Automatic algorithm for monitoring systolic pressure variation and difference in pulse pressure

BACKGROUND: Difference in pulse pressure (dPP) reliably predicts fluid responsiveness in patients. We have developed a respiratory variation (RV) monitoring device (RV monitor), which continuously records both airway pressure and arterial blood pressure (ABP). We compared the RV monitor measurements with manual dPP measurements. METHODS: ABP and airway pressure (PAW) from 24 patients were recorded. Data were fed to the RV monitor to calculate dPP and systolic pressure variation in two different ways: (a) considering both ABP and PAW (RV algorithm) and (b) ABP only (RV(slim) algorithm). Additionally, ABP and PAW were recorded intraoperatively in 10-min intervals for later calculation of dPP by manual assessment. Interobserver variability was determined. Manual dPP assessments were used for comparison with automated measurements. To estimate the importance of the PAW signal, RV(slim) measurements were compared with RV measurements. RESULTS: For the 24 patients, 174 measurements (6-10 per patient) were recorded. Six observers assessed dPP manually in the first 8 patients (10-min interval, 53 measurements); no interobserver variability occurred using a computer-assisted method. Bland-Altman analysis showed acceptable bias and limits of agreement of the 2 automated methods compared with the manual method (RV: -0.33% +/- 8.72% and RV(slim): -1.74% +/- 7.97%). The difference between RV measurements and RV(slim) measurements is small (bias -1.05%, limits of agreement 5.67%). CONCLUSIONS: Measurements of the automated device are comparable with measurements obtained by human observers, who use a computer-assisted method. The importance of the PAW signal is questionable.

Arterial blood pressure during early sepsis and outcome

OBJECTIVE: To evaluate the association between arterial blood pressure (ABP) during the first 24 h and mortality in sepsis. DESIGN: Retrospective cohort study. SETTING: Multidisciplinary intensive care unit (ICU). PATIENTS AND PARTICIPANTS: A total of 274 septic patients. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Hemodynamic, and laboratory parameters were extracted from a PDMS database. The hourly time integral of ABP drops below clinically relevant systolic arterial pressure (SAP), mean arterial pressure (MAP), and mean perfusion pressure (MPP = MAP - central venous pressure) levels was calculated for the first 24 h after ICU admission and compared with 28-day-mortality. Binary and linear regression models (adjusted for SAPS II as a measure of disease severity), and a receiver operating characteristic (ROC) analysis were applied. The areas under the ROC curve were largest for the hourly time integrals of ABP drops below MAP 60 mmHg (0.779 vs. 0.764 for ABP drops below MAP 55 mmHg; P < or = 0.01) and MPP 45 mmHg. No association between the hourly time integrals of ABP drops below certain SAP levels and mortality was detected. One or more episodes of MAP < 60 mmHg increased the risk of death by 2.96 (CI 95%, 1.06-10.36, P = 0.04). The area under the ROC curve to predict the need for renal replacement therapy was highest for the hourly time integral of ABP drops below MAP 75 mmHg. CONCLUSIONS: A MAP level > or = 60 mmHg may be as safe as higher MAP levels during the first 24 h of ICU therapy in septic patients. A higher MAP may be required to maintain kidney function.

CYP17A1 Enzyme Activity Is Linked to Ambulatory Blood Pressure in a Family-Based Population Study

BACKGROUND Genome-wide association studies have linked CYP17A1 coding for the steroid hormone synthesizing enzyme 17α-hydroxylase (CYP17A1) to blood pressure (BP). We hypothesized that the genetic signal may translate into a correlation of ambulatory BP (ABP) with apparent CYP17A1 activity in a family-based population study and estimated the heritability of CYP17A1 activity. METHODS In the Swiss Kidney Project on Genes in Hypertension, day and night urinary excretions of steroid hormone metabolites were measured in 518 participants (220 men, 298 women), randomly selected from the general population. CYP17A1 activity was assessed by 2 ratios of urinary steroid metabolites: one estimating the combined 17α-hydroxylase/17,20-lyase activity (ratio 1) and the other predominantly 17α-hydroxylase activity (ratio 2). A mixed linear model was used to investigate the association of ABP with log-transformed CYP17A1 activities exploring effect modification by urinary sodium excretion. RESULTS Daytime ABP was positively associated with ratio 1 under conditions of high, but not low urinary sodium excretion (P interaction <0.05). Ratio 2 was not associated with ABP. Heritability estimates (SE) for day and night CYP17A1 activities were 0.39 (0.10) and 0.40 (0.09) for ratio 1, and 0.71 (0.09) and 0.55 (0.09) for ratio 2 (P values <0.001). CYP17A1 activities, assessed with ratio 1, were lower in older participants. CONCLUSIONS Low apparent CYP17A1 activity (assessed with ratio 1) is associated with elevated daytime ABP when salt intake is high. CYP17A1 activity is heritable and diminished in the elderly. These observations highlight the modifying effect of salt intake on the association of CYP17A1 with BP.

Resting and reactive blood pressure as predictors of ambulatory blood pressure in older hypertensive adults

Background. A review of the literature suggests that Hypertension (HTN) in older adults is associated with sympathetic stimulation that results in increasing blood pressure (BP) reactivity. If clinical assessment of BP captured sympathetic stimulation, it would be valuable for hypertension management. ^ Objectives. The study examined whether reactive change scores from a short BPR protocol, resting blood pressure (BP), or resting pulse pressure (PP) is a better predictor of 24 hour ambulatory BP and BP load in cardiac patients. ^ Method. The study used a single-group design, with both an experimental clinical component and an observational field component. Both components used repeated measurement methods. The study population consisted of 45 adult patients with a mean age of 64.6 ± 8.5 years who were diagnosed with cardiac disease and who were taking anti-hypertensive medication. Blood pressure reactivity was operationalized with a speech protocol. During the speech protocol, BP was measured with an automatic device (Dinamap 825XT) while subjects talked about their health and about their usual day. Twenty-four hour ambulatory BP measurement (Spacelabs 90207 monitor) followed the speech protocol. ^ Results. Resting SBP and resting PP were significant predictors of 24-hour SBP, and resting SBP was a significant predictor of SBP load. No predictors were significant of 24-hour DBP or DBP load. ^ Conclusions. Initial resting BP and PP may be used in clinical settings to assess hypertension management. Future studies are necessary to confirm the ability of resting BP to predict ABP and BP load in older, medicated hypertensives. ^

Ambulatory blood pressure and physical activity in heart failure

Background. Ambulatory blood pressure (ABP) measurement is a means of monitoring cardiac function in a noninvasive way, but little is known about ABP in heart failure (HF) patients. Blood pressure (BP) declines during sleep as protection from consistent BP load, a phenomenon termed "dipping." The aims of this study were (1) to compare BP dipping and physical activity between two groups of HF patients with different functional statuses and (2) to determine whether the strength of the association between ambulatory BP and PA is different between these two different functional statuses of HF. ^ Methods. This observational study used repeated measures of ABP and PA over a 24-hour period to investigate the profiles of BP and PA in community-based individuals with HF. ABP was measured every 30 minutes by using a SpaceLabs 90207, and a Basic Motionlogger actigraph was used to measure PA minute by minute. Fifty-six participants completed both BP and physical activity for a 24-hour monitoring period. Functional status was based on New York Heart Association (NYHA) ratings. There were 27 patients with no limitation of PA (NYHA class I HF) and 29 with some limitation of PA but no discomfort at rest (NYHA class II or III HF). The sample consisted of 26 men and 30 women, aged 45 to 91 years (66.96 ± 12.35). ^ Results. Patients with NYHA class I HF had significantly greater dipping percent than those with NYHA class II/III HF after controlling their left ventricular ejection fraction (LVEF). In a mixed model analysis (PROC MIXED, SAS Institute, v 9.1), PA was significantly related to ambulatory systolic and diastolic BP and mean arterial pressure. The strength of the association between PA and ABP readings was not significantly different for the two groups of patients. ^ Conclusions. These preliminary findings demonstrate differences between NYHA class I and class II/III of HF in BP dipping status and ABP but not PA. Longitudinal research is recommended to improve understanding of the influence of disease progression on changes in 24-hour physical activity and BP profiles of this patient population. ^ Key Words. Ambulatory Blood Pressure; Blood Pressure Dipping; Heart Failure; Physical Activity. ^

The role of cardiorespiratory fitness and weight status on 24-hr ambulatory blood pressure among adolescents

BACKGROUND: This observational research study investigated the association of cardiorespiratory fitness and weight status with repeated measures of 24-hr ambulatory blood pressure (24-hr ABP). Little is known about these associations and few data exist examining the interaction between cardiorespiratory fitness and weight status and the contributions of each on 24-hr ABP in youth. ^ METHODS: This research study used secondary analysis data from the "Adolescent Blood Pressure and Anger: Ethnic Differences" study. This current study sample included 374 African-American, Anglo-American, and Mexican-American adolescents 11-16 years of age. Mixed-effects models were used for testing the relationship between weight status and cardiorespiratory fitness and repeated measures of ambulatory blood pressure over 24 hours (24-hr ABP). Weight status was categorized into "normal weight" (BMI<85th percentile), "overweight" (85th≤BMI<95th), and "obese" (BMI≥95th). Cardiorespiratory fitness, determined by heart rate recovery (HRR), was defined as the difference between heart rate at peak exercise and heart rate at two minutes post-exercise, as measured by a height-adjusted step test and stratified into two groups: low and high fitness, using a median split. Ambulatory blood pressure (ABP) was monitored for a 24-hr period on a school day using the Spacelabs ambulatory monitor (Model 90207). Blood pressure and heart rate were recorded at 30 minute intervals throughout the day of recording and at 60 minute intervals during sleep. ^ RESULTS: No significant associations were found between weight status and mean 24-hr systolic blood pressure (SBP) or mean arterial pressure (MAP). A significant and inverse association between weight status and mean 24-hr diastolic blood pressure (DBP) was revealed. Cardiorespiratory fitness was significantly and inversely associated with mean 24-hr ABP. High fitness adolescents had significantly lower mean 24-hr SPB, DBP, and MAP measurements than low fitness adolescents. Compared to low fitness adolescents, high fitness adolescents had 1.90 mmHg, 1.16 mmHg, and 1.68 mmHg lower mean 24-hr SBP, DBP, and MAP, respectively. Additionally, high fitness appeared to afford protection from higher mean 24-hr SBP and MAP, irrespective of weight status. Among normal weight adolescents, low fitness resulted in higher mean 24-hr SBP and MAP, compared to their fit counterparts. Among adolescents categorized as high fitness, increasing weight status did not appear to result in higher mean 24-hr SBP or MAP. Cardiorespiratory fitness, rather than weight status, appeared to be a more dominant predictor of mean 24-hr SBP and MAP. ^ CONCLUSIONS: To our knowledge, this research is the first study to investigate the independent and combined contributions of cardiorespiratory fitness and weight status on 24-hr ABP, all objectively measured. The results of this study may potentially guide and inform future research. It appears that early cardiovascular disease (CVD) prevention should focus on improving cardiorespiratory fitness levels among all adolescents, particularly those adolescents least fit, regardless of their weight status, while obesity prevention efforts continue.^

Sedimentology on sediment cores from the eastern Weddell Sea, Antarctica

Sediment cores from nine sites along a profile on the Antarctic continental margin off Kapp Norvegia were analysed sedimentologicaly. The carbonate and organic carbon content, grain size distribution, composition of the coarse fraction and clay minerals were determined. d18O- and d13C-isotope ratios were also measured. The distribution of ice rafted debris was determined by a new method. Sedimentation-rates were obtained from 230Th- and 14C-analyses. A segregation into seven different sediment facies was made possible by different sedimentological parameters, which can be attributed to different sedimentation environments and conditions. Thr profile can be divided morphologicaly into shelf, upper continental slope, slope terrace and lower continental slope. The paratill facies is deposited on the shelf during an interglacial phase and consists mainly of ice rafted sediments. A portion of the fine fraction is being carried away by the antarctic coastel current. The sedimentation rate lies between 0 and 3 cm/1000 a. The coarse grained deposits of the upper, relatively steep continental slope, were specified as a rest sediment. Current and gravity sediment transport are responsible for the intensive sorting of ice rafted material coming from the shelf. The fine sediment is carried away by currents while sand and silt are deposited as small turbidites on the slope terrace. The morainic facies only appears at the base of the upper continental slope and defines ice advances, beyond the shelf margin. The facies mainly consists of transported shelf sediments. The interglacial facies, deposited during the interglacial phases on the continental slope, are characterized by high proportions of ice raft, coarse mean grain size, low content of montmorillonite and a carbonate content, which mainly originates from planktonic foraminifera (N. pachyderma). At the central part of the slope the sedimentation rate is at its lowest (2 cm/1000 a) and increases to 3-4 cm/1000 a towards the sea, due to high production of biogenic components and towards the continent due to an increasing input of terrigenous material. Sedimentary conditions during glacial times are depicted in the glacial facies by a low content of ice rafted debris, a lower mean grain size and a high content of montmorillonite. Biogeneous components are absent. The sedimentation rate is generally about 1 cm/1000a. A transition facies is deposited during the transition from glacial to interglacial conditions. Typical for this facies, with a terrigenous composition similar to the interglacial facies, is a high content of radiolaria. The reason for the change of plankton from a siliceous to a carbonacous fauna may have been the changing hydrography caused by the sea ice. The surge facies is deposited at the continental margin under the ice shelf and is a sediment exclusively delivered by currents. With the aid of this facies it was, for the first time possible to prove the existence of Antarctic ice surges, an aspect wh ich has been discussed for the past 20 years.

AFRICA BUILD Portal: developing a social network of African health researchers and educators

One of the main outputs of the project is a collaborative platform which integrates a myriad of research and learning resources. This article presents the first prototype of this platform: the AFRICA BUILD Portal (ABP 1.0). The ABP is a Web 2.0 platform which facilitates the access, in a collaborative manner, to these resources. Through a usable web interface, the ABP has been designed to avoid, as much as possible, the connectivity problems of African institutions. In this paper, we suggest that the access to complex systems does not imply slow response rates, and that their development model guides the project to a natural technological transfer, adaptation and user acceptance. Finally, this platform aims to motivate research attitudes during the learning process and stimulate user?s collaborations.

Sistema de e-learning en el entorno AFRICA BUILD Portal

Diversos estudios consideran que las claves para el desarrollo técnico, social y económico de los países en desarrollo, y en especial en África, son la educación, la investigación y la innovación. No obstante, en el ámbito sanitario en particular, la formación e investigación en África sigue siendo escasa por diversos motivos. Por un lado, los investigadores africanos encuentran dificultades añadidas para obtener financiación frente a investigadores en países de desarrollo. Y, por otro lado, los investigadores no disponen de las herramientas y tecnologías adecuadas para acceder a información relevante para su trabajo. En este contexto, el proyecto AFRICA BUILD tiene como principal objetivo mejorar y fomentar la investigación y educación sanitaria en África a través de las nuevas tecnologías. Uno de los resultados principales de este proyecto es el AFRICA BUILD Portal (ABP), que pretende ser un punto de encuentro para los investigadores africanos, donde podrán encontrar un amplio abanico de herramientas que les permita no sólo mejorar su educación, sino compartir conocimientos con otros investigadores. Este portal, que está actualmente en desarrollo, pretende fomentar la comunicación entre instituciones africanas y les proveerá herramientas biomédicas avanzadas. En este Trabajo de Fin de Grado se han marcado como principal objetivo la mejora del sistema de e-learning que existía en el ABP. El nuevo sistema será: (i) más potente, óptimo y rico en funcionalidades, (ii) tendrá una importante base social permitiendo a los usuarios aportar información y compartir conocimiento, y (iii) será distribuido y escalable, capaz de integrar distintos gestores de contenidos didácticos como fuentes de información. Los resultados obtenidos son positivos y el nuevo sistema de aprendizaje ha mejorado la usabilidad, funcionalidad y apariencia del anterior. Para concluir, la herramienta posee aún un gran margen de mejora, pero gracias al trabajo realizado el sistema de e-learning es ahora más social, distribuido, escalable e innovador. ---ABSTRACT---Several studies find that the keys to the technical, social and economic development of developing countries, especially in Africa, are education, research and innovation. However, in the health sector in particular, training and research in Africa remains low for various reasons. On the one hand, African researchers experience additional difficulties for funding against researchers in developing countries. And on the other hand, researchers do not have the right tools and technologies to access information relevant to their work. In this context, the AFRICA BUILD project's main objective is to improve and enhance research and health education in Africa through new technologies. One of the main results of this project is the AFRICA BUILD Portal (ABP), which aims to be a meeting point for African researchers, where they can find a wide range of tools that allows them to not only improve their education but to share knowledge with other researchers. This portal, which is currently under development, aims to promote communication between African institutions and will provide advanced biomedical tools. The main objective of this Final Year Project is the improvement of the former elearning system that already existed in the ABP. The new system will be: (i) more powerful, richer in features, (ii) will have an important social base allowing users to contribute information and knowledge sharing; and (iii) will be distributed and scalable, capable of integrating different learning management systems as sources of information. The final results obtained are fairly positive and the new e-learning system has improved its usability, functionality and appearance of the former. To conclude, the tool still has much room for improvement, but thanks to the new features of the improved elearning system has become more social, distributed, scalable and innovative.

Aplicación Móvil orientada a M-Learning e implementación de una capa de Servicios Web para el acceso remoto para la plataforma AFRICA BUILD Portal.

El presente Trabajo de Fin de Grado (TFG) se enmarca dentro del proyecto AFRICA BUILD. Dicho proyecto tiene como objetivo principal fomentar la investigación y fortalecer las capacidades de cuatro centros de educación superior en África a través de las TIC. Para cumplir este objetivo se ha diseñado el sistema AFRICA BUILD Portal (ABP). El ABP consiste en una solución web basada en “e-learning” para estudiantes, profesores e investigadores dentro del continente africano. El objetivo de este TFG consiste en ampliar la accesibilidad y el uso del portal a través de dispositivos móviles. La solución propuesta en este TFG consiste en el desarrollo de dos soluciones que complementan el ABP: (I) una capa de servicios web para el portal y (II) la versión App para dispositivos móviles del mismo. Cabe destacar la relación existente entre ambas soluciones ya que la segunda necesita de la primera para poder funcionar y comunicarse así con el portal.

Actin-Bundling Protein Isolated from Pollen Tubes of Lily : Biochemical and Immunocytochemical Characterization

A 135-kD actin-bundling protein was purified from pollen tubes of lily (Lilium longiflorum) using its affinity to F-actin. From a crude extract of the pollen tubes, this protein was coprecipitated with exogenously added F-actin and then dissociated from F-actin by treating it with high-ionic-strength solution. The protein was further purified sequentially by chromatography on a hydroxylapatite column, a gel-filtration column, and a diethylaminoethyl-cellulose ion-exchange column. In the present study, this protein is tentatively referred to as P-135-ABP (Plant 135-kD Actin-Bundling Protein). By the elution position from a gel-filtration column, we estimated the native molecular mass of purified P-135-ABP to be 260 kD, indicating that it existed in a dimeric form under physiological conditions. This protein bound to and bundled F-actin prepared from chicken breast muscle in a Ca2+-independent manner. The binding of 135-P-ABP to actin was saturated at an approximate stoichiometry of 26 actin monomers to 1 dimer of P-135-ABP. By transmission electron microscopy of thin sections, we observed cross-bridges between F-actins with a longitudinal periodicity of 31 nm. Immunofluorescence microscopy using rhodamine-phalloidin and antibodies against the 135-kD polypeptide showed that P-135-ABP was colocalized with bundles of actin filaments in lily pollen tubes, leading us to conclude that it is the factor responsible for bundling the filaments.

Auxins induce clustering of the auxin-binding protein at the surface of maize coleoptile protoplasts.

The predominant localization of the major auxin-binding protein (ABP1) of maize is within the lumen of the endoplasmic reticulum. Nevertheless, all the electrophysiological evidence supporting a receptor role for ABP1 implies that a functionally important fraction of the protein must reside at the outer face of the plasma membrane. Using methods of protoplast preparation designed to minimize proteolysis, we report the detection of ABP at the surface of maize coleoptile protoplasts by the technique of silver-enhanced immunogold viewed by epipolarization microscopy. We also show that ABP clusters following auxin treatment and that this response is temperature-dependent and auxin-specific.

Participación colaborativa de alumnos mayores en prácticas experimentales de laboratorio y en casos de aprendizaje basado en problemas de asignaturas de Ciencias de la Salud

El envejecimiento de la población requiere educar a los mayores en hábitos de salud para obtener mejor calidad de vida y asegurar estados de mayor autonomía y menor dependencia. Algunas actividades formativas de la Universidad Permanente de la Universidad de Alicante (UPUA) están orientadas a que el alumno adopte un estilo de vida lo más sano posible y conductas positivas de salud. Bajo estas premisas se han impartido 3 asignaturas de ciencias de la salud: “Biología: Bases celulares de la enfermedad” (BBCE), “Medicina básica: cambios del cuerpo humano” (MBCCH) y “Medicina básica: fundamentos de patología humana” (MBFPH). En ellas se fomentó la participación colaborativa de los alumnos para facilitar su aprendizaje implicándolos en tareas atractivas y motivadoras. En BBCE realizaron sencillas experiencias de laboratorio para conocer aspectos básicos del método de investigación científica. Los alumnos entendieron algunos mecanismos elementales del funcionamiento del cuerpo y el origen de ciertas enfermedades a través del conocimiento de la estructura y función de las células, tejidos y órganos. En MBCCH y MBFPH, se recurrieron a las técnicas didácticas de “Aprendizaje Basado en Problemas” (ABP) y “Juegos de rol” para hacer más evidentes las conclusiones de los casos planteados e interiorizar mejor el aprendizaje adquirido. En MBCCH los alumnos comprendieron los cambios debidos a la evolución natural del organismo humano a lo largo de la vida y durante el proceso de enfermar. En MBFPH profundizaron en los mecanismos que originan las principales enfermedades del organismo humano y en su prevención con hábitos saludables.

ABPgame+ o cómo hacer del último curso de ingeniería una primera experiencia profesional

Algunos de los aspectos clave en el desarrollo profesional de un ingeniero son su capacidad para trabajar en equipo, para integrar diferentes puntos de vista y para desarrollar grandes proyectos con un alto nivel de incertidumbre. Los planes de estudio de las titulaciones que preparan a estos futuros ingenieros no pueden permanecer ajenos a estas necesidades y deben plantear situaciones lo más cercanas posible a la realidad que se encontrarán nuestros egresados en su vida laboral. Estas razones, nos han llevado a plantear una experiencia innovadora en una titulación de nueva implantación como es el Grado en Ingeniería Multimedia. Hemos elegido, para ello, la metodología del Aprendizaje Basado en Proyectos (ABP), aplicada al itinerario de Creación y Entretenimiento Digital en cuarto curso, donde los estudiantes, agrupados en equipos, desarrollan un único gran proyecto durante el año, que es un videojuego. Queremos destacar dos consecuencias de esta experiencia: primero, el papel fundamental de la asignatura Proyectos Multimedia, sirviendo de apoyo al resto de asignaturas al llevar el peso de la gestión de los equipos y del seguimiento del proyecto. Y después, que los estudiantes pueden obtener un producto terminado al final del curso que les permita inaugurar su portafolio profesional.

Experiencia de trabajo colaborativo internacional para la elaboración de material docente

El aprendizaje basado en problemas (ABP) se viene utilizando desde hace años como estrategia de enseñanza porque fomenta el autoaprendizaje y está bien valorado por los estudiantes. El objetivo de este trabajo fue crear una colección de problemas que sea de utilidad como recurso didáctico para el estudio de la Farmacología. Para ello se preparó una colección de problemas sobre alteraciones del comportamiento inducidas por fármacos, para ser utilizados en tres universidades iberoamericanas: Universidad de Alicante (España), Universidad Nacional de Tucumán (Argentina) y Universidad de Montevideo (Uruguay). Los problemas fueron elaborados de forma colaborativa por profesores de las tres universidades; fueron analizados por expertos en diferentes materias (psiquiatría, derecho, sociología) y después fueron aplicados a nivel grado (Criminología, Universidad de Alicante y Odontología, Universidad de Tucumán) y postgrado (Universidad de Montevideo). La calidad del aprendizaje se midió de forma cuantitativa (grado de acierto a las preguntas que se realizaban después de cada problema) y de forma cualitativa (valoración de las actitudes mediante encuesta con escala Likert). En todos los casos los problemas demostraron ser de utilidad en las tres universidades y fueron bien valorados por el profesorado, los expertos y los estudiantes.