Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: a position paper of the vascular domain of the European Association for Cardio-Thoracic Surgery†.

Ischaemic spinal cord injury (SCI) remains the Achilles heel of open and endovascular descending thoracic and thoracoabdominal repair. Neurological outcomes have improved coincidentially with the introduction of neuroprotective measures. However, SCI (paraplegia and paraparesis) remains the most devastating complication. The aim of this position paper is to provide physicians with broad information regarding spinal cord blood supply, to share strategies for shortening intraprocedural spinal cord ischaemia and to increase spinal cord tolerance to transitory ischaemia through detection of ischaemia and augmentation of spinal cord blood perfusion. This study is meant to support physicians caring for patients in need of any kind of thoracic or thoracoabdominal aortic repair in decision-making algorithms in order to understand, prevent or reverse ischaemic SCI. Information has been extracted from focused publications available in the PubMed database, which are cohort studies, experimental research reports, case reports, reviews, short series and meta-analyses. Individual chapters of this position paper were assigned and after delivery harmonized by Christian D. Etz, Ernst Weigang and Martin Czerny. Consequently, further writing assignments were distributed within the group and delivered in August 2014. The final version was submitted to the EJCTS for review in September 2014.

Normal values for pancreatic stone protein in different age groups.

BACKGROUND Pancreatic stone protein (PSP) has been identified as a promising sepsis marker in adults, children and neonates. However, data on population-based reference values are lacking. This study aimed to establish age-specific reference values for PSP. METHODS PSP was determined using a specific ELISA. PSP serum concentrations were determined in 372 healthy subjects including 217 neonates, 94 infants and children up to 16 years, and 61 adults. The adjacent categories method was used to determine which age categories had significantly different PSP concentrations. RESULTS PSP circulating levels were not gender-dependent and ranged from 1.0 to 99.4 ng/ml with a median of 9.2 ng/ml. PSP increased significantly between the age categories, from a median of 2.6 ng/ml in very preterm newborns, to 6.3 ng/ml in term newborns, to 16.1 ng/ml in older children (p < 0.001). PSP levels were higher on postnatal day three compared to levels measured immediately post delivery (p < 0.001). Paired umbilical artery and umbilical vein samples were strongly correlated (p < 0.001). Simultaneously obtained capillary heel-prick versus venous samples showed a good level of agreement for PSP (Rho 0.89, bias 19 %). CONCLUSIONS This study provides age-specific normal values that may be used to define cut-offs for future trials on PSP. We demonstrate an age-dependent increase of PSP from birth to childhood.

[Future cardiac pacemakers – technical visions].

Cardiac pacemakers are routinely used for the treatment of bradyarrhythmias. Contemporary pacemakers are reliable and allow for a patient specific programming. However, pacemaker replacements due to battery depletion are common (~25 % of all implantation procedures) and bear the risk of complications. Batteryless pacemakers may allow overcoming this limitation. To power a batteryless pacemaker, a mechanism for intracorporeal energy harvesting is required. Such a generator may consist out of subcutaneously implanted solar cells, transforming the small amount of transcutaneously available light into electrical energy. Alternatively, intravascular turbines may harvest energy from the blood flow. Energy may also be harvested from the ventricular wall motion by a dedicated mechanical clockwork converting motion into electrical energy. All these approaches have successfully been tested in vivo. Pacemaker leads constitute another Achilles heel of contemporary pacemakers. Thus, leadless devices are desired. Miniaturized pacemaker circuits and suitable energy harvesting mechanisms (incorporated in a single device) may allow catheter-based implantation of the pacemaker in the heart. Such miniaturized battery- and leadless pacemakers would combine the advantages of both approaches and overcome major limitations of today’s systems.

Kinematic pattern of the drag-flick: a case study

The drag-flick is more efficient than hits or pushes when a penalty corner situation is in effect in field hockey. Previous research has studied the biomechanical pattern of the drag-flick, trying to find the cues for an optimal performance. On the other hand, some other studies have examined the most effective visual pick-up of relevant information in shots and goalkeeper anticipation. The aim of this study was to analyse the individual differences in the drag-flick pattern in order to provide relevant information for goalkeepers. One female skilled drag-flicker participated in the study. A VICON optoelectronic sy stem (Oxford Metrics, Oxford, UK) was used to capture the drag-flicks with six cameras. The results showed that the main significant differences between right and left shots (p<0.05) in the stick angles, stick minimum angular velocity and front foot-ball distance were when the front foot heel contacted the floor(T1) and at the minimum velocity of the stick, before the dragging action (T3). The findings showed that the most relevant information might be picked up at the ball-and-stick location before the dragging action.

Análisis experimental y por el método de los elementos finitos del estado de tensiones en uniones carpinteras de empalme de llave

In this research, the halved and tabled traditional timber scarf joint is analyzed. This joint consists in two end joint pieces usually subjected to tension. Initially, the study is discussed from an experimental point of view. In this way, 3 critical cross-sections are established (section of the notch, section of the horizontal plane and reduced section) and mechanical tests are performed to achieve the failure on each of critical sections by changing the geometry of the joint. The study is completed by developing a finite element model which allows verify experimental results and extend the analysis to other geometries. This model has to simulate the real behavior of the material which is being studied, so mechanical tests are performed to obtain the elastic constants and the coefficients of friction of the material. In the reduced section, an abrupt decrease of the effective cross-section takes place, and this effect is also experimentally analyzed. These tests indicate that a crack is initiated before the bending-tension failure occurs in the reduced section. The test material consists of wood of Pinus sylvestris L. coming from the “Valsaín´s Sawmill” (Segovia) with “premium quality” according to the nonstructural wood visual classification of sawmill. It is observed that initiation of a crack, in the mortise (bottom of reduced section), and shear stress concentration, at the initial part of the heel (beginning of horizontal plane), completely determine the mechanical behaviour of the joint, resulting in 3 failure modes: local compression failure in the section of the notch, shear failure in the horizontal plane, and failure of stresses concentration, mainly perpendicular to the grain tension, at the bottom of reduced section. The geometric optimization is obtained for halved and tabled traditional scarf joint, when the joint has made with similar properties of wood than tested specimens, for any height and width of the cross-section. It is considered the failure due to the initiation of a crack in reduced section, by applying a correction coefficient into the usual equation used to design the members subjected to both tension and bending. Therefore, it is possible to obtain, analytically, the design conditions to be met of the 3 critical cross-sections. According to the theoretical optimization, the tension strength of complete cross-section is reduced until 14%, when using this type of joint. The experimental optimization indicates even a greater reduction, until 6%. En el presente trabajo de investigación se analiza el comportamiento mecánico de las uniones tradicionales de empalme de llave, que consisten en dos piezas unidas por sus testas transmitiéndose entre ellas principalmente un esfuerzo de tracción. Inicialmente, el estudio se aborda desde un punto de vista experimental. De este modo, se establecen las 3 secciones críticas o de estudio (sección del encaje, sección rasante del cogote y sección reducida) y se realizan ensayos mecánicos, variando la geometría de la unión, para alcanzar la rotura en cada una de ellas. Se completa el estudio mediante la elaboración de un modelo por elementos finitos que permite verificar los resultados experimentales y ampliar el análisis a otras geometrías. Este modelo debe simular el comportamiento real del material objeto de estudio, por lo que se realizan ensayos para obtener las constantes elásticas y los coeficientes de rozamiento del mismo. También se analiza, experimentalmente, el efecto entalladura que reduce bruscamente la sección completa del tirante, estableciendo que el fallo por flexotracción en la sección reducida de la pieza, no llega a producirse por el inicio previo de una grieta. El material de ensayo consiste en madera de Pinus sylvestris L. (pino silvestre) procedente del Aserradero de Valsaín (Segovia) y de calidad “Extra” o “Primera” según la clasificación visual no estructural del aserradero. Se observa que el inicio de una grieta en la mortaja del rediente y la concentración de tensiones tangenciales en la parte inicial del cogote, determinan completamente el comportamiento mecánico de la unión, dando lugar a 3 modos distintos de rotura: fallo por compresión en la sección del encaje, fallo por cortante en la sección rasante y fallo por concentración de tensiones, principalmente tracciones perpendiculares, en el rebaje de la sección reducida. Se consigue optimizar geométricamente cualquier empalme de llave confeccionado con madera de características similares a la ensayada, para cualquier valor de la altura y de la anchura de la sección. Se considera el agotamiento en la sección reducida causado por el inicio de grieta, mediante la aplicación de un coeficiente corrector en la expresión habitual de agotamiento por flexotracción, en consecuencia, finalmente es posible obtener, de modo analítico, un valor del índice de agotamiento en cada una de las 3 secciones de estudio. La optimización teórica del empalme de llave indica que la capacidad resistente del tirante bruto se reduce al 14%, cuando se coloca este tipo de unión tradicional. Experimentalmente se obtiene, que, para la sección ensayada, la capacidad resistente del tirante bruto se reduce todavía más, llegando al 6%.

Numerical and experimental study of appendages in racing yachts and their influence on the free surface

Las prestaciones de un velero de regatas se estiman por medio de los Programas de Predicción de Velocidad (VPP) que incluyen las características de estabilidad y modelos aero e hidrodinámico del barco. Por esta razón, es importante tener una evaluación adecuada de las fuerzas en apéndices y de su variación en diferentes condiciones de navegación, escora y deriva. Además, para el cálculo de las fuerzas en los apéndices es importante conocer sus características hidrodinámicas cuando trabajan conjuntamente en un campo fluido fuertemente modificado por la carena. Por esta razón, se han utilizado una serie de ensayos realizados en el Canal de Ensayos de la ETSIN con el objetivo de validar códigos numéricos que permiten una evaluación más rápida y focalizada en los distintos fenómenos que se producen. Dichos ensayos se han realizado de forma que pudiera medirse independientemente las fuerzas hidrodinámicas en cada apéndice, lo que permitirá evaluar el reparto de fuerzas en diferentes condiciones de navegación para poder profundizar en las interacciones entre carena, quilla y timón. Las técnicas numéricas permiten capturar detalles que difícilmente se pueden visualizar en ensayos experimentales. En este sentido, se han probado las últimas técnicas utilizadas en los últimos workshops y se ha enfocado el estudio a un nuevo método con el objetivo de mostrar una metodologia más rápida que pueda servir a la industria para este tipo de aproximación al problema. ABSTRACT The performances of a racing sailboat are estimated by means of the speed prediction programs (VPP), which include the ship stability characteristics and the aero and hydrodynamic models. For this reason, it is important to have an adequate evaluation of the forces in appendices and its variation in different sailing conditions, heel and leeway Moreover, for the analysis of the forces in the appendices, it is important to know their hydrodynamic characteristics when they work together in a fluid field strongly modified by the canoe body. For this reason, several tests have been done in the ETSIN towing tank with the aim to validate numeric codes that allowing faster analysis and they permit to focus on the different phenomena that occur there. Such tests have been done in a way that the hydrodynamic forces in each appendage could be measured independently allowing assessing the distribution of forces in different sailing conditions to be able to deepen the interactions between the canoe body, the keel and the rudder. Numerical techniques allow capturing details that can hardly be displayed in experimental tests. In this sense, the latest techniques used in the recent workshops have been reviewed and the study has been focused to propose a new model with the aim to show a new faster methodology which serves the industry for this type of approach to the problem.

Continuous amperometric monitoring of glucose in a brittle diabetic chimpanzee with a miniature subcutaneous electrode

The performance of an amperometric biosensor, consisting of a subcutaneously implanted miniature (0.29 mm diameter, 5 × 10−4 cm2 mass transporting area), 90 s 10–90% rise/decay time glucose electrode, and an on-the-skin electrocardiogram Ag/AgCl electrode was tested in an unconstrained, naturally diabetic, brittle, type I, insulin-dependent chimpanzee. The chimpanzee was trained to wear on her wrist a small electronic package and to present her heel for capillary blood samples. In five sets of measurements, averaging 5 h each, 82 capillary blood samples were assayed, their concentrations ranging from 35 to 400 mg/dl. The current readings were translated to blood glucose concentration by assaying, at t = 1 h, one blood sample for each implanted sensor. The rms error in the correlation between the sensor-measured glucose concentration and that in capillary blood was 17.2%, 4.9% above the intrinsic 12.3% rms error of the Accu-Chek II reference, through which the illness of the chimpanzee was routinely managed. Linear regression analysis of the data points taken at t>1 h yielded the relationship (Accu-Chek) = 0.98 × (implanted sensor) + 4.2 mg/dl, r2 = 0.94. The capillary blood and the subcutaneous glucose concentrations were statistically indistinguishable when the rate of change was less than 1 mg/(dl⋅min). However, when the rate of decline exceeded 1.8 mg/(dl⋅min) after insulin injection, the subcutaneous glucose concentration was transiently higher.

The Missing Piece: Empowerment of Roma Grassroots Organisations in EU Roma Integration Policies. IES Policy Brief Issue 2014/10/December 2014

Summary. The fourth edition of Roma Pride has brought Roma civic activism back in the spotlight. This Roma-rights mobilization, taking place every October in several European cities, has emphasized the centrality of an active civil society in pursuing a successful integration of the Roma in Europe. The ‘Award for Roma Integration’ and the ‘Civil Society Prize 2014’ conferred last October by the European Union (EU) to Roma and pro-Roma Civil Society Organizations (CSOs) have confirmed this approach. Nonetheless, a general discontent towards the EU Roma Integration Policies exists within the Roma Civil Society, who calls for stronger support to and the promotion of “Romaled change”. This Policy Brief investigates the reasons behind such discontent and identifies the ‘distance’ from Roma communities as the Achilles heel of EU policies. It argues for further efforts by the EU to empower Roma organisations operating at the grassroots through community capacity building, structured dialogue and simplification of the funding mechanisms.

The works of Jack London. --

[v.1] Adventure. -- [v.2] Before Adam. -- [v.3] Burning Daylight. -- [v.4] The call of the wild. -- [v.5] The cruise of the Snark. -- [v.6] The iron heel. -- [v.7] Martin Eden. -- [v.8] The sea-wolf. -- [v.9] South sea tales. -- [v.10] The valley of the moon. -- [v.11] When God laughs. -- [v.12] White Fang.

Nederlandsch tijdschrift voor verloskunde, ziekten der vrouwenen en der kindern.

Mode of access: Internet.

Sagittal movement of the medial longitudinal arch is unchanged in plantar fasciitis

Background: Although a lowered medial longitudinal arch has been cited as a causal factor in plantar fasciitis, there is little experimental evidence linking arch motion to the pathogenesis of the condition. This study investigated the sagittal movement of the arch in subjects with and without plantar fasciitis during gait. Methods: Digital fluoroscopy was used to acquire dynamic lateral radiographs from 10 subjects with unilateral plantar fasciitis and 10 matched control subjects. The arch angle and the first metatarsophalangeal joint angle were digitized and their respective maxima recorded. Sagittal movement of the arch was defined as the angular change between heel strike and the maximum arch angle observed during the stance phase of gait. The-thickness of the proximal plantar fascia was determined from sagittal sonograms of both feet. ANOVA models were used to identify differences between limbs with respect to each dependent variable. Relationships between arch movement and fascial thickness were investigated using correlations. Results: There was no significant difference in either the movement or maximum arch angle between limbs. However, subjects with plantar fasciitis were found to have a larger metatarsophalangeal joint angle than controls (P < 0.05). Whereas the symptomatic and asymptomatic plantar fascia were thicker than those of control feet (P < 0.05), significant correlations were noted between fascial thickness and peak arch and metatarsophalangeal joint angles (P < 0.05) in the symptomatic limb only. Conclusions: Neither abnormal shape nor movement of the arch are associated with chronic plantar fasciitis. However, arch mechanics may influence the severity of plantar fasciitis once the condition is present. Digital flexion, in contrast, has a protective role in what might be a bilateral disease process.

Hearing sensitivity and bone mineral density in older adults: the Health, Aging and Body Composition Study

Bone mineral density (BMD) may be associated with hearing loss in older adults. Demineralization of the cochlear capsule has been associated with hearing loss in those with Paget's disease of the bone and otosclerosis. Osteoporosis may also result in cochlear capsule demineralization. We hypothesized that lower hip BMD and lower heel ultrasound measurements would be associated with hearing loss in a population-based sample of 2,089 older black and white men and women. Bone parameters and hearing function were measured at the fourth clinical follow-up visit. Audiometric threshold testing was used to measure air- and bone-conduction hearing sensitivity. BMD of the hip and its subregions was measured using dual-energy X-ray absorptiometry. Calcaneal bone measurements [broadband ultrasound attenuation (BUA), speed of sound (SOS) and the quantitative ultrasound index (QUI)] were obtained using heel ultrasound. After adjusting for known hearing loss risk factors, no association was found between hearing and any of the bone measurements in whites and black women. In black men, however, lower hip BMD was associated with higher odds of hearing loss; for each standard deviation decrease in total hip BMD, the odds of hearing loss were 1.41 (95% confidence interval 1.08, 1.83), 1.39 (95% CI 1.07, 1.82) for femoral neck BMD and 1.65 (95% CI 1.26, 2.16) for trochanter BMD. Conductive hearing loss was associated with lower heel ultrasound measurements, though only among white men. The results of this study are mixed and inconclusive. Lower BMD of the hip and its subregions was associated with hearing loss among black men, but not among whites or black women. Lower measurements on heel ultrasound were associated with conductive hearing loss, though only among white men. These results suggest that axial and appendicular bone parameters may be modestly associated with hearing loss in older men, but not in women.

Strain and excursion of the sciatic, tibial, and plantar nerves during a modified straight leg raising test

A modified straight leg raising (SLR) in which ankle dorsiflexion is performed before hip flexion has been suggested to diagnose distal neuropathies such as tarsal tunnel syndrome. This study evaluates the clinical hypothesis that strain in the nerves around the ankle and foot caused by ankle dorsiflexion can be further increased with hip flexion. Linear displacement transducers were inserted into the sciatic, tibial, and plantar nerves and plantar fascia of eight embalmed cadavers to measure strain during the modified SLR. Nerve excursion was measured with a digital calliper. Ankle dorsiflexion resulted in a significant strain and distal. excursion of the tibial nerve. With the ankle in dorsiflexion, the proximal excursion and tension increase in the sciatic nerve associated with hip flexion were transmitted distally along the nerve from the hip to beyond the ankle. As hip flexion had an impact on the nerves around the ankle and foot but not on the plantar fascia, the modified SLR may be a useful test to differentially diagnose plantar heel pain. Although the modified SLR caused the greatest increase in nerve strain nearest the moving joint, mechanical forces acting on peripheral nerves are transmitted well beyond the moving joint. (c) 2006 Orthopaedic Research Society.

Highly demanding resistive vibration exercise program is tolerated during 56 days of strict bed-rest

Several studies have tried to find countermeasures against musculoskeletal de-conditioning during bed-rest, but none of them yielded decisive results. We hypothesised that resistive vibration exercise (RVE) might be a suitable training modality. We have therefore carried out a bed-rest study to evaluate its feasibility and efficacy during 56 days of bed-rest. Twenty healthy male volunteers aged 24 to 43 years were recruited and, after medical check-ups, randomised to a non-exercising control (Ctrl) group or a group that performed RVE 11 times per week. Strict bed-rest was controlled by video surveillance. The diet was controlled. RVE was performed in supine position, with a static force component of about twice the body weight and a smaller dynamic force component. RVE comprised four different units (squats, heel raises, toe raises, kicks), each of which lasted 60 - 100 seconds. Pre and post exercise levels of lactate were measured once weekly. Body weight was measured daily on a bed scale. Pain questionnaires were obtained in regular intervals during and after the bed-rest. Vibration frequency was set to 19 Hz at the beginning and progressed to 25.9 Hz (SD 1.9) at the end of the study, suggesting that the dynamic force component increased by 90%. The maximum sustainable exercise time for squat exercise increased from 86 s (SD 21) on day 11 of the BR to 176 s (SD 73) on day 53 (p = 0.006). On the same days, post-exercise lactate levels increased from 6.9 mmol/l (SD2.3) to 9.2 mmol/l (SD 3.5, p = 0.01). On average, body weight was unchanged in both groups during bed-rest, but single individuals in both groups depicted significant weight changes ranging from -10% to + d10% (p < 0.001). Lower limb pain was more frequent during bed-rest in the RVE subjects than in Ctrl (p = 0.035). During early recovery, subjects of both groups suffered from muscle pain to a comparable extent, but foot pain was more common in Ctrl than in RVE (p = 0.013 for plantar pain, p = 0.074 for dorsal foot pain). Our results indicate that RVE is feasible twice daily during bed-rest in young healthy males, provided that one afternoon and one entire day per week are free. Exercise progression, mainly by progression of vibration frequency, yielded increases in maximum sustainable exercise time and blood lactate. In conclusion, RVE as performed in this study, appears to be safe.

Pain relief for neonates in Australian hospitals: A need to improve evidence-based practice

Objective: To ascertain the extent to which neonatal analgesia was used in Australia for minor invasive procedures as an indicator of evidence-based practice in neonatology. Methods: A cross-sectional telephone survey of hospitals in all Australian states and territories with more than 200 deliveries per year was carried out. Questions were asked regarding awareness of the benefits and the use of analgesia for minor invasive procedures in term and near term neonates. Analysis was undertaken according to state and territory, annual birth numbers and the level of neonatal nursery care available. Results: Data were available from 212 of 214 eligible hospitals. Of the total respondents, 51% and 70% respectively were aware of the benefits of sucrose and breast-feeding for neonatal analgesia. Eleven per cent of units administered sucrose before venepuncture and 25% of units used breast-feeding. Ten per cent of units used sucrose before heel prick with 49% utilizing breast-feeding. Expressed breast milk was used in 10% of units. Analgesia was given less frequently before intravenous cannulation compared to venepuncture and heel prick. Awareness and implementation of neonatal analgesia varied widely in the states and territories. There was a trend for hospitals providing a higher level of neonatal care to have a greater awareness of sucrose as an analgesic (P < 0.0001) and the use of sucrose for venepuncture (P = 0.029), heel prick (P = 0.025) and intravenous catheter insertion (P = 0.013). Similar trends were found on analysis according to birth number of the maternity units. Smaller units had a greater usage of breast-feeding as an analgesic for heel prick (P = 0.017). Conclusion: Despite good evidence for the administration of sucrose and breast milk in providing effective analgesia for newborn infants, it is not widely used in Australia. It is imperative that the gap between research findings and clinical practice with regard to neonatal analgesia be addressed.