Training and accreditation in cardiovascular magnetic resonance in Europe: a position statement of the working group on cardiovascular magnetic resonance of the European Society of Cardiology.

Cardiovascular magnetic resonance (CMR) has become an established imaging modality which provides often unique information on a wide range of cardiovascular diseases. The European Society of Cardiology (ESC) training curriculum reflects the emerging role of CMR by recommending that all trainees obtain a minimum level of training in CMR and by defining criteria for subspecialty training in CMR. 1 The wider use of CMR requires the definition of standards for data acquisition, reporting, and training in CMR across Europe. At the same time, training and accreditation in all cardiac imaging methods should be harmonized and integrated to promote the training of cardiac imaging specialists. The recommendations presented in this document are intended to inform the discussion about standards for accreditation and certification in CMR in Europe and the discussion on integrated imaging training. At present, the recommendations in this position statement are not to be interpreted as guidelines. Until such guidelines are available and nationally ratified, physicians will be able to train and practice CMR according to current national regulations.

A program for the computation of power and determination of sample size in hierarchical experimental designs.

We have devised a program that allows computation of the power of F-test, and hence determination of appropriate sample and subsample sizes, in the context of the one-way hierarchical analysis of variance with fixed effects. The power at a fixed alternative is an increasing function of the sample size and of the subsample size. The program makes it easy to obtain the power of F-test for a range of values of sample and subsample sizes, and therefore the appropriate sizes based on a desired power. The program can be used for the 'ordinary' case of the one-way analysis of variance, as well as for hierarchical analysis of variance with two stages of sampling. Examples are given of the practical use of the program.

Effect of the Glenosphere Position and Size on Reverse Shoulder Prostheses Mobility

Introduction: Several methods have already been proposed to improve the mobility of reversed prostheses (lateral or inferior displacement, increase of the glenosphere size). However, the effect of these design changes have only been evaluated on the maximal range of motion and were not related to activities of daily living (ADL). Our aim was thus to measure the effect of these design changes and to relate it to 4 typical ADL. Methods: CT data were used to reconstruct a accurate geometric model of the scapula and humerus. The Aequalis reversed prosthesis (Tornier) was used. The mobility of a healthy shoulder was compared to the mobility of 4 different reversed designs: 36 and 42 mm glenospheres diameters, inferior (4 mm) and lateral (3.2 mm) glenospheres displacements. The complete mobility map of the prosthesis was compared to kinematics measurement on healthy subjects for 4 ADL: 1) hand to contra lateral shoulder, 2) hand to mouth, 3) combing hair, 4) hand to back pocket. The results are presented as percentage of the allowed movement of the prosthestic shouder relative to the healthy shoulder, considered as the control group. Results: None of the tested designs allowed to recover a full mobility. The differences of allowed range of motion among each prosthetic designs appeared mainly in two of the 4 movements: hand to back pocket and hand to contra lateral shoulder. For the hand to back pocket, the 36 had the lowest mobility range, particularly for the last third of the movement. The 42 appeared to be a good compromise for all ADL activities. Conclusion: Reverse shoulder prostheses does not allow to recover a full range of motion compared to healthy shoulders, even for ADL. The present study allowed to obtain a complete 3D mobility map for several glenosphere positions and sizes, and to relate it to typical ADL. We mainly observed an improved mobility with inferior displacement and increased glenosphere size. We would suggest to use larger glenosphere, whenever it is possible.

Major impact of body position on arterial stiffness indices derived from radial applanation tonometry in pregnant and non pregnant woman

Pendant la grossesse, la pression artérielle reste stable malgré une nette augmentation du volume d'éjection systolique et du débit cardiaque. Cette stabilité vient d'un côté d'une vasodilatation périphérique entraînant une diminution des résistances périphériques et d'un autre côté d'une moindre rigidité des principales artères notamment l'aorte. En conséquence, l'amplitude des ondes de pouls est atténuée, de même que leur vitesse de propagation dans le sens tant antérogade que rétrograde (ondes réfléchies). Les ondes réfléchies tendent ainsi à atteindre l'aorte ascendante plus tard durant la systole, voire durant la diastole, ce qui peut contribuer à diminuer la pression puisée. La prééclampsie perturbe massivement ce processus d'adaptation. Il s'agit d'une maladie hypertensive de la grossesse engendrant une importante morbidité et mortalité néonatale et maternelle. Il est à remarquer que la diminution de la rigidité artérielle n'est pas observée chez les patientes atteintes avec pour conséquence une forte augmentation de la pression systolique centrale (aortique) par les ondes réfléchies. Ce fait a été établi grâce à l'existence de la tonométrie d'aplanation, une méthode permettant l'évaluation non invasive de l'onde de pouls centrale. Dans cette méthode, un senseur de pression piézo-électrique permet de capter l'onde de pouls périphérique, le plus souvent sur l'artère radiale. Par la suite, un algorithme validé permet d'en déduire la forme de l'onde de pouls centrale et de visualiser à quel moment du cycle cardiaque s'y ajoutent les ondes réfléchies. Plusieurs études font état d'une forte augmentation de la pression systolique centrale par les ondes réfléchies chez les patientes atteintes de prééclampsie, suggérant l'utilisation de cette méthode pour le diagnostic et le monitoring voire pour le dépistage de ces patientes. Pour atteindre ce but, il est nécessaire d'établir des normes en rapport notamment avec l'âge gestationnel. Dans la littérature, les données pertinentes actuellement disponibles sont variables, voire contradictoires. Par exemple, les ondes réfléchies proéminentes dans la partie diastolique de l'onde de pouls centrale disparaissaient chez des patientes enceintes au 3eme trimestre comparées à des contrôles non enceintes dans une étude lausannoise, alors que deux autres études présentent l'observation contraire. Autre exemple, certains auteurs décrivent une diminution progressive de l'augmentation systolique jusqu'à l'accouchement alors que d'autres rapportent un nadir aux environs du 6ème mois, suivi d'un retour à des valeurs plus élevées en fin de grossesse. Les mesures effectuées dans toutes ces études différaient dans leur exécution, les patientes étant notamment dans des postions corporelles différentes (couchées, semi-couchées, assises, en décubitus latéral). Or nous savons que le status hémodynamique est très sensible aux changements de position, particulièrement durant la grossesse où l'utérus gravide est susceptible d'avoir des interactions mécaniques avec les veines et possiblement les artères abdominales. Ces différences méthodologiques pourraient donc expliquer, au moins en partie, l'hétérogénéité des résultats concernant l'onde de pouls chez la femme enceinte, ce qui à notre connaissance n'a jamais été exploré. Nous avons mesuré l'onde de pouls dans les positions assise et couchée chez des femmes enceintes, au 3eme trimestre d'une grossesse non compliquée, et nous avons effectué une comparaison avec des données similaire obtenues chez des femmes non enceintes en bonne santé habituelle. Les résultats montrent que la position du corps a un impact majeur sur la forme de l'onde de pouls centrale. Comparée à la position assise, la position couchée se caractérise par une moindre augmentation systolique et, par contraste, une augmentation diastolique plus marquée. De manière inattendue, cet effet s'observe aussi bien en présence qu'en l'absence de grossesse, suggérant que la cause première n'en réside pas dans les interactions mécaniques de l'utérus gravide avec les vaisseaux sanguins abdominaux. Nos observations pourraient par contre être expliquées par l'influence de la position du corps, via un phénomène hydrostatique simple, sur la pression transmurale des artères éloignées du coeur, tout particulièrement celles des membres inférieurs et de l'étage abdominal. En position verticale, ces vaisseaux augmenteraient leur rigidité pour résister à la distension de leur paroi, ce qui y accroîtrait la vitesse de propagation des ondes de pression. En l'état, cette explication reste hypothétique. Mais quoi qu'il en soit, nos résultats expliquent certaines discordances entre les études conduites à ce jour pour caractériser l'influence de la grossesse physiologique sur la forme de l'onde de pouls central. De plus, ils indiquent que la position du corps doit être prise en compte lors de toute investigation utilisant la tonométrie d'applanation pour déterminer la rigidité des artères chez les jeunes femmes enceintes ou non. Il sera aussi nécessaire d'en tenir compte pour établir des normes en vue d'une utilisation de la tonométrie d'aplanation pour dépister ou suivre les patientes atteintes de prééclampsie. Il serait enfin intéressant d'évaluer si l'effet de la position sur la forme de l'onde de pouls central existe également dans l'autre sexe et chez des personnes plus âgées.

Communication in networks with hierarchical branching

We present a simple model of communication in networks with hierarchical branching. We analyze the behavior of the model from the viewpoint of critical systems under different situations. For certain values of the parameters, a continuous phase transition between a sparse and a congested regime is observed and accurately described by an order parameter and the power spectra. At the critical point the behavior of the model is totally independent of the number of hierarchical levels. Also scaling properties are observed when the size of the system varies. The presence of noise in the communication is shown to break the transition. The analytical results are a useful guide to forecasting the main features of real networks.

Hierarchical neural network with high storage capacity

A recent method used to optimize biased neural networks with low levels of activity is applied to a hierarchical model. As a consequence, the performance of the system is strongly enhanced. The steps to achieve optimization are analyzed in detail.

Membrane-destabilizing activity of pH-responsive cationic lysine-based surfactants: role of charge position and alkyl chain length

Many strategies for treating diseases require the delivery of drugs into the cell cytoplasm following internalization within endosomal vesicles. Thus, compounds triggered by low pH to disrupt membranes and release endosomal contents into the cytosol are of particular interest. Here, we report novel cationic lysine-based surfactants (hydrochloride salts of N¿- and N¿-acyl lysine methyl ester) that differ in the position of the positive charge and the length of the alkyl chain. Amino acid-based surfactants could be promising novel biomaterials in drug delivery systems, given their biocompatible properties and low cytotoxic potential. We examined their ability to disrupt the cell membrane in a range of pH values, concentrations and incubation times, using a standard hemolysis assay as a model of endosomal membranes. Furthermore, we addressed the mechanism of surfactant-mediated membrane destabilization, including the effects of each surfactant on erythrocyte morphology as a function of pH. We found that only surfactants with the positive charge on the ¿-amino group of lysine showed pH-sensitive hemolytic activity and improved kinetics within the endosomal pH range, indicating that the positive charge position is critical for pH-responsive behavior. Moreover, our results showed that an increase in the alkyl chain length from 14 to 16 carbon atoms was associated with a lower ability to disrupt cell membranes. Knowledge on modulating surfactant-lipid bilayer interactions may help us to develop more efficient biocompatible amino acid-based drug delivery devices.

Density-based hierarchical clustering of pyro-sequences on a large scale--the case of fungal ITS1.

MOTIVATION: Analysis of millions of pyro-sequences is currently playing a crucial role in the advance of environmental microbiology. Taxonomy-independent, i.e. unsupervised, clustering of these sequences is essential for the definition of Operational Taxonomic Units. For this application, reproducibility and robustness should be the most sought after qualities, but have thus far largely been overlooked. RESULTS: More than 1 million hyper-variable internal transcribed spacer 1 (ITS1) sequences of fungal origin have been analyzed. The ITS1 sequences were first properly extracted from 454 reads using generalized profiles. Then, otupipe, cd-hit-454, ESPRIT-Tree and DBC454, a new algorithm presented here, were used to analyze the sequences. A numerical assay was developed to measure the reproducibility and robustness of these algorithms. DBC454 was the most robust, closely followed by ESPRIT-Tree. DBC454 features density-based hierarchical clustering, which complements the other methods by providing insights into the structure of the data. AVAILABILITY: An executable is freely available for non-commercial users at ftp://ftp.vital-it.ch/tools/dbc454. It is designed to run under MPI on a cluster of 64-bit Linux machines running Red Hat 4.x, or on a multi-core OSX system. CONTACT: dbc454@vital-it.ch or nicolas.guex@isb-sib.ch.

Sampling Position under No-Tillage System Affects the Results of Soil Physical Properties

ABSTRACT Understanding the spatial behavior of soil physical properties under no-tillage system (NT) is required for the adoption and maintenance of a sustainable soil management system. The aims of this study were to quantify soil bulk density (BD), porosity in the soil macropore domain (PORp) and in the soil matrix domain (PORm), air capacity in the soil matrix (ACm), field capacity (FC), and soil water storage capacity (FC/TP) in the row (R), interrow (IR), and intermediate position between R and IR (designated IP) in the 0.0-0.10 and 0.10-0.20 m soil layers under NT; and to verify if these soil properties have systematic variation in sampling positions related to rows and interrows of corn. Soil sampling was carried out in transect perpendicular to the corn rows in which 40 sampling points were selected at each position (R, IR, IP) and in each soil layer, obtaining undisturbed samples to determine the aforementioned soil physical properties. The influence of sampling position on systematic variation of soil physical properties was evaluated by spectral analysis. In the 0.0-0.1 m layer, tilling the crop rows at the time of planting led to differences in BD, PORp, ACm, FC and FC/TP only in the R position. In the R position, the FC/TP ratio was considered close to ideal (0.66), indicating good water and air availability at this sampling position. The R position also showed BD values lower than the critical bulk density that restricts root growth, suggesting good soil physical conditions for seed germination and plant establishment. Spectral analysis indicated that there was systematic variation in soil physical properties evaluated in the 0.0-0.1 m layer, except for PORm. These results indicated that the soil physical properties evaluated in the 0.0-0.1 m layer were associated with soil position in the rows and interrows of corn. Thus, proper assessment of soil physical properties under NT must take into consideration the sampling positions and previous location of crop rows and interrows.

Joint Official Positions of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX(®). Executive Summary of the 2010 Position Development Conference on Interpretation and use of FRAX® in clinical practice.

The International Society for Clinical Densitometry (ISCD) and the International Osteoporosis Foundation (IOF) convened the FRAX(®) Position Development Conference (PDC) in Bucharest, Romania, on November 14, 2010, following a two-day joint meeting of the ISCD and IOF on the "Interpretation and Use of FRAX(®) in Clinical Practice." These three days of critical discussion and debate, led by a panel of international experts from the ISCD, IOF and dedicated task forces, have clarified a number of important issues pertaining to the interpretation and implementation of FRAX(®) in clinical practice. The Official Positions resulting from the PDC are intended to enhance the quality and clinical utility of fracture risk assessment worldwide. Since the field of skeletal assessment is still evolving rapidly, some clinically important issues addressed at the PDCs are not associated with robust medical evidence. Accordingly, some Official Positions are based largely on expert opinion. Despite limitations inherent in such a process, the ISCD and IOF believe it is important to provide clinicians and technologists with the best distillation of current knowledge in the discipline of bone densitometry and provide an important focus for the scientific community to consider. This report describes the methodology and results of the ISCD-IOF PDC dedicated to FRAX(®).

Relationship between Speed and Lateral Position on Curves, September 2012

Excessive speed is often cited as a primary driver factor in crashes, particularly rural two-lane crashes. It has also been suggested that speed plays a significant role in crashes on curves. However, the relationship between speed and crashes on curves is not well documented because it is difficult to determine driver speed after the fact when investigating a crash. One method to begin documenting this relationship is to explore the relationship between lateral position and speed as a crash surrogate. For this study, the researchers collected speed and lateral position data for three rural two-lane curves. The relationship between lateral position and speed was assessed by comparing the odds of a near-lane crossing for vehicles traveling 5 or more mph over the advisory speed to those for vehicles traveling below that threshold.