of exercise performed at self-selected workloads: implications for theory and practice.

PubMed

Szabo, Attila

2003-09-01

Given that most studies to date examined the connection between exercise and affect without considering the participants' preferred exercise workload, in this research the affective-benefits of jogging or running at a participant-selected pace were investigated in a pilot field and a laboratory experiment. Ninety-six male and female students (19.5 yrs) took part in the pilot field experiment whereas 32 women (20.3 yrs) completed the laboratory experiment. In both experiments, the participants ran/jogged for 20 minutes at a self-selected pace. They completed an abbreviated version of a 'right now form' of the Profile of Mood States (POMS - Grove and Prapavessis, 1992) inventory before and after exercise. In both experiments all dependent measures changed significantly from pre- to post-exercise, except 'fatigue' and 'vigor' that did not change in the laboratory. Total mood disturbance (TMD) decreased significantly in both experiments (68% and 89%). No significant correlations were found between exercise intensity (expressed as percent (%) of maximal heart rate reserve) and the magnitude of changes seen in the dependent measures. It is concluded that exercising at a self-selected workload yields positive changes in affect that are unrelated to exercise intensity. These results suggest that the physiological theories linking exercise with positive changes in affect, in which exercise intensity is instrumental, could not account for the acute affective benefits of exercise. It is proposed that a 'cognitive appraisal hypothesis' may be more appropriate in explaining the acute affective benefits of exercise.

Effects of pacing magnitudes and forms on bistability width in a modeled ventricular tissue

NASA Astrophysics Data System (ADS)

Huang, Xiaodong; Liu, Xuemei; Zheng, Lixian; Mi, Yuanyuan; Qian, Yu

2013-07-01

Bistability in periodically paced cardiac tissue is relevant to cardiac arrhythmias and its control. In the present paper, one-dimensional tissue of the phase I Luo-Rudy model is numerically investigated. The effects of various parameters of pacing signals on bistability width are studied. The following conclusions are obtained: (i) Pacing can be classified into two types: pulsatile and sinusoidal types. Pulsatile pacing reduces bistability width as its magnitude is increased. Sinusoidal pacing increases the width as its amplitude is increased. (ii) In a pacing period the hyperpolarizing part plays a more important role than the depolarizing part. Variations of the hyperpolarizing ratio in a period evidently change the width of bistability and its variation tendency. (iii) A dynamical mechanism is proposed to qualitatively explain the phenomena, which reveals the reason for the different effects of pulsatile and sinusoidal pacing on bistability. The methods for changing bistability width by external pacing may help control arrhythmias in cardiology.

The role of emotions on pacing strategies and performance in middle and long duration sport events.

PubMed

Baron, B; Moullan, F; Deruelle, F; Noakes, T D

2011-05-01

Thepacing strategy may be defined as the process in which the total energy expenditure during exercise is regulated on a moment-to-moment basis in order to ensure that the exercise bout can be completed in a minimum time and without a catastrophic biological failure. Experienced athletes develop a stable template of the power outputs they are able to sustain for different durations of exercise, but it is not known how they originally develop this template or how that template changes with training and experience. While it is understood that the athlete's physiological state makes an important contribution to this process, there has been much less interest in the contribution that the athlete's emotional status makes. The aim of this review is to evaluate the literature of physiological, neurophysiological and perceptual responses during exercise in order to propose a complex model interpretation of this process which may be a critical factor determining success in middle- and long-duration sporting competitions. We describe unconscious/physiological and conscious/emotional mechanisms of control, the focus of which are to ensure that exercise terminates before catastrophic failure occurs in any bodily system. We suggest that training sessions teach the athlete to select optimal pacing strategies by associating a level of emotion with the ability to maintain that pace for exercise of different durations. That pacing strategy is then adopted in future events. Finally, we propose novel perspectives to maximise performance and to avoid overtraining by paying attention also to the emotional state in training process.

42 CFR 460.30 - Program agreement requirement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Program Agreement § 460.30 Program agreement requirement. (a) A PACE organization must...

42 CFR 460.30 - Program agreement requirement.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Program Agreement § 460.30 Program agreement requirement. (a) A PACE organization must...

42 CFR 460.50 - Termination of PACE program agreement.

Code of Federal Regulations, 2011 CFR

2011-10-01

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

42 CFR 460.50 - Termination of PACE program agreement.

Code of Federal Regulations, 2010 CFR

2010-10-01

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

42 CFR 460.180 - Medicare payment to PACE organizations.

Code of Federal Regulations, 2011 CFR

2011-10-01

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

Adiabatically tapered microstructured mode converter for selective excitation of the fundamental mode in a few mode fiber.

PubMed

Taher, Aymen Belhadj; Di Bin, Philippe; Bahloul, Faouzi; Tartaret-Josnière, Etienne; Jossent, Mathieu; Février, Sébastien; Attia, Rabah

2016-01-25

We propose a new technique to selectively excite the fundamental mode in a few mode fiber (FMF). This method of excitation is made from a single mode fiber (SMF) which is inserted facing the FMF into an air-silica microstructured cane before the assembly is adiabatically tapered. We study theoretically and numerically this method by calculating the effective indices of the propagated modes, their amplitudes along the taper and the adiabaticity criteria, showing the ability to achieve an excellent selective excitation of the fundamental mode in the FMF with negligible loss. We experimentally demonstrate that the proposed solution provides a successful mode conversion and allows an almost excellent fundamental mode excitation in the FMF (representing 99.8% of the total power).

An Innovative Structural Mode Selection Methodology: Application for the X-33 Launch Vehicle Finite Element Model

NASA Technical Reports Server (NTRS)

Hidalgo, Homero, Jr.

2000-01-01

An innovative methodology for determining structural target mode selection and mode selection based on a specific criterion is presented. An effective approach to single out modes which interact with specific locations on a structure has been developed for the X-33 Launch Vehicle Finite Element Model (FEM). We presented Root-Sum-Square (RSS) displacement method computes resultant modal displacement for each mode at selected degrees of freedom (DOF) and sorts to locate modes with highest values. This method was used to determine modes, which most influenced specific locations/points on the X-33 flight vehicle such as avionics control components, aero-surface control actuators, propellant valve and engine points for use in flight control stability analysis and for flight POGO stability analysis. Additionally, the modal RSS method allows for primary or global target vehicle modes to also be identified in an accurate and efficient manner.

DefenseLink Special: Travels with Pace, March 2006

Science.gov Websites

Us Travels with Pace Chairman of the Joint Chiefs of Staff Marine Gen. Peter Pace U.S. Marine Gen . Peter Pace, chairman of the Joint Chiefs of Staff, speaks to students attending the Turkish War College U.S. Air Force Staff Sgt. D. Myles Cullen Hi-Res Pace Wraps Up Visit to Allied Nations WASHINGTON

Pacing and Defibrillators in Complex Congenital Heart Disease

PubMed Central

Chubb, Henry; O’Neill, Mark; Rosenthal, Eric

2016-01-01

Device therapy in the complex congenital heart disease (CHD) population is a challenging field. There is a myriad of devices available, but none designed specifically for the CHD patient group, and a scarcity of prospective studies to guide best practice. Baseline cardiac anatomy, prior surgical and interventional procedures, existing tachyarrhythmias and the requirement for future intervention all play a substantial role in decision making. For both pacing systems and implantable cardioverter defibrillators, numerous factors impact on the merits of system location (endovascular versus non-endovascular), lead positioning, device selection and device programming. For those with Fontan circulation and following the atrial switch procedure there are also very specific considerations regarding access and potential complications. This review discusses the published guidelines, device indications and the best available evidence for guidance of device implantation in the complex CHD population. PMID:27403295

Effect of short-term rapid ventricular pacing followed by pacing interruption on arterial blood pressure in healthy pigs and pigs with tachycardiomyopathy.

PubMed

Skrzypczak, P; Zyśko, D; Pasławska, U; Noszczyk-Nowak, A; Janiszewski, A; Gajek, J; Nicpoń, J; Kiczak, L; Bania, J; Zacharski, M; Tomaszek, A; Jankowska, E A; Ponikowski, P; Witkiewicz, W

2014-01-01

Ventricular tachycardia may lead to haemodynamic deterioration and, in the case of long term persistence, is associated with the development of tachycardiomyopathy. The effect of ventricular tachycardia on haemodynamics in individuals with tachycardiomyopathy, but being in sinus rhythm has not been studied. Rapid ventricular pacing is a model of ventricular tachycardia. The aim of this study was to determine the effect of rapid ventricular pacing on blood pressure in healthy animals and those with tachycardiomyopathy. A total of 66 animals were studied: 32 in the control group and 34 in the study group. The results of two groups of examinations were compared: the first performed in healthy animals (133 examinations) and the second performed in animals paced for at least one month (77 examinations). Blood pressure measurements were taken during chronic pacing--20 min after onset of general anaesthesia, in baseline conditions (20 min after pacing cessation or 20 min after onset of general anaesthesia in healthy animals) and immediately after short-term rapid pacing. In baseline conditions significantly higher systolic and diastolic blood pressure was found in healthy animals than in those with tachycardiomyopathy. During an event of rapid ventricular pacing, a significant decrease in systolic and diastolic blood pressure was found in both groups of animals. In the group of chronically paced animals the blood pressure was lower just after restarting ventricular pacing than during chronic pacing. Cardiovascular adaptation to ventricular tachycardia develops with the length of its duration. Relapse of ventricular tachycardia leads to a blood pressure decrease more pronounced than during chronic ventricular pacing.

Anatomical approach to permanent His bundle pacing: Optimizing His bundle capture.

PubMed

Vijayaraman, Pugazhendhi; Dandamudi, Gopi

2016-01-01

Permanent His bundle pacing is a physiological alternative to right ventricular pacing. In this article we describe our approach to His bundle pacing in patients with AV nodal and intra-Hisian conduction disease. It is essential for the implanters to understand the anatomic variations of the His bundle course and its effect on the type of His bundle pacing achieved. We describe several case examples to illustrate our anatomical approach to permanent His bundle pacing in this article. Copyright © 2016 Elsevier Inc. All rights reserved.

Therapeutic effects of selective atrioventricular node vagal stimulation in atrial fibrillation and heart failure.

PubMed

Zhang, Youhua; Popović, Zoran B; Kusunose, Kenya; Mazgalev, Todor N

2013-01-01

Atrial fibrillation (AF) and heart failure (HF) frequently coexist. We have previously demonstrated that selective atrioventricular node (AVN) vagal stimulation (AVN-VS) can be used to control ventricular rate during AF. Due to withdrawal of vagal activity in HF, the therapeutic effects of AVN-VS may be compromised in the combined condition of AF and HF. Accordingly, this study was designed to evaluate the therapeutic effects of AVN-VS to control ventricular rate in AF and HF. A combined model of AF and HF was created by implanting a dual chamber pacemaker in 24 dogs. A newly designed bipolar electrode was inserted into the ganglionic AVN fat pad and connected to a nerve stimulator for delivering AVN-VS. In all dogs, HF was induced by high rate ventricular pacing at 220 bpm for 4 weeks. AF was then induced and maintained by rapid atrial pacing at 600 bpm after discontinuation of ventricular pacing. These HF + AF dogs were randomized into control (n = 9) and AVN-VS (n = 15) groups. In the latter group, vagal stimulation (310 μs, 20 Hz, 3-7 mA) was delivered continuously for 6 months. Compared with the control, AVN-VS had a consistent effect on ventricular rate slowing (by >50 bpm, all P < 0.001) during the entire 6-month observation period that was associated with left ventricular functional improvement. Moreover, AVN-VS was well tolerated by the treated animals. AVN-VS achieved consistent rate slowing, which was associated with improved ventricular function in a canine AF and HF model. Thus, AVN-VS may be a novel, effective therapeutic option in the combined condition of AF and HF. © 2012 Wiley Periodicals, Inc.

Two-speed phacoemulsification for soft cataracts using optimized parameters and procedure step toolbar with the CENTURION Vision System and Balanced Tip.

PubMed

Davison, James A

2015-01-01

To present a cause of posterior capsule aspiration and a technique using optimized parameters to prevent it from happening when operating soft cataracts. A prospective list of posterior capsule aspiration cases was kept over 4,062 consecutive cases operated with the Alcon CENTURION machine and Balanced Tip. Video analysis of one case of posterior capsule aspiration was accomplished. A surgical technique was developed using empirically derived machine parameters and customized setting-selection procedure step toolbar to reduce the pace of aspiration of soft nuclear quadrants in order to prevent capsule aspiration. Two cases out of 3,238 experienced posterior capsule aspiration before use of the soft quadrant technique. Video analysis showed an attractive vortex effect with capsule aspiration occurring in 1/5 of a second. A soft quadrant removal setting was empirically derived which had a slower pace and seemed more controlled with no capsule aspiration occurring in the subsequent 824 cases. The setting featured simultaneous linear control from zero to preset maximums for: aspiration flow, 20 mL/min; and vacuum, 400 mmHg, with the addition of torsional tip amplitude up to 20% after the fluidic maximums were achieved. A new setting selection procedure step toolbar was created to increase intraoperative flexibility by providing instantaneous shifting between the soft and normal settings. A technique incorporating a reduced pace for soft quadrant acquisition and aspiration can be accomplished through the use of a dedicated setting of integrated machine parameters. Toolbar placement of the procedure button next to the normal setting procedure button provides the opportunity to instantaneously alternate between the two settings. Simultaneous surgeon control over vacuum, aspiration flow, and torsional tip motion may make removal of soft nuclear quadrants more efficient and safer.

Right Ventricular Outflow Tract Septal Pacing Is Superior to Right Ventricular Apical Pacing

PubMed Central

Zou, Cao; Song, Jianping; Li, Hui; Huang, Xingmei; Liu, Yuping; Zhao, Caiming; Shi, Xin; Yang, Xiangjun

2015-01-01

Background The effects of right ventricular apical pacing (RVAP) and right ventricular outflow tract (RVOT) septal pacing on atrial and ventricular electrophysiology have not been thoroughly compared. Methods and Results To identify a more favorable pacing strategy with fewer adverse effects, 80 patients who had complete atrioventricular block with normal cardiac function and who were treated with either RVAP (n=42) or RVOT septal pacing (n=38) were recruited after an average of 2 years of follow‐up. The data from electrocardiography and echocardiography performed before pacemaker implantation and at the end of follow‐up were collected. The patients in the RVOT septal pacing and RVAP groups showed similar demographic and clinical characteristics before pacing treatments. After a mean follow‐up of 2 years, the final maximum P‐wave duration; P‐wave dispersion; Q‐, R‐, and S‐wave complex duration; left atrial volume index; left ventricular end‐systolic diameter; ratio of transmitral early diastolic filling velocity to mitral annular early diastolic velocity; and interventricular mechanical delay in the RVOT septal pacing group were significantly less than those in the RVAP group (P<0.05). The final left ventricular ejection fraction of the RVOT septal pacing group was significantly higher than that of the RVAP group (P<0.05). Conclusions Compared with RVAP, RVOT septal pacing has fewer adverse effects regarding atrial electrical activity and structure in patients with normal cardiac function. PMID:25896891

Tools for Genetic Studies in Experimental Populations of Polyploids.

PubMed

Bourke, Peter M; Voorrips, Roeland E; Visser, Richard G F; Maliepaard, Chris

2018-01-01

Polyploid organisms carry more than two copies of each chromosome, a condition rarely tolerated in animals but which occurs relatively frequently in the plant kingdom. One of the principal challenges faced by polyploid organisms is to evolve stable meiotic mechanisms to faithfully transmit genetic information to the next generation upon which the study of inheritance is based. In this review we look at the tools available to the research community to better understand polyploid inheritance, many of which have only recently been developed. Most of these tools are intended for experimental populations (rather than natural populations), facilitating genomics-assisted crop improvement and plant breeding. This is hardly surprising given that a large proportion of domesticated plant species are polyploid. We focus on three main areas: (1) polyploid genotyping; (2) genetic and physical mapping; and (3) quantitative trait analysis and genomic selection. We also briefly review some miscellaneous topics such as the mode of inheritance and the availability of polyploid simulation software. The current polyploid analytic toolbox includes software for assigning marker genotypes (and in particular, estimating the dosage of marker alleles in the heterozygous condition), establishing chromosome-scale linkage phase among marker alleles, constructing (short-range) haplotypes, generating linkage maps, performing genome-wide association studies (GWAS) and quantitative trait locus (QTL) analyses, and simulating polyploid populations. These tools can also help elucidate the mode of inheritance (disomic, polysomic or a mixture of both as in segmental allopolyploids) or reveal whether double reduction and multivalent chromosomal pairing occur. An increasing number of polyploids (or associated diploids) are being sequenced, leading to publicly available reference genome assemblies. Much work remains in order to keep pace with developments in genomic technologies. However, such technologies also offer the promise of understanding polyploid genomes at a level which hitherto has remained elusive.

Tools for Genetic Studies in Experimental Populations of Polyploids

PubMed Central

Bourke, Peter M.; Voorrips, Roeland E.; Visser, Richard G. F.; Maliepaard, Chris

2018-01-01

Polyploid organisms carry more than two copies of each chromosome, a condition rarely tolerated in animals but which occurs relatively frequently in the plant kingdom. One of the principal challenges faced by polyploid organisms is to evolve stable meiotic mechanisms to faithfully transmit genetic information to the next generation upon which the study of inheritance is based. In this review we look at the tools available to the research community to better understand polyploid inheritance, many of which have only recently been developed. Most of these tools are intended for experimental populations (rather than natural populations), facilitating genomics-assisted crop improvement and plant breeding. This is hardly surprising given that a large proportion of domesticated plant species are polyploid. We focus on three main areas: (1) polyploid genotyping; (2) genetic and physical mapping; and (3) quantitative trait analysis and genomic selection. We also briefly review some miscellaneous topics such as the mode of inheritance and the availability of polyploid simulation software. The current polyploid analytic toolbox includes software for assigning marker genotypes (and in particular, estimating the dosage of marker alleles in the heterozygous condition), establishing chromosome-scale linkage phase among marker alleles, constructing (short-range) haplotypes, generating linkage maps, performing genome-wide association studies (GWAS) and quantitative trait locus (QTL) analyses, and simulating polyploid populations. These tools can also help elucidate the mode of inheritance (disomic, polysomic or a mixture of both as in segmental allopolyploids) or reveal whether double reduction and multivalent chromosomal pairing occur. An increasing number of polyploids (or associated diploids) are being sequenced, leading to publicly available reference genome assemblies. Much work remains in order to keep pace with developments in genomic technologies. However, such technologies also offer the promise of understanding polyploid genomes at a level which hitherto has remained elusive. PMID:29720992

LBTO's long march to full operation: step 2

NASA Astrophysics Data System (ADS)

Veillet, Christian; Ashby, David S.; Christou, Julian C.; Hill, John M.; Little, John K.; Summers, Douglas M.; Wagner, R. Mark; Masciadri, Elena; Turchi, Alessio

2016-08-01

Step 1 (Veillet et al.1), after a review of the development of the Large Binocular Telescope Observatory (LBTO from the early concepts of the early 80s to mid-2014, outlined a six-year plan (LBT2020) aimed at optimizing LBTO's scientific production while mitigating the consequences of the inevitable setbacks brought on by the considerable complexity of the telescope and the very diverse nature of the LBTO partnership. Step 2 is now focusing on the first two years of implementation of this plan, presenting the encountered obstacles, technical, cultural and political, and how they were overcome. Weather and another incident with one of the Adaptive Secondaries slowed down commissioning activities. All the facility instruments should have been commissioned and offered in binocular mode in early or mid-2016. It will happen instead by the end of 2016. On a brighter side, the first scientific publications using the LBT as a 23-m telescope through interferometry were published in 2015 and the overall number of publications has been raising at a good pace. Three second generation instruments were selected, scheduled to come on the telescope in the next three to five years. They will all use the excellent performance of the LBT Adaptive Optics (AO), which will be even better thanks to an upgrade of the AO to be completed in 2018. Less progress than hoped was made to move the current observing mode of the telescope to a whole LBT-wide queue. In two years from now, we should have a fully operational telescope, including a laser-based Ground Layer AO (GLAO) system, hopefully fully running in queue, with new instruments in development, new services offered to the users, and a stronger scientific production.

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

Code of Federal Regulations, 2011 CFR

2011-10-01

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

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

Code of Federal Regulations, 2010 CFR

2010-10-01

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

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

PubMed Central

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

2010-01-01

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

Interatrial septum versus right atrial appendage pacing for prevention of atrial fibrillation : A meta-analysis of randomized controlled trials.

PubMed

Zhang, L; Jiang, H; Wang, W; Bai, J; Liang, Y; Su, Y; Ge, J

2017-07-28

Interatrial septum (IAS) pacing seems to be a promising strategy for the prevention of atrial fibrillation (AF); however, studies have yielded conflicting results. This meta-analysis was to compare IAS with right atrial appendage (RAA) pacing on the prevention of postpacing AF occurrence. Pubmed, MEDLINE, EMBASE and Web of Science databases were searched through October 2016 for randomized controlled trials comparing IAS with RAA pacing on the prevention of AF. Data concerning study design, patient characteristics and outcomes were extracted. Risk ratio (RR), weighted mean differences (WMD) or standardized mean differences (SMD) were calculated using fixed or random effects models. A total of 12 trials involving 1146 patients with dual-chamber pacing were included. Although IAS was superior to RAA pacing in terms of reducing the number of AF episodes (SMD = -0.29, P = 0.05), AF burden (SMD = -0.41, P = 0.008) and P -wave duration (WMD = -34.45 ms, P < 0.0001), neither permanent AF occurrence (RR = 0.94, P = 0.58) nor recurrences of AF (RR = 0.88, P = 0.36) were reduced by IAS pacing. Nevertheless, no differences were observed concerning all-cause death (RR = 1.04, P = 0.88), procedure-related events (RR = 1.17, P = 0.69) and pacing parameters between IAS and RAA pacing in the follow-up period. IAS pacing is safe and as well tolerated as RAA pacing. Although IAS pacing may fail to prevent permanent AF occurrence and recurrences of AF, it is able to not only improve interatrial conduction, but also reduce AF burden.

Tunable mode and line selection by injection in a TEA CO2 laser

NASA Technical Reports Server (NTRS)

Menzies, R. T.; Flamant, P. H.; Kavaya, M. J.; Kuiper, E. N.

1984-01-01

Tunable mode selection by injection in pulsed CO2 lasers is examined, and both analytical and numerical models are used to compute the required injection power for a variety of experimental cases. These are treated in two categories: mode selection at a desired frequency displacement from the center frequency of a transition line in a dispersive cavity and mode (and line) selection at the center frequency of a selected transition line in a nondispersive cavity. The results point out the potential flexibility of pulsed injection in providing wavelength tunable high-energy single-frequency pulses.

Pacing a data transfer operation between compute nodes on a parallel computer

DOEpatents

Blocksome, Michael A [Rochester, MN

2011-09-13

Methods, systems, and products are disclosed for pacing a data transfer between compute nodes on a parallel computer that include: transferring, by an origin compute node, a chunk of an application message to a target compute node; sending, by the origin compute node, a pacing request to a target direct memory access (`DMA`) engine on the target compute node using a remote get DMA operation; determining, by the origin compute node, whether a pacing response to the pacing request has been received from the target DMA engine; and transferring, by the origin compute node, a next chunk of the application message if the pacing response to the pacing request has been received from the target DMA engine.

Procedure times, complication rates, and survival times associated with single-chamber versus dual-chamber pacemaker implantation in dogs with clinical signs of bradyarrhythmia: 54 cases (2004-2009).

PubMed

Genovese, David W; Estrada, Amara H; Maisenbacher, Herbert W; Heatwole, Bonnie A; Powell, Melanie A

2013-01-15

To compare procedure times and major and minor complication rates associated with single-chamber versus dual-chamber pacemaker implantation and with 1-lead, 2-lead, and 3-lead pacemaker implantation in dogs with clinical signs of bradyarrhythmia. Retrospective case series. 54 dogs that underwent pacemaker implantation because of clinical signs of bradyarrhythmia. Medical records of dogs that received pacemakers between July 2004 and December 2009 were reviewed for information regarding signalment, diagnosis, pacemaker implantation, pacemaker type, complications, and survival time. Analyses were performed to determine significant differences in anesthesia time, procedure time, and outcome for dogs on the basis of pacing mode and number of pacing leads. 28 of 54 (51.9%) dogs received single-chamber pacemakers and 26 (48.1%) received dual-chamber pacemakers. Mean ± SD procedural time was significantly longer for patients with dual-chamber pacemakers (133.5 ± 51.3 minutes) than for patients with single-chamber pacemakers (94.9 ± 37.0 minutes), and procedure time increased significantly as the number of leads increased (1 lead, 102.3 ± 51.1 minutes; 2 leads, 114.9 ± 24.8 minutes; 3 leads, 158.2 ± 8.5 minutes). Rates of major and minor complications were not significantly different between dogs that received single-chamber pacemakers and those that received dual-chamber pacemakers or among dogs grouped on the basis of the number of pacing leads placed. Although dual-chamber pacemaker implantation did result in increased procedural and anesthesia times, compared with single-chamber pacemaker implantation, this did not result in a higher complication rate.

Thrombo-embolic events in left ventricular endocardial pacing: long-term outcomes from a multicentre UK registry.

PubMed

Sawhney, Vinit; Domenichini, Giulia; Gamble, James; Furniss, Guy; Panagopoulos, Dimitrios; Lambiase, Pier; Rajappan, Kim; Chow, Anthony; Lowe, Martin; Sporton, Simon; Earley, Mark J; Dhinoja, Mehul; Campbell, Niall; Hunter, Ross J; Haywood, Guy; Betts, Tim R; Schilling, Richard J

2018-06-01

Endocardial left ventricular (LV) pacing is a viable alternative in patients with failed coronary sinus (CS) lead implantation. However, long-term thrombo-embolic risk remains unknown. Much of the data have come from a small number of centres. We examined the safety and efficacy of endocardial LV pacing to determine the long-term thrombo-embolic risk. Registries from four UK centres were combined to include 68 patients with endocardial leads with a mean follow-up of 20 months. These were compared to a matched 1:2 control group with conventional CS leads. Medical records were reviewed, and patients contacted for follow-up. Ischaemic stroke occurred in four patients (6%) in the endocardial arm providing an annual event rate (AER) of 3.6% over a 20 month follow-up; compared to 9 patients (6.6%) amongst controls with an AER of 3.4% over a 23-month follow-up. Regression analyses showed a significant association between sub-therapeutic international normalized ratio and stroke (P = 0.0001) in the endocardial arm. There was no association between lead material and mode of delivery (transatrial/transventricular) and stroke. Mortality rate was 12 and 15 per 100 patient years in the endocardial and control arm respectively with end-stage heart failure being the commonest cause. Endocardial LV lead in heart failure patients has a good success rate at 1.6 year follow-up. However, it is associated with a thrombo-embolic risk (which is not different from conventional CS leads) attributable to sub-therapeutic anticoagulation. Randomized control trials and studies on non-vitamin K antagonist oral anticoagulants are required to ascertain the potential of widespread clinical application of this therapeutic modality.

Waveguide mode converter and method using same

DOEpatents

Moeller, Charles P.

1990-01-01

A waveguide mode converter converts electromagnetic power being transmitted in a TE.sub.0n or a TM.sub.0n mode, where n is an integer, to an HE.sub.11 mode. The conversion process occurs in a single stage without requiring the power to pass through any intermediate modes. The converter comprises a length of circular corrugated waveguide formed in a multiperiod periodic curve. The period of the curve is selected to couple the desired modes and decouple undesired modes. The corrugation depth is selected to control the phase propagation constant, or wavenumbers, of the input and output modes, thereby preventing coherent coupling to competing modes. In one embodiment, both the period and amplitude of the curve may be selectively adjusted, thereby allowing the converter to be tuned to maximize the conversion efficiency.

Improvement of cardiac function with device-based diaphragmatic stimulation in chronic heart failure patients: the randomized, open-label, crossover Epiphrenic II Pilot Trial.

PubMed

Beeler, Remo; Schoenenberger, Andreas W; Bauer, Peter; Kobza, Richard; Bergner, Michael; Mueller, Xavier; Schlaepfer, Reinhard; Zuber, Michel; Erne, Susanne; Erne, Paul

2014-03-01

Device-based pacing-induced diaphragmatic stimulation (PIDS) may have therapeutic potential for chronic heart failure (HF) patients. We studied the effects of PIDS on cardiac function and functional outcomes. In 24 chronic HF patients with CRT, an additional electrode was attached to the left diaphragm. Randomized into two groups, patients received the following PIDS modes for 3 weeks in a different sequence: (i) PIDS off (control group); (ii) PIDS 0 ms mode (PIDS simultaneously with ventricular CRT pulse); or (iii) PIDS optimized mode (PIDS with optimized delay to ventricular CRT pulse). For PIDS optimization, acoustic cardiography was used. Effects of each PIDS mode on dyspnoea, power during exercise testing, and LVEF were assessed. Dyspnoea improved with the PIDS 0 ms mode (P = 0.057) and the PIDS optimized mode (P = 0.034) as compared with the control group. Maximal power increased from median 100.5 W in the control group to 104.0 W in the PIDS 0 ms mode (P = 0.092) and 109.5 W in the PIDS optimized mode (P = 0.022). Median LVEF was 33.5% in the control group, 33.0% in the PIDS 0 ms mode, and 37.0% in the PIDS optimized mode (P = 0.763 and P = 0.009 as compared with the control group, respectively). PIDS was asymptomatic in all patients. PIDS improves dyspnoea, working capacity, and LVEF in chronic HF patients over a 3 week period in addition to CRT. This pilot study demonstrates proof of principle of an innovative technology which should be confirmed in a larger sample. NCT00769678. © 2013 The Authors. European Journal of Heart Failure © 2013 European Society of Cardiology.

Normal-mode selectivity in ultrafast Raman excitations in C60

NASA Astrophysics Data System (ADS)

Zhang, G. P.; George, Thomas F.

2006-01-01

Ultrafast Raman spectra are a powerful tool to probe vibrational excitations, but inherently they are not normal-mode specific. For a system as complicated as C60 , there is no general rule to target a specific mode. A detailed study presented here aims to investigate normal-mode selectivity in C60 by an ultrafast laser. To accurately measure mode excitation, we formally introduce the kinetic-energy-based normal-mode analysis which overcomes the difficulty with the strong lattice anharmonicity and relaxation. We first investigate the resonant excitation and find that mode selectivity is normally difficult to achieve. However, for off-resonant excitations, it is possible to selectively excite a few modes in C60 by properly choosing an optimal laser pulse duration, which agrees with previous experimental and theoretical findings. Going beyond the phenomenological explanation, our study shines new light on the origin of the optimal duration: The phase matching between the laser field and mode vibration determines which mode is strongly excited or suppressed. This finding is very robust and should be a useful guide for future experimental and theoretical studies in more complicated systems.

Normal mode selectivity in ultrafast Raman excitations in C60

NASA Astrophysics Data System (ADS)

Zhang, Guoping; George, Thomas F.

2006-05-01

Ultrafast Raman spectra are a powerful tool to probe vibrational excitations, but inherently they are not normal-mode specific. For a system as complicated as C60, there is no general rule to target a specific mode. A detailed study presented here aims to investigate normal mode selectivity in C60 by an ultrafast laser. To accurately measure mode excitation, we formally introduce the kinetic energy-based normal mode analysis which overcomes the difficulty with the strong lattice anharmonicity and relaxation. We first investigate the resonant excitation and find that mode selectivity is normally difficult to achieve. However, for off-resonant excitations, it is possible to selectively excite a few modes in C60 by properly choosing an optimal laser pulse duration, which agrees with previous experimental and theoretical findings. Going beyond the phenomenological explanation, our study shines new light on the origin of the optimal duration: The phase matching between laser field and mode vibration determines which mode is strongly excited or suppressed. This finding is very robust and may be a useful guide for future experimental and theoretical studies in more complicated systems.

Design of ProjectRun21: a 14-week prospective cohort study of the influence of running experience and running pace on running-related injury in half-marathoners.

PubMed

Damsted, Camma; Parner, Erik Thorlund; Sørensen, Henrik; Malisoux, Laurent; Nielsen, Rasmus Oestergaard

2017-11-06

Participation in half-marathon has been steeply increasing during the past decade. In line, a vast number of half-marathon running schedules has surfaced. Unfortunately, the injury incidence proportion for half-marathoners has been found to exceed 30% during 1-year follow-up. The majority of running-related injuries are suggested to develop as overuse injuries, which leads to injury if the cumulative training load over one or more training sessions exceeds the runners' load capacity for adaptive tissue repair. Owing to an increase of load capacity along with adaptive running training, the runners' running experience and pace abilities can be used as estimates for load capacity. Since no evidence-based knowledge exist of how to plan appropriate half-marathon running schedules considering the level of running experience and running pace, the aim of ProjectRun21 is to investigate the association between running experience or running pace and the risk of running-related injury. Healthy runners using Global Positioning System (GPS) watch between 18 and 65 years will be invited to participate in this 14-week prospective cohort study. Runners will be allowed to self-select one of three half-marathon running schedules developed for the study. Running data will be collected objectively by GPS. Injury will be based on the consensus-based time loss definition by Yamato et al.: "Running-related (training or competition) musculoskeletal pain in the lower limbs that causes a restriction on or stoppage of running (distance, speed, duration, or training) for at least 7 days or 3 consecutive scheduled training sessions, or that requires the runner to consult a physician or other health professional". Running experience and running pace will be included as primary exposures, while the exposure to running is pre-fixed in the running schedules and thereby conditioned by design. Time-to-event models will be used for analytical purposes. ProjectRun21 will examine if particular subgroups of runners with certain running experiences and running paces seem to sustain more running-related injuries compared with other subgroups of runners. This will enable sport coaches, physiotherapists as well as the runners to evaluate their injury risk of taking up a 14-week running schedule for half-marathon.

Echocardiography for cardiac resynchronization therapy: recommendations for performance and reporting--a report from the American Society of Echocardiography Dyssynchrony Writing Group endorsed by the Heart Rhythm Society.

PubMed

Gorcsan, John; Abraham, Theodore; Agler, Deborah A; Bax, Jeroen J; Derumeaux, Genevieve; Grimm, Richard A; Martin, Randy; Steinberg, Jonathan S; Sutton, Martin St John; Yu, Cheuk-Man

2008-03-01

Echocardiography plays an evolving and important role in the care of heart failure patients treated with biventricular pacing, or cardiac resynchronization therapy (CRT). Numerous recent published reports have utilized echocardiographic techniques to potentially aide in patient selection for CRT prior to implantation and to optimized device settings afterwards. However, no ideal approach has yet been found. This consensus report evaluates the contemporary applications of echocardiography for CRT including relative strengths and technical limitations of several techniques and proposes guidelines regarding current and possible future clinical applications. Principal methods advised to qualify abnormalities in regional ventricular activation, known as dyssynchrony, include longitudinal velocities by color-coded tissue Doppler and the difference in left ventricular to right ventricular ejection using routine pulsed Doppler, or interventricular mechanical delay. Supplemental measures of radial dynamics which may be of additive value include septal-to-posterior wall delay using M-mode in patients with non-ischemic disease with technically high quality data, or using speckle tracking radial strain. A simplified post-CRT screening for atrioventricular optimization using Doppler mitral inflow velocities is also proposed. Since this is rapidly changing field with new information being added frequently, future modification and refinements in approach are anticipated to continue.

Pacing in Olympic track races: competitive tactics versus best performance strategy.

PubMed

Thiel, Christian; Foster, Carl; Banzer, Winfried; De Koning, Jos

2012-01-01

The purpose of this study was to describe pacing strategies in the 800 to 10,000-m Olympic finals. We asked 1) if Olympic finals differed from World Records, 2) how variable the pace was, 3) whether runners faced catastrophic events, and 4) for the winning strategy. Publically available data from the Beijing 2008 Olympic Games gathered by four transponder antennae under the 400-m track were analysed to extract descriptors of pacing strategies. Individual pacing patterns of 133 finalists were visualised using speed by distance plots. Six of eight plots differed from the patterns reported for World Records. The coefficient of running speed variation was 3.6-11.4%. In the long distance finals, runners varied their pace every 100 m by a mean 1.6-2.7%. Runners who were 'dropped' from the field achieved a stable running speed and displayed an endspurt. Top contenders used variable pacing strategies to separate themselves from the field. All races were decided during the final lap. Olympic track finalists employ pacing strategies which are different from World Record patterns. The observed micro- and macro-variations of pace may have implications for training programmes. Dropping off the pace of the leading group is an active step, and the result of interactive psychophysiological decision making.

Meta-Analysis of Single-Case Research Design Studies on Instructional Pacing.

PubMed

Tincani, Matt; De Mers, Marilyn

2016-11-01

More than four decades of research on instructional pacing has yielded varying and, in some cases, conflicting findings. The purpose of this meta-analysis was to synthesize single-case research design (SCRD) studies on instructional pacing to determine the relative benefits of brisker or slower pacing. Participants were children and youth with and without disabilities in educational settings, excluding higher education. Tau-U, a non-parametric statistic for analyzing data in SCRD studies, was used to determine effect size estimates. The article extraction yielded 13 instructional pacing studies meeting contemporary standards for high quality SCRD research. Eleven of the 13 studies reported small to large magnitude effects when two or more pacing parameters were compared, suggesting that instructional pacing is a robust instructional variable. Brisker instructional pacing with brief inter-trial interval (ITI) produced small increases in correct responding and medium to large reductions in challenging behavior compared with extended ITI. Slower instructional pacing with extended wait-time produced small increases in correct responding, but also produced small increases in challenging behavior compared with brief wait-time. Neither brief ITI nor extended wait-time meets recently established thresholds for evidence-based practice, highlighting the need for further instructional pacing research. © The Author(s) 2016.

Principles of Fuel and Fuel Systems, 8-4. Military Curriculum Materials for Vocational and Technical Education.

ERIC Educational Resources Information Center

Army Ordnance Center and School, Aberdeen Proving Ground, MD.

This volume of student materials for a secondary/postsecondary level course in principles of fuel and fuel systems is one of a number of military-developed curriculum packages selected for adaptation to vocational instruction and curriculum development in a civilian setting. The purpose of the individualized, self-paced course is to provide the…

Using the RPE-Talk Scale to Individualize Physical Activity for Students

ERIC Educational Resources Information Center

Nye, Susan B.; Todd, M. Kent

2013-01-01

For some students, self-selecting a pace during exercise may not provide enough of a physical challenge. Others push themselves so hard that they tire out before they can experience the benefits of exercise. In order to improve self-monitoring of exercise intensity, a variety of tools using the perception of effort and the ability to talk while…

Multiyear Subcontractor Selection Criteria Analysis.

DTIC Science & Technology

1983-09-01

advancement are program instability, higher costs, and increased lead-times. Compounding the instability created by advancing technology are changes in...drive smaller firms out of business (17:46). Technology is advancing at an ever increasing pace, demanding higher performance and larger amounts of engi...Process Adding to the external factors mentioned above, the weapon systems acquisition process tends to retard pro- ductivity advancements by its very

Correlated evolution of beak morphology and song in the neotropical woodcreeper radiation.

PubMed

Derryberry, Elizabeth Perrault; Seddon, Nathalie; Claramunt, Santiago; Tobias, Joseph Andrew; Baker, Adam; Aleixo, Alexandre; Brumfield, Robb Thomas

2012-09-01

Mating signals may diversify as a byproduct of morphological adaptation to different foraging niches, potentially driving speciation. Although many studies have focused on the direct influence of ecological and sexual selection on signal divergence, the role of indirect mechanisms remains poorly understood. Using phenotypic and molecular datasets, we explored the interplay between morphological and vocal evolution in an avian radiation characterized by dramatic beak variation, the Neotropical woodcreepers (Dendrocolaptinae). We found evidence of a trade-off between the rate of repetition of song syllables and frequency bandwidth: slow paced songs had either narrow or wide frequency bandwidths, and bandwidth decreased as song pace increased. This bounded phenotypic space for song structure supports the hypothesis that passerine birds face a motor constraint during song production. Diversification of acoustic characters within this bounded space was correlated with diversification of beak morphology. In particular, species with larger beaks produced slower songs with narrower frequency bandwidths, suggesting that ecological selection on beak morphology influences the diversification of woodcreeper songs. Because songs in turn mediate mate choice and species recognition in birds, these results indicate a broader role for ecology in avian diversification. © 2012 The Author(s). Evolution© 2012 The Society for the Study of Evolution.

Impact of pacemaker mode in patients with atrioventricular conduction disturbance after trans-catheter aortic valve implantation.

PubMed

Takahashi, Masao; Badenco, Nicolas; Monteau, Jacques; Gandjbakhch, Estelle; Extramiana, Fabrice; Urena, Marina; Karam, Nicole; Marijon, Eloi; Algalarrondo, Vincent; Teiger, Emmanuel; Lellouche, Nicolas

2018-03-14

This study aimed to assess the impact of pacemaker mode programming on clinical outcomes in patients with high-degree atrioventricular conduction disturbance (AVCD) after transcatheter aortic valve implantation (TAVI). Although high-degree AVCD after TAVI can receive pacemaker, recovery of the AVCD is often observed. Specific pacemaker algorithms (AAI-DDD mode switch) are available which favor spontaneous atrioventricular conduction. Of 1,621 consecutive multi-center TAVI patients, 269 (16.4%) received pacemaker. We retrospectively included 91 patients with persistent high-degree AVCD at hospital discharge. Pacemaker dependency was defined as absence, inadequate intrinsic ventricular rhythm, or ventricular pacing time > 95% on pacemaker interrogation during follow-up. Comparison of heart failure hospitalization and death between conventional DDD (cDDD) and other modes was examined (AAI-DDD and VVI). During a mean follow-up duration of 13 months, the pacemaker dependency rate was 52.8%. Patients with cDDD mode (N = 36: 40.0%) had significantly more pacemaker dependency. Multivariate analysis showed that cDDD mode was independently associated with pacemaker dependency (odds ratio = 3.63, P = 0.03). Moreover, cDDD patients had a significant higher incidence of heart failure hospitalization (Hospitalization: cDDD vs. others = 45.4% vs. 18.2%, P = 0.03) and had a higher incidence of mortality (Death: cDDD vs. the others = 27.0% vs. 4.4%, P = 0.06). Up to half of patients implanted for high-degree AVCD after TAVI had conduction recovery. Patients with cDDD programming at hospital discharge had more pacemaker dependency and a worse cardiac prognosis. Thus, pacemaker mode should be systematically set to promote spontaneous atrioventricular conduction in patients with pacemaker implantation after TAVI. © 2018 Wiley Periodicals, Inc.

Initial experience with mode switching in a dual sensor, dual chamber pacemaker in patients with paroxysmal atrial tachyarrhythmias.

PubMed

den Dulk, K; Dijkman, B; Pieterse, M; Wellens, H

1994-11-01

Mode switching algorithms have been developed to avoid tracking of atrial fibrillation (AF) or flutter (AFL) during DDD(R) pacing. Upon recognition of AF or AFL, the mode is switched to a nontracking, sensor driven mode. The Vitatron Diamond model 800 pacemaker does this on a beat-to-beat basis. Atrial events occurring within a "physiological range" (+/- 15 beats/min) calculated from a running average of the atrial rate are tracked. When atrial events are not tracked the escape interval is either determined by the sensor(s) or by a fallback algorithm thereby preventing large increases in V-V interval during mode switching. Loss of atrioventricular (AV) synchrony by atrial premature beats and after an episode of AF or AFL is prevented by atrial synchronization pulses (ASP), which are delivered after a safe interval (timed out from the sensed premature atrial event) has expired and before delivery of the next ventricular stimulus. We implanted 26 such devices in 18 men and 8 women with symptomatic second- or third-degree AV block and paroxysmal AF or AFL. Their ages ranged from 18-84 years (mean 60), and the follow-up ranged from 2-13 months (mean 8). During pacemaker check-up, exercise testing or 24-hour Holter monitoring one or more episodes of mode switching was documented in 8 patients. In these 8 patients a smooth transition (ventricular rate) from sinus rhythm to AF or AFL was documented on one or more occasions, without inappropriate increase in ventricular rate in the DDDR mode. None of the patients complained of palpitations.(ABSTRACT TRUNCATED AT 250 WORDS)

Mode perturbation method for optimal guided wave mode and frequency selection.

PubMed

Philtron, J H; Rose, J L

2014-09-01

With a thorough understanding of guided wave mechanics, researchers can predict which guided wave modes will have a high probability of success in a particular nondestructive evaluation application. However, work continues to find optimal mode and frequency selection for a given application. This "optimal" mode could give the highest sensitivity to defects or the greatest penetration power, increasing inspection efficiency. Since material properties used for modeling work may be estimates, in many cases guided wave mode and frequency selection can be adjusted for increased inspection efficiency in the field. In this paper, a novel mode and frequency perturbation method is described and used to identify optimal mode points based on quantifiable wave characteristics. The technique uses an ultrasonic phased array comb transducer to sweep in phase velocity and frequency space. It is demonstrated using guided interface waves for bond evaluation. After searching nearby mode points, an optimal mode and frequency can be selected which has the highest sensitivity to a defect, or gives the greatest penetration power. The optimal mode choice for a given application depends on the requirements of the inspection. Copyright © 2014 Elsevier B.V. All rights reserved.

Relationship between left atrium catheter contact force and pacing threshold.

PubMed

Barrio-López, Teresa; Ortiz, Mercedes; Castellanos, Eduardo; Lázaro, Carla; Salas, Jefferson; Madero, Sergio; Almendral, Jesús

2017-08-01

The purpose of this study is to analyze the relationship between contact force (CF) and pacing threshold in left atrium (LA). Six to ten LA sites were studied in 28 consecutive patients with atrial fibrillation undergoing pulmonary vein isolation. Median CF, bipolar and unipolar electrogram voltage, impedance, and bipolar and unipolar thresholds for consistent constant capture and for consistent intermittent capture were measured at each site. Pacing threshold measurements were performed at 188 LA sites. Both unipolar and bipolar pacing thresholds correlated significantly with median CF; however, unipolar pacing threshold correlated better (unipolar: Pearson R -0.45; p < 0.001; Spearman Rho -0.62; p < 0.001, bipolar: Pearson R -0.39; p < 0.001; Spearman Rho -0.52; p < 0.001). Consistent constant capture threshold had better correlation with median CF than consistent intermittent capture threshold for both unipolar and bipolar pacing (Pearson R -0.45; p < 0.001 and Spearman Rho -0.62; p < 0.001 vs. Pearson R -0.35; p < 0.001; Spearman Rho -0.52; p < 0.001). The best pacing threshold cutoff point to detect a good CF (>10 g) was 3.25 mA for unipolar pacing with 69% specificity and 73% sensitivity. Both increased to 80% specificity and 74% sensitivity for sites with normal bipolar voltage and a pacing threshold cutoff value of 2.85 mA. Pacing thresholds correlate with CF in human not previously ablated LA. Since the combination of a normal bipolar voltage and a unipolar pacing threshold <2.85 mA provide reasonable parameters of validity, pacing threshold could be of interest as a surrogate for CF in LA.

"Coffee, tea and me": moderate doses of caffeine affect sexual behavior in female rats.

PubMed

Guarraci, Fay A; Benson, Anastasia

2005-11-01

The present study evaluated the effects of acute caffeine administration on paced mating behavior and partner preference in ovariectomized rats primed with estrogen and progesterone. In Experiment 1, female rats were tested for paced mating behavior following acute administration of caffeine (15 mg/kg). Caffeine shortened the latency to return to a male following an ejaculation. Although this dose of caffeine did not alter the likelihood of leaving a male after receiving sexual stimulation, locomotor activity did increase significantly. Experiment 2 evaluated the dose response characteristics of caffeine (7.5, 15, 30 mg/kg) administration on paced mating behavior. Replicating Experiment 1, caffeine at the lower doses shortened the latency to return to a male following an ejaculation. Finally, to determine whether the effects of caffeine (15 mg/kg) on contact-return latency reflect a change in sexual motivation or merely an inability to inhibit locomotion, rats were tested for partner preference (intact male vs. estrous female) following caffeine administration (Experiment 3). Although caffeine did not disrupt preference for a sexual partner, caffeine selectively increased visits to the male when physical contact was possible. Collectively, these results suggest that the effects of caffeine on female mating behavior may reflect an increase in both sexual motivation and locomotor activity.

Triple-site pacing for cardiac resynchronization in permanent atrial fibrillation - Acute phase results from a prospective observational study.

PubMed

Marques, Pedro; Nobre Menezes, Miguel; Lima da Silva, Gustavo; Bernardes, Ana; Magalhães, Andreia; Cortez-Dias, Nuno; Carpinteiro, Luís; de Sousa, João; Pinto, Fausto J

2016-06-01

Multi-site pacing is emerging as a new method for improving response to cardiac resynchronization therapy (CRT), but has been little studied, especially in patients with atrial fibrillation. We aimed to assess the effects of triple-site (Tri-V) vs. biventricular (Bi-V) pacing on hemodynamics and QRS duration. This was a prospective observational study of patients with permanent atrial fibrillation and ejection fraction <40% undergoing CRT implantation (n=40). One right ventricular (RV) lead was implanted in the apex and another in the right ventricular outflow tract (RVOT) septal wall. A left ventricular (LV) lead was implanted in a conventional venous epicardial position. Cardiac output (using the FloTrac™ Vigileo™ system), mean QRS and ejection fraction were calculated. Mean cardiac output was 4.81±0.97 l/min with Tri-V, 4.68±0.94 l/min with RVOT septal and LV pacing, and 4.68±0.94 l/min with RV apical and LV pacing (p<0.001 for Tri-V vs. both BiV). Mean pre-implantation QRS was 170±25 ms, 123±18 ms with Tri-V, 141±25 ms with RVOT septal pacing and LV pacing and 145±19 with RV apical and LV pacing (p<0.001 for Tri-V vs. both BiV and pre-implantation). Mean ejection fraction was significantly higher with Tri-V (30±11%) vs. Bi-V pacing (28±12% with RVOT septal and LV pacing and 28±11 with RV apical and LV pacing) and pre-implantation (25±8%). Tri-V pacing produced higher cardiac output and shorter QRS duration than Bi-V pacing. This may have a significant impact on the future of CRT. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

Risk perception influences athletic pacing strategy.

PubMed

Micklewright, Dominic; Parry, David; Robinson, Tracy; Deacon, Greg; Renfree, Andrew; St Clair Gibson, Alan; Matthews, William J

2015-05-01

The objective of this study is to examine risk taking and risk perception associations with perceived exertion, pacing, and performance in athletes. Two experiments were conducted in which risk perception was assessed using the domain-specific risk taking (DOSPERT) scale in 20 novice cyclists (experiment 1) and 32 experienced ultramarathon runners (experiment 2). In experiment 1, participants predicted their pace and then performed a 5-km maximum effort cycling time trial on a calibrated Kingcycle mounted bicycle. Split times and perceived exertion were recorded every kilometer. In experiment 2, each participant predicted their split times before running a 100-km ultramarathon. Split times and perceived exertion were recorded at seven checkpoints. In both experiments, higher and lower risk perception groups were created using median split of DOSPERT scores. In experiment 1, pace during the first kilometer was faster among lower risk perceivers compared with higher risk perceivers (t(18) = 2.0, P = 0.03) and faster among higher risk takers compared with lower risk takers (t(18) = 2.2, P = 0.02). Actual pace was slower than predicted pace during the first kilometer in both the higher risk perceivers (t(9) = -4.2, P = 0.001) and lower risk perceivers (t(9) = -1.8, P = 0.049). In experiment 2, pace during the first 36 km was faster among lower risk perceivers compared with higher risk perceivers (t(16) = 2.0, P = 0.03). Irrespective of risk perception group, actual pace was slower than predicted pace during the first 18 km (t(16) = 8.9, P < 0.001) and from 18 to 36 km (t(16) = 4.0, P < 0.001). In both experiments, there was no difference in performance between higher and lower risk perception groups. Initial pace is associated with an individual's perception of risk, with low perceptions of risk being associated with a faster starting pace. Large differences between predicted and actual pace suggest that the performance template lacks accuracy, perhaps indicating greater reliance on momentary pacing decisions rather than preplanned strategy.

Advanced online control mode selection for gas turbine aircraft engines

NASA Astrophysics Data System (ADS)

Wiseman, Matthew William

The modern gas turbine aircraft engine is a complex, highly nonlinear system the operates in a widely varying environment. Traditional engine control techniques based on the hydro mechanical control concepts of early turbojet engines are unable to deliver the performance required from today's advanced engine designs. A new type of advanced control utilizing multiple control modes and an online mode selector is investigated, and various strategies for improving the baseline mode selection architecture are introduced. The ability to five-tune actuator command outputs is added to the basic mode selection and blending process, and mode selection designs that we valid for the entire flight envelope are presented. Methods for optimizing the mode selector to improve overall engine performance are also discussed. Finally, using flight test data from a GE F110-powered F16 aircraft, the full-envelope mode selector designs are validated and shown to provide significant performance benefits. Specifically, thrust command tracking is enhanced while critical engine limits are protected, with very little impact on engine efficiency.

The effect of visitor number and spice provisioning in pacing expression by jaguars evaluated through a case study.

PubMed

Vidal, L S; Guilherme, F R; Silva, V F; Faccio, M C S R; Martins, M M; Briani, D C

2016-06-01

Captive animals exhibit stereotypic pacing in response to multiple causes, including the inability to escape from human contact. Environmental enrichment techniques can minimize pacing expression. By using an individual-based approach, we addressed whether the amount of time two males and a female jaguar (Panthera onca) devote to pacing varied with the number of visitors and tested the effectiveness of cinnamon and black pepper in reducing pacing. The amount of time that all jaguars engaged in pacing increased significantly with the number of visitors. Despite the difference between the males regarding age and housing conditions, both devoted significantly less time to pacing following the addition of both spices, which indicates their suitability as enrichment techniques. Mean time devoted to pacing among the treatments did not differ for the female. Our findings pointed out to the validity of individual-based approaches, as they can reveal how suitable olfactory stimuli are to minimizing stereotypies irrespective of particular traits.

Passive harmonic mode locking by mode selection in Fabry-Perot diode lasers with patterned effective index.

PubMed

Bitauld, David; Osborne, Simon; O'Brien, Stephen

2010-07-01

We demonstrate passive harmonic mode locking of a quantum-well laser diode designed to support a discrete comb of Fabry-Perot modes. Spectral filtering of the mode spectrum was achieved using a nonperiodic patterning of the cavity effective index. By selecting six modes spaced at twice the fundamental mode spacing, near-transform-limited pulsed output with 2 ps pulse duration was obtained at a repetition rate of 100 GHz.

Prevention of Adverse Electrical and Mechanical Remodeling with Bi-Ventricular Pacing in a Rabbit Model of Myocardial Infarction

PubMed Central

Saba, Samir; Mathier, Michael A.; Mehdi, Haider; Gursoy, Erdal; Liu, Tong; Choi, Bum-Rak; Salama, Guy; London, Barry

2008-01-01

Background: Biventricular (BIV) pacing can improve cardiac function in heart failure (HF). Objective: To investigate the mechanisms of benefit of BIV pacing using a rabbit model of myocardial infarction (MI). Methods: New Zealand White rabbits were divided into 4 groups: sham-operated (C), MI with no pacing (MI), MI with right ventricular pacing (MI+RV), and MI with BIV pacing (MI+BIV), and underwent serial electrocardiograms and echocardiograms. At 4 weeks, hearts were excised and tissue was extracted from various areas of the left ventricle (LV). Results: Four weeks after coronary ligation, BIV pacing prevented systolic and diastolic dilation of the LV as well as the reduction in its fractional shortening, restored the QRS width and the rate-dependent QT intervals to their baseline values, and prevented the decline of the ether-a-go-go (erg) protein levels. This prevention of remodeling was not documented in the MI+RV groups. Conclusions: In this rabbit model of BIV pacing and MI, we demonstrate prevention of adverse mechanical and electrical remodeling of the heart. These changes may underlie some of the benefits seen with BIV pacing in HF patients with more severe LV dysfunction. PMID:18180026

The efficacy of self-paced study in multitrial learning.

PubMed

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

2015-05-01

In 2 experiments we investigated the efficacy of self-paced study in multitrial learning. In Experiment 1, native speakers of English studied lists of Dutch-English word pairs under 1 of 4 imposed fixed presentation rate conditions (24 × 1 s, 12 × 2 s, 6 × 4 s, or 3 × 8 s) and a self-paced study condition. Total study time per list was equated for all conditions. We found that self-paced study resulted in better recall performance than did most of the fixed presentation rates, with the exception of the 12 × 2 s condition, which did not differ from the self-paced condition. Additional correlational analyses suggested that the allocation of more study time to difficult pairs than to easy pairs might be a beneficial strategy for self-paced learning. Experiment 2 was designed to test this hypothesis. In 1 condition, participants studied word pairs in a self-paced fashion without any restrictions. In the other condition, participants studied word pairs in a self-paced fashion but total study time per item was equated. The results showed that allowing self-paced learners to freely allocate study time over items resulted in better recall performance. (c) 2015 APA, all rights reserved).

42 CFR 460.102 - Interdisciplinary team.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Interdisciplinary team. 460.102 Section 460.102... ELDERLY (PACE) PACE Services § 460.102 Interdisciplinary team. (a) Basic requirement. A PACE organization must meet the following requirements: (1) Establish an interdisciplinary team at each Pace center to...

42 CFR 460.102 - Interdisciplinary team.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Interdisciplinary team. 460.102 Section 460.102... ELDERLY (PACE) PACE Services § 460.102 Interdisciplinary team. (a) Basic requirement. A PACE organization must meet the following requirements: (1) Establish an interdisciplinary team at each Pace center to...

42 CFR 460.102 - Interdisciplinary team.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Interdisciplinary team. 460.102 Section 460.102... ELDERLY (PACE) PACE Services § 460.102 Interdisciplinary team. (a) Basic requirement. A PACE organization must meet the following requirements: (1) Establish an interdisciplinary team at each Pace center to...

42 CFR 460.102 - Interdisciplinary team.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Interdisciplinary team. 460.102 Section 460.102... ELDERLY (PACE) PACE Services § 460.102 Interdisciplinary team. (a) Basic requirement. A PACE organization must meet the following requirements: (1) Establish an interdisciplinary team at each Pace center to...

42 CFR 460.102 - Interdisciplinary team.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Interdisciplinary team. 460.102 Section 460.102... ELDERLY (PACE) PACE Services § 460.102 Interdisciplinary team. (a) Basic requirement. A PACE organization must meet the following requirements: (1) Establish an interdisciplinary team at each Pace center to...

Spatial resolution of pace mapping of idiopathic ventricular tachycardia/ectopy originating in the right ventricular outflow tract.

PubMed

Bogun, Frank; Taj, Majid; Ting, Michael; Kim, Hyungjin Myra; Reich, Stephen; Good, Eric; Jongnarangsin, Krit; Chugh, Aman; Pelosi, Frank; Oral, Hakan; Morady, Fred

2008-03-01

Pace mapping has been used to identify the site of origin of focal ventricular arrhythmias. The spatial resolution of pace mapping has not been adequately quantified using currently available three-dimensional mapping systems. The purpose of this study was to determine the spatial resolution of pace mapping in patients with idiopathic ventricular tachycardia or premature ventricular contractions originating in the right ventricular outflow tract. In 16 patients with idiopathic ventricular tachycardia/ectopy from the right ventricular outflow tract, comparisons and classifications of pace maps were performed by two observers (good pace map: match >10/12 leads; inadequate pace map: match < or =10/12 leads) and a customized MATLAB 6.0 program (assessing correlation coefficient and normalized root mean square of the difference (nRMSd) between test and template signals). With an electroanatomic mapping system, the correlation coefficient of each pace map was correlated with the distance between the pacing site and the effective ablation site. The endocardial area within the 10-ms activation isochrone was measured. The ablation procedure was effective in all patients. Sites with good pace maps had a higher correlation coefficient and lower nRMSd than sites with inadequate pace maps (correlation coefficient: 0.96 +/- 0.03 vs 0.76 +/- 0.18, P <.0001; nRMSd: 0.41 +/- 0.16 vs 0.89 +/- 0.39, P <.0001). Using receiver operating characteristic curves, appropriate cutoff values were >0.94 for correlation coefficient (sensitivity 81%, specificity 89%) and < or =0.54 for nRMSd (sensitivity 76%, specificity 80%). Good pace maps were located a mean of 7.3 +/- 5.0 mm from the effective ablation site and had a mean activation time of -24 +/- 7 ms. However, in 3 (18%) of 16 patients, the best pace map was inadequate at the effective ablation site, with an endocardial activation time at these sites of -25 +/- 12 ms. Pace maps with correlation coefficient > or =0.94 were confined to an area of 1.8 +/- 0.6 cm2. The 10-ms isochrone measured 1.2 +/- 0.7 cm2. The spatial resolution of a good pace map for targeting ventricular tachycardia/ectopy is 1.8 cm2 in the right ventricular outflow tract and therefore is inferior to the spatial resolution of activation mapping as assessed by isochronal activation. In approximately 20% of patients, pace mapping is unreliable in identifying the site of origin, possibly due a deeper site of origin and preferential conduction via fibers connecting the focus to the endocardial surface.

Feasibility of dual-chamber (DDD) pacing via a single-pass (VDD) pacing lead employing a floating atrial ring (dipole): case series, future considerations, and refinements.

PubMed

Kassotis, John; Voigt, Louis; Mongwa, Mbu; Reddy, C V R

2005-01-01

The objective of this study was to assess the feasibility of DDD pacing from a standard single-pass VDD pacemaker system. Over the past 2 decades significant advances have been made in the development of single-pass VDD pacing systems. These have been shown in long-term prospective studies to effectively preserve atrioventricular (AV)synchrony in patients with AV block and normal sinus node function. What remains problematic is the development of a single-pass pacing system capable of DDD pacing. Such a lead configuration would be useful in those patients with peripheral venous anomalies and in younger patients with congenital anomalies, which may require lead revisions in the future. In addition, with the increased use of resynchronization (biventricular pacing) therapy, the availability of a reliable single-pass lead will minimize operative time, enhance patient safety, and minimize the amount of hardware within the heart. The feasibility of DDD pacing via a Medtronic Capsure VDD-2 (Model #5038) pacing lead was evaluated. Twenty patients who presented with AV block and normal sinus node function were recruited for this study. Atrial pacing thresholds and sensitivities were assessed intraoperatively in the supine position with various respiratory maneuvers. Five patients who agreed to participate in long-term follow-up received a dual-chamber generator and were evaluated periodically over a 12-month period. Mean atrial sensitivity was 2.35 +/- 0.83 mV at the time of implantation. Effective atrial stimulation was possible in all patients at the time of implantation (mean stimulation threshold 3.08 +/- 1.04 V at 0.5 ms [bipolar], 3.34 +/- 0.95 V at 0.5 ms [unipolar]). Five of the 20 patients received a Kappa KDR701 generator, and atrial electrical properties were followed up over a 1-year period. There was no significant change in atrial pacing threshold or incidence of phrenic nerve stimulation over the 1-year follow-up. A standard single-pass VDD pacing lead system was capable of DDD pacing intraoperatively and during long-term follow-up. Despite higher than usual thresholds via the atrial dipole, pacemaker telemetry revealed < 10% use of atrial pacing dipole over a 12-month period, which would minimally deplete the pacemaker's battery. In addition, the telemetry confirmed appropriate sensing and pacing of the atrial dipole throughout the study period. At this time such systems can serve as back-up DDD pacing systems with further refinements required to optimize atrial thresholds in all patients.

The Use of Epicardial Electrogram as a Simple Guide to Select the Optimal Site of Left Ventricular Pacing in Cardiac Resynchronization Therapy

PubMed Central

Fatemi, Marjaneh; Le Gal, Grégoire; Blanc, Jean-Jacques; Mansourati, Jacques; Etienne, Yves

2011-01-01

Cardiac resynchronization therapy (CRT) has been demonstrated to improve symptoms and survival in patients with left ventricular (LV) systolic dysfunction and dyssynchrony. To achieve this goal, the LV lead should be positioned in a region of delayed contraction. We hypothesized that pacing at the site of late electrical activation was also associated with long-term response to CRT. We conducted a retrospective study on 72 CRT patients. For each patient, we determined the electrical delay (ED) from the onset of QRS to the epicardial EGM and the ratio of ED to QRS duration (ED/QRS duration). After a followup of 30 ± 20 months, 47 patients responded to CRT. Responders had a significantly longer ED and greater ratio of ED/QRS duration than nonresponders. An ED/QRS duration ≥0.38 predicted a response to CRT with 89% specificity and 53% sensitivity. PMID:21403903

Avionics Architectures for Exploration: Building a Better Approach for (Human) Spaceflight Avionics

NASA Technical Reports Server (NTRS)

Goforth, Montgomery B.; Ratliff, James E.; Hames, Kevin L.; Vitalpur, Sharada V.

2014-01-01

The field of Avionics is advancing far more rapidly in terrestrial applications than in space flight applications. Spaceflight Avionics are not keeping pace with expectations set by terrestrial experience, nor are they keeping pace with the need for increasingly complex automation and crew interfaces as we move beyond Low Earth Orbit. NASA must take advantage of the strides being made by both space-related and terrestrial industries to drive our development and sustaining costs down. This paper describes ongoing efforts by the Avionics Architectures for Exploration (AAE) project chartered by NASA's Advanced Exploration Systems (AES) Program to evaluate new avionic architectures and technologies, provide objective comparisons of them, and mature selected technologies for flight and for use by other AES projects. Results from the AAE project's FY13 efforts are discussed, along with the status of FY14 efforts and future plans.

Symptoms of chronic fatigue syndrome/myalgic encephalopathy are not determined by activity pacing when measured by the chronic pain coping inventory.

PubMed

Thompson, D P; Antcliff, D; Woby, S R

2018-03-01

Chronic fatigue syndrome/myalgic encephalopathy (CFS/ME) is a chronic illness which can cause significant fatigue, pain and disability. Activity pacing is frequently advocated as a beneficial coping strategy, however, it is unclear whether pacing is significantly associated with symptoms in people with CFS/ME. The first aim of this study was therefore to explore the cross-sectional associations between pacing and levels of pain, disability and fatigue. The second aim was to explore whether changes in activity pacing following participation in a symptom management programme were related to changes in clinical outcomes. Cross-sectional study exploring the relationships between pacing, pain, disability and fatigue (n=114) and pre-post treatment longitudinal study of a cohort of patients participating in a symptom management programme (n=35). Out-patient physiotherapy CFS/ME service. One-hundred and fourteen adult patients with CFS/ME. Pacing was assessed using the chronic pain coping inventory. Pain was measured using a Numeric Pain Rating Scale, fatigue with the Chalder Fatigue Scale and disability with the Fibromyalgia Impact Questionnaire. No significant associations were observed between activity pacing and levels of pain, disability or fatigue. Likewise, changes in pacing were not significantly associated with changes in pain, disability or fatigue following treatment. Activity pacing does not appear to be a significant determinant of pain, fatigue or disability in people with CFS/ME when measured with the chronic pain coping index. Consequently, the utility and measurement of pacing require further investigation. Copyright © 2017 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Influence of pacing site characteristics on response to cardiac resynchronization therapy.

PubMed

Wong, Jorge A; Yee, Raymond; Stirrat, John; Scholl, David; Krahn, Andrew D; Gula, Lorne J; Skanes, Allan C; Leong-Sit, Peter; Klein, George J; McCarty, David; Fine, Nowell; Goela, Aashish; Islam, Ali; Thompson, Terry; Drangova, Maria; White, James A

2013-07-01

Transmural scar occupying left ventricular (LV) pacing regions has been associated with reduced response to cardiac resynchronization therapy (CRT). However, spatial influences of lead tip delivery relative to scar at both pacing sites remain poorly explored. This study evaluated scar distribution relative to LV and right ventricular (RV) lead tip placement through coregistration of late gadolinium enhancement MRI and cardiac computed tomographic (CT) findings. Influences on CRT response were assessed by serial echocardiography. Sixty patients receiving CRT underwent preimplant late gadolinium enhancement MRI, postimplant cardiac CT, and serial echocardiography. Blinded segmental evaluations of mechanical delay, percentage scar burden, and lead tip location were performed. Response to CRT was defined as a reduction in LV end-systolic volume ≥15% at 6 months. The mean age and LV ejection fraction were 64±9 years and 25±7%, respectively. Mean scar volume was higher among CRT nonresponders for both the LV (23±23% versus 8±14% [P=0.01]) and RV pacing regions (40±32% versus 24±30% [P=0.04]). Significant pacing region scar was identified in 13% of LV pacing regions and 37% of RV pacing regions. Absence of scar in both regions was associated with an 81% response rate compared with 55%, 25%, and 0%, respectively, when the RV, LV, or both pacing regions contained scar. LV pacing region dyssynchrony was not predictive of response. Myocardial scar occupying the LV pacing region is associated with nonresponse to CRT. Scar occupying the RV pacing region is encountered at higher frequency and seems to provide a more intermediate influence on CRT response.

Systematic review and meta-analysis of left ventricular endocardial pacing in advanced heart failure: Clinically efficacious but at what cost?

PubMed

Graham, Adam J; Providenica, Rui; Honarbakhsh, Shohreh; Srinivasan, Neil; Sawhney, Vinit; Hunter, Ross; Lambiase, Pier

2018-04-01

Cardiac resynchronization using a left ventricular (LV) epicardial lead placed in the coronary sinus is now routinely used in the management of heart failure patients. LV endocardial pacing is an alternative when this is not feasible, with outcomes data sparse. To review the available evidence on the efficacy and safety of endocardial LV pacing via meta-analysis. EMBASE, MEDLINE, and COCHRANE databases with the search term "endocardial biventricular pacing" or "endocardial cardiac resynchronization" or "left ventricular endocardial" or "endocardial left ventricular." Comparisons of pre-and post-QRS width, LV ejection fraction (LVEF), and New York Heart Association (NYHA) functional classification was performed, and mean differences (and respective 95% confidence interval [CI]) applied as a measurement of treatment effect. Fifteen studies, including 362 patients, were selected. During a mean follow-up of 40 ± 24.5 months, death occurred in 72 patients (11 per 100 patient-years). Significant improvements in LVEF (mean difference 7.9%, 95% CI 5-10%, P < 0.0001; I 2  = 73%), QRS width (mean difference: -41% 95% -75 to -7%; P < 0.0001; I 2  = 94%), and NYHA class (mean difference: -1.06, 95% CI -1.2 to -0.9, P < 0.0001; I 2  = 60%), (all P < 0.0001) occurred. Stroke rate was 3.3-4.2 per 100 patient-years, which is higher than equivalent heart failure trial populations and recent meta-analysis that included small case series. LV endocardial lead implantation is a potentially efficacious alternative to CS lead placement, but preliminary data suggest a potentially higher risk of stroke during follow-up when compared to the expected incidence of stroke in similar cohorts of patients. © 2018 Wiley Periodicals, Inc.

42 CFR 460.186 - PACE premiums.

Code of Federal Regulations, 2011 CFR

2011-10-01

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

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

ERIC Educational Resources Information Center

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

2013-01-01

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

Unintended Outcomes of University-Community Partnerships: Building Organizational Capacity with PACE International Partners

ERIC Educational Resources Information Center

Lloyd, Kate; Clark, Lindie; Hammersley, Laura; Baker, Michaela; Rawlings-Sanaei, Felicity; D'ath, Emily

2015-01-01

Professional and Community Engagement (PACE) at Macquarie University provides experiential opportunities for students and staff to contribute to more just, inclusive and sustainable societies by engaging in activities with partner organizations. PACE International offers a range of opportunities with partners overseas. Underpinning PACE is a…

Pulsatile support using a rotary left ventricular assist device with an electrocardiography-synchronized rotational speed control mode for tracking heart rate variability.

PubMed

Arakawa, Mamoru; Nishimura, Takashi; Takewa, Yoshiaki; Umeki, Akihide; Ando, Masahiko; Kishimoto, Yuichiro; Kishimoto, Satoru; Fujii, Yutaka; Date, Kazuma; Kyo, Shunei; Adachi, Hideo; Tatsumi, Eisuke

2016-06-01

We previously developed a novel control system for a continuous-flow left ventricular assist device (LVAD), the EVAHEART, and demonstrated that sufficient pulsatility can be created by increasing its rotational speed in the systolic phase (pulsatile mode) in a normal heart animal model. In the present study, we assessed this system in its reliability and ability to follow heart rate variability. We implanted an EVAHEART via left thoracotomy into five goats for the Study for Fixed Heart Rate with ventricular pacing at 80, 100, 120 and 140 beats/min and six goats for the Study for native heart rhythm. We tested three modes: the circuit clamp, the continuous mode and the pulsatile mode. In the pulsatile mode, rotational speed was increased during the initial 35 % of the RR interval by automatic control based on the electrocardiogram. Pulsatility was evaluated by pulse pressure and dP/dt max of aortic pressure. As a result, comparing the pulsatile mode with the continuous mode, the pulse pressure was 28.5 ± 5.7 vs. 20.3 ± 7.9 mmHg, mean dP/dt max was 775.0 ± 230.5 vs 442.4 ± 184.7 mmHg/s at 80 bpm in the study for fixed heart rate, respectively (P < 0.05). The system successfully determined the heart rate to be 94.6 % in native heart rhythm. Furthermore, pulse pressure was 41.5 ± 7.9 vs. 27.8 ± 5.6 mmHg, mean dP/dt max was 716.2 ± 133.9 vs 405.2 ± 86.0 mmHg/s, respectively (P < 0.01). In conclusion, our newly developed the pulsatile mode for continuous-flow LVADs reliably provided physiological pulsatility with following heart rate variability.

The Value in Rushing: Memory and Selectivity when Short on Time

PubMed Central

Middlebrooks, Catherine D.; Murayama, Kou; Castel, Alan D.

2016-01-01

While being short on time can certainly limit what one remembers, are there always such costs? The current study investigates the impact of time constraints on selective memory and the self-regulated study of valuable information. Participants studied lists of words ranging in value from 1-10 points, with the goal being to maximize their score during recall. Half of the participants studied these words at a constant presentation rate of either 1 or 5 seconds. The other half of participants studied under both rates, either fast (1sec) during the first several lists and then slow (5sec) during later lists, or vice versa. Study was then self-paced during a final segment of lists for all participants to determine how people regulate their study time after experiencing different presentation rates during study. While participants recalled more words overall when studying at a 5-second rate, there were no significant differences in terms of value-based recall, with all participants demonstrating better recall for higher-valued words and similar patterns of selectivity, regardless of study time or prior timing experience. Self-paced study was also value-based, with participants spending more time studying high-value words than low-value. Thus, while being short on time may have impaired memory overall, participants’ attention to item value during study was not differentially impacted by the fast and slow timing rates. Overall, these findings offer further insight regarding the influence that timing schedules and task experience have on how people selectively focus on valuable information. PMID:27305652

A Mathematical Model to Predict Endothelial Cell Density Following Penetrating Keratoplasty With Selective Dropout From Graft Failure

PubMed Central

Riddlesworth, Tonya D.; Kollman, Craig; Lass, Jonathan H.; Patel, Sanjay V.; Stulting, R. Doyle; Benetz, Beth Ann; Gal, Robin L.; Beck, Roy W.

2014-01-01

Purpose. We constructed several mathematical models that predict endothelial cell density (ECD) for patients after penetrating keratoplasty (PK) for a moderate-risk condition (principally Fuchs' dystrophy or pseudophakic/aphakic corneal edema). Methods. In a subset (n = 591) of Cornea Donor Study participants, postoperative ECD was determined by a central reading center. Various statistical models were considered to estimate the ECD trend longitudinally over 10 years of follow-up. A biexponential model with and without a logarithm transformation was fit using the Gauss-Newton nonlinear least squares algorithm. To account for correlated data, a log-polynomial model was fit using the restricted maximum likelihood method. A sensitivity analysis for the potential bias due to selective dropout was performed using Bayesian analysis techniques. Results. The three models using a logarithm transformation yield similar trends, whereas the model without the transform predicts higher ECD values. The adjustment for selective dropout turns out to be negligible. However, this is possibly due to the relatively low rate of graft failure in this cohort (19% at 10 years). Fuchs' dystrophy and pseudophakic/aphakic corneal edema (PACE) patients had similar ECD decay curves, with the PACE group having slightly higher cell densities by 10 years. Conclusions. Endothelial cell loss after PK can be modeled via a log-polynomial model, which accounts for the correlated data from repeated measures on the same subject. This model is not significantly affected by the selective dropout due to graft failure. Our findings warrant further study on how this may extend to ECD following endothelial keratoplasty. PMID:25425307

Femtosecond pulse inscription of a selective mode filter in large mode area fibers

NASA Astrophysics Data System (ADS)

Krämer, Ria G.; Voigtländer, Christian; Freier, Erik; Liem, Andreas; Thomas, Jens U.; Richter, Daniel; Schreiber, Thomas; Tünnermann, Andreas; Nolte, Stefan

2013-02-01

We present a selective mode filter inscribed with ultrashort pulses directly into a few mode large mode area (LMA) fiber. The mode filter consists of two refractive index modifications alongside the fiber core in the cladding. The refractive index modifications, which were of approximately the same order of magnitude as the refractive index difference between core and cladding have been inscribed by nonlinear absorption of femtosecond laser pulses (800 nm wavelength, 120 fs pulse duration). If light is guided in the core, it will interact with the inscribed modifications causing modes to be coupled out of the core. In order to characterize the mode filter, we used a femtosecond inscribed fiber Bragg grating (FBG), which acts as a wavelength and therefore mode selective element in the LMA fiber. Since each mode has different Bragg reflection wavelengths, an FBG in a multimode fiber will exhibit multiple Bragg reflection peaks. In our experiments, we first inscribed the FBG using the phase mask scanning technique. Then the mode filter was inscribed. The reflection spectrum of the FBG was measured in situ during the inscription process using a supercontinuum source. The reflectivities of the LP01 and LP11 modes show a dependency on the length of the mode filter. Two stages of the filter were obtained: one, in which the LP11 mode was reduced by 60% and one where the LP01 mode was reduced by 80%. The other mode respectively showed almost no losses. In conclusion, we could selectively filter either the fundamental or higher order modes.

Path planning during combustion mode switch

DOEpatents

Jiang, Li; Ravi, Nikhil

2015-12-29

Systems and methods are provided for transitioning between a first combustion mode and a second combustion mode in an internal combustion engine. A current operating point of the engine is identified and a target operating point for the internal combustion engine in the second combustion mode is also determined. A predefined optimized transition operating point is selected from memory. While operating in the first combustion mode, one or more engine actuator settings are adjusted to cause the operating point of the internal combustion engine to approach the selected optimized transition operating point. When the engine is operating at the selected optimized transition operating point, the combustion mode is switched from the first combustion mode to the second combustion mode. While operating in the second combustion mode, one or more engine actuator settings are adjusted to cause the operating point of the internal combustion to approach the target operating point.

Surviving or Thriving? Do Teachers Have Lower Perceived Control and Well-Being than Other Professions?

ERIC Educational Resources Information Center

Grenville-Cleave, Bridget; Boniwell, Ilona

2012-01-01

Teaching is not what it used to be. The complexity and intensity of the pressures on teachers and the pace of education reform are unprecedented. The aim of this research was to explore perceived control and well-being in teachers and other professionals. A mixed methods design was selected. Phase 1 consisted of an online quantitative survey (298…

JPRS Report, China, Selected Provincial Reports.

DTIC Science & Technology

1991-07-26

114.8 billion yuan. The province’s gross value of the scientific and technological sector, vast numbers of industrial output totalled 219.77 billion...and technological progress made increasingly were valued at 57.04 billion yuan, increasing at an important contributions to economic growth. Educa...outlook and investment environment showed new fairly comfortable life. In 1990, urban people’s per- improvements. The pace of technological transforma

The Effect of Scheduling Models for Introductory Algebra on 9th-Grade Students, Test Scores and Grades

ERIC Educational Resources Information Center

O'Hanlon, Angela L.

2011-01-01

The purpose of the study was to determine the effect of pacing and scheduling of algebra coursework on assigned 9th-grade students who traditionally would qualify for pre-algebra instruction and same course 9th-grade students who traditionally would qualify for standard algebra instruction. Students were selected based on completion of first-year…

PACE (Revised). Resource Guide. Research & Development Series No. 240D.

ERIC Educational Resources Information Center

Ashmore, M. Catherine; Pritz, Sandra G.

This resource guide contains information on the Program for Acquiring Competence in Entrepreneurship (PACE) materials, a glossary, and listings of sources of information. Introductory materials include a description of PACE, information on use of PACE materials, and objectives of the 18 units for all three levels at which they are developed. An…

Predicting Successful Completion Using Student Delay Indicators in Undergraduate Self-Paced Online Courses

ERIC Educational Resources Information Center

Lim, Janine M.

2016-01-01

Self-paced online courses meet flexibility and learning needs of many students, but skepticism persists regarding the quality and the tendency for students to procrastinate in self-paced courses. Research is needed to understand procrastination and delay patterns of students in online self-paced courses to predict successful completion and…

Mode selection and tuning of single-frequency short-cavity VECSELs

DOE PAGES

Serkland, Darwin K.; So, Haley M.; Peake, Gregory M.; ...

2018-03-05

Here, we report on mode selection and tuning properties of vertical-external-cavity surface-emitting lasers (VECSELs) containing coupled semiconductor and external cavities of total length less than 1 mm. Our goal is to create narrowlinewidth (<1MHz) single-frequency VECSELs that operate near 850 nm on a single longitudinal cavity resonance and tune versus temperature without mode hops. We have designed, fabricated, and measured VECSELs with external-cavity lengths ranging from 25 to 800 μm. Lastly, we compare simulated and measured coupled-cavity mode frequencies and discuss criteria for single mode selection.

Further evidence for the role of gap junctions in the delayed antiarrhythmic effect of cardiac pacing.

PubMed

Miskolczi, Gottfried; Gönczi, Márton; Kovács, Mária; Seprényi, György; Végh, Ágnes

2015-07-01

The objective of this study was to provide evidence that gap junctions are involved in the delayed antiarrhythmic effect of cardiac pacing. Twenty-four dogs were paced through the right ventricle (4 × 5 min, rate of 240 beats/min) 24 h prior to a 25 min occlusion of the left anterior descending coronary artery. Some of these paced dogs were infused with 50 (n = 7) or 100 μmol/L (n = 7) of the gap junction uncoupler carbenoxolone (CBX), prior to and during the occlusion. Ten sham-paced dogs, subjected only to occlusion, served as the controls. Cardiac pacing markedly reduced the number of ectopic beats and episodes of ventricular tachycardia (VT), as well the incidence of VT and ventricular fibrillation during occlusion. The changes in severity of ischaemia and tissue electrical resistance were also less marked compared with the unpaced controls. Pacing also preserved the permeability of gap junctions, the phosphorylation of connexin43, and the structural integrity of the intercalated discs. The closing of gap junctions with CBX prior to and during ischaemia markedly attenuated or even abolished these protective effects of pacing. Our results support the previous findings that gap junctions play a role in the delayed antiarrhythmic effect of cardiac pacing.

Differential effects of film on preschool children's behaviour dependent on editing pace.

PubMed

Kostyrka-Allchorne, Katarzyna; Cooper, Nicholas R; Gossmann, Anna Maria; Barber, Katy J; Simpson, Andrew

2017-05-01

Evidence on how the pace of television and film editing affects children's behaviour and attention is inconclusive. We examined whether a fast-paced film affected how preschool-aged children interacted with toys. The study comprised 70 children (36 girls) aged two to four-and-a-half years who attended preschools in Essex, United Kingdom. The children were paired up and tested with either a fast- or a slow-paced film of a narrator reading a children's story. The fast-paced version had 102 camera cuts and 16 still images, and the slow-paced version had 22 camera cuts and four still images. Each dyad took part in two video-recorded free-play sessions, before and after they watched one of the specially edited four-minute films. The number of toys the children played with before and after the film sessions was recorded. Before they watched the films, the children's behaviour did not differ between the groups. However, after watching the film, the children in the fast-paced group shifted their attention between toys more frequently than the children who watched the slow-paced film. Even a brief exposure to differently paced films had an immediate effect on how the children interacted with their toys. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Surprisingly Low Limits of Selection in Plant Domestication

PubMed Central

Allaby, Robin G.; Kitchen, James L.; Fuller, Dorian Q.

2015-01-01

Current debate concerns the pace at which domesticated plants emerged from cultivated wild populations and how many genes were involved. Using an individual-based model, based on the assumptions of Haldane and Maynard Smith, respectively, we estimate that a surprisingly low number of 50–100 loci are the most that could be under selection in a cultivation regime at the selection strengths observed in the archaeological record. This finding is robust to attempts to rescue populations from extinction through selection from high standing genetic variation, gene flow, and the Maynard Smith-based model of threshold selection. Selective sweeps come at a cost, reducing the capacity of plants to adapt to new environments, which may contribute to the explanation of why selective sweeps have not been detected more frequently and why expansion of the agrarian package during the Neolithic was so frequently associated with collapse. PMID:27081302

Pacing and Self-regulation: Important Skills for Talent Development in Endurance Sports.

PubMed

Elferink-Gemser, Marije T; Hettinga, Florentina J

2017-07-01

Pacing has been characterized as a multifaceted goal-directed process of decision making in which athletes need to decide how and when to invest their energy during the race, a process essential for optimal performance. Both physiological and psychological characteristics associated with adequate pacing and performance are known to develop with age. Consequently, the multifaceted skill of pacing might be under construction throughout adolescence, as well. Therefore, the authors propose that the complex skill of pacing is a potential important performance characteristic for talented youth athletes that needs to be developed throughout adolescence. To explore whether pacing is a marker for talent and how talented athletes develop this skill in middle-distance and endurance sports, they aim to bring together literature on pacing and literature on talent development and self-regulation of learning. Subsequently, by applying the cyclical process of self-regulation to pacing, they propose a practical model for the development of performance in endurance sports in youth athletes. Not only is self-regulation essential throughout the process of reaching the long-term goal of athletic excellence, but it also seems crucial for the development of pacing skills within a race and the development of a refined performance template based on previous experiences. Coaches and trainers are advised to incorporate pacing as a performance characteristic in their talent-development programs by stimulating their athletes to reflect, plan, monitor, and evaluate their races on a regular basis to build performance templates and, as such, improve their performance.

PACE4 is an important driver of ZR-75-1 estrogen receptor-positive breast cancer proliferation and tumor progression.

PubMed

Panet, François; Couture, Frédéric; Kwiatkowska, Anna; Desjardins, Roxane; Guérin, Brigitte; Day, Robert

2017-08-01

Breast cancer is the most frequent and deadly malignancy in women worldwide. Despite national screening programs combined with new treatments relapse rate remain high and new therapies are needed. From previous work, we identified PACE4, a member of the proprotein convertase (PCs) family of endoproteases, as a novel therapeutic target in prostate cancer. In the present study we asked the question if PACE4 could also be a potential target in breast cancer. In clinical samples of breast adenocarcinoma, we observed a specific overexpression of PACE4 in the estrogen-receptor (ER) positive subtype. We therefore looked for a breast cancer cell line model which would be representative and thus focused on the ZR-75-1 since it both expresses PACE4 and is estrogen-receptor positive. We compared stable knockdowns of furin, PACE4 and PC7 in the estrogen-receptor-positive cell line ZR-75-1 to evaluate their respective contribution to cell growth and tumor progression. PACE4 was the only PC displaying an impact on cell growth. A PACE4 peptide-based inhibitor (C23) was tested and shown to decrease proliferation of ZR-75-1 cells in cell based assays. C23 also had potent effects of tumor progression in vivo on xenografts of the ZR-75-1 cell line in athymic nude mice. Thus, PACE4-silencing and systemic administration of a PACE4 inhibitor resulted in hindered tumor progression with reduction in proliferative indices and increased cell quiescence assessed with biomarkers. Our results suggest that PACE4 is a promising target for estrogen-receptor-positive breast cancer. Copyright © 2017 Elsevier GmbH. All rights reserved.

Impact of high-grade Atrioventricular block and cumulative frequent pacing on atrial arrhythmias.

PubMed

Wali, Eisha; Deshmukh, Amrish; Bukari, Abdallah; Broman, Michael; Aziz, Zaid; Beaser, Andrew; Upadhyay, Gaurav; Nayak, Hemal M; Tung, Roderick; Ozcan, Cevher

2018-06-21

The relationship between high-grade AV block (HGAVB) with cumulative frequent pacing and risk of atrial arrhythmias (AAs) has not been well characterized. We hypothesized HGAVB and pacing may have significant impact on incidence and prevalence of AAs by modulating atrial substrate. To determine impact of HGAVB and pacing on AAs including atrial fibrillation (AF), atrial flutter (AFL), and atrial tachycardia (AT). All consecutive patients who underwent dual chamber pacemaker implantation for HGAVB from 2005 to 2011 at the University of Chicago were included. AAs and percent of pacing were detected through device interrogation. Patients' data were collected from electronic medical records and clinic visits. A total of 166 patients (mean age 71±15 years; 54% female, 56% African-American) were studied. AF was documented in 27% of patients before pacemaker implantation. During a mean 5.8±2.2 years of follow-up, 47% had device-detected AF, 10% AFL and 26% AT. New-onset AF was documented in 40 of the 122 patients without prior AF (33%). Continuous (≥99%) right ventricular pacing was associated with significantly decreased AF prevalence (34% versus 59%, p = 0.005), and correlated with lower incidence (26% versus 41%, p = 0.22). Pacing suppressed AF in 14% of patients with baseline AF; those patients had lower atrial pacing (3.2% versus 45%, p < 0.0001). Left atrial dilation was the only independent predictor of AF with frequent pacing (p = 0.009). HGAVB is associated with high incidence and prevalence of AAs with and without pacing. Cumulative frequent (≥99%) ventricular pacing reduces risk of AF in patients with HGAVB. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

New approaches to determine fatigue in elite athletes during intensified training: Resting metabolic rate and pacing profile

PubMed Central

2017-01-01

Background Elite rowers complete a high volume of training across a number of modalities to prepare for competition, including periods of intensified load, which may lead to fatigue and short-term performance decrements. As yet, the influence of substantial fatigue on resting metabolic rate (RMR) and exercise regulation (pacing), and their subsequent utility as monitoring parameters, has not been explicitly investigated in elite endurance athletes. Method Ten National-level rowers completed a four-week period of intensified training. RMR, body composition and energy intake were assessed PRE and POST the four-week period using indirect calorimetry, Dual-Energy X-Ray Densitometry (DXA), and three-day food diary, respectively. On-water rowing performance and pacing strategy was evaluated from 5 km time trials. Wellness was assessed weekly using the Multicomponent Training Distress Scale (MTDS). Results Significant decreases in absolute (mean ± SD of difference, p-value: -466 ± 488 kJ.day-1, p = 0.01) and relative RMR (-8.0 ± 8.1 kJ.kg.FFM-1, p = 0.01) were observed. Significant reductions in body mass (-1.6 ± 1.3 kg, p = 0.003) and fat mass (-2.2 ± 1.2 kg, p = 0.0001) were detected, while energy intake was unchanged. On-water 5 km rowing performance worsened (p < 0.05) and an altered pacing strategy was evident. Fatigue and total mood disturbance significantly increased across the cycle (p < 0.05), and trends were observed for reduced vigour and increased sleep disturbance (p < 0.1). Conclusion Four weeks of heavy training decreased RMR and body composition variables in elite rowers and induced substantial fatigue, likely related to an imbalance between energy intake and output. This study demonstrates that highly experienced athletes do not necessarily select the correct energy intake during periods of intensified training, and this can be assessed by reductions in RMR and body composition. The shortfall in energy availability likely affected recovery from training and altered 5 km time trial pacing strategy, resulting in reduced performance. PMID:28296943

The enhanced ASDEX Upgrade pellet centrifuge launcher

NASA Astrophysics Data System (ADS)

Plöckl, B.; Lang, P. T.

2013-10-01

Pellets played an important role in the program of ASDEX Upgrade serving both for investigations on efficient particle fuelling and high density scenarios but also for pioneering work on Edge Localised Mode (ELM) pacing and mitigation. Initially designed for launching fuelling pellets from the magnetic low field side, the system was converted already some time ago to inject pellets from the magnetic high field side as much higher fuelling efficiency was found using this configuration. In operation for more than 20 years, the pellet launching system had to undergo a major revision and upgrading, in particular of its control system. Furthermore, the control system installed adjacent to the launcher had to be transferred to a more distant location enforcing a complete galvanic separation from torus potential and a fully remote control solution. Changing from a hybrid system consisting of PLC S5/S7 and some hard wired relay control to a state of the art PLC system allowed the introduction of several new operational options enabling more flexibility in the pellet experiments. This article describes the new system architecture of control hardware and software, the operating procedure, and the extended operational window. First successful applications for ELM pacing and triggering studies are presented as well as utilization for the development of high density scenarios.

The enhanced ASDEX Upgrade pellet centrifuge launcher.

PubMed

Plöckl, B; Lang, P T

2013-10-01

Pellets played an important role in the program of ASDEX Upgrade serving both for investigations on efficient particle fuelling and high density scenarios but also for pioneering work on Edge Localised Mode (ELM) pacing and mitigation. Initially designed for launching fuelling pellets from the magnetic low field side, the system was converted already some time ago to inject pellets from the magnetic high field side as much higher fuelling efficiency was found using this configuration. In operation for more than 20 years, the pellet launching system had to undergo a major revision and upgrading, in particular of its control system. Furthermore, the control system installed adjacent to the launcher had to be transferred to a more distant location enforcing a complete galvanic separation from torus potential and a fully remote control solution. Changing from a hybrid system consisting of PLC S5/S7 and some hard wired relay control to a state of the art PLC system allowed the introduction of several new operational options enabling more flexibility in the pellet experiments. This article describes the new system architecture of control hardware and software, the operating procedure, and the extended operational window. First successful applications for ELM pacing and triggering studies are presented as well as utilization for the development of high density scenarios.

The enhanced ASDEX Upgrade pellet centrifuge launcher

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

Plöckl, B.; Lang, P. T.

2013-10-15

Pellets played an important role in the program of ASDEX Upgrade serving both for investigations on efficient particle fuelling and high density scenarios but also for pioneering work on Edge Localised Mode (ELM) pacing and mitigation. Initially designed for launching fuelling pellets from the magnetic low field side, the system was converted already some time ago to inject pellets from the magnetic high field side as much higher fuelling efficiency was found using this configuration. In operation for more than 20 years, the pellet launching system had to undergo a major revision and upgrading, in particular of its control system.more » Furthermore, the control system installed adjacent to the launcher had to be transferred to a more distant location enforcing a complete galvanic separation from torus potential and a fully remote control solution. Changing from a hybrid system consisting of PLC S5/S7 and some hard wired relay control to a state of the art PLC system allowed the introduction of several new operational options enabling more flexibility in the pellet experiments. This article describes the new system architecture of control hardware and software, the operating procedure, and the extended operational window. First successful applications for ELM pacing and triggering studies are presented as well as utilization for the development of high density scenarios.« less

Pacing, Pixels, and Paper: Flexibility in Learning Words from Flashcards

ERIC Educational Resources Information Center

Sage, Kara; Rausch, Joseph; Quirk, Abigail; Halladay, Lauren

2016-01-01

The present study focused on how self-control over pace might help learners successfully extract information from digital learning aids. Past research has indicated that too much control over pace can be overwhelming, but too little control over pace can be ineffective. Within the popular self-testing domain of flashcards, we sought to elucidate…

Effects of Modality and Pace on Achievement, Mental Effort, and Positive Affect in Multimedia Learning Environments

ERIC Educational Resources Information Center

Izmirli, Serkan; Kurt, Adile Askim

2016-01-01

The purpose of the study was to examine the effects of instruction given with different multimedia modalities (written text + animation or narration + animation) on the academic achievement, cognitive load, and positive affect in different paces (learner-paced or system-paced); 97 freshmen university students divided into four groups taught in…

The effects of husbandry training on stereotypic pacing in captive African wild dogs (Lycaon pictus).

PubMed

Shyne, Amanda; Block, Martin

2010-01-01

To examine the effects of operant conditioning on stereotypic pacing in 3 female African wild dogs located at the Franklin Park Zoo in Boston, this study made recordings of pacing behavior immediately following individual sessions of husbandry training and 2 no-training conditions. The study found significant differences in the percentage of observations spent in stereotypic pacing behaviors for all 3 dogs among the 3 different conditions. The authors discuss the data in terms of the contribution of motivated tasks to the effects and the role of food deprivation in the expression of stereotypic pacing. The study suggests that even short periods of training may improve the African wild dogs' welfare by reducing stereotypic pacing following the conditioning sessions.

Rate-dependent Loss of Capture during Ventricular Pacing.

PubMed

Wang, Jingfeng; Chen, Haiyan; Su, Yangang; Ge, Junbo

2015-01-01

A 63-year-old patient who had undergone atrial septal defect surgical repair received implantation of a single chamber VVI pacemaker for long RR intervals during atrial fibrillation. One week later, an intermittent loss of capture and sensing failure was detected at a pacing rate of 70 beats/min. However, a successful capture was observed during rapid pacing. Consequently, the pacing rate was temporarily adjusted to 90 beats/min. At the 3-month follow-up, the pacemaker was shown to be functioning properly independent of the pacing rate. An echocardiogram showed that the increased pacing rates were accompanied by a reduction in the right ventricular outflow tract dimension. The pacemaker was then permanently programmed at a lower rate of 60 beats/min.

Mode selective generation of guided waves by systematic optimization of the interfacial shear stress profile

NASA Astrophysics Data System (ADS)

Yazdanpanah Moghadam, Peyman; Quaegebeur, Nicolas; Masson, Patrice

2015-01-01

Piezoelectric transducers are commonly used in structural health monitoring systems to generate and measure ultrasonic guided waves (GWs) by applying interfacial shear and normal stresses to the host structure. In most cases, in order to perform damage detection, advanced signal processing techniques are required, since a minimum of two dispersive modes are propagating in the host structure. In this paper, a systematic approach for mode selection is proposed by optimizing the interfacial shear stress profile applied to the host structure, representing the first step of a global optimization of selective mode actuator design. This approach has the potential of reducing the complexity of signal processing tools as the number of propagating modes could be reduced. Using the superposition principle, an analytical method is first developed for GWs excitation by a finite number of uniform segments, each contributing with a given elementary shear stress profile. Based on this, cost functions are defined in order to minimize the undesired modes and amplify the selected mode and the optimization problem is solved with a parallel genetic algorithm optimization framework. Advantages of this method over more conventional transducers tuning approaches are that (1) the shear stress can be explicitly optimized to both excite one mode and suppress other undesired modes, (2) the size of the excitation area is not constrained and mode-selective excitation is still possible even if excitation width is smaller than all excited wavelengths, and (3) the selectivity is increased and the bandwidth extended. The complexity of the optimal shear stress profile obtained is shown considering two cost functions with various optimal excitation widths and number of segments. Results illustrate that the desired mode (A0 or S0) can be excited dominantly over other modes up to a wave power ratio of 1010 using an optimal shear stress profile.

Two-mode elliptical-core weighted fiber sensors for vibration analysis

NASA Technical Reports Server (NTRS)

Vengsarkar, Ashish M.; Murphy, Kent A.; Fogg, Brian R.; Miller, William V.; Greene, Jonathan A.; Claus, Richard O.

1992-01-01

Two-mode, elliptical-core optical fibers are demonstrated in weighted, distributed and selective vibration-mode-filtering applications. We show how appropriate placement of optical fibers on a vibrating structure can lead to vibration mode filtering. Selective vibration-mode suppression on the order of 10 dB has been obtained using tapered two-mode, circular-core fibers with tapering functions that match the second derivatives of the modes of vibration to be enhanced. We also demonstrate the use of chirped, two-mode gratings in fibers as spatial modal sensors that are equivalents of shaped piezoelectric sensors.

Upgrading from VVI to DDD pacing Mode during elective replacement of pulse generator: a comparative clinical-functional analysis.

PubMed

Teno, Luiz Antonio Castilho; Costa, Roberto; Martinelli Filho, Martino; Castilho, Fabian Cecchi Teno; Ruiz, Ivan

2007-02-01

Evaluate the clinical and functional behavior of the ventricular and atrioventricular stimulation modes in the elective replacement of pulse generator in patients with chagasic cardiopathy and atrioventricular block. Twenty-seven patients under ventricular and atrioventricular stimulation were comparatively evaluated at the beginning of the study, and alternately in ventricular and atrioventricular modes in two 90-day phases, with regard to: the clinical behavior evaluated according to quality of life and functional class, and the functional behavior evaluated by transthoracic echocardiography and the six-minute walk test. The statistical analysis was performed with patients at baseline, and under ventricular and atrioventricular modes, using the chi-square test and the repeated measures analysis of variance, and taking into consideration a 0.05 level of significance. The mean quality-of-life scores were: functional capacity (VVI 71.3+/-18.2 , DDD 69.3+/-20.4); overall health status (VVI 68.1+/-21.8, DDD 69.4+/-19.4) and vitality (VVI 64.8+/-24.6 , DDD 67.6+/-25.5); on echocardiography: LVEF (VVI 52.5+/-12.8 , DDD 51.8+/-14.9), LVDD (VVI 53.0+/-7.7 , DDD 42.4+/-7.8), LA (VVI 38.6+/-5.4 DDD 38.5+/-5.1), and in the six-minute walk test: distance walked (VVI 463.4+/-84.7, DDD 462.6+/-63.4). There were four cases of complications, three of them associated with the change in stimulation mode. This study showed no differences between the two stimulation modes in the clinical behavior assessed by quality of life and functional class, and in the functional behavior, evaluated according to the ecochardiographic findings and the six-minute walk test.

Book Reviews

NASA Astrophysics Data System (ADS)

Horner, Joseph L.

1987-04-01

Progress in the fields of integrated optics and fiber optics is continuing at a rapid pace. Recognizing this trend, the goal of the author is to provide an introductory textbook on time-harmonic electromagnetic theory, with an emphasis on optical rather than microwave technologies. The book is appropriate for an upper-level undergraduate or graduate course. Each chapter includes examples of problems. The book focuses on several areas of prime importance to intergrated optics. These include dielectric waveguide analysis, couple-mode thoery, Bragg scattering, and prism coupling There is very little coverage of active components such as electro-optic modulators and switches. The author assumes the reader has a working knowledge of vector calculus and is familiar with Maxwell's equations.

Particle compositions with a pre-selected cell internalization mode

NASA Technical Reports Server (NTRS)

Ferrari, Mauro (Inventor); Decuzzi, Paolo (Inventor)

2012-01-01

A method of formulating a particle composition having a pre-selected cell internalization mode involves selecting a target cell having surface receptors and obtaining particles that have i) surface moieties, that have an affinity for or are capable of binding to the surface receptors of the cell and ii) a preselected shape, where a surface distribution of the surface moieties on the particles and the shape of the particles are effective for the pre-selected cell internalization mode.

Risk Stratification of Future Left Ventricular Dysfunction for Patients with Indications for Right Ventricular Pacing due to Bradycardia.

PubMed

Ooka, Junichi; Tanaka, Hidekazu; Hatani, Yutaka; Hatazawa, Keiko; Matsuzoe, Hiroki; Shimoura, Hiroyuki; Sano, Hiroyuki; Sawa, Takuma; Motoji, Yoshiki; Mochizuki, Yasuhide; Ryo-Koriyama, Keiko; Matsumoto, Kensuke; Fukuzawa, Koji; Hirata, Ken-Ichi

2017-10-21

Although right ventricular (RV) pacing is the only effective treatment for patients with symptomatic bradycardia, it creates left ventricular (LV) dyssynchrony, which can induce LV dysfunction and heart failure. The current criterion for consideration of cardiac resynchronization therapy (CRT) is LV ejection fraction (LVEF) ≤ 35%, but indication for CRT in patients required for RV pacing with LVEF > 35% remains unclear.We studied 40 patients, all LVEF ≥ 35%, who had undergone implantable cardioverter-defibrillator implantation with RV pacing < 5%. Echocardiography was performed at baseline and during RV pacing. LV dyssynchrony was defined as anteroseptal-to-posterior wall delay from the mid-LV short-axis view using two-dimensional speckle-tracking radial strain (significant: ≥ 130 ms). Patients were divided into two groups based on baseline LVEF: normal LVEF ( ≥ 50%; n = 20) and mildly reduced LVEF (35-50%; n = 20).LVEF and LV dyssynchrony in patients with mildly reduced LVEF deteriorated significantly during RV pacing compared to those in patients with normal LVEF. Moreover, changes in LV dyssynchrony during RV pacing significantly correlated with changes in LVEF (r = -0.44, P < 0.01). Multivariate logistic regression analysis showed that baseline LVEF was the only independent predictor and baseline LVEF < 48% predictive of significant LV dyssynchrony during RV pacing.The extent of RV pacing-induced LV dysfunction may be associated with baseline LV function. These adverse effects on patients with mildly reduced LVEF of 35-50% and indications for RV pacing due to bradycardia can thus be prevented by CRT.

Catheter Ablation of Focal Atrial Tachycardia Using Remote Magnetic Navigation.

PubMed

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

2018-05-01

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

Pacing: a concept analysis of the chronic pain intervention.

PubMed

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

2013-01-01

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

Sex-specific responses to self-paced, high-intensity interval training with variable recovery periods.

PubMed

Laurent, C Matthew; Vervaecke, Lauren S; Kutz, Matthew R; Green, J Matthew

2014-04-01

This study examined sex-specific responses during self-paced, high-intensity interval training (HIIT). Sixteen (8 men and 8 women) individuals completed a peak oxygen uptake test and 3 treadmill HIIT sessions on separate days. The HIIT sessions consisted of six 4-minute intervals performed at the highest self-selected intensity individuals felt they could maintain. Recovery between intervals was counterbalanced and consisted of 1-, 2-, or 4-minute recovery during each trial. Relative measures of intensity, including percentage of velocity at VO2peak (vVO2peak), %VO2peak, %HRmax, and blood lactate concentration ([La]), were observed during the trials. Perceived readiness was recorded immediately before and ratings of perceived exertion (RPE) were recorded at the end of each interval with session RPE recorded after each trial. Results revealed a significant effect of sex on %vVO2peak (p < 0.01) and %HRmax (p < 0.01). Data show that across trials, men self-select higher %vVO2peak (84.5 vs. 80.7%), whereas women produce higher %HRmax (96.9 vs. 92.1%) and %VO2peak (89.6 vs. 86.1%) with no difference in [La] or perceptual responses. These findings support the notion that women may demonstrate improved recovery during high-intensity exercise, as they will self-select intensities resulting in greater cardiovascular strain. Moreover, results confirm previous findings suggesting that a 2:1 work-to-rest ratio is optimal during HIIT for both men and women.

A Closer Look at Split Visual Attention in System- and Self-Paced Instruction in Multimedia Learning

ERIC Educational Resources Information Center

Schmidt-Weigand, Florian; Kohnert, Alfred; Glowalla, Ulrich

2010-01-01

Two experiments examined visual attention distribution in learning from text and pictures. Participants watched a 16-step multimedia instruction on the formation of lightning. In Experiment 1 (N=90) the instruction was system-paced (fast, medium, slow pace), while it was self-paced in Experiment 2 (N=31). In both experiments the text modality was…

Helping Girls Get Back on Track: An Implementation Study of the PACE Center for Girls

ERIC Educational Resources Information Center

Treskon, Louisa; Millenky, Megan; Freedman, Lily

2017-01-01

PACE Center for Girls is a unique program that provides academic and social services to girls ages 11 to 18. Girls eligible for PACE exhibit multiple health, safety, and delinquency risk factors, such as poor academic performance, exposure to abuse or violence, truancy, risky sexual behavior, and substance abuse. PACE seeks to help them onto a…

What Pace Is Best? Assessing Adults' Learning from Slideshows and Video

ERIC Educational Resources Information Center

Sage, Kara

2014-01-01

When acquiring information from a 2D platform, self-control and/or optimal pacing may help reduce cognitive load and enhance learning outcomes. In the present research, adults viewed novel action sequences via one of four learning media: (1) self-paced slideshows, where viewers advanced through slides at their own pace by clicking a mouse, (2)…

77 FR 28900 - Amended Certification Regarding Eligibility to Apply for Worker Adjustment Assistance

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-16

... Enterprises, Inc., Fitzgerald, Georgia TA-W-81,004C Pace American Enterprises, Inc., Lebanon, Oregon TA-W-81... Enterprises, Inc., Lebanon, Oregon (TA-W- 81,004C); and Pace American Enterprises, Inc., Hurricane, Utah (TA-W...., Fitzgerald, Georgia (TA-W-81,004B), Pace American Enterprises, Inc., Lebanon, Oregon (TA-W-81,004C), Pace...

Forms of work organization and associations with shoulder disorders: Results from a French working population.

PubMed

Bodin, Julie; Garlantézec, Ronan; Costet, Nathalie; Descatha, Alexis; Fouquet, Natacha; Caroly, Sandrine; Roquelaure, Yves

2017-03-01

The aim of this study was to identify forms of work organization in a French region and to study associations with the occurrence of symptomatic and clinically diagnosed shoulder disorders in workers. Workers were randomly included in this cross-sectional study from 2002 to 2005. Sixteen organizational variables were assessed by a self-administered questionnaire: i.e. shift work, job rotation, repetitiveness of tasks, paced work/automatic rate, work pace dependent on quantified targets, permanent controls or surveillance, colleagues' work and customer demand, and eight variables measuring decision latitude. Five forms of work organization were identified using hierarchical cluster analysis (HCA) of variables and HCA of workers: low decision latitude with pace constraints, medium decision latitude with pace constraints, low decision latitude with low pace constraints, high decision latitude with pace constraints and high decision latitude with low pace constraints. There were significant associations between forms of work organization and symptomatic and clinically-diagnosed shoulder disorders. Copyright © 2016 Elsevier Ltd. All rights reserved.

Optimal pacing for right ventricular and biventricular devices: minimizing, maximizing, and right ventricular/left ventricular site considerations.

PubMed

Gillis, Anne M

2014-10-01

The results from numerous clinical studies provide guidance for optimizing outcomes related to RV or biventricular pacing in the pacemaker and ICD populations. (1) Programming algorithms to minimize RV pacing is imperative in patients with dual-chamber pacemakers who have intrinsic AV conduction or intermittent AV conduction block. (2) Dual-chamber ICDs should be avoided in candidates without an indication for bradycardia pacing. (3) Alternate RV septal pacing sites may be considered at the time of pacemaker implantation. (4) Biventricular pacing may be beneficial in some patients with mild LV dysfunction. (5) LV lead placement at the site of latest LV activation is desirable. (6) Programming CRT systems to achieve biventricular/LV pacing >98.5% is important. (7) Protocols for AV and VV optimization in patients with CRT are not recommended after device implantation but may be considered for CRT nonresponders. (8) Novel algorithms to maximize the benefit of CRT are in evolution further.

42 CFR 460.162 - Voluntary disenrollment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Participant Enrollment and Disenrollment § 460.162 Voluntary disenrollment. A PACE...

42 CFR 460.162 - Voluntary disenrollment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Participant Enrollment and Disenrollment § 460.162 Voluntary disenrollment. A PACE...

On the Raman threshold of passive large mode area fibers

NASA Astrophysics Data System (ADS)

Jauregui, Cesar; Limpert, Jens; Tünnermann, Andreas

2011-02-01

The output power of fiber optic laser systems has been exponentially increasing in the last years. However, non-linear effects, and in particular stimulated Raman scattering (SRS), are threatening to seriously limit the development pace in the near future. SRS can take place anywhere along the laser system, however it is actually the passive delivery fiber at the end of the system, the section where SRS is most likely to occur. The common way to combat this problem is to use the so-called Large Mode Area (LMA) fibers. However, these fibers are expensive and have a multimode nature that will either reduce the beam quality of the laser output or require a careful excitation of the fundamental mode. Furthermore, the larger the core area, the more complicated it will be to sustain single-mode operation. Therefore, it is becoming increasingly important to be able to determine which is the minimum core area required in the delivery fiber to avoid SRS. This calculation is usually carried out using the conventional formula for the Raman Threshold published by R.G. Smith in 1972: Pth =16Aeff gRLeff . In this work we demonstrate that this formula and the conclusions derived from it are inaccurate for short (several meters long) LMA fibers. For example, one widely spread belief (obtained from this expression) is that there is no dependence of the Raman intensity threshold (Ith=Pth/Aeff) on the mode area. However, our calculations show otherwise. Additionally, we have obtained an improved Raman threshold formula valid for short LMA fibers.

Transferring PACE Assessments Upon Home Sale

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

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

A significant barrier to investing in renewable energy and comprehensive energy efficiency improvements to homes across the country is the initial capital cost. Property Assessed Clean Energy (PACE) financing is one of several new financial models broadening access to clean energy by addressing this upfront cost issue. Recently, the White House cited PACE programs as an important element of its 'Recovery through Retrofit' plan. The residential PACE model involves the creation of a special clean energy financing district that homeowners elect to opt into. Once opted in, the local government (usually at the city or county level) finances the upfrontmore » investment of the renewable energy installation and/or energy efficiency improvements. A special lien is attached to the property and the assessment is paid back as a line item on the property tax bill. As of April 2010, 17 states have passed legislation to allow their local governments to create PACE programs, two already have the authority to set up PACE programs, and over 10 additional states are actively developing enabling legislation. This policy brief analyzes one of the advantages of PACE, which is the transferability of the special assessment from one homeowner to the next when the home is sold. This analysis focuses on the potential for the outstanding lien to impact the sales negotiation process, rather than the legal nature of the lien transfer itself. The goal of this paper is to consider what implications a PACE lien may have on the home sales negotiation process so that it can be addressed upfront rather than risk a future backlash to PACE programs. If PACE programs do expand at a rapid rate, the chances are high that there will be other cases where prospective buyers uses PACE liens to negotiate lower home prices or require repayment of the lien as a condition of sale. As a result, PACE programs should highlight this issue as a potential risk factor for the sake of full disclosure. A good example of this is in Boulder County where the following statement is included in the ClimateSmart PACE program materials: 'Please Note: There is no legal requirement that the loan be paid off when you refinance or sell your home. However, this may be an item subject to negotiation with a future buyer and may also be a matter of negotiation with the mortgage lender.' Such candid disclosure for what might be a low risk event can be debated. However, a selling point of PACE programs is the transferability of the lien to the new homeowner. To the degree this benefit is questioned, PACE programs may end up looking more like home equity loan financing, with the associated debt repaid at closing, rather than property-based financing that remains with the improved home. While it is possible that upfront disclosure might negatively impact participation rates in PACE programs, it also will protect the integrity of a PACE program in later years if such situations come to pass. Ideally, this will become less of an issue over time as more homebuyers understand the positive economic and societal benefits of owning a home with clean energy features.« less

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

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

Saha, Devashree

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

42 CFR 460.12 - Application requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Organization Application and Waiver Process § 460.12 Application requirements. (a...

42 CFR 460.104 - Participant assessment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Services § 460.104 Participant assessment. (a) Initial comprehensive assessment—(1...

42 CFR 460.12 - Application requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Organization Application and Waiver Process § 460.12 Application requirements. (a...

Metabolic rate covaries with fitness and the pace of the life history in the field

PubMed Central

Pettersen, Amanda K.; White, Craig R.; Marshall, Dustin J.

2016-01-01

Metabolic rate reflects the ‘pace of life’ in every organism. Metabolic rate is related to an organism's capacity for essential maintenance, growth and reproduction—all of which interact to affect fitness. Although thousands of measurements of metabolic rate have been made, the microevolutionary forces that shape metabolic rate remain poorly resolved. The relationship between metabolic rate and components of fitness are often inconsistent, possibly because these fitness components incompletely map to actual fitness and often negatively covary with each other. Here we measure metabolic rate across ontogeny and monitor its effects on actual fitness (lifetime reproductive output) for a marine bryozoan in the field. We also measure key components of fitness throughout the entire life history including growth rate, longevity and age at the onset of reproduction. We found that correlational selection favours individuals with higher metabolic rates in one stage and lower metabolic rates in the other—individuals with similar metabolic rates in each developmental stage displayed the lowest fitness. Furthermore, individuals with the lowest metabolic rates lived for longer and reproduced more, but they also grew more slowly and took longer to reproduce initially. That metabolic rate is related to the pace of the life history in nature has long been suggested by macroevolutionary patterns but this study reveals the microevolutionary processes that probably generated these patterns. PMID:27226476

The impact of a primary care e-communication intervention on the participation of chronic disease patients who had not reached guideline suggested treatment goals.

PubMed

Lussier, Marie-Thérèse; Richard, Claude; Glaser, Emma; Roberge, Denis

2016-04-01

To evaluate the efficacy of two web-based educational approaches on doctor-patient communication. The study focused on chronic disease (CD) patients in a lengthy relationship with their family physician (FP) who had not reached guideline suggested treatment goals (off-target) for their CDs. 322 hypertensive, diabetic, or dyslipidemic patients of 18 FPs were randomised into three groups: Usual Care (UC), e-Learning (e-L) and e-Learning+Workshop (e-L+W). Interventions were based on Cegala's PACE system: Prepare, Ask questions, Check understanding, Express concerns. Communication was evaluated using the Roter Interaction Analysis System (RIAS), MEDICODE and questionnaires. Encounter length was similar across groups. RIAS showed that e-L+W group engaged in more socio-emotional talk and PACE-like utterances. MEDICODE showed that interventions increased frequency, initiative and dialogue for selected CD medication themes. Quality of communication was perceived as satisfactory at baseline and did not change. Following interventions, CD patients were more activated even in well-established doctor-patient relationships. PACE web-based interventions are accessible and effective at increasing CD patients' participation. They increase legitimacy to express the patient experience. FPs should present this type of training to CD patients as an integral part of their routine practice and consider referring patients to complete it. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Metabolite toxicity determines the pace of molecular evolution within microbial populations.

PubMed

Lilja, Elin E; Johnson, David R

2017-02-14

The production of toxic metabolites has shaped the spatial and temporal arrangement of metabolic processes within microbial cells. While diverse solutions to mitigate metabolite toxicity have evolved, less is known about how evolution itself is affected by metabolite toxicity. We hypothesized that the pace of molecular evolution should increase as metabolite toxicity increases. At least two mechanisms could cause this. First, metabolite toxicity could increase the mutation rate. Second, metabolite toxicity could increase the number of available mutations with large beneficial effects that selection could act upon (e.g., mutations that provide tolerance to toxicity), which consequently would increase the rate at which those mutations increase in frequency. We tested this hypothesis by experimentally evolving the bacterium Pseudomonas stutzeri under denitrifying conditions. The metabolite nitrite accumulates during denitrification and has pH-dependent toxic effects, which allowed us to evolve P. stutzeri at different magnitudes of nitrite toxicity. We demonstrate that increased nitrite toxicity results in an increased pace of molecular evolution. We further demonstrate that this increase is generally due to an increased number of available mutations with large beneficial effects and not to an increased mutation rate. Our results demonstrate that the production of toxic metabolites can have important impacts on the evolutionary processes of microbial cells. Given the ubiquity of toxic metabolites, they could also have implications for understanding the evolutionary histories of biological organisms.

The effect of aging on pacing strategies of cross-country skiers and the role of performance level.

PubMed

Nikolaidis, Pantelis Theodoros; Villiger, Elias; Rosemann, Thomas; Knechtle, Beat

2018-01-01

The participation of master cross-country (XC) skiers in training and competition has increased during the last decades; however, little is known yet about whether these athletes differ from their younger counterparts in aspects of performance such as pacing. Therefore, the aim of the present study was to examine the combined effect of age and performance (race time) on pacing in cross-country (XC) skiing. We analyzed all finishers ( n  = 79,722) in 'Vasaloppet' from 2012 to 2017, the largest cross-country skiing race in the world, classified according to their race time into 10 groups: 3-4 h, 4-5 h, ..., 12-13 h. A trivial main effect of sex on total pace range was observed ( p  < 0.001, η 2  = 0.002), where women (44.1 ± 10.2%) had larger total pace range than men (40.9 ± 11.8%). A large main effect of performance group on total pace range was shown ( p  < 0.001, η 2  = 0.160), where the smallest total pace range was 21.8 ± 1.9% (3-4 h group) and the largest 50.1 ± 9.9% (10-11 h group). A trivial sex×performance group interaction on total pace range was found ( p  < 0.001, η 2  = 0.001) with the largest sex difference in pacing shown in 9-10 h group. A trivial and small main effect of age was found in women ( p  < 0.001, η 2  = 0.005) and men ( p  < 0.001, η 2  = 0.011), respectively, where the masters had smaller total pace range than their younger counterparts. A trivial age group×performance group interaction on total pace range was observed in both women ( p  < 0.001, η 2  = 0.008) and men ( p  < 0.001, η 2  = 0.006) with smaller differences among age groups in the faster performance groups. In summary, master XC skiers adopted a relatively even pacing independently from their race time and the differences in pacing from the younger XC skiers were more pronounced in the slower masters. These findings suggest that exercise attenuates the decline of performance in master XC skiers as shown by the similar pacing strategies between fast master XC skiers and their younger counterparts.

The CMS Journey to LHC Physics

ScienceCinema

Virdee, Tejinder

2018-04-27

An overview of the design, the construction and physics of CMS will be given. A history of construction, encompassing the R&D; and challenges faced over the last decade and a half, will be recalled using selected examples. CMS is currently in the final stages of installation and commissioning is gathering pace. After a short status report of where CMS stands today some of the expected (great) physics to come will be outlined.

Online Instruction and Virtual Schools for Middle and High School Students: Twenty-First-Century Fads or Progressive Teaching Methods for Today's Pupils?

ERIC Educational Resources Information Center

Morgan, Hani

2015-01-01

Online education in K-12 settings has increased considerably in recent years, but there is little research supporting its use at this level. Online courses help students learn at their own pace, select different locations to do their work, and choose flexible times to complete assignments. However, some students learn best in a face-to-face…

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

PubMed

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

1988-09-01

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

42 CFR 460.172 - Documentation of disenrollment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Participant Enrollment and Disenrollment § 460.172 Documentation of disenrollment. A PACE...

Helping Girls Get Back on Track: An Implementation Study of the PACE Center for Girls. Executive Summary

ERIC Educational Resources Information Center

Treskon, Louisa; Millenky, Megan; Freedman, Lily

2017-01-01

PACE Center for Girls is a unique program that provides academic and social services to girls ages 11 to 18. Girls eligible for PACE exhibit multiple health, safety, and delinquency risk factors, such as poor academic performance, exposure to abuse or violence, truancy, risky sexual behavior, and substance abuse. PACE seeks to help them onto a…

Assessing the PACE of California residential solar deployment: Impacts of Property Assessed Clean Energy programs on residential solar photovoltaic deployment in California, 2010-2015

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

Deason, Jeff; Murphy, Sean

A new study by Berkeley Lab found that residential Property Assessed Clean Energy (R-PACE) programs increased deployment of residential solar photovoltaic (PV) systems in California, raising it by about 7-12% in cities that adopt these programs. R-PACE is a financing mechanism that uses a voluntary property tax assessment, paid off over time, to facilitate energy improvements and, in some jurisdictions, water and resilience measures. While previous studies demonstrated that early, regional R-PACE programs increased solar PV deployment, this new analysis is the first to demonstrate these impacts from the large, statewide R-PACE programs dominating the California market today, which usemore » private capital to fund the upfront costs of the improvements. Berkeley Lab estimated the impacts using econometric techniques on two samples: -Large cities only, allowing annual demographic and economic data as control variables -All California cities, without these annual data Analysis of both samples controls for several factors other than R-PACE that would be expected to drive solar PV deployment. We infer that on average, cities with R-PACE programs were associated with greater solar PV deployment in our study period (2010-2015). In the large cities sample, solar PV deployment in jurisdictions with R-PACE programs was higher by 1.1 watts per owner-occupied household per month, or 12%. Across all cities, solar PV deployment in jurisdictions with R-PACE programs was higher by 0.6 watts per owner-occupied household per month, or 7%. The large cities results are statistically significant at conventional levels; the all-cities results are not. The estimates imply that the majority of solar PV deployment financed by R-PACE programs would likely not have occurred in their absence. Results suggest that R-PACE programs have increased PV deployment in California even in relatively recent years, as R-PACE programs have grown in market share and as alternate approaches for financing solar PV have developed. The U.S. Department of Energy’s Building Technologies Office supported this research.« less

Left ventricular epicardial activation increases transmural dispersion of repolarization in healthy, long QT, and dilated cardiomyopathy dogs.

PubMed

Bai, Rong; Lü, Jiagao; Pu, Jun; Liu, Nian; Zhou, Qiang; Ruan, Yanfei; Niu, Huiyan; Zhang, Cuntai; Wang, Lin; Kam, Ruth

2005-10-01

Benefits of cardiac resynchronization therapy (CRT) are well established. However, less is understood concerning its effects on myocardial repolarization and the potential proarrhythmic risk. Healthy dogs (n = 8) were compared to a long QT interval (LQT) model (n = 8, induced by cesium chloride, CsCl) and a dilated cardiomyopathy with congestive heart failure (DCM-CHF, induced by rapid ventricular pacing, n = 5). Monophasic action potential (MAP) recordings were obtained from the subendocardium, midmyocardium, subepicardium, and the transmural dispersion of repolarization (TDR) was calculated. The QT interval and the interval from the peak to the end of the T wave (T(p-e)) were measured. All these characteristics were compared during left ventricular epicardial (LV-Epi), right ventricular endocardial (RV-Endo), and biventricular (Bi-V) pacing. In healthy dogs, TDR prolonged to 37.54 ms for Bi-V pacing and to 47.16 ms for LV-Epi pacing as compared to 26.75 ms for RV-Endo pacing (P < 0.001), which was parallel to an augmentation in T(p-e) interval (Bi-V pacing, 64.29 ms; LV-Epi pacing, 57.89 ms; RV-Endo pacing, 50.29 ms; P < 0.01). During CsCl exposure, Bi-V and LV-Epi pacing prolonged MAPD, TDR, and T(p-e) interval as compared to RV-Endo pacing. The midmyocardial MAPD (276.30 ms vs 257.35 ms, P < 0.0001) and TDR (33.80 ms vs 27.58 ms, P=0.002) were significantly longer in DCM-CHF dogs than those in healthy dogs. LV-Epi and Bi-V pacing further prolonged the MAPD and TDR in this model. LV-Epi and Bi-V pacing result in prolongation of ventricular repolarization time, and increase of TDR accounted for a parallel augmentation of the T(p-e) interval, which provides evidence that T(p-e) interval accurately represents TDR. These effects are magnified in the LQT and DCM-CHF canine models in addition to their intrinsic transmural heterogeneity in the intact heart. This mechanism may contribute to the development of malignant ventricular arrhythmias, such as torsades de pointes (TdP) in congestive heart failure (CHF) patients treated with CRT.

Effects of enhanced pacing modalities on health care resource utilization and costs in bradycardia patients: An analysis of the randomized MINERVA trial.

PubMed

Boriani, Giuseppe; Manolis, Antonis S; Tukkie, Raymond; Mont, Lluis; Pürerfellner, Helmut; Santini, Massimo; Inama, Giuseppe; Serra, Paolo; Gulizia, Michele; Samoilenko, Igor Vasilyevich; Wolff, Claudia; Holbrook, Reece; Gavazza, Federica; Padeletti, Luigi

2015-06-01

Many patients who suffer from bradycardia and need cardiac pacing also have atrial fibrillation (AF). New pacemaker algorithms, such as atrial preventive pacing and atrial antitachycardia pacing (DDDRP) and managed ventricular pacing (MVP), have been specifically designed to reduce AF occurrence and duration and to minimize the detrimental effects of right ventricular pacing. The randomized MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial established that DDDRP + MVP pacing modality reduced permanent AF in bradycardia patients as compared with standard dual-chamber pacing (DDDR). The aim of this study was to estimate the cost savings due to lower AF-related health care utilization events based on health care costs from the United States and the European Union. Dual-chamber pacemaker patients with a history of paroxysmal or persistent AF were randomly assigned to receive DDDR (n = 385) or the advanced features (DDDRP + MVP; n = 383). We used published health care costs from the United States and the European Union (Italy, Spain, and the United Kingdom) to estimate the costs associated with AF-related hospitalizations and emergency visits. The rate of AF-related hospitalizations was significantly lower in the DDDRP + MVP group than in the conventional pacemaker group (DDDR group; 42% reduction; incidence rate ratio 0.58). Similarly, a significant reduction of 68% was observed for AF-related emergency department visits (incidence rate ratio 0.32; P < .001). As a consequence, DDDRP + MVP could potentially reduce health care costs by 40%-44%. Over a ten-year period, the cost savings per 100 patients ranged from $35,702 in the United Kingdom to $121,831 in the United States. New pacing algorithms such as DDDRP + MVP used in the MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial successfully reduced AF-related health care utilization, resulting in significant cost savings to payers. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Binding of anticancer drug daunomycin to a TGGGGT G-quadruplex DNA probed by all-atom molecular dynamics simulations: additional pure groove binding mode and implications on designing more selective G-quadruplex ligands.

PubMed

Shen, Zhanhang; Mulholland, Kelly A; Zheng, Yujun; Wu, Chun

2017-09-01

DNA G-quadruplex structures are emerging cancer-specific targets for chemotherapeutics. Ligands that bind to and stabilize DNA G-quadruplexes have the potential to be anti-cancer drugs. Lack of binding selectivity to DNA G-quadruplex over DNA duplex remains a major challenge when attempting to develop G-quadruplex ligands into successful anti-cancer drugs. Thorough understanding of the binding nature of existing non-selective ligands that bind to both DNA quadruplex and DNA duplex will help to address this challenge. Daunomycin and doxorubicin, two commonly used anticancer drugs, are examples of non-selective DNA ligands. In this study, we extended our early all-atom binding simulation studies between doxorubicin and a DNA duplex (d(CGATCG) 2 ) to probe the binding between daunomycin and a parallel DNA quadruplex (d(TGGGGT) 4 ) and DNA duplex. In addition to the end stacking mode, which mimics the mode in the crystal structure, a pure groove binding mode was observed in our free binding simulations. The dynamic and energetic properties of these two binding modes are thoroughly examined, and a detailed comparison is made between DNA quadruplex binding modes and DNA duplex binding modes. Implications on the design of more selective DNA quadruplex ligands are also discussed. Graphical abstract Top stacking and groov binding modes from the MD simulations.

42 CFR 460.116 - Explanation of rights.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Participant Rights § 460.116 Explanation of rights. (a) Written policies. A PACE...

42 CFR 460.116 - Explanation of rights.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Participant Rights § 460.116 Explanation of rights. (a) Written policies. A PACE...

Left Ventricular Reverse Remodeling With Biventricular Versus Right Ventricular Pacing in Patients With Atrioventricular Block and Heart Failure in the BLOCK HF Trial.

PubMed

St John Sutton, Martin; Plappert, Ted; Adamson, Philip B; Li, Pei; Christman, Shelly A; Chung, Eugene S; Curtis, Anne B

2015-05-01

Biventricular pacing in heart failure (HF) improves survival, relieves symptoms, and attenuates left ventricular (LV) remodeling. However, little is known about biventricular pacing in HF patients with atrioventricular block because they are typically excluded from biventricular trials. The Biventricular versus Right Ventricular Pacing in Heart Failure Patients with Atrioventricular Block (BLOCK HF) trial randomized patients with atrioventricular block, New York Heart Association symptom classes I to III HF, and LV ejection fraction ≤50% to biventricular or right ventricular pacing. Doppler echocardiograms were obtained at randomization (after 30 to 60 days of right ventricular pacing postimplant) and every 6 months through 24 months. Data analysis comparing changes in 10 prespecified echo parameters over time was conducted using a Bayesian design. LV end systolic volume index was also evaluated as a predictor of mortality/morbidity. Of 691 randomized subjects, 624 had paired Doppler echocardiogram data for ≥1 analyses at 6, 12, 18, or 24 months. Biventricular pacing significantly reduced LV volume indices and intraventricular mechanical delay, and improved LV ejection fraction, consistent with LV reverse remodeling. These parameters showed little change with right ventricular pacing alone, indicating no systematic reverse remodeling with right ventricular pacing. LV end systolic volume index was predictive of mortality/morbidity; the estimated risk increased up to 1% for every 1 mL/m(2) increase in LV end systolic volume index. LV end systolic volume index is a significant predictor of mortality/morbidity in this population. Cardiac structure and function are improved with biventricular pacing for patients with atrioventricular block and LV systolic dysfunction. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00267098. © 2015 American Heart Association, Inc.

The Effect of Right Ventricular Apical and Nonapical Pacing on the Short- and Long-Term Changes in Left Ventricular Ejection Fraction: A Systematic Review and Meta-Analysis of Randomized-Controlled Trials.

PubMed

Hussain, Mohammad Akhtar; Furuya-Kanamori, Luis; Kaye, Gerald; Clark, Justin; Doi, Suhail A R

2015-09-01

The right ventricular apex (RVA) is the traditional lead site for chronic pacing but in some patients may cause impaired left ventricular (LV) systolic function over time. Comparisons with right ventricular nonapical (RVNA) pacing sites have generated inconsistent results and recent meta-analyses have demonstrated unclear benefit due to heterogeneity across studies. A systematic search for randomized controlled trials that compared LV ejection fraction (LVEF) outcomes between RVNA and RVA pacing was performed up to October 2014. Twenty-four studies (n = 1,628 patients) met the inclusion criteria. To avoid between study heterogeneity two homogenous groups were created; group 1 where studies reported a difference (in favor of RVNA pacing) and group 2 where studies reported no difference between pacing sites. For group 1, weighted mean difference between RVNA and RVA pacing in terms of LVEF at follow-up was 5.40% (95% confidence interval [CI]: 3.94-6.87), related in part to group one's RVA arm demonstrating a significant reduction (mean loss -3.31%; 95% CI: -6.19 to -0.43) in LVEF between study baseline and end of follow-up. Neither of these finding were seen in group 2. Weighted regression modeling demonstrated that inclusion of poor baseline LVEF (<40%) in combination with greater than 12 months follow-up was three times more common in group 1 compared to group 2 (weighted relative risk 2.82; 95% CI: 1.03-7.72; P = 0.043). In patients requiring chronic right ventricular pacing where there is inclusion of impaired baseline LVEF (<40%), RVA pacing is associated with deterioration in LV function relative to RVNA pacing. © 2015 Wiley Periodicals, Inc.

Role of apamin-sensitive small conductance calcium-activated potassium currents in long-term cardiac memory in rabbits.

PubMed

Yin, Dechun; Chen, Mu; Yang, Na; Wu, Adonis Z; Xu, Dongzhu; Tsai, Wei-Chung; Yuan, Yuan; Tian, Zhipeng; Chan, Yi-Hsin; Shen, Changyu; Chen, Zhenhui; Lin, Shien-Fong; Weiss, James N; Chen, Peng-Sheng; Everett, Thomas H

2018-05-01

Apamin-sensitive small conductance calcium-activated K current (I KAS ) is up-regulated during ventricular pacing and masks short-term cardiac memory (CM). The purpose of this study was to determine the role of I KAS in long-term CM. CM was created with 3-5 weeks of ventricular pacing and defined by a flat or inverted T wave off pacing. Epicardial optical mapping was performed in both paced and normal ventricles. Action potential duration (APD 80 ) was determined during right atrial pacing. Ventricular stability was tested before and after I KAS blockade. Four paced hearts and 4 normal hearts were used for western blotting and histology. There were no significant differences in either echocardiographic parameters or fibrosis levels between groups. Apamin induced more APD 80 prolongation in CM than in normal ventricles (mean [95% confidence interval]: 9.6% [8.8%-10.5%] vs 3.1% [1.9%-4.3%]; P <.001). Apamin significantly lengthened APD 80 in the CM model at late activation sites, indicating significant I KAS up-regulation at those sites. The CM model also had altered Ca 2+ handling, with the 50% Ca 2+ transient duration and amplitude increased at distal sites compared to a proximal site (near the pacing site). After apamin, the CM model had increased ventricular fibrillation (VF) inducibility (paced vs control: 33/40 (82.5%) vs 7/20 (35%); P <.001) and longer VF durations (124 vs 26 seconds; P <.001). Chronic ventricular pacing increases Ca 2+ transients at late activation sites, which activates I KAS to maintain repolarization reserve. I KAS blockade increases VF vulnerability in chronically paced rabbit ventricles. Copyright © 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Pulmonary vein isolation using a pace-capture-guided versus an adenosine-guided approach: effect on dormant conduction and long-term freedom from recurrent atrial fibrillation--a prospective study.

PubMed

Andrade, Jason G; Pollak, Scott J; Monir, George; Khairy, Paul; Dubuc, Marc; Roy, Denis; Talajic, Mario; Deyell, Marc; Rivard, Léna; Thibault, Bernard; Guerra, Peter G; Nattel, Stanley; Macle, Laurent

2013-12-01

Atrial fibrillation recurrence after pulmonary vein (PV) isolation is associated with PV to left atrium reconduction. We prospectively studied the use of 2 procedural techniques designed to facilitate identification of residual gaps within the index ablation line. After wide circumferential PV isolation, 40 patients received additional ablation targeted at locations of left atrial capture during high-output pacing (pace-capture group), while 40 patients underwent adenosine testing with targeted ablation at sites of dormant conduction (adenosine group). Patients were followed up at 3, 6, and 12 months. After PV isolation, high-output pace-capture was documented in 39 PVs (25%; 50% of patients) in the pace-capture group. Dormant conduction was unmasked in 34 PVs (22%; 53% of patients) in the adenosine group. A subset of 25 patients in the pace-capture group underwent adenosine testing without targeted ablation of dormant conduction. In these patients, only 10 out of 86 PVs (11.6%; 24% of patients) demonstrated dormant conduction after the elimination of local pace-capture. At a follow-up of 329±124 days, the single procedure off antiarrhythmic drug freedom from recurrent atrial fibrillation was 67.5% in the adenosine group and 65.0% in the pace-capture group (P=0.814). Procedure duration and fluoroscopy time were significantly longer in the pace-capture group (P=0.002 and P<0.001), whereas radiofrequency ablation time was comparable (P=0.192). The use of high-output pacing post-PV isolation results in a significant reduction in the incidence of dormant conduction with a comparable long-term freedom from recurrent atrial fibrillation (versus adenosine-guided ablation). The use of these approaches requires evaluation in a long-term prospective randomized study. [corrected].

42 CFR 460.18 - CMS evaluation of applications.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Organization Application and Waiver Process § 460.18 CMS evaluation of applications...

42 CFR 460.22 - Service area designation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Organization Application and Waiver Process § 460.22 Service area designation. (a) An...

42 CFR 460.20 - Notice of CMS determination.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Organization Application and Waiver Process § 460.20 Notice of CMS determination. (a...

42 CFR 460.71 - Oversight of direct participant care.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Administrative Requirements § 460.71 Oversight of direct participant care...

42 CFR 460.94 - Required services for Medicare participants.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Services § 460.94 Required services for Medicare participants. (a) Except...

42 CFR 460.18 - CMS evaluation of applications.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Organization Application and Waiver Process § 460.18 CMS evaluation of applications...

42 CFR 460.22 - Service area designation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Organization Application and Waiver Process § 460.22 Service area designation. (a) An...

42 CFR 460.94 - Required services for Medicare participants.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Services § 460.94 Required services for Medicare participants. (a) Except...

42 CFR 460.20 - Notice of CMS determination.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Organization Application and Waiver Process § 460.20 Notice of CMS determination. (a...

Factors influencing pacing in triathlon

PubMed Central

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

2014-01-01

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

Capture of activation during ventricular arrhythmia using distributed stimulation.

PubMed

Meunier, Jason M; Ramalingam, Sanjiv; Lin, Shien-Fong; Patwardhan, Abhijit R

2007-04-01

Results of previous studies suggest that pacing strength stimuli can capture activation during ventricular arrhythmia locally near pacing sites. The existence of spatio-temporal distribution of excitable gap during arrhythmia suggests that multiple and timed stimuli delivered over a region may permit capture over larger areas. Our objective in this study was to evaluate the efficacy of using spatially distributed pacing (DP) to capture activation during ventricular arrhythmia. Data were obtained from rabbit hearts which were placed against a lattice of parallel wires through which biphasic pacing stimuli were delivered. Electrical activity was recorded optically. Pacing stimuli were delivered in sequence through the parallel wires starting with the wire closest to the apex and ending with one closest to the base. Inter-stimulus delay was based on conduction velocity. Time-frequency analysis of optical signals was used to determine variability in activation. A decrease in standard deviation of dominant frequencies of activation from a grid of locations that spanned the captured area and a concurrence with paced frequency were used as an index of capture. Results from five animals showed that the average standard deviation decreased from 0.81 Hz during arrhythmia to 0.66 Hz during DP at pacing cycle length of 125 ms (p = 0.03) reflecting decreased spatio-temporal variability in activation during DP. Results of time-frequency analysis during these pacing trials showed agreement between activation and paced frequencies. These results show that spatially distributed and timed stimulation can be used to modify and capture activation during ventricular arrhythmia.

Modified complementary ensemble empirical mode decomposition and intrinsic mode functions evaluation index for high-speed train gearbox fault diagnosis

NASA Astrophysics Data System (ADS)

Chen, Dongyue; Lin, Jianhui; Li, Yanping

2018-06-01

Complementary ensemble empirical mode decomposition (CEEMD) has been developed for the mode-mixing problem in Empirical Mode Decomposition (EMD) method. Compared to the ensemble empirical mode decomposition (EEMD), the CEEMD method reduces residue noise in the signal reconstruction. Both CEEMD and EEMD need enough ensemble number to reduce the residue noise, and hence it would be too much computation cost. Moreover, the selection of intrinsic mode functions (IMFs) for further analysis usually depends on experience. A modified CEEMD method and IMFs evaluation index are proposed with the aim of reducing the computational cost and select IMFs automatically. A simulated signal and in-service high-speed train gearbox vibration signals are employed to validate the proposed method in this paper. The results demonstrate that the modified CEEMD can decompose the signal efficiently with less computation cost, and the IMFs evaluation index can select the meaningful IMFs automatically.

Electrically assisted bandedge mode selection of photonic crystal lasing in chiral nematic liquid crystals

NASA Astrophysics Data System (ADS)

Wang, Chun-Ta; Chen, Chun-Wei; Yang, Tzu-Hsuan; Nys, Inge; Li, Cheng-Chang; Lin, Tsung-Hsien; Neyts, Kristiaan; Beeckman, Jeroen

2018-01-01

Selection of the bandedge lasing mode of a photonic crystal laser has been realized in a fluorescent dye doped chiral nematic liquid crystal by exerting electrical control over the mode competition. The bandedge lasing can be reversibly switched from the short-wavelength edge mode to the long-wavelength edge mode by applying a voltage of only 20 V, without tuning the bandgap. The underlying mechanism is the field-induced change in the order parameter of the fluorescent dye in the liquid crystal. The orientation of the transition dipole moment determines the polarization state of the dye emission, thereby promoting lasing in the bandedge mode that favors the emission polarization. Moreover, the dynamic mode-selection capability is retained upon polymer-stabilizing the chiral nematic liquid crystal laser. In the polymer-stabilized system, greatly improved stability and lasing performance are observed.

Magnon Mode Selective Spin Transport in Compensated Ferrimagnets.

PubMed

Cramer, Joel; Guo, Er-Jia; Geprägs, Stephan; Kehlberger, Andreas; Ivanov, Yurii P; Ganzhorn, Kathrin; Della Coletta, Francesco; Althammer, Matthias; Huebl, Hans; Gross, Rudolf; Kosel, Jürgen; Kläui, Mathias; Goennenwein, Sebastian T B

2017-06-14

We investigate the generation of magnonic thermal spin currents and their mode selective spin transport across interfaces in insulating, compensated ferrimagnet/normal metal bilayer systems. The spin Seebeck effect signal exhibits a nonmonotonic temperature dependence with two sign changes of the detected voltage signals. Using different ferrimagnetic garnets, we demonstrate the universality of the observed complex temperature dependence of the spin Seebeck effect. To understand its origin, we systematically vary the interface between the ferrimagnetic garnet and the metallic layer, and by using different metal layers we establish that interface effects play a dominating role. They do not only modify the magnitude of the spin Seebeck effect signal but in particular also alter its temperature dependence. By varying the temperature, we can select the dominating magnon mode and we analyze our results to reveal the mode selective interface transmission probabilities for different magnon modes and interfaces. The comparison of selected systems reveals semiquantitative details of the interfacial coupling depending on the materials involved, supported by the obtained field dependence of the signal.

A Low-Cost Simulation Model for R-Wave Synchronized Atrial Pacing in Pediatric Patients with Postoperative Junctional Ectopic Tachycardia

PubMed Central

Michel, Miriam; Egender, Friedemann; Heßling, Vera; Dähnert, Ingo; Gebauer, Roman

2016-01-01

Background Postoperative junctional ectopic tachycardia (JET) occurs frequently after pediatric cardiac surgery. R-wave synchronized atrial (AVT) pacing is used to re-establish atrioventricular synchrony. AVT pacing is complex, with technical pitfalls. We sought to establish and to test a low-cost simulation model suitable for training and analysis in AVT pacing. Methods A simulation model was developed based on a JET simulator, a simulation doll, a cardiac monitor, and a pacemaker. A computer program simulated electrocardiograms. Ten experienced pediatric cardiologists tested the model. Their performance was analyzed using a testing protocol with 10 working steps. Results Four testers found the simulation model realistic; 6 found it very realistic. Nine claimed that the trial had improved their skills. All testers considered the model useful in teaching AVT pacing. The simulation test identified 5 working steps in which major mistakes in performance test may impede safe and effective AVT pacing and thus permitted specific training. The components of the model (exclusive monitor and pacemaker) cost less than $50. Assembly and training-session expenses were trivial. Conclusions A realistic, low-cost simulation model of AVT pacing is described. The model is suitable for teaching and analyzing AVT pacing technique. PMID:26943363

Right Ventricular Pacing for Assessment of Cavo-Tricuspid Isthmus Block.

PubMed

Venkataraman, Ganesh; Wish, Marc; Friehling, Ted; Strickberger, S Adam

2016-01-01

Background: Cavo-tricuspid isthmus (CTI) dependent atrial flutter is typically treated with cardiac ablation. Standard techniques to assess CTI block after ablation can be technically challenging. Right ventricular (RV) pacing may allow for another technique to assess CTI block after ablation. Objective: The purpose of this study was to evaluate RV pacing as a method to assess CTI block after ablation of CTI dependent atrial flutter, and define endpoints of ablation using this technique. Methods: 28 patients undergoing ablation of CTI dependent atrial flutter with intact ventriculoatrial (VA) conduction were prospectively enrolled in this study and underwent the RV pacing protocol, as well as standard coronary sinus (CS) pacing techniques to assess CTI block. Results: The mean trans-isthmus conduction interval during CS pacing (TICI CS ) at 600 and 400ms after CTI ablation was 168 +/- 9ms and 175 +/- 18ms, respectively. The mean trans-isthmus conduction interval during RV pacing (TICI RV ) at 600ms and 400ms after CTI ablation was 109 +/- 5ms and 111 +/- 5ms, respectively. A TICI RV >100ms was associated with a successful outcome after CTI ablation. Conclusions: RV pacing may add incremental value in the assessment of CTI block in patients undergoing ablation of CTI dependent atrial flutter.

Kinematic hand parameters in front crawl at different paces of swimming.

PubMed

Samson, Mathias; Monnet, Tony; Bernard, Anthony; Lacouture, Patrick; David, Laurent

2015-11-05

The aim of this study was to investigate the evolution of kinematic hand parameters (sweepback angle, angle of attack, velocity, acceleration and orientation of the hand relative to the absolute coordinate system) throughout an aquatic stroke and to study the possible modifications caused by a variation of the swimming pace. Seventeen competitive swimmers swam at long distance, middle distance and sprint paces. Parameters were calculated from the trajectory of seven markers on the hand measured with an optoelectronic system. Results showed that kinematic hand parameters evolve differently depending on the pace. Angle of attack, sweepback angle, acceleration and orientation of the hand do not vary significantly. The velocity of the hand increases when the pace increases, but only during the less propulsive phases (entry and stretch and downsweep to catch). The more the pace increases and the more the absolute durations of the entry and stretch and downsweep to catch phases decrease. Absolute durations of the insweep and upsweep phases remain constant. During these phases, the propulsive hand forces calculated do not vary significantly when the pace increases. The increase of swimming pace is then explained by the swimmer's capacity to maintain propulsive phases rather than increasing the force generation within each cycle. Copyright © 2015 Elsevier Ltd. All rights reserved.

An assessment of spacecraft target mode selection methods

NASA Astrophysics Data System (ADS)

Mercer, J. F.; Aglietti, G. S.; Remedia, M.; Kiley, A.

2017-11-01

Coupled Loads Analyses (CLAs), using finite element models (FEMs) of the spacecraft and launch vehicle to simulate critical flight events, are performed in order to determine the dynamic loadings that will be experienced by spacecraft during launch. A validation process is carried out on the spacecraft FEM beforehand to ensure that the dynamics of the analytical model sufficiently represent the behavior of the physical hardware. One aspect of concern is the containment of the FEM correlation and update effort to focus on the vibration modes which are most likely to be excited under test and CLA conditions. This study therefore provides new insight into the prioritization of spacecraft FEM modes for correlation to base-shake vibration test data. The work involved example application to large, unique, scientific spacecraft, with modern FEMs comprising over a million degrees of freedom. This comprehensive investigation explores: the modes inherently important to the spacecraft structures, irrespective of excitation; the particular 'critical modes' which produce peak responses to CLA level excitation; an assessment of several traditional target mode selection methods in terms of ability to predict these 'critical modes'; and an indication of the level of correlation these FEM modes achieve compared to corresponding test data. Findings indicate that, although the traditional methods of target mode selection have merit and are able to identify many of the modes of significance to the spacecraft, there are 'critical modes' which may be missed by conventional application of these methods. The use of different thresholds to select potential target modes from these parameters would enable identification of many of these missed modes. Ultimately, some consideration of the expected excitations is required to predict all modes likely to contribute to the response of the spacecraft in operation.

VDD vs DDD pacemakers: a meta-analysis.

PubMed

Shurrab, Mohammed; Elitzur, Yair; Healey, Jeff S; Gula, Lorne; Kaoutskaia, Anna; Israel, Carsten; Lau, Ching; Crystal, Eugene

2014-11-01

Dual-chamber (DDD) and VDD pacing are recognized alternatives for patients with advanced atrioventricular (AV) conduction abnormalities and spared sinus node function. The comparative data between these 2 modes are limited. A literature search was performed using multiple major databases. Outcomes of interest were (1) adverse events including incidence of atrial fibrillation (AF) and (2) procedural parameters. Odds ratio (OR) was reported for dichotomous variables and standardized mean difference (SMD) for continuous variables. Eight controlled studies (7 cohorts and 1 randomized controlled trial: total 1942 patients) were included. VDD mode was used in 922 patients. Mean follow-up period for the VDD group was 51 ± 24 months. There was a trend toward lower overall adverse events in the VDD group (9.6% vs 11.6%; OR, 0.74 [95% confidence interval (CI), 0.51-1.05; P = 0.09]). Shorter implantation and fluoroscopy times were noted with VDD pacing (46.2 ± 12 vs 65.9 ± 20 minutes; SMD, -0.96 [95% CI, -1.26 to -0.66; P < 0.0001] and 4.6 ± 1 vs 9.3 ± 0.4 minutes; SMD, -0.83 [95% CI, -1.38 to -0.29; P = 0.003], respectively). Mean P-wave amplitude was significantly lower in VDD (1.5 ± 0.8 mV vs 3.1 ± 0.9 mV; P = 0.02). The incidence of AF was lower in the VDD group but it did not reach statistical significance (7.5% vs 13.0%; OR, 0.7; 95% CI, 0.39-1.27; P = 0.24). This meta-analysis suggests that VDD is a reasonable alternative to DDD pacemakers with lower pneumothorax risk and shorter implantation and fluoroscopy times. More high-quality data are required to definitively compare the 2 strategies. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Service user preferences for diabetes education in remote and rural areas of the Highlands and Islands of Scotland.

PubMed

Hall, Jenny; Skinner, Fiona; Tilley, Phil; MacRury, Sandra

2018-03-01

Diabetes prevalence in Scotland is 5.3%, with type 2 diabetes accounting for 86.7% of all cases in the National Health Service Highlands health board area and 85.7% in the Western Isles. Structured education is a key component in the management of this chronic disease. However, current group session models are less feasible in lower-population non-urban environments due to distance, participant numbers and access to appropriately trained healthcare professionals. Group sessions may also be a less attractive option in small communities, where people tend to have close day-to-day personal contact. This study assesses the access and delivery preferences of remote and rural service users in the Highlands and Western Isles to structured diabetes education programs. The study used a mixed methods approach of focus groups and questionnaires with people with type 2 diabetes in the Highlands and Islands of Scotland. Both modes of participation were designed to explore perception of diabetes knowledge, diabetes education and use of technology. One-to-one delivery was the delivery method of choice; however, there was a preference for a digital approach over group education sessions. Service users expressed a strong desire to be able to learn at their own pace, when and where they wanted to, and with no requirement to travel. To address these requirements an online resource, providing access to both learning sessions and trusted sources of information, was the preferred mode of delivery. People with type 2 diabetes living in remote and rural areas of the Scottish Highlands and Islands who already use the internet are receptive to the use of digital technology for delivery of diabetes education and are interested in learning more about management of their condition through this medium. They believe that a technology approach will provide them with more control over the pace of learning, and where and when this learning can take place.

PACE and the Medicare+Choice risk-adjusted payment model.

PubMed

Temkin-Greener, H; Meiners, M R; Gruenberg, L

2001-01-01

This paper investigates the impact of the Medicare principal inpatient diagnostic cost group (PIP-DCG) payment model on the Program of All-Inclusive Care for the Elderly (PACE). Currently, more than 6,000 Medicare beneficiaries who are nursing home certifiable receive care from PACE, a program poised for expansion under the Balanced Budget Act of 1997. Overall, our analysis suggests that the application of the PIP-DCG model to the PACE program would reduce Medicare payments to PACE, on average, by 38%. The PIP-DCG payment model bases its risk adjustment on inpatient diagnoses and does not capture adequately the risk of caring for a population with functional impairments.

Implantable cardioverter defibrillator does not cure the heart.

PubMed

Sławuta, Agnieszka; Boczar, Krzysztof; Ząbek, Andrzej; Gajek, Jacek; Lelakowski, Jacek; Vijayaraman, Pugazhendhi; Małecka, Barbara

2018-01-23

A man with non-ischemic cardiomyopathy, EF 22%, permanent AF and ICD was admitted for elective device replacement. The need for the optimization of the ventricular rate and avoidance of right ventricular pacing made it necessary to up-grade the existing pacing system using direct His bundle pacing and dual chamber ICD. This enabled the regularization of ventricular rate, avoiding the RV pacing and optimize the beta-blocker dose. The one month follow-up already showed reduction in left ventricle diameter, improvement in ejection fraction, NYHA class decrease to II. The His bundle pacing enabled the optimal treatment of the patient resulting in excellent clinical improvement.

The PACE trial: It's time to broaden perceptions and move on.

PubMed

Petrie, Keith J; Weinman, John

2017-08-01

The continued critiques of the PACE trial highlight how differing beliefs about the causes of chronic fatigue syndrome still influence how scientific studies in this area are accepted and evaluated. Causal beliefs about chronic fatigue syndrome and a modern version of Cartesian dualism are important in understanding the reaction to the PACE trial. The continued debate on the PACE trial seems to miss the fact that science is incremental. An unfortunate outcome of the PACE controversy and intimidation of researchers may be less research in the area. It is time to move on from criticism and collect more data on effective treatments.

Two-speed phacoemulsification for soft cataracts using optimized parameters and procedure step toolbar with the CENTURION Vision System and Balanced Tip

PubMed Central

Davison, James A

2015-01-01

Purpose To present a cause of posterior capsule aspiration and a technique using optimized parameters to prevent it from happening when operating soft cataracts. Patients and methods A prospective list of posterior capsule aspiration cases was kept over 4,062 consecutive cases operated with the Alcon CENTURION machine and Balanced Tip. Video analysis of one case of posterior capsule aspiration was accomplished. A surgical technique was developed using empirically derived machine parameters and customized setting-selection procedure step toolbar to reduce the pace of aspiration of soft nuclear quadrants in order to prevent capsule aspiration. Results Two cases out of 3,238 experienced posterior capsule aspiration before use of the soft quadrant technique. Video analysis showed an attractive vortex effect with capsule aspiration occurring in 1/5 of a second. A soft quadrant removal setting was empirically derived which had a slower pace and seemed more controlled with no capsule aspiration occurring in the subsequent 824 cases. The setting featured simultaneous linear control from zero to preset maximums for: aspiration flow, 20 mL/min; and vacuum, 400 mmHg, with the addition of torsional tip amplitude up to 20% after the fluidic maximums were achieved. A new setting selection procedure step toolbar was created to increase intraoperative flexibility by providing instantaneous shifting between the soft and normal settings. Conclusion A technique incorporating a reduced pace for soft quadrant acquisition and aspiration can be accomplished through the use of a dedicated setting of integrated machine parameters. Toolbar placement of the procedure button next to the normal setting procedure button provides the opportunity to instantaneously alternate between the two settings. Simultaneous surgeon control over vacuum, aspiration flow, and torsional tip motion may make removal of soft nuclear quadrants more efficient and safer. PMID:26355695

42 CFR 460.150 - Eligibility to enroll in a PACE program.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Participant Enrollment and Disenrollment § 460.150 Eligibility to enroll in a...

42 CFR 460.28 - Notice of CMS determination on waiver requests.

Code of Federal Regulations, 2011 CFR

2011-10-01

... HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Organization Application and Waiver Process § 460.28 Notice of...

42 CFR 460.28 - Notice of CMS determination on waiver requests.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Organization Application and Waiver Process § 460.28 Notice of...

42 CFR 460.150 - Eligibility to enroll in a PACE program.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Participant Enrollment and Disenrollment § 460.150 Eligibility to enroll in a...

A method for selective excitation of Ince-Gaussian modes in an end-pumped solid-state laser

NASA Astrophysics Data System (ADS)

Lei, J.; Hu, A.; Wang, Y.; Chen, P.

2014-12-01

A method for selective excitation of Ince-Gaussian modes is presented. The method is based on the spatial distributions of Ince-Gaussian modes as well as the transverse mode selection theory. Significant diffraction loss is introduced in a resonator by using opaque lines at zero-intensity positions, and this loss allows to excite a specific mode; we call this method "loss control." We study the method by means of numerical simulation of a half-symmetric laser resonator. The simulated field is represented by angular spectrum of the plane waves representation, and its changes are calculated by the two-dimensional fast Fourier transform algorithm when it passes through the optical elements and propagates back and forth in the resonator. The output lasing modes of our method have an overlap of over 90 % with the target Ince-Gaussian modes. The method will be beneficial to the further study of properties and potential applications of Ince-Gaussian modes.

Mode Selection Rules for a Two-Delay System with Positive and Negative Feedback Loops

NASA Astrophysics Data System (ADS)

Takahashi, Kin'ya; Kobayashi, Taizo

2018-04-01

The mode selection rules for a two-delay system, which has negative feedback with a short delay time t1 and positive feedback with a long delay time t2, are studied numerically and theoretically. We find two types of mode selection rules depending on the strength of the negative feedback. When the strength of the negative feedback |α1| (α1 < 0) is sufficiently small compared with that of the positive feedback α2 (> 0), 2m + 1-th harmonic oscillation is well sustained in a neighborhood of t1/t2 = even/odd, i.e., relevant condition. In a neighborhood of the irrelevant condition given by t1/t2 = odd/even or t1/t2 = odd/odd, higher harmonic oscillations are observed. However, if |α1| is slightly less than α2, a different mode selection rule works, where the condition t1/t2 = odd/even is relevant and the conditions t1/t2 = odd/odd and t1/t2 = even/odd are irrelevant. These mode selection rules are different from the mode selection rule of the normal two-delay system with two positive feedback loops, where t1/t2 = odd/odd is relevant and the others are irrelevant. The two types of mode selection rules are induced by individually different mechanisms controlling the Hopf bifurcation, i.e., the Hopf bifurcation controlled by the "boosted bifurcation process" and by the "anomalous bifurcation process", which occur for |α1| below and above the threshold value αth, respectively.

Colony pace: a life-history trait affecting social insect epidemiology.

PubMed

Buechel, Séverine Denise; Schmid-Hempel, Paul

2016-01-13

Among colonies of social insects, the worker turnover rate (colony 'pace') typically shows considerable variation. This has epidemiological consequences for parasites, because in 'fast-paced' colonies, with short-lived workers, the time of parasite residence in a given host will be reduced, and further transmission may thus get less likely. Here, we test this idea and ask whether pace is a life-history strategy against infectious parasites. We infected bumblebees (Bombus terrestris) with the infectious gut parasite Crithidia bombi, and experimentally manipulated birth and death rates to mimic slow and fast pace. We found that fewer workers and, importantly, fewer last-generation workers that are responsible for rearing sexuals were infected in colonies with faster pace. This translates into increased fitness in fast-paced colonies, as daughter queens exposed to fewer infected workers in the nest are less likely to become infected themselves, and have a higher chance of founding their own colonies in the next year. High worker turnover rate can thus act as a strategy of defence against a spreading infection in social insect colonies. © 2016 The Author(s).

PACE4 regulates proliferation, migration and invasion in human breast cancer MDA-MB-231 cells.

PubMed

Wang, Feifei; Wang, Lin; Pan, Jihong

2015-01-01

PACE4 is one of the proprotein convertases (PC) that participate in the post-translational activation of inactive proteins, leading to mature, biologically active proteins. The processing reactions occur in pairs of basic amino acids. PACE4 is an extracellular PC that binds to growth factors and several components of the extracellular matrix contributing to tumor progression. In the present study, the PACE4 gene was silenced by small interfering RNA (siRNA), and the knockdown human breast cancer MDA-MB-231 cells showed significantly reduced proliferation, migration and invasion rates. Flow cytometry analysis indicated that downregulation of PACE4 increases the percentage of cells arrested at the G0/G1 phase. Moreover, the expression of genes involved in cell growth, invasion and adhesion, i.e., IGF-2, MMP9 and MPZL2 was significantly decreased following siRNA-mediated silencing of PACE4. Taken together, these results indicate that PACE4 plays an important role in human breast cancer, and that it might represent a novel target for breast cancer therapy.

Effects of substitution, pressure, and temperature on the phonon mode in layered-rocksalt-type Li{sub (1−x)/2}Ga{sub (1−x)/2}Zn{sub x}O (x = 0.036–0.515) alloys

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

Tan, Lijie; Hu, Qiwei; Lei, Li, E-mail: lei@scu.edu.cn

2015-11-14

ZnO-based semiconductor alloys, Li{sub (1−x)/2}Ga{sub (1−x)/2}Zn{sub x}O (x = 0.036–0.515) with a layered-rocksalt-type structure, have been prepared under high pressure. The composition, pressure, and temperature dependence of phonons have been studied by Raman spectroscopy. We observe two disorder-activated Raman (DAR) modes when the Zn composition x increases: a broad Raman peak at ca. 400 cm{sup −1} and a left-shoulder peak at ca. 530 cm{sup −1} on the low-frequency side of A{sub 1g} mode at ca. 580 cm{sup −1}, which can be explained by reference to the phonon density of states for rocksalt-type ZnO. With the increase of the pressure and temperature, the left-shoulder DAR modemore » induced by substitution does not change at the same pace with the A{sub 1g} mode at Brillouin-zone center. We find that ion substitution can be seen as a kind of chemical pressure, and the chemical pressure caused by internal substitution and the physical pressure caused by external compression have equivalent effects on the shortening of correlation length, the distortion of crystal lattice, and the change of atomic occupation.« less

Recommendations for pacemaker implantation for the treatment of atrial tachyarrhythmias and resynchronisation therapy for heart failure: A report from the task force on pacemaker indications of the Dutch Working Group on Cardiac Pacing.

PubMed

van Hemel, N M; Dijkman, B; de Voogt, W G; Beukema, W P; Bosker, H A; de Cock, C C; Jordaens, L J L M; van Gelder, I C; van Gelder, L M; van Mechelen, R; Ruiter, J H; Sedney, M I; Slegers, L C

2004-01-01

Today, new pacing algorithms and stimulation methods for the prevention and interruption of atrial tachyarrhythmias can be applied on patients who need bradycardia pacing for conventional reasons. In addition, biventricular pacing as additive treatment for patients with severe congestive heart failure due to ventricular systolic dysfunction and prolonged intraventricular conduction has shown to improve symptoms and reduce hospital admissions. These new pacing technologies and the optimising of the pacing programmes are complex, expensive and time-consuming. Based on many clinical studies the indications for these devices are beginning to emerge. To support the cardiologist's decision-making and to prevent waste of effort and resources, the 'ad hoc committee' has provided preliminary recommendations for implantable devices to treat atrial tachyarrhythmias and to extend the treatment of congestive heart failure respectively.

Method of Controlling Steering of a Ground Vehicle

NASA Technical Reports Server (NTRS)

Guo, Raymond (Inventor); Atluri, Venkata Prasad (Inventor); Bluethmann, William J. (Inventor); Lee, Chunhao J. (Inventor); Vitale, Robert L. (Inventor); Dawson, Andrew D. (Inventor)

2016-01-01

A method of controlling steering of a vehicle through setting wheel angles of a plurality of modular electronic corner assemblies (eModules) is provided. The method includes receiving a driving mode selected from a mode selection menu. A position of a steering input device is determined in a master controller. A velocity of the vehicle is determined, in the master controller, when the determined position of the steering input device is near center. A drive mode request corresponding to the selected driving mode to the plurality of steering controllers is transmitted to the master controller. A required steering angle of each of the plurality of eModules is determined, in the master controller, as a function of the determined position of the steering input device, the determined velocity of the vehicle, and the selected first driving mode. The eModules are set to the respective determined steering angles.

Mode selection in square resonator microlasers for widely tunable single mode lasing.

PubMed

Tang, Ming-Ying; Sui, Shao-Shuai; Yang, Yue-De; Xiao, Jin-Long; Du, Yun; Huang, Yong-Zhen

2015-10-19

Mode selection in square resonator semiconductor microlasers is demonstrated by adjusting the width of the output waveguide coupled to the midpoint of one side. The simulation and experimental results reveal that widely tunable single mode lasing can be realized in square resonator microlasers. Through adjusting the width of the output waveguide, the mode interval of the high-Q modes can reach four times of the longitudinal mode interval. Therefore, mode hopping can be efficiently avoided and the lasing wavelength can be tuned continuously by tuning the injection current. For a 17.8-μm-side-length square microlaser with a 1.4-μm-width output waveguide, mode-hopping-free single-mode operation is achieved with a continuous tuning range of 9.2 nm. As a result, the control of the lasing mode is realized for the square microlasers.

Loss of pace capture on the ablation line: a new marker for complete radiofrequency lesions to achieve pulmonary vein isolation.

PubMed

Steven, Daniel; Reddy, Vivek Y; Inada, Keiichi; Roberts-Thomson, Kurt C; Seiler, Jens; Stevenson, William G; Michaud, Gregory F

2010-03-01

Catheter ablation procedures for atrial fibrillation (AF) often involve circumferential antral isolation of pulmonary veins (PV). Inability to reliably identify conduction gaps on the ablation line necessitates placing additional lesions within the intended lesion set. This pilot study investigated the relationship between loss of pace capture directly along the ablation line and electrogram criteria for PV isolation (PVI). Using a 3-dimensional anatomic mapping system and irrigated-tip radiofrequency (RF) ablation catheter, lesions were placed in the PV antra to encircle ipsilateral vein pairs until pace capture at 10 mA/2 ms no longer occurred along the line. During ablation, a circular mapping catheter was placed in an ipsilateral PV, but the electrograms were not revealed until loss-of-pace capture. The procedural end point was PVI (entrance and exit block). Thirty patients (57 +/- 12 years; 15 male [50%]) undergoing PVI in 2 centers (3 primary operators) were included (left atrial diameter 40 +/- 4 mm, left ventricular ejection fraction 60 +/- 7%). All patients reached the end points of complete PVI and loss of pace capture. When PV electrograms were revealed after loss of pace capture along the line, PVI was present in 57 of 60 (95%) vein pairs. In the remaining 3 of 60 (5%) PV pairs, further RF applications achieved PVI. The procedure duration was 237 +/- 46 minutes, with a fluoroscopy time of 23 +/- 9 minutes. Analysis of the blinded PV electrograms revealed that even after PVI was achieved, additional sites of pace capture were present on the ablation line in 30 of 60 (50%) of the PV pairs; 10 +/- 4 additional RF lesions were necessary to fully achieve loss of pace capture. After ablation, the electrogram amplitude was lower at unexcitable sites (0.25 +/- 0.15 mV vs. 0.42 +/- 0.32 mV, P < .001), but there was substantial overlap with pace capture sites, suggesting that electrogram amplitude lacks specificity for identifying pace capture sites. Complete loss of pace capture directly along the circumferential ablation line correlates with entrance block in 95% of vein pairs and can be achieved without circular mapping catheter guidance. Thus, pace capture along the ablation line can be used to identify conduction gaps. Interestingly, more RF ablation energy was required to achieve loss of pace capture along the ablation line than for entrance block into PVs. Further study is warranted to determine whether this method results in more durable ablation lesions that reduce recurrence of AF. Copyright 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Multibody dynamics: Modeling component flexibility with fixed, free, loaded, constraint, and residual modes

NASA Technical Reports Server (NTRS)

Spanos, John T.; Tsuha, Walter S.

1989-01-01

The assumed-modes method in multibody dynamics allows the elastic deformation of each component in the system to be approximated by a sum of products of spatial and temporal functions commonly known as modes and modal coordinates respectively. The choice of component modes used to model articulating and non-articulating flexible multibody systems is examined. Attention is directed toward three classical Component Mode Synthesis (CMS) methods whereby component normal modes are generated by treating the component interface (I/F) as either fixed, free, or loaded with mass and stiffness contributions from the remaining components. The fixed and free I/F normal modes are augmented by static shape functions termed constraint and residual modes respectively. A mode selection procedure is outlined whereby component modes are selected from the Craig-Bampton (fixed I/F plus constraint), MacNeal-Rubin (free I/F plus residual), or Benfield-Hruda (loaded I/F) mode sets in accordance with a modal ordering scheme derived from balance realization theory. The success of the approach is judged by comparing the actuator-to-sensor frequency response of the reduced order system with that of the full order system over the frequency range of interest. A finite element model of the Galileo spacecraft serves as an example in demonstrating the effectiveness of the proposed mode selection method.

Optogenetic pacing in Drosophila melanogaster (Conference Presentation)

NASA Astrophysics Data System (ADS)

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

2016-03-01

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

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

PubMed

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

1996-12-01

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

Pacing: A concept analysis of a chronic pain intervention

PubMed Central

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

2013-01-01

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

Selection of experimental modal data sets for damage detection via model update

NASA Technical Reports Server (NTRS)

Doebling, S. W.; Hemez, F. M.; Barlow, M. S.; Peterson, L. D.; Farhat, C.

1993-01-01

When using a finite element model update algorithm for detecting damage in structures, it is important that the experimental modal data sets used in the update be selected in a coherent manner. In the case of a structure with extremely localized modal behavior, it is necessary to use both low and high frequency modes, but many of the modes in between may be excluded. In this paper, we examine two different mode selection strategies based on modal strain energy, and compare their success to the choice of an equal number of modes based merely on lowest frequency. Additionally, some parameters are introduced to enable a quantitative assessment of the success of our damage detection algorithm when using the various set selection criteria.

Human Factors Engineering. A Self-Paced Text, Lessons 36-40,

DTIC Science & Technology

1981-08-01

proposed contract does not involve ’significant human interface for operation/ maintenance /control,’ the selection guide should not be used. Turn to Page 98... work space configuration, packaging, and labeling. These are all aspects of maintenance which need to be incorporated into the original design plans... work done. An ROC is a ’Required Operational Capability’ statement that is required by the Army during the system acquisition process . Return to Page

Self-regulated learning of important information under sequential and simultaneous encoding conditions.

PubMed

Middlebrooks, Catherine D; Castel, Alan D

2018-05-01

Learners make a number of decisions when attempting to study efficiently: they must choose which information to study, for how long to study it, and whether to restudy it later. The current experiments examine whether documented impairments to self-regulated learning when studying information sequentially, as opposed to simultaneously, extend to the learning of and memory for valuable information. In Experiment 1, participants studied lists of words ranging in value from 1-10 points sequentially or simultaneously at a preset presentation rate; in Experiment 2, study was self-paced and participants could choose to restudy. Although participants prioritized high-value over low-value information, irrespective of presentation, those who studied the items simultaneously demonstrated superior value-based prioritization with respect to recall, study selections, and self-pacing. The results of the present experiments support the theory that devising, maintaining, and executing efficient study agendas is inherently different under sequential formatting than simultaneous. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Two aspects of feedforward postural control: anticipatory postural adjustments and anticipatory synergy adjustments.

PubMed

Klous, Miriam; Mikulic, Pavle; Latash, Mark L

2011-05-01

We used the framework of the uncontrolled manifold hypothesis to explore the relations between anticipatory synergy adjustments (ASAs) and anticipatory postural adjustments (APAs) during feedforward control of vertical posture. ASAs represent a drop in the index of a multimuscle-mode synergy stabilizing the coordinate of the center of pressure in preparation to an action. ASAs reflect early changes of an index of covariation among variables reflecting muscle activation, whereas APAs reflect early changes in muscle activation levels averaged across trials. The assumed purpose of ASAs is to modify stability of performance variables, whereas the purpose of APAs is to change magnitudes of those variables. We hypothesized that ASAs would be seen before APAs and that this finding would be consistent with regard to the muscle-mode composition defined on the basis of different tasks and phases of action. Subjects performed a voluntary body sway task and a quick, bilateral shoulder flexion task under self-paced and reaction time conditions. Surface muscle activity of 12 leg and trunk muscles was analyzed to identify sets of 4 muscle modes for each task and for different phases within the shoulder flexion task. Variance components in the muscle-mode space and indexes of multimuscle-mode synergy stabilizing shift of the center of pressure were computed. ASAs were seen ∼ 100-150 ms prior to the task initiation, before APAs. The results were consistent with respect to different sets of muscle modes defined over the two tasks and different shoulder flexion phases. We conclude that the preparation for a self-triggered postural perturbation is associated with two types of anticipatory adjustments, ASAs and APAs. They reflect different feedforward processes within the hypothetical hierarchical control scheme, resulting in changes in patterns of covariation of elemental variables and in their patterns averaged across trials, respectively. The results show that synergies quantified using dissimilar sets of muscle modes show similar feedforward changes in preparation to action.

Pace Speaks Across America - February 21 2007 - U.S. Department of Defense

Science.gov Websites

Washington State, Oregon, Alaska and Florida. Pace Discusses Force Levels, Military Challenges WASHINGTON Iraq, force levels or tour lengths, Marine Gen. Peter Pace is eager to answer frankly and completely

Adiabatically tapered splice for selective excitation of the fundamental mode in a multimode fiber.

PubMed

Jung, Yongmin; Jeong, Yoonchan; Brambilla, Gilberto; Richardson, David J

2009-08-01

We propose a simple and effective method to selectively excite the fundamental mode of a multimode fiber by adiabatically tapering a fusion splice to a single-mode fiber. We experimentally demonstrate the method by adiabatically tapering splice (taper waist=15 microm, uniform length=40 mm) between single-mode and multimode fiber and show that it provides a successful mode conversion/connection and allows for almost perfect fundamental mode excitation in the multimode fiber. Excellent beam quality (M(2) approximately 1.08) was achieved with low loss and high environmental stability.

Extrinsic and intrinsic factors associated with non-contact injury in adult pace bowlers: a systematic review protocol.

PubMed

Olivier, Benita; Stewart, Aimee; Taljaard, Tracy; Burger, Elaine; Brukner, Peter; Orchard, John; Gray, Janine; Botha, Nadine; Mckinon, Warrick

2015-01-01

Review question: which extrinsic and intrinsic factors are associated with non-contact injury in adult cricket pace bowlers?Review objective: the objective of this review is to determine the extrinsic and intrinsic factors associated with non-contact injury in adult pace bowlers. Cricket is generally considered to be a sport of low injury risk compared to other sports. In cricket, the pace bowler strives towards the adoption of a bowling technique with a relatively low injury threat that will, at the same time, allow for a fast (>120km/hr) and accurate delivery to the opposing batsman. However, of all the various roles of the cricket player, the pace bowler has the highest risk of injury, especially for low back and lower limb (lower quarter) injury. The reason for this high risk of injury is due to the inherent, high-load biomechanical nature of the pace bowling action. The high prevalence of injury amongst pace bowlers highlights the great need for research into factors associated with injury.Both extrinsic and intrinsic factors work in combination to predispose the bowler to injury. Extrinsic or environment-related factors include bowling workload (the numbers of overs a bowler bowls), player position (first, second or third change) and time of play (morning or afternoon). A high bowling workload has been linked with a higher risk of injury in pace bowlers. Foster et al. found in an observational study that bowling too many overs in a single spell or bowling too many spells may increase the pace bowler's risk of sustaining a low back injury. In another observational study, Dennis et al. found that an exceptionally high bowling workload as well as an uncommonly low bowling workload is associated with injury risk. The major extrinsic factors for bowling injury identified by Orchard et al. are a high number of match overs bowled in the previous week, number of days of play and bowling second (batting first) in a match. Extrinsic factors are known to make the bowler more susceptible to injury, especially in the presence of intrinsic factors.Intrinsic, or person-related, factors include muscle strength, flexibility, balance and biomechanics. Intrinsic, strength-related factors, such as shoulder depression, horizontal flexion strength for the preferred limb and quadriceps power in the non-preferred limb are also significantly related to back injuries in fast bowlers. Both upper limb and lower limb-related intrinsic factors are known to be associated with injury. A prospective study by Dennis et al. aimed to identify the risk factors for injury in adolescent cricket fast bowlers. Their findings concluded that bowlers with a hip internal rotation range of motion of ≤30° on the leg ipsilateral to the bowling arm were at a significantly reduced risk of injury compared with bowlers with >40° of rotation. Moreover, bowlers with ankle dorsiflexion lunge of 12.1-14.0 cm on the leg contralateral to the bowling arm were at a significantly increased risk of injury compared to bowlers with a lunge of >14 cm. Reduced hamstring flexibility was also associated with lumbar disc abnormalities. Bowling-related biomechanical risk factors for injury have been established such as trunk rotation of the shoulders by to a more side-on position during the delivery stride. Portus et al. also reported that shoulder counter-rotation was significantly higher in bowlers who reported lumbar spine stress fractures, while the non-trunk injured group displayed a more flexed knee at front foot contact and ball release. In addition to the above kinematic risk factors, there are high ground reaction forces associated with the power phase - between the front foot placement and ball release components of the pace bowling action. A combination of kinematic bowling related issues as described above and high ground reaction forces may predispose the bowler to injury.Morton et al. conducted a systematic review on pace bowlers between the ages of 13.7 and 22.5 years on risk factors and successful interventions for cricket-related low back pain. Young cricketers between the ages of 13 and 18 years are different to adults in terms of their physiology which impacts on their predisposition to injury and phases of healing. Young cricketers may differ from an adult population in that young pace bowlers who sustain injuries during their bowling career may have given up on the sport by the time they approach adulthood, and the composition of the adult pace bowler population group is therefore affected by natural selection which may cause this group to differ from the original population. Caution is thus advised when generalizing findings from this young population group to adult pace bowlers which emphasizes the need for studies amongst adult pace bowlers. Furthermore, the review by Morton et al. included articles that specifically investigated factors associated with low back pain. However, due to the interconnectedness between the spine and the lower limbs, kinematic variables affecting the spine will also affect the load placed on the lower limbs with subsequent risk of injury. The interdependent mechanical interactions in a linked segment system such as the system of motion of the low back can be caused by movement coordination patterns in other body segments. The systematic review by Morton et al. only included intrinsic factors while the proposed review will also look at extrinsic factors. Therefore, the primary objective of this review is to determine extrinsic and intrinsic factors associated with non-contact injury in adult pace bowlers.

G-band harmonic multiplying gyrotron traveling-wave amplifier with a mode-selective circuit

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

Yeh, Y. S.; Chen, Chang-Hong; Wang, Z. W.

Harmonic multiplying gyrotron traveling-wave amplifiers (gyro-TWAs) permit for magnetic field reduction and frequency multiplication. A high-order-mode harmonic multiplying gyro-TWA with large circuit dimensions and low ohmic loss can achieve a high average power. By amplifying a fundamental harmonic TE{sub 01} drive wave, the second harmonic component of the beam current initiates a TE{sub 02} wave to be amplified. Wall losses can suppress some competing modes because they act as an effective sink of the energy of the modes. However, such wall losses do not suppress all competing modes as the fields are contracted in the copper section in the gyro-TWA.more » An improved mode-selective circuit, using circular waveguides with the specified radii, can provide the rejection points within the frequency range to suppress the competing modes. The simulated results reveal that the mode-selective circuit can provide an attenuation of more than 10 dB to suppress the competing modes (TE{sub 21}, TE{sub 51}, TE{sub 22}, and TE{sub 03}). A G-band second harmonic multiplying gyro-TWA with the mode-selective circuit is predicted to yield a peak output power of 50 kW at 198.8 GHz, corresponding to a saturated gain of 55 dB at an interaction efficiency of 10%. The full width at half maximum bandwidth is 5 GHz.« less

Non-invasive red light optogenetic pacing and optical coherence microscopy (OCM) imaging for drosophila melanogaster (Conference Presentation)

NASA Astrophysics Data System (ADS)

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

2017-02-01

Cardiac pacing could be a powerful tool for investigating mammalian cardiac electrical conduction systems as well as for treatment of certain cardiac pathologies. However, traditional electrical pacing using pacemaker requires an invasive surgical procedure. Electrical currents from the implanted electrodes can also cause damage to heart tissue, further restricting its utility. Optogenetic pacing has been developed as a promising, non-invasive alternative to electrical stimulation for controlling animal heart rhythms. It induces heart contractions by shining pulsed light on transgene-generated microbial opsins, which in turn activate the light gated ion channels in animal hearts. However, commonly used opsins in optogenetic pacing, such as channelrhodopsin-2 (ChR2), require short light wavelength stimulation (475 nm), which is strongly absorbed and scattered by tissue. Here, we performed optogenetic pacing by expression of recently engineered red-shifted microbial opsins, ReaChR and CsChrimson, in a well-established animal model, Drosophila melanogaster, using the 617 nm stimulation light pulses. The OCM technique enables non-invasive optical imaging of animal hearts with high speed and ultrahigh axial and transverse resolutions. We integrated a customized OCM system with the optical stimulation system to monitor the optogenetic pacing noninvasively. The use of red-sifted opsins enabled deeper penetration of simulating light at lower power, which is promising for applications of optogenetic pacing in mammalian cardiac pathology studies or clinical treatments in the future.

[Clinical experiences with four newly developed, surface modified stimulation electrodes].

PubMed

Winter, U J; Fritsch, J; Liebing, J; Höpp, H W; Hilger, H H

1993-05-01

Newly developed pacing electrodes with so-called porous surfaces promise a significantly improved post-operative pacing and sensing threshold. We therefore investigated four newly developed leads (ELA-PMCF-860 n = 10; Biotronik-60/4-DNP n = 10, CPI-4010 n = 10, Intermedics-421-03-Biopore n = 6) connected to two different pacing devices (Intermedics NOVA II, Medtronic PASYS) in 36 patients (18 men, 18 women, age: 69.7 +/- 9.8 years) suffering from symptomatic bradycardia. The individual electrode maturation process was investigated by means of repeated measurements of pacing threshold, electrode impedance in acute, subacute, and chronic phase, as well as energy consumption and sensing behavior in the chronic phase. However, with the exception of the 4010, the investigated leads showed largely varying values of the pacing threshold with individual peaks occurring from the second up to the 13th week. All leads had nearly similar chronic pacing thresholds (PMCF 0.13 +/- 0.07; DNP 0.25 +/- 0.18; Biopore 0.15 +/- 0.05; 4010 0.14 +/- 0.05 ms). Impedance measurements revealed higher, but not significantly different values for the DNP (PMCF 582 +/- 112, DNP 755 +/- 88, Biopore 650 +/- 15, 4010 718 +/- 104 Ohm). Despite differing values for pacing threshold and impedance, the energy consumption in the chronic phase during threshold-adapted, but secure stimulation (3 * impulse-width at pacing threshold) were comparable.

Staying Connected on the Road: A Comparison of Different Types of Smart Phone Use in a Driving Simulator

PubMed Central

McNabb, Jaimie; Gray, Rob

2016-01-01

Previous research on smart phone use while driving has primarily focused on phone calls and texting. Drivers are now increasingly using their phone for other activities during driving, in particular social media, which have different cognitive demands. The present study compared the effects of four different smart phone tasks on car-following performance in a driving simulator. Phone tasks were chosen that vary across two factors: interaction medium (text vs image) and task pacing (self-paced vs experimenter-paced) and were as follows: Text messaging with the experimenter (text/other-paced), reading Facebook posts (text/self-paced), exchanging photos with the experimenter via Snapchat (image, experimenter -paced), and viewing updates on Instagram (image, experimenter -paced). Drivers also performed a driving only baseline. Brake reaction times (BRTs) were significantly greater in the text-based conditions (Mean = 1.16 s) as compared to both the image-based conditions (Mean = 0.92 s) and the baseline (0.88 s). There was no significant difference between BRTs in the image-based and baseline conditions and there was no significant effect of task-pacing. Similar results were obtained for Time Headway variability. These results are consistent with the picture superiority effect found in memory research and suggest that image-based interfaces could provide safer ways to “stay connected” while driving than text-based interfaces. PMID:26886099

Antiarrhythmic properties of atrial pacing.

PubMed

Kliś, Magdalena; Sławuta, Agnieszka; Gajek, Jacek

2017-01-01

Bradycardia, atrial stretch and dilatation, autonomic nervous system disorders, and the presence of triggers such as atrial premature contractions, are factors which predispose a person to paroxysmal AF. Atrial pacing not only eliminates bradycardia but also prevents atrial premature contractions and dispersion of refractoriness, which are a substrate for atrial fibrillation. As the prolonged duration of atrial activation during pacing, especially from locations changing the physiological pattern of this activation (right atrium lateral wall, right atrium appendage), negatively influences both a mechanical and an electrical function of the atria, the atrial pacing site affects an atrial arrhythmogenesis. A conventional atrial lead location in the right atrium appendage causes non-physiological activation propagation, resulting in a prolongation of the activation time of both atria. This location is optimal according to a passive fixation of the atrial lead but the available contemporary active fixation leads could potentially be located in any area of the atrium. There is growing evidence of the benefit of pacing, imitating the physiological propagation of impulses within the atria. It seems that the Bachmann's bundle pacing is the best pacing site within the atria, not only positively influencing the atrial mechanical function but also best fulfilling the so-called atrial resynchronization function, in particular in patients with interatrial conduction delay. It can be effectively achieved using only one atrial electrode, and the slight shortening of atrioventricular conduction provides an additional benefit of this atrial pacing site.

Interaction between spiral and paced waves in cardiac tissue

PubMed Central

Agladze, Konstantin; Kay, Matthew W.; Krinsky, Valentin; Sarvazyan, Narine

2010-01-01

For prevention of lethal arrhythmias, patients at risk receive implantable cardioverter-defibrillators, which use high-frequency antitachycardia pacing (ATP) to convert tachycardias to a normal rhythm. One of the suggested ATP mechanisms involves paced-induced drift of rotating waves followed by their collision with the boundary of excitable tissue. This study provides direct experimental evidence of this mechanism. In monolayers of neonatal rat cardiomyocytes in which rotating waves of activity were initiated by premature stimuli, we used the Ca2+-sensitive indicator fluo 4 to observe propagating wave patterns. The interaction of the spiral tip with a paced wave was then monitored at a high spatial resolution. In the course of the experiments, we observed spiral wave pinning to local heterogeneities within the myocyte layer. High-frequency pacing led, in a majority of cases, to successful termination of spiral activity. Our data show that 1) stable spiral waves in cardiac monolayers tend to be pinned to local heterogeneities or areas of altered conduction, 2) overdrive pacing can shift a rotating wave from its original site, and 3) the wave break, formed as a result of interaction between the spiral tip and a paced wave front, moves by a paced-induced drift mechanism to an area where it may become unstable or collide with a boundary. The data were complemented by numerical simulations, which was used to further analyze experimentally observed behavior. PMID:17384124

Staying Connected on the Road: A Comparison of Different Types of Smart Phone Use in a Driving Simulator.

PubMed

McNabb, Jaimie; Gray, Rob

2016-01-01

Previous research on smart phone use while driving has primarily focused on phone calls and texting. Drivers are now increasingly using their phone for other activities during driving, in particular social media, which have different cognitive demands. The present study compared the effects of four different smart phone tasks on car-following performance in a driving simulator. Phone tasks were chosen that vary across two factors: interaction medium (text vs image) and task pacing (self-paced vs experimenter-paced) and were as follows: Text messaging with the experimenter (text/other-paced), reading Facebook posts (text/self-paced), exchanging photos with the experimenter via Snapchat (image, experimenter-paced), and viewing updates on Instagram (image, experimenter-paced). Drivers also performed a driving only baseline. Brake reaction times (BRTs) were significantly greater in the text-based conditions (Mean = 1.16 s) as compared to both the image-based conditions (Mean = 0.92 s) and the baseline (0.88 s). There was no significant difference between BRTs in the image-based and baseline conditions and there was no significant effect of task-pacing. Similar results were obtained for Time Headway variability. These results are consistent with the picture superiority effect found in memory research and suggest that image-based interfaces could provide safer ways to "stay connected" while driving than text-based interfaces.

On efficiency and interpretation of sawteeth pacing with on-axis ICRH modulation in JET

NASA Astrophysics Data System (ADS)

Murari, A.; Craciunescu, T.; Peluso, E.; Lerche, E.; Gelfusa, M.; Contributors, JET

2017-12-01

In metallic machines ICRH heating is playing an increasingly important role. One of its most recent applications on the Joint Europena Torus (JET) is sawtooth control by ICRH modulation, for avoiding triggering dangerous neo-classical tearing modes (NTMs) and counteracting impurity accumulation. Some of the main difficulties of these experiments are the assessment of the synchronization efficiency and the understanding of the main physical mechanisms at play. In this paper, three independent classes of statistical indicators are introduced to address these issues: Recurrence Plots, Convergent Cross Mapping and Transfer Entropy. The application to JET experiments with the ILW shows that the proposed indicators agree quite well among themselves and provide sound estimates of the efficiency of the synchronisation scheme investigated. They also support, with a shot to shot basis analysis and an estimate of the uncertainties, the interpretation that the fast ions play a fundamental role in the stabilization of the sawteeth, in both L and H mode. Proposals for experiments to be carried out in the future to consolidate the interpretation of the results are discussed.

42 CFR 460.76 - Transportation services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Transportation services. 460.76 Section 460.76... ELDERLY (PACE) PACE Administrative Requirements § 460.76 Transportation services. (a) Safety, accessibility, and equipment. A PACE organization's transportation services must be safe, accessible, and...

42 CFR 460.76 - Transportation services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Transportation services. 460.76 Section 460.76... ELDERLY (PACE) PACE Administrative Requirements § 460.76 Transportation services. (a) Safety, accessibility, and equipment. A PACE organization's transportation services must be safe, accessible, and...

42 CFR 460.76 - Transportation services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Transportation services. 460.76 Section 460.76... ELDERLY (PACE) PACE Administrative Requirements § 460.76 Transportation services. (a) Safety, accessibility, and equipment. A PACE organization's transportation services must be safe, accessible, and...

Effect of right ventricular pacing lead site on left ventricular function in patients with high-grade atrioventricular block: results of the Protect-Pace study.

PubMed

Kaye, Gerald C; Linker, Nicholas J; Marwick, Thomas H; Pollock, Lucy; Graham, Laura; Pouliot, Erika; Poloniecki, Jan; Gammage, Michael

2015-04-07

Chronic right ventricle (RV) apical (RVA) pacing is standard treatment for an atrioventricular (AV) block but may be deleterious to left ventricle (LV) systolic function. Previous clinical studies of non-apical pacing have produced conflicting results. The aim of this randomized, prospective, international, multicentre trial was to compare change in LV ejection fraction (LVEF) between right ventricular apical and high septal (RVHS) pacing over a 2-year study period. We randomized 240 patients (age 74 ± 11 years, 67% male) with a high-grade AV block requiring >90% ventricular pacing and preserved baseline LVEF >50%, to receive pacing at the RVA (n = 120) or RVHS (n = 120). At 2 years, LVEF decreased in both the RVA (57 ± 9 to 55 ± 9%, P = 0.047) and the RVHS groups (56 ± 10 to 54 ± 10%, P = 0.0003). However, there was no significant difference in intra-patient change in LVEF between confirmed RVA (n = 85) and RVHS (n = 83) lead position (P = 0.43). There were no significant differences in heart failure hospitalization, mortality, the burden of atrial fibrillation, or plasma brain natriutetic peptide levels between the two groups. A significantly greater time was required to place the lead in the RVHS position (70 ± 25 vs. 56 ± 24 min, P < 0.0001) with longer fluoroscopy times (11 ± 7 vs. 5 ± 4 min, P < 0.0001). In patients with a high-grade AV block and preserved LV function requiring a high percentage of ventricular pacing, RVHS pacing does not provide a protective effect on left ventricular function over RVA pacing in the first 2 years. ClinicalTrials.gov number NCT00461734. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

Transcatheter leadless pacemaker implantation in a patient with a transvenous dual-chamber pacemaker already in place.

PubMed

Karjalainen, Pasi P; Nammas, Wail; Paana, Tuomas

2016-01-01

An 83-year-old lady had a DDDR pacemaker inserted in 1997 for symptomatic atrioventricular block. She underwent battery replacement in 2008. In 2010, she developed atrial fibrillation; the pacemaker was switched to VVIR mode. During the last 2years, ventricular lead threshold increased progressively. In December 2015, she presented for elective battery replacement. After successful battery replacement, the ventricular lead threshold remained high; therefore, we implanted a leadless transcatheter pacemaker, via femoral vein access, using a dedicated catheter delivery system. Electrical measurements at this stage revealed a pacing threshold of 0.28V at 0.24msec, and an impedance of 650Ω. Copyright © 2016 Elsevier Inc. All rights reserved.

A Pilot Study on the Effects of Slow Paced Breathing on Current Food Craving.

PubMed

Meule, Adrian; Kübler, Andrea

2017-03-01

Heart rate variability biofeedback (HRV-BF) involves slow paced breathing (approximately six breaths per minute), thereby maximizing low-frequent heart rate oscillations and baroreflex gain. Mounting evidence suggests that HRV-BF promotes symptom reductions in a variety of physical and mental disorders. It may also positively affect eating behavior by reducing food cravings. The aim of the current study was to investigate if slow paced breathing can be useful for attenuating momentary food craving. Female students performed paced breathing either at six breaths per minute (n = 32) or at nine breaths per minute (n = 33) while watching their favorite food on the computer screen. Current food craving decreased during a first resting period, increased during paced breathing, and decreased during a second resting period in both conditions. Although current hunger increased in both conditions during paced breathing as well, it remained elevated after the second resting period in the nine breaths condition only. Thus, breathing rate did not influence specific food craving, but slow paced breathing appeared to have a delayed influence on state hunger. Future avenues are suggested for the study of HRV-BF in the context of eating behavior.

Optogenetic pacing in Drosophila melanogaster

PubMed Central

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

2015-01-01

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

Heart rate autonomic regulation system at rest and during paced breathing among patients with CRPS as compared to age-matched healthy controls.

PubMed

Bartur, Gadi; Vatine, Jean-Jacques; Raphaely-Beer, Noa; Peleg, Sara; Katz-Leurer, Michal

2014-09-01

The objective of this study is to assess the autonomic nerve heart rate regulation system at rest and its immediate response to paced breathing among patients with complex regional pain syndrome (CRPS) as compared with age-matched healthy controls. Quasiexperimental. Outpatient clinic. Ten patients with CRPS and 10 age- and sex-matched controls. Participants underwent Holter ECG (NorthEast Monitoring, Inc., Maynard, MA, USA) recording during rest and biofeedback-paced breathing session. Heart rate variability (HRV), time, and frequency measures were assessed. HRV and time domain values were significantly lower at rest among patients with CRPS as compared with controls. A significant association was noted between pain rank and HRV frequency measures at rest and during paced breathing; although both groups reduced breathing rate significantly during paced breathing, HRV time domain parameters increased only among the control group. The increased heart rate and decreased HRV at rest in patients with CRPS suggest a general autonomic imbalance. The inability of the patients to increase HRV time domain values during paced breathing may suggest that these patients have sustained stress response with minimal changeability in response to slow-paced breathing stimuli. Wiley Periodicals, Inc.

Positive pacing in elite IRONMAN triathletes.

PubMed

Angehrn, Nicole; Rüst, Christoph A.; Nikolaidis, Pantelis T.; Rosemann, Thomas; Knechtle, Beat

2016-12-31

Pacing is known to influence athletic performance. For the Ironman triathlon program, a positive pacing strategy, i.e., the continuous decrease of speed over time was recommended. By analyzing split times, we assessed the pacing strategies of the top 100 finishers of the cycling part of 13 Ironman races and of the running part of 11 Ironman races taking place in 2014. Furthermore, sex-associated differences in performance and pacing strategies were calculated. We analyzed 7,687 cycling and 11,894 running split times of 1,392 triathletes (1,263 men, 129 women). Changes in speed were assessed using mixed-effects regression analyses. A continuous decrease in speed was observed during cycling in 10/13 races, and during running in 11/11 races. In 6/13 races, women decreased their speed during cycling significantly more than men. The running part showed no significant difference of changes in speed between the sexes. In summary, in the Ironman races evaluated, a positive pacing strategy was adopted in most races. Women were slower than men in 6/13 cycling races, but there was no difference between men and women in the run splits. Women used the same pacing strategy as men.

Towards PACE Atmospheric Correction, Aerosol and Cloud Products: Making Use of Expanded Spectral, Angular and Polarimetric Information.

NASA Astrophysics Data System (ADS)

Remer, L. A.; Boss, E.; Ahmad, Z.; Cairns, B.; Chowdhary, J.; Coddington, O.; Davis, A. B.; Dierssen, H. M.; Diner, D. J.; Franz, B. A.; Frouin, R.; Gao, B. C.; Garay, M. J.; Heidinger, A.; Ibrahim, A.; Kalashnikova, O. V.; Knobelspiesse, K. D.; Levy, R. C.; Omar, A. H.; Meyer, K.; Platnick, S. E.; Seidel, F. C.; van Diedenhoven, B.; Werdell, J.; Xu, F.; Zhai, P.; Zhang, Z.

2017-12-01

NASA's Science Team for the Plankton, Aerosol, Clouds, ocean Ecosystem (PACE) mission is concluding three years of study exploring the science potential of expanded spectral, angular and polarization capability for space-based retrievals of water leaving radiance, aerosols and clouds. The work anticipates future development of retrievals to be applied to the PACE Ocean Color Instrument (OCI) and/or possibly a PACE Multi-Angle Polarimeter (MAP). In this presentation we will report on the Science Team's accomplishments associated with the atmosphere (significant efforts are also directed by the ST towards the ocean). Included in the presentation will be sensitivity studies that explore new OCI capabilities for aerosol and cloud layer height, aerosol absorption characterization, cloud property retrievals, and how we intend to move from heritage atmospheric correction algorithms to make use of and adjust to OCI's hyperspectral and UV wavelengths. We will then address how capabilities will improve with the PACE MAP, how these capabilities from both OCI and MAP correspond to specific societal benefits from the PACE mission, and what is still needed to close the gaps in our understanding before the PACE mission can realize its full potential.

Is Self-Paced Instruction Really Worth It?

ERIC Educational Resources Information Center

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

1975-01-01

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

42 CFR 460.76 - Transportation services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Administrative Requirements § 460.76 Transportation services. (a) Safety... participants. (2) Handling emergency situations. (e) Changes in care plan. As part of the interdisciplinary...

42 CFR 460.76 - Transportation services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Administrative Requirements § 460.76 Transportation services. (a) Safety... participants. (2) Handling emergency situations. (e) Changes in care plan. As part of the interdisciplinary...

42 CFR 460.62 - Governing body.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE... patient care responsibilities. (5) Fiscal operations. (6) Development of policies on participant health and safety, including a comprehensive, systemic operational plan to ensure the health and safety of...

Notation system and overlay diagrams for the analysis of paced electrocardiograms.

PubMed

Bernstein, A D; Parsonnet, V

1983-01-01

With the advent of adaptive dual-chamber pacing, the interaction between the pacemaker and the heart is becoming increasingly complex and the interpretation of paced electrocardiograms more difficult. We have developed a set of notation conventions for use in teaching and rhythm-strip analysis. Easily-drawn symbols delineate successful, unsuccessful, and inhibited pacing and sensing events as well as refractory and blanking periods. Another application is to generate movable transparent overlays after programming a pacemaker, to be used in interpreting subsequent rhythm strips.

Using left-ventricular-only pacing to eliminate T-wave oversensing in a biventricular implantable cardiac defibrillator.

PubMed

Khoo, Clarence; Bennett, Matthew; Chakrabarti, Santabhanu; LeMaitre, John; Tung, Stanley K K

2013-02-01

A man aged 75 years and with nonischemic cardiomyopathy had implantation of a biventricular implantable cardiac defibrillator (ICD). Consistent biventricular pacing was limited by intermittent T-wave oversensing (TWOS). A strategy of left-ventricular-only pacing was used to eliminate TWOS. This strategy obviates the need to reduce ventricular sensitivity and thus may be an effective alternative to biventricular pacing complicated by TWOS. Copyright © 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Mode competition and selection in overmoded surface wave oscillator

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

Wang, Guangqiang; Zeng, Peng; Wang, Dongyang

2016-05-15

The overmoded surface wave oscillator (SWO) is one of the promising devices to generate high-power millimeter and subterahertz waves for its merits of high efficiency and easy fabrication. But the employed slow wave structure with large diameter may introduce mode competition as the adverse effects. Therefore, the mode competition and selection in the overmoded surface wave oscillator are investigated in detail in this paper. By using the theoretical analysis and particle-in-cell simulation, the potential transverse mode and axial mode competition is pointed out, and the physical mechanisms and methods for mode selection are investigated. At last, the results are verifiedmore » in the design of a 0.14 THz overmoded SWO without mode competition, which can generate the output power up to 70 MW at the frequency of 146.3 GHz with conversion efficiency almost 20% when beam voltage and current are, respectively, about 313 kV and 1.13 kA.« less

Magnon mode selective spin transport in compensated ferrimagnets

DOE PAGES

Cramer, Joel; Guo, Er -Jia; Geprags, Stephan; ...

2017-04-13

We investigate the generation of magnonic thermal spin currents and their mode selective spin transport across interfaces in insulating, compensated ferrimagnet/normal metal bilayer systems. The spin Seebeck effect signal exhibits a nonmonotonic temperature dependence with two sign changes of the detected voltage signals. Using different ferrimagnetic garnets, we demonstrate the universality of the observed complex temperature dependence of the spin Seebeck effect. To understand its origin, we systematically vary the interface between the ferrimagnetic garnet and the metallic layer, and by using different metal layers we establish that interface effects play a dominating role. They do not only modify themore » magnitude of the spin Seebeck effect signal but in particular also alter its temperature dependence. By varying the temperature, we can select the dominating magnon mode and we analyze our results to reveal the mode selective interface transmission probabilities for different magnon modes and interfaces. As a result, the comparison of selected systems reveals semiquantitative details of the interfacial coupling depending on the materials involved, supported by the obtained field dependence of the signal.« less

Magnon mode selective spin transport in compensated ferrimagnets

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

Cramer, Joel; Guo, Er -Jia; Geprags, Stephan

We investigate the generation of magnonic thermal spin currents and their mode selective spin transport across interfaces in insulating, compensated ferrimagnet/normal metal bilayer systems. The spin Seebeck effect signal exhibits a nonmonotonic temperature dependence with two sign changes of the detected voltage signals. Using different ferrimagnetic garnets, we demonstrate the universality of the observed complex temperature dependence of the spin Seebeck effect. To understand its origin, we systematically vary the interface between the ferrimagnetic garnet and the metallic layer, and by using different metal layers we establish that interface effects play a dominating role. They do not only modify themore » magnitude of the spin Seebeck effect signal but in particular also alter its temperature dependence. By varying the temperature, we can select the dominating magnon mode and we analyze our results to reveal the mode selective interface transmission probabilities for different magnon modes and interfaces. As a result, the comparison of selected systems reveals semiquantitative details of the interfacial coupling depending on the materials involved, supported by the obtained field dependence of the signal.« less

Medical Education in Infectious Diseases. Using Smartphone Apps for Active Learning

PubMed Central

Valdez, Luis; Gray, Andrea; Ramos, Gaston; Siu, Hugo

2017-01-01

Abstract Background Active Learning using smartphone technology can be implemented as a tool for teaching medical students (MS) and residents (Rs). The use of technology would increase participation and enhance student learning by engaging them in solving ID clinical case scenarios. Our objective was to describe the methods used and to share the opinions of the users of such active learning methods. Methods The smartphone applications used were Socrative and WhatsApp. We used Socrative during the Universidad Peruana de Ciencias Aplicadas (UPC) ID course for MS in two different ways. In selected lectures (4 of 32), teacher paced questions were asked based on clinical scenarios related to the topic reviewed, and by voluntary homework questionnaires (student paced). At the British American Hospital (BAH) Medicine Department (MS and Rs) Socrative was used similarly: during some noon lectures (teacher paced questions) and during the baseline MS exam and Rs mid-year exam and voluntary homework questions (student paced). WhatsApp is currently used at the BAH with questions send from Monday to Friday. MS /Rs answer individually via WhatsApp to the mentor in charge. The right answer is given the next day. Questions using WhatsApp deal with recent cases seen at the Wards or in the outpatient clinic, and are designed so that the MS/Rs must do quick literature searches in order to provide the right answer. Results Forty-one MS/Rs answered the survey on Socrative use, 25 of 48 (52%) of UPC MS and 16 (89%) MS/Rs from the BAH. Forty (97%) believed using Socrative had influenced their learning and all but 2 believed it promoted participation from the class. 36 (87.8%) would like to have Socrative used in other lectures and 35 (85%) in other courses. Only one person voted against Socrative use in courses or lectures. With regards to WhatsApp use 16 MS/Rs from BAH answered the survey. Six had used before WhatsApp as a teaching tool. All felt the methodology was useful for learning and promoting reading and would recommend this methodology to promote learning on a student paced way. Conclusion Socrative and WhatsApp can be used for teaching ID through MS/Rs smartphones. Most MS/Rs who were surveyed recommended the use of such methods in their education. Disclosures All authors: No reported disclosures.

Comparison of right ventricular septal pacing and right ventricular apical pacing in patients receiving cardiac resynchronization therapy defibrillators: the SEPTAL CRT Study

PubMed Central

Leclercq, Christophe; Sadoul, Nicolas; Mont, Lluis; Defaye, Pascal; Osca, Joaquim; Mouton, Elisabeth; Isnard, Richard; Habib, Gilbert; Zamorano, Jose; Derumeaux, Genevieve; Fernandez-Lozano, Ignacio; Dupuis, Jean-Marc; Rouleau, Frédéric; Tassin, Aude; Bordachar, Pierre; Clémenty, Jacques; Lafitte, Stephane; Ploux, Sylvan; Reant, Patricia; Ritter, Philippe; Defaye, Pascal; Jacon, Peggy; Mondesert, Blandine; Saunier, Carole; Vautrin, Estelle; Kacet, Salem; Guedon-Moreau, Laurence; Klug, Didier; Kouakam, Claude; Marechaux, Sylvestre; Marquie, Christelle; Polge, Anne Sophie; Richardson, Marjorie; Chevallier, Philippe; De Breyne, Brigitte; Lotek, Marcin M.; Nonin, Emilie; Pineau, Julien; Deharo, Jean-Claude; Bastard, Emilie; Franceschi, Frédéric; Habib, Gilbert; Jego, Christophe; Peyrouse, Eric; Prevot, Sebastien; Saint-Joseph, Hôpital; Bremondy, Michel; Faure, Jacques; Ferracci, Ange; Lefevre, Jean; Pisapia, Andre; Davy, Jean-Marc; Cransac, Frederic; Cung, Tien Tri; Georger, Frederic; Pasquie, Jean-Luc; Raczka, Franck; Sportouch-Dukhan, Catherine; Sadoul, Nicolas; Blangy, Hugues; Bruntz, Jean-François; Freysz, Luc; Groben, Laurent; Huttin, Olivier; Bammert, Antoine; Burban, Marc; Cebron, Jean-Pierre; Gras, Daniel; Frank, Robert; Duthoit, Guillaume; Hidden-Lucet, Françoise; Himbert, Caroline; Isnard, Richard; Lacotte, Jérôme; Pousset, Françoise; Zerah, Thierry; Leclercq, Christophe; Bellouin, Annaïk; Crocq, Christophe; Deplace, Christian; Donal, Erwan; Hamon, Cécile; Mabo, Philippe; Romain, Olivier; Solnon, Aude; Frederic, Anselme; Bauer, Fabrice; Bernard, Mathieu; Godin, Benedicte; Kurtz, Baptiste; Savoure, Arnaud; Copie, Xavier; Lascault, Gilles; Paziaud, Olivier; Piot, Olivier; Touche, Thierry; Delay, Toulouse Marc; Chilon, Talia; Detis, Nicolas; Duparc, Alexandre; Hebrard, Aurélien; Massabuau, Pierre; Maury, Philippe; Mondoly, Pierre; Rumeau, Philippe; Pasteur, Clinique; Boveda, Serge; Adrover, Laurence; Combes, Nicolas; Deplagne, Antoine; Marco-Baertich, Isabelle; Fondard, Olivier; Martínez, Juan Gabriel; Ibañez Criado, José Luis; Ortuño, Diego; Mont, Lluis; Berruezo, Antonio; Eduard, Belu; Martín, Ana; Merschon, Franco M.; Sitges, Marta; Tolosana, José María; Vidal, Bárbara; Hebron, H. Valle; i Mitjans, Angel Moya; Rodriguez, Oscar Alcalde; Rodriguez Palomares, José Fernando; Rivas, Nuria; Teixidó, Gisela; de Hierro, H. Puerta; Lozano, Ignacio Fernández; Ruiz Bautista, Maria Lorena; Castro, Victor; Cavero, Miguel Angel; Gutierrez, Carlos; Ros, Natalia; de la Victoria, H. Virgen; Alzueta Rodriguez, Francisco Javier; Cabrera, Fernando; Cordero, Alberto Barrera; Peña, José Luis; de Valme Sevilla, H.; Gonzáles, Juan Lealdel Ojo; Garcia Medina, Mª Dolores; Jiménez, Ricardo Pavón; Villagomez, David; de la Salud Toledo, H. Virgen; Castellanos Martinez, Eduardo; Alcalá, Juan; Maicas, Carolina; Arias Palomares, Miguel Angel; Puchol, Alberto; Valencia, H. La Fé; OscaAsensi, Joaquim; Carmona, Anastasio Quesada; De Carranza, Mª José Sancho-Tello; De Ros, José Olagüe; Pareja, Enrique Castro; Pérez, Oscar Cano; Saez, Ana Osa; Hortega, H. Rio; Guilarte, Benito Herreros; Muñoz San Jose, Juan Francisco; Pérez Sanz, Teresa Myriam; Logeart, Damien; Gil, Maria Lopez; Leclercq, Christophe; Lozano, Ignacio Fernandez; de Hierro, H. Puerta; Derumeaux, Genevieve

2016-01-01

Abstract Aims Cardiac resynchronization therapy (CRT) is a recommended treatment of heart failure (HF) patients with depressed left ventricular ejection fraction and wide QRS. The optimal right ventricular (RV) lead position being a matter of debate, we sought to examine whether RV septal (RVS) pacing was not inferior to RV apical (RVA) pacing on left ventricular reverse remodelling in patients receiving a CRT-defibrillator. Methods and results Patients (n = 263, age = 63.4 ± 9.5 years) were randomly assigned in a 1:1 ratio to RVS (n = 131) vs. RVA (n = 132) pacing. Left ventricular end-systolic volume (LVESV) reduction between baseline and 6 months was not different between the two groups (−25.3 ± 39.4 mL in RVS group vs. −29.3 ± 44.5 mL in RVA group, P = 0.79). Right ventricular septal pacing was not non-inferior (primary endpoint) to RVA pacing with regard to LVESV reduction (average difference = −4.06 mL; P = 0.006 with a −20 mL non-inferiority margin). The percentage of ‘echo-responders’ defined by LVESV reduction >15% between baseline and 6 months was similar in both groups (50%) with no difference in the time to first HF hospitalization or death (P = 0.532). Procedural or device-related serious adverse events occurred in 68 patients (RVS = 37) with no difference between the two groups (P = 0.401). Conclusion This study demonstrates that septal RV pacing in CRT is non-inferior to apical RV pacing for LV reverse remodelling at 6 months with no difference in the clinical outcome. No recommendation for optimal RV lead position can hence be drawn from this study. ClinicalTrials. gov number NCT 00833352. PMID:26374852

Reduction in unnecessary ventricular pacing fails to affect hard clinical outcomes in patients with preserved left ventricular function: a meta-analysis.

PubMed

Shurrab, Mohammed; Healey, Jeff S; Haj-Yahia, Saleem; Kaoutskaia, Anna; Boriani, Giuseppe; Carrizo, Aldo; Botto, Gianluca; Newman, David; Padeletti, Luigi; Connolly, Stuart J; Crystal, Eugene

2017-02-01

Several pacing modalities across multiple manufacturers have been introduced to minimize unnecessary right ventricular pacing. We conducted a meta-analysis to assess whether ventricular pacing reduction modalities (VPRM) influence hard clinical outcomes in comparison to standard dual-chamber pacing (DDD). An electronic search was performed using Cochrane Central Register, PubMed, Embase, and Scopus. Only randomized controlled trials (RCT) were included in this analysis. Outcomes of interest included: frequency of ventricular pacing (VP), incident persistent/permanent atrial fibrillation (PerAF), all-cause hospitalization and all-cause mortality. Odds ratios (OR) were reported for dichotomous variables. Seven RCTs involving 4119 adult patients were identified. Ventricular pacing reduction modalities were employed in 2069 patients: (MVP, Medtronic Inc.) in 1423 and (SafeR, Sorin CRM, Clamart) in 646 patients. Baseline demographics and clinical characteristics were similar between VPRM and DDD groups. The mean follow-up period was 2.5 ± 0.9 years. Ventricular pacing reduction modalities showed uniform reduction in VP in comparison to DDD groups among all individual studies. The incidence of PerAF was similar between both groups {8 vs. 10%, OR 0.84 [95% confidence interval (CI) 0.57; 1.24], P = 0.38}. Ventricular pacing reduction modalities showed no significant differences in comparison to DDD for all-cause hospitalization or all-cause mortality [9 vs. 11%, OR 0.82 (95% CI 0.65; 1.03), P= 0.09; 6 vs. 6%, OR 0.97 (95% CI 0.74; 1.28), P = 0.84, respectively]. Novel VPRM measures effectively reduce VP in comparison to standard DDD. When actively programmed, VPRM did not improve clinical outcomes and were not superior to standard DDD programming in reducing incidence of PerAF, all-cause hospitalization, or all-cause mortality.

Angiotensin-converting enzyme and matrix metalloproteinase inhibition with developing heart failure: comparative effects on left ventricular function and geometry

NASA Technical Reports Server (NTRS)

McElmurray, J. H. 3rd; Mukherjee, R.; New, R. B.; Sampson, A. C.; King, M. K.; Hendrick, J. W.; Goldberg, A.; Peterson, T. J.; Hallak, H.; Zile, M. R.;

Comparison of right ventricular septal pacing and right ventricular apical pacing in patients receiving cardiac resynchronization therapy defibrillators: the SEPTAL CRT Study.

PubMed

Leclercq, Christophe; Sadoul, Nicolas; Mont, Lluis; Defaye, Pascal; Osca, Joaquim; Mouton, Elisabeth; Isnard, Richard; Habib, Gilbert; Zamorano, Jose; Derumeaux, Genevieve; Fernandez-Lozano, Ignacio

2016-02-01

Cardiac resynchronization therapy (CRT) is a recommended treatment of heart failure (HF) patients with depressed left ventricular ejection fraction and wide QRS. The optimal right ventricular (RV) lead position being a matter of debate, we sought to examine whether RV septal (RVS) pacing was not inferior to RV apical (RVA) pacing on left ventricular reverse remodelling in patients receiving a CRT-defibrillator. Patients (n = 263, age = 63.4 ± 9.5 years) were randomly assigned in a 1:1 ratio to RVS (n = 131) vs. RVA (n = 132) pacing. Left ventricular end-systolic volume (LVESV) reduction between baseline and 6 months was not different between the two groups (-25.3 ± 39.4 mL in RVS group vs. -29.3 ± 44.5 mL in RVA group, P = 0.79). Right ventricular septal pacing was not non-inferior (primary endpoint) to RVA pacing with regard to LVESV reduction (average difference = -4.06 mL; P = 0.006 with a -20 mL non-inferiority margin). The percentage of 'echo-responders' defined by LVESV reduction >15% between baseline and 6 months was similar in both groups (50%) with no difference in the time to first HF hospitalization or death (P = 0.532). Procedural or device-related serious adverse events occurred in 68 patients (RVS = 37) with no difference between the two groups (P = 0.401). This study demonstrates that septal RV pacing in CRT is non-inferior to apical RV pacing for LV reverse remodelling at 6 months with no difference in the clinical outcome. No recommendation for optimal RV lead position can hence be drawn from this study. NCT 00833352. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

Different regions of latest electrical activation during left bundle-branch block and right ventricular pacing in cardiac resynchronization therapy patients determined by coronary venous electro-anatomic mapping.

PubMed

Mafi Rad, Masih; Blaauw, Yuri; Dinh, Trang; Pison, Laurent; Crijns, Harry J; Prinzen, Frits W; Vernooy, Kevin

2014-11-01

Current targeted left ventricular (LV) lead placement strategy is directed at the latest activated region during intrinsic activation. However, cardiac resynchronization therapy (CRT) is most commonly applied by simultaneous LV and right ventricular (RV) pacing without contribution from intrinsic conduction. Therefore, targeting the LV lead to the latest activated region during RV pacing might be more appropriate. We investigated the difference in LV electrical activation sequence between left bundle-branch block (LBBB) and RV apex (RVA) pacing using coronary venous electro-anatomic mapping (EAM). Twenty consecutive CRT candidates with LBBB underwent intra-procedural coronary venous EAM during intrinsic activation and RVA pacing using EnSite NavX. Left ventricular lead placement was aimed at the latest activated region during LBBB according to current recommendations. In all patients, LBBB was associated with a circumferential LV activation pattern, whereas RVA pacing resulted in activation from the apex of the heart to the base. In 10 of 20 patients, RVA pacing shifted the latest activated region relative to LBBB. In 18 of 20 patients, the LV lead was successfully positioned in the latest activated region during LBBB. For the whole study population, LV lead electrical delay, expressed as percentage of QRS duration, was significantly shorter during RVA pacing than during LBBB (72 ± 13 vs. 82 ± 5%, P = 0.035). Right ventricular apex pacing alters LV electrical activation pattern in CRT patients with LBBB, and shifts the latest activated region in a significant proportion of these patients. These findings warrant reconsideration of the current practice of LV lead targeting for CRT. © 2014 The Authors. European Journal of Heart Failure © 2014 European Society of Cardiology.

Kinetics of atrial repolarization alternans in a free-behaving ovine model.

PubMed

Jousset, Florian; Tenkorang, Joanna; Vesin, Jean-Marc; Pascale, Patrizio; Ruchat, Patrick; Rollin, Anne Garderes; Fromer, Martin; Narayan, Sanjiv M; Pruvot, Etienne

2012-09-01

Kinetics of Atrial Repolarization Alternans. Repolarization alternans (Re-ALT), a beat-to-beat alternation in action potential repolarization, promotes dispersion of repolarization, wavebreaks, and reentry. Recently, Re-ALT has been shown to play an important role in the transition from rapid pacing to atrial fibrillation (AF) in humans. The detailed kinetics of atrial Re-ALT, however, has not been reported so far. We developed a chronic free-behaving ovine pacing model to study the kinetics of atrial Re-ALT as a function of pacing rate. Thirteen sheep were chronically implanted with 2 pacemakers for the recording of broadband right atrial unipolar electrograms and delivery of rapid pacing protocols. Beat-to-beat differences in the atrial T-wave apex amplitude as a measure of Re-ALT and activation time were analyzed at incremental pacing rates until the effective refractory period (ERP) defined as stable 2:1 capture. Atrial Re-ALT appeared intermittently but without periodicity, and increased in amplitude as a function of pacing rate until ERP. Intermittent 2:1 atrial capture was observed at pacing cycle lengths 40 ms above ERP, and increased in duration as a function of pacing rate. Episodes of rapid pacing-induced AF were rare, and were preceded by Re-ALT or complex oscillations of atrial repolarization, but without intermittent capture. We show in vivo that atrial Re-ALT developed and increased in magnitude with rate until stable 2:1 capture. In rare instances where capture failure did not occur, Re-ALT and complex oscillations of repolarization surged and preceded AF initiation. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1003-1012, September 2012). © 2012 Wiley Periodicals, Inc.

eHealth interventions for family carers of people with long term illness: A promising approach?

PubMed

Sin, Jacqueline; Henderson, Claire; Spain, Debbie; Cornelius, Victoria; Chen, Tao; Gillard, Steve

2018-03-01

Family carers of people who have long term illness often experience physical and mental health morbidities, and burden. While there is good evidence to suggest that carers benefit from psychosocial interventions, these have primarily been delivered via face-to-face individual or group-formats. eHealth interventions offer a novel, accessible and self-paced approach to care delivery. Whether these are effective for carers' wellbeing has been little explored. This paper reports the first comprehensive systematic review in this area. A total of 78 studies, describing 62 discrete interventions, were identified. Interventions commonly aimed to promote carers' knowledge, self-efficacy, caregiving appraisal, and reduce global health morbidities. Interventions were offered to carers of people with a wide range of long term illness; dementia has been the most researched area, as reported in 40% of studies. Clinical and methodological heterogeneity in interventions precluded meta-analyses, and so data were analysed narratively. The most popular approach has comprised psychoeducational interventions delivered via an enriched online environment with supplementary modes of communication, such as network support with professionals and peers. Overall, carers appreciate the flexibility and self-paced nature of eHealth interventions, with high rates of satisfaction and acceptability. More studies using robust designs are needed to extend the evidence base. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Comparison of lumbo-pelvic kinematics during trunk forward bending and backward return between patients with acute low back pain and asymptomatic controls.

PubMed

Shojaei, Iman; Salt, Elizabeth G; Hooker, Quenten; Van Dillen, Linda R; Bazrgari, Babak

2017-01-01

Prior studies have reported differences in lumbo-pelvic kinematics during a trunk forward bending and backward return task between individuals with and without chronic low back pain; yet, the literature on lumbo-pelvic kinematics of patients with acute low back pain is scant. Therefore, the purpose of this study was set to investigate lumbo-pelvic kinematics in this cohort. A case-control study was conducted to investigate the differences in pelvic and thoracic rotation along with lumbar flexion as well as their first and second time derivatives between females with and without acute low back pain. Participants in each group completed one experimental session wherein they performed trunk forward bending and backward return at self-selected and fast paces. Compared to controls, individuals with acute low back pain had larger pelvic range of rotations and smaller lumbar range of flexions. Patients with acute low back pain also adopted a slower pace compared to asymptomatic controls which was reflected in smaller maximum values for angular velocity, deceleration and acceleration of lumbar flexion. Irrespective of participant group, smaller pelvic range of rotation and larger lumbar range of flexion were observed in younger vs. older participants. Reduced lumbar range of flexion and slower task pace, observed in patients with acute low back pain, may be the result of a neuromuscular adaptation to reduce the forces and deformation in the lower back tissues and avoid pain aggravation. Copyright © 2016 Elsevier Ltd. All rights reserved.

77 FR 3958 - Mortgage Assets Affected by PACE Programs

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-26

... of home improvement projects (e.g., home insulation, solar panels, geothermal energy units, etc... (``ANPR'') concerning mortgage assets affected by Property Assessed Clean Energy (``PACE'') programs and... February 28, 2011, that deal with property assessed clean energy (PACE) programs.'' In response to and...

On the Effectiveness of a Neural Network for Adaptive External Pacing.

ERIC Educational Resources Information Center

Montazemi, Ali R.; Wang, Feng

1995-01-01

Proposes a neural network model for an intelligent tutoring system featuring adaptive external control of student pacing. An experiment was conducted, and students using adaptive external pacing experienced improved mastery learning and increased motivation for time management. Contains 66 references. (JKP)