The effect of innate compliance on the performance of a counterpulsation device

Cardiovascular disease (CVD) continues to be one of the top causes of mortality in the world. World Heart Organization (WHO) reported that in 2004, CVD contributed to almost 30% of death from estimated worldwide death figures of 58 million[1]. Heart failure treatment varies from lifestyle adjustment to heart transplantation; its aims are to reduce HF symptoms, prolong patient survival and minimize risk [2]. One alternative available in the market for HF treatment is Left Ventricular Assist Device (LVAD). Chronic Intermittent Mechanical Support (CIMS) device is a novel (LVAD) heart failure treatment using counterpulsation similar to Intra Aortic Balloon Pumps (IABP). However, the implantation site of the CIMS balloon is in the ascending aorta just distal to aortic valve contrasted with IABP in the descending aorta. Counterpulsation coupled with implantation close to the aortic valve enables comparable flow augmentation with reduced balloon volume. Two prototypes of the CIMS balloon were constructed using rapid prototyping: the straight-body model is a cylindrical tube with a silicone membrane lining with zero expansive compliance. The compliant-body model had a bulging structure that allowed the membrane to expand under native systolic pressure increasing the device’s static compliance to 1.5 mL/mmHg. This study examined the effect of device compliance and vascular compliance on counterpulsating flow augmentation. Both prototypes were tested on a two-element Windkessel model human mock circulatory loop (MCL). The devices were placed just distal to aortic valve and left coronary artery. The MCL mimicked HF with cardiac output of 3 L/min, left ventricular pressure of 85/15 mmHg, aortic pressure of 70/50 mmHg and left coronary artery flow rate of 66 mL/min. The mean arterial pressure (MAP) was calculated to be 57 mmHg. Arterial compliance was set to be1.25 mL/mmHg and 2.5 mL/mmHg. Inflation of the balloon was triggered at the dicrotic notch while deflation was at minimum aortic pressure prior to systole. Important haemodynamics parameters such as left ventricular pressure (LVP), aortic pressure (AoP), cardiac output (CO), left coronary artery flowrate (QcorMean), and dP (Peak aortic diastolic augmentation pressure – AoPmax ) were simultaneously recorded for both non-assisted mode and assisted mode. ANOVA was used to analyse the effect of both factors (balloon and arterial compliance) to flow augmentation. The results showed that for cardiac output and left coronary artery flowrate, there were significant difference between balloon and arterial compliance at p < 0.001. Cardiac output recorded maximum output at 18% for compliant body and stiff arterial compliance. Left coronary artery flowrate also recorded around 20% increase due to compliant body and stiffer arterial compliance. Resistance to blood ejection recorded highest difference for combination of straight body and stiffer arterial compliance. From these results it is clear that both balloon and arterial compliance are statistically significant factors for flow augmentation on peripheral artery and reduction of resistance. Although the result for resistance reduction was different from flow augmentation, these results serves as an important aspect which will influence the future design of the CIMS balloon and its control strategy. References: 1. Mathers C, Boerma T, Fat DM. The Global Burden of disease:2004 update. Geneva: World Heatlh Organization; 2008. 2. Jessup M, Brozena S. Heart Failure. N Engl J Med 2003;348:2007-18.

Application of analytic hierarchy process for measuring and comparing the global performance of intensive care units

Purpose: To develop a model for the global performance measurement of intensive care units (ICUs) and to apply that model to compare the services for quality improvement. Materials and Methods: Analytic hierarchy process, a multiple-attribute decision-making technique, is used in this study to evolve such a model. The steps consisted of identifying the critical success factors for the best performance of an ICU, identifying subfactors that influence the critical factors, comparing them pairwise, deriving their relative importance and ratings, and calculating the cumulative performance according to the attributes of a given ICU. Every step in the model was derived by group discussions, brainstorming, and consensus among intensivists. Results: The model was applied to 3 ICUs, 1 each in Barbados, Trinidad, and India in tertiary care teaching hospitals of similar setting. The cumulative performance rating of the Barbados ICU was 1.17 when compared with that of Trinidad and Indian ICU, which were 0.82 and 0.75, respectively, showing that the Trinidad and Indian ICUs performed 70% and 64% with respect to Barbados ICU. The model also enabled identifying specific areas where the ICUs did not perform well, which helped to improvise those areas. Conclusions: Analytic hierarchy process is a very useful model to measure the global performance of an ICU. © 2005 Elsevier Inc. All rights reserved.

Quantitative assessment of the pharmacotherapy of biopolar disorder and schizophrenia

The work present in this thesis was aimed at assessing the efficacy of lithium in the acute treatment of mania and for the prophylaxis of bipolar disorder, and investigating the value of plasma haloperidol concentration for predicting response to treatment in schizophrenia. The pharmacogenetics of psychotropic drugs is critically appraised to provide insights into interindividual variability in response to pharmacotherapy, In clinical trials of acute mania, a number of measures have been used to assess the severity of illness and its response to treatment. Rating instruments need to be validated in order for a clinical study to provide reliable and meaningful estimates of treatment effects, Eight symptom-rating scales were identified and critically assessed, The Mania Rating Scale (MRS) was the most commonly used for assessing treatment response, The advantage of the MRS is that there is a relatively extensive database of studies based on it and this will no doubt ensure that it remains a gold standard for the foreseeable future. Other useful rating scales are available for measuring mania but further cross-validation and validation against clinically meaningful global changes are required. A total of 658 patients from 12 trials were included in an evaluation of the efficacy of lithium in the treatment of acute mania. Treatment periods ranged from 3 to 4 weeks. Efficacy was estimated using (i) the differences in the reduction in mania severity scores, and (ii) the ratio and difference in improvement response rates. The response rate ratio for lithium against placebo was 1.95 (95% CI 1.17 to 3.23). The mean number needed to treat was 5 (95% CI 3 to 20). Patients were twice as likely to obtain remission with lithium than with chlorpromazine (rate ratio = 1.96, 95% CI 1.02 to 3.77). The mean number needed to treat (NNT) was 4 (95% CI 3 to 9). Neither carbamazepine nor valproate was more effective than lithium. The response rate ratios were 1.01 (95% CI 0.54 to 1.88) for lithium compared to carbarnazepine and 1.22 (95% CI 0.91 to 1.64) for lithium against valproate. Haloperidol was no better than lithium on the basis of improvement based on assessment of global severity. The differences in effects between lithium and risperidone were -2.79 (95% CI -4.22 to -1.36) in favour of risperidone with respect to symptom severity improvement and -0.76 (95% CI -1.11 to -0,41) on the basis of reduction in global severity of disease. Symptom and global severity was at least as well controlIed with lithium as with verapamil. Lithium caused more side-effects than placebo and verapamil, but no more than carbamazepine or valproate. A total of 554 patients from 13 trials were included in the statistical analysis of lithium's efficacy in the prophylaxis of bipolar disorder. The mean follow-up period was 5-34 months. The relapse risk ratio for lithium versus placebo was 0.47 (95% CI 0.26 to 0.86) and the NNT was 3 (95% CI 2 to 7). The relapse risk ratio for lithium versus imipramine was 0.62 (95% CI 0.46 to 0.84) and the NNT was 4 (951% Cl 3 to 7), The combination of lithium and imipramine was no more effective than lithium alone. The risk of relapse was greater with lithium alone than with the lithium-divalproate combination. A risk difference of 0.60 (95% CI 0.21 to 0.99) and an NNT of 2 (95% CI 1 to 5) were obtained. Lithium was as effective as carbamazepine. Based on individual data concerning plasma haloperidol concentration and percent improvement in psychotic symptoms, our results suggest an acceptable concentration range of 11.20-30.30 ng/mL A minimum of 2 weeks should be allowed before evaluating therapeutic response. Monitoring of drug plasma levels seems not to be necessary unless behavioural toxicity or noncompliance is suspected. Pharmacokinetics and pharmacodynamics, which are mainly determined by genetic factors, contribute to interindividual and interethnic variations in clinical response to drugs. These variations are primarily due to differences in drug metabolism. Variability in pharmacokinetics of a number of drugs is associated with oxidation polymorphism. Debrisoquine/sparteine hydroxylase (CYP2D6) and the S-mephenytoin hydroxylase (CYP2C19) are polymorphic P450 enzymes with particular importance in psychopharmacotherapy. The enzymes are responsible for the metabolism of many commonly used antipsychotic and antidepressant drugs. The incidence of poor metabolisers of debrisoquine and S-mephenytoin varies widely among populations. Ethnic variations in polymorphic isoenzymes may, at least in part, explain ethnic differences in response to pharmacotherapy of antipsychotics and antidepressant drugs.

Global optimisation of cold-formed steel sections

In this thesis, standard algorithms are used to carry out the optimisation of cold-formed steel purlins such as zed, channel and sigma sections, which are assumed to be simply supported and subjected to a gravity load. For zed, channel and sigma section, the local buckling, distortional buckling and lateral-torsional buckling are considered respectively herein. Currently, the local buckling is based on the BS 5950-5:1998 and EN 1993-1-3:2006. The distortional buckling is calculated by the direct strength method employing the elastic distortional buckling which is calculated by three available approaches such as Hancock (1995), Schafer and Pekoz (1998), Yu (2005). In the optimisation program, the lateral-torsional buckling based on BS 5950-5:1998, AISI and analytical model of Li (2004) are investigated. For the optimisation program, the programming codes are written for optimisation of channel, zed and sigma beam. The full study has been coded into a computer-based analysis program (MATLAB).

Global marketing of industrial products:are interpersonal relationships always critical?

The present paper examines the issue of whether interpersonal relationships are critical for global marketing of industrial products. The fields of relationship marketing, IMP group research, sales research, and network theory have stressed the importance of interpersonal relationships in the business-to-business or industrial marketing context. In contrast to this emphasis on interpersonal relationships, we argue that industrial firms can both conceive and enhance marketing strategies based on developing high quality and consistent processes, products, services or outcomes (consistent processes and outcomes). Such strategies are especially important given the fact that developing interpersonal relationships is expensive due to their reliance on frequent and/or face-to-face communications. In this paper, we examine industry and country contexts that lead to the choice of alternative industrial product marketing strategies and highlight some future research directions and managerial implications.

Absorptive capacity and the benefits from global reservoirs of knowledge:evidence from a linked China-OECD dataset

This paper investigates the role of absorptive capacity in the diffusion of global technology with sector and firm heterogeneity. We construct the FDI-intensity weighted global R&D stock for each industry and link it to Chinese firm-level panel data relating to 53,981 firms over the period 2001-2005. Non-parametric frontier analysis is employed to explore how absorptive capacity affects technical change and catch-up in the presence of global knowledge spillovers. We find that R&D activities and training at individual firms serve as an effective source of absorptive capability. The contribution of absorptive capacity varies according to the type of FDI and the extent of openness.

Is there a global model of learning organizations? An empirical, cross-nation study

This paper develops and tests a learning organization model derived from HRM and dynamic capability literatures in order to ascertain the model's applicability across divergent global contexts. We define a learning organization as one capable of achieving on-going strategic renewal, arguing based on dynamic capability theory that the model has three necessary antecedents: HRM focus, developmental orientation and customer-facing remit. Drawing on a sample comprising nearly 6000 organizations across 15 countries, we show that learning organizations exhibit higher performance than their less learning-inclined counterparts. We also demonstrate that innovation fully mediates the relationship between our conceptualization of the learning organization and organizational performance in 11 of the 15 countries we examined. It is the first time in our knowledge that these questions have been tested in a major, cross-global study, and our work contributes to both HRM and dynamic capability literatures, especially where the focus is the applicability of best practice parameters across national boundaries.

Creating research collaboration among the global community of sales scholars:key takeaways from the 2013 AMA faculty consortium

Within the contemporary business milieu, the discipline of selling and sales management has taken on a more prominent role in recent years. Myriad factors have contributed to the rise of interest in sales including globalization, technology, more sophisticated analytical approaches and new opportunities for co-creation of value between organizations and their customers. Over the past three decades, seven faculty consortia in sales have served as milestones to document the progress 2of the field, particularly the evolution of academic research. This article provides key takeaways from the most recent American Marketing Association (AMA) Faculty Consortium in Selling and Sales Management, which had the overarching goal of fostering new opportunities for building intercontinental research teams to effectively address the substantive issues for the future of the field. © 2014 Pi Sigma Epsilon National Educational Foundation.

The global competitiveness of regions

The aim of this book is to consider theoretically the notion of the global competitiveness of regions, as well as giving attention as to how such competitiveness may be empirically measured. With this in mind, the book has three specific objectives: first, to place the concept of regional competitiveness within the context of regional economic development theory; second, to present a rationale and method for quantifying the global competitiveness of regions; and, third, to undertake the most geographically widespread analysis of regional competitiveness differences across the globe. With regard to the third goal, the analysis incorporates more than 500 regions across Europe, North and South America, Asia-Pacific, the Middle East, and the so-called BRIC economies of Brazil, Russia, India, and China. The importance of the concept of competitiveness has increased rapidly in recent years, with the issues surrounding it becoming, at the same time, more empirically refined and theoretically complex. The focus on regions reflects the growing consensus that they are the primary spatial units that compete to attract investment, and it is at the regional level that knowledge is circulated and transferred, resulting in agglomerations, or clusters, of industrial and service sector enterprises. This growing acknowledgement of the region’s role as a key spatial unit of organisation has led to attention turning to competitiveness at a more regional level. The book explores the results of the World Competitiveness Index of Regions (WCIR), covering the rankings and results of the 2014 edition. The WCIR provides a tool for analysing the development of a range of regional economies across the globe. It enables an illustration of the changing patterns of regional competitiveness on the international stage to be generated. In fundamental terms, the WCIR aims to produce an integrated and overall benchmark of the knowledge capacity, capability, and sustainability of each region, and the extent to which this knowledge is translated into economic value and transferred into the wealth of the citizens of each region.