Analysis of nocturnal oxygen saturation recordings using kernel entropy to assist in sleep apnea-hypopnea diagnosis

In this study, a new entropy measure known as kernel entropy (KerEnt), which quantifies the irregularity in a series, was applied to nocturnal oxygen saturation (SaO 2) recordings. A total of 96 subjects suspected of suffering from sleep apnea-hypopnea syndrome (SAHS) took part in the study: 32 SAHS-negative and 64 SAHS-positive subjects. Their SaO 2 signals were separately processed by means of KerEnt. Our results show that a higher degree of irregularity is associated to SAHS-positive subjects. Statistical analysis revealed significant differences between the KerEnt values of SAHS-negative and SAHS-positive groups. The diagnostic utility of this parameter was studied by means of receiver operating characteristic (ROC) analysis. A classification accuracy of 81.25% (81.25% sensitivity and 81.25% specificity) was achieved. Repeated apneas during sleep increase irregularity in SaO 2 data. This effect can be measured by KerEnt in order to detect SAHS. This non-linear measure can provide useful information for the development of alternative diagnostic techniques in order to reduce the demand for conventional polysomnography (PSG). © 2011 IEEE.

The development and investigation of a novel pulsatile heart assist device

Cardiovascular diseases (CVD) contributed to almost 30% of worldwide mortality; with heart failure being one class of CVD. One popular and widely available treatment for heart failure is the intra-aortic balloon pump (IABP). This heart assist device is used in counterpulsation to improve myocardial function by increasing coronary perfusion, and decreasing aortic end-diastolic pressure (i.e. the resistance to blood ejection from the heart). However, this device can only be used acutely, and patients are bedridden. The subject of this research is a novel heart assist treatment called the Chronic Intermittent Mechanical Support (CIMS) which was conceived to offer advantages of the IABP device chronically, whilst overcoming its disadvantages. The CIMS device comprises an implantable balloon pump, a percutaneous drive line, and a wearable driver console. The research here aims to determine the haemodynamic effect of balloon pump activation under in vitro conditions. A human mock circulatory loop (MCL) with systemic and coronary perfusion was constructed, capable of simulating various degrees of heart failure. Two prototypes of the CIMS balloon pump were made with varying stiffness. Several experimental factors (balloon inflation/deflation timing, Helium gas volume, arterial compliance, balloon pump stiffness and heart valve type) form the factorial design experiments. A simple modification to the MCL allowed flow visualisation experiments using video recording. Suitable statistical tests were used to analyse the data obtained from all experiments. Balloon inflation and deflation in the ascending aorta of the MCL yielded favourable results. The sudden balloon deflation caused the heart valve to open earlier, thus causing longer valve opening duration in a cardiac cycle. It was also found that pressure augmentation in diastole was significantly correlated with increased cardiac output and coronary flowrate. With an optimum combination (low arterial compliance and low balloon pump stiffness), systemic and coronary perfusions were increased by 18% and 21% respectively, while the aortic end-diastolic pressure (forward flow resistance) decreased by 17%. Consequently, the ratio of oxygen supply and demand to myocardium (endocardial viability ratio, EVR) increased between 33% and 75%. The increase was mostly attributed to diastolic augmentation rather than systolic unloading.

An overview of Total Factor Productivity estimations adjusted for pollutant outputs:an application to sugarcane farming

The conventional Total Factor Productivity (TFP) measurement does not incorporate the effects of undesirable outputs, which are harmful to the environment. Using sugarcane farming in Kenya, this paper illustrates the differences between the conventional Malmquist index measures where the environment variable is not adjusted and environment-adjusted measures using both hyperbolic and directional distance functions. The mean TFP change estimates for the conventional Malmquist index, adjusted hyperbolic index and Luenberger indicator were 3.13%, 0.11% and 2.21%, respectively. The conventional non-adjusted measure lies between the two adjusted measures of hyperbolic index and Luenberger indicator. © 2012 Inderscience Enterprises Ltd.

The 'law of requisite variety' may assist climate change negotiations:a review of the Kyoto and Durban meetings

Ashby wrote about cybernetics, during which discourse he described a Law that attempts to resolve difficulties arising in complex situations – he suggested using variety to combat complexity. In this paper, we note that the delegates to the UN Framework Convention on Climate Change (UNFCCC) meeting in Kyoto, 1997, were offered a ‘simplifying solution’ to cope with the complexity of discussing multiple pollutants allegedly contributing to ‘climate change’. We assert that the adoption of CO2eq has resulted in imprecise thinking regarding the ‘carbon footprint’ – that is, ‘CO2’ – to the exclusion of other pollutants. We propose, as Ashby might have done, that the CO2eq and other factors within the ‘climate change’ negotiations be disaggregated to allow careful and specific individual solutions to be agreed on each factor. We propose a new permanent and transparent ‘action group’ be in charge of agenda setting and to manage the messy annual meetings. This body would be responsible for achieving accords at these annual meetings, rather than forcing this task on national hosts. We acknowledge the task is daunting and we recommend moving on from Ashby's Law to Beer's Viable Systems approach.

Regularity analysis of nocturnal oximetry recordings to assist in the diagnosis of sleep apnoea syndrome

The relationship between sleep apnoea–hypopnoea syndrome (SAHS) severity and the regularity of nocturnal oxygen saturation (SaO2) recordings was analysed. Three different methods were proposed to quantify regularity: approximate entropy (AEn), sample entropy (SEn) and kernel entropy (KEn). A total of 240 subjects suspected of suffering from SAHS took part in the study. They were randomly divided into a training set (96 subjects) and a test set (144 subjects) for the adjustment and assessment of the proposed methods, respectively. According to the measurements provided by AEn, SEn and KEn, higher irregularity of oximetry signals is associated with SAHS-positive patients. Receiver operating characteristic (ROC) and Pearson correlation analyses showed that KEn was the most reliable predictor of SAHS. It provided an area under the ROC curve of 0.91 in two-class classification of subjects as SAHS-negative or SAHS-positive. Moreover, KEn measurements from oximetry data exhibited a linear dependence on the apnoea–hypopnoea index, as shown by a correlation coefficient of 0.87. Therefore, these measurements could be used for the development of simplified diagnostic techniques in order to reduce the demand for polysomnographies. Furthermore, KEn represents a convincing alternative to AEn and SEn for the diagnostic analysis of noisy biomedical signals.

The application of laser welding on Left Ventricular Assist Device (LVAD)

A successful and useful treatment for end-stage heart failure is Left ventricular assist device (LVAD). An important part - a hydrodynamically suspended impeller exposed to corrosive conditions, required to sealed hermetically into micro packages. Laser beam welded (LBW) Ti6Al4V alloy has been adopted in anti-corrosion micro packages for the impeller of a (LVAD). Thin and narrow welds were required for such medical equipment. Pulsed Nd:YAG welding was successfully adopted as sealing method for the impeller. ©2011 IEEE.

The effect of basketball sport aerobics on basketball skill development for fifth-grade students

The purpose of this study was to investigate the effectiveness of an experimental teaching method, Sport Aerobics, on the basketball skill acquisition of fifth grade students. This study investigated the differences in the shooting, dribbling, and passing scores of students taught with Sport Aerobics instruction compared to those taught with a traditional method, Practice Style. Sport Aerobics is an instructional method based on a theoretical framework developed by the researcher to enhance skill acquisition. This framework leads to teaching strategies such as using immediate feedback and specific cueing; arranging for students to engage in object free movement; arranging lessons, according to the framework's concept of movement progression, into lessons staged according to skill and sub-skill complexity; and instructing based on whole group organization. Sport Aerobic instructional strategies were designed to facilitate process learning that is recognized as important in today's development learning approach for age related curriculums. In contrast, the traditional Practice Style uses product-oriented strategies. ^ Four classrooms, consisting of seventy-nine fifth grade students from two physical education programs, at different locations, were randomly assigned to two treatments; Sport Aerobics and Practice Style for instruction over a 15 period curriculum. Using the American Alliance Physical Education Recreation & Dance tests, both groups were pretested and posttested for skill achievement of shooting, dribbling, and passing. Pretest and posttest skill score samples were collected and evaluated. ANCOVAs were performed on the posttests adjusted for the pretests to determine whether or not there would be greater achievement of skills with the Sport Aerobics method. Results failed to establish significant scoring differences between the two methods. Based on the literature and study findings a recommendation is made that longer lesson units will assist in the investigation of the effectiveness of both the instructional model and the individual elements that facilitate skill acquisition. ^

Official Airlines Assist Meeting Planners

Selecting an airline as the official one for a convention or meeting can save meeting planners time, money, and a lot of work. The author discusses ways in which airlines can work with conferences of all sizes.

The impact of standards -based practices in mathematics on the achievement of low -performing students

This study examined standards-based mathematics reform initiatives to determine if they would improve student achievement on the part of low-performing students. New curricula, the Carnegie Learning Cognitive Tutor®, were provided for algebra and geometry students. The new instructional strategy relied on both the teacher-led instruction and the use of computers to differentiate instruction for individual students. Mathematics teachers received ongoing professional development to help them implement the new curricula. In addition, teachers were provided with ongoing support to assist them with the transformation of the learning environments for students using standards-based practices. This quasi-experimental (nonrandomized) study involved teachers in two matched urban high schools. Analyses (ANCOVAs) revealed that the experimental group with an appropriately implemented program had significantly higher learning gains than the comparison group as determined by the students' 2007 mathematics Developmental Scale Score (DSS). In addition, the experimental group's adjusted mean for the second interim mathematics assessment was significantly higher than the comparison group's mean. The findings support the idea that if the traditional curriculum is replaced with standards-based curriculum, and the curriculum is implemented as intended, low-performing students may make significant learning gains. With respect to the teaching practices as observed with the Classroom Observation Protocol (COP), t-tests were conducted on four constructs. The results for both the algebra and geometry teachers on the constructs were not significant. The COP indicated that teachers in both the experimental and comparison groups used traditional instruction strategies in their classrooms. The analyses of covariance (ANCOVA) on the use of technology revealed no significant main effects for computer use.

The impact of standards-based practices in mathematics on the achievement of low-performing students

This study examined standards-based mathematics reform initiatives to determine if they would improve student achievement on the part of low-performing students. New curricula, the Carnegie Learning Cognitive Tutor®, were provided for algebra and geometry students. The new instructional strategy relied on both the teacher-led instruction and the use of computers to differentiate instruction for individual students. Mathematics teachers received ongoing professional development to help them implement the new curricula. In addition, teachers were provided with ongoing support to assist them with the transformation of the learning environments for students using standards-based practices. This quasi-experimental (nonrandomized) study involved teachers in two matched urban high schools. Analyses (ANCOVAs) revealed that the experimental group with an appropriately implemented program had significantly higher learning gains than the comparison group as determined by the students' 2007 mathematics Developmental Scale Score (DSS). In addition, the experimental group's adjusted mean for the second interim mathematics assessment was significantly higher than the comparison group's mean. The findings support the idea that if the traditional curriculum is replaced with standards-based curriculum, and the curriculum is implemented as intended, low-performing students may make significant learning gains. With respect to the teaching practices as observed with the Classroom Observation Protocol (COP), t-tests were conducted on four constructs. The results for both the algebra and geometry teachers on the constructs were not significant. The COP indicated that teachers in both the experimental and comparison groups used traditional instruction strategies in their classrooms. The analyses of covariance (ANCOVA) on the use of technology revealed no significant main effects for computer use.

STRUCTURAL AND FUNCTIONAL CORRELATES OF EXERCISE VENTILATORY INEFFICIENCY IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS WITH MILD-TO-MODERATE SPIROMETRIC ABNORMALITIES

Background: Individuals with chronic obstructive pulmonary disease (COPD) have higher than normal ventilatory equivalents for carbon dioxide (VE/VCO2) during exercise. There is growing evidence that emphysema on thoracic computed tomography (CT) scans is associated with poor exercise capacity in COPD patients with only mild-to-moderate airflow obstruction. We hypothesized that emphysema is an underlying cause of microvascular dysfunction and ventilatory inefficiency, which in turn contributes to reduced exercise capacity. We expected ventilatory inefficiency to be associated with a) the extent of emphysema; b) lower diffusing capacity for carbon monoxide; c) a reduced pulmonary blood flow response to exercise; and d) reduced exercise capacity. Methods: In a cross-sectional study, 19 subjects with mild-to-moderate COPD (mean ± SD FEV1= 82 ± 13% predicted, 12 GOLD grade 1) and 26 age-, sex-, and activity-matched controls underwent a ramp-incremental symptom-limited exercise test on a cycle ergometer. Ventilatory inefficiency was assessed by the minimum VE/VCO2 value (nadir). A subset of subjects also completed repeated constant work rate exercise bouts with non-invasive measurements of pulmonary blood flow. Emphysema was quantified as the percentage of attenuation areas below -950 Housefield Units on CT scans. An electronic scoresheet was used to keep track of emphysema sub-types. Results: COPD subjects typically had centrilobular emphysema (76.8 ± 10.1% of total emphysema) in the upper lobes (upper/lower lobe ratio= 0.82 ± 0.04). They had lower peak oxygen uptake (VO2), higher VE/VCO2 nadir and greater dyspnea scores than controls (p<0.05). Lower peak O2 and worse dyspnea were found in COPD subjects with VE/VCO2 nadirs ≥ 30. COPD subjects had blunted increases in pulmonary blood flow from rest to iso-VO2 exercise (p<0.05). Higher VE/VCO2 nadir in COPD subjects correlated with emphysema severity (r= 0.63), which in turn correlated with reduced lung diffusing capacity (r= -0.72) and blunted changes in pulmonary blood flow from rest to exercise (r= -0.69) (p<0.01). Conclusions: Ventilation “wasted” in emphysematous areas is associated with reduced exercise ventilatory efficiency in mild-to-moderate COPD. Exercise ventilatory inefficiency links structure (emphysema) and function (gas transfer) to a key clinical outcome (reduced exercise capacity) in COPD patients with modest spirometric abnormalities.

Uses of agent-based modeling for health communication: the TELL ME case study

Government communication is an important management tool during a public health crisis, but understanding its impact is difficult. Strategies may be adjusted in reaction to developments on the ground and it is challenging to evaluate the impact of communication separately from other crisis management activities. Agent-based modeling is a well-established research tool in social science to respond to similar challenges. However, there have been few such models in public health. We use the example of the TELL ME agent-based model to consider ways in which a non-predictive policy model can assist policy makers. This model concerns individuals’ protective behaviors in response to an epidemic, and the communication that influences such behavior. Drawing on findings from stakeholder workshops and the results of the model itself, we suggest such a model can be useful: (i) as a teaching tool, (ii) to test theory, and (iii) to inform data collection. We also plot a path for development of similar models that could assist with communication planning for epidemics.