Pain measurement and management in elderly patients : Clinical studies in long term hospital care and after cardiac surgery

The proportion of patients over 75 years of age, receiving all different types of healthcare, is constantly increasing. The elderly undergo surgery and anaesthetic procedures more often than middle-aged patients. Poor pain management in the elderly is still an issue. Although the elderly consumes the greatest proportion of prescribed medicines in Western Europe, most clinical pharmacological studies have been performed in healthy volunteers or middle-aged patients. The aim of this study was to investigate pain measurement and management in cognitively impaired patients in long term hospital care and in cognitively normal elderly patients after cardiac surgery. This thesis incorporated 366 patients, including 86 home-dwelling or hospitalized elderly with chronic pain and 280 patients undergoing cardiac surgery with acute pain. The mean age of patients was 77 (SD ± 8) years and approximately 8400 pain measurements were performed with four pain scales: Verbal Rating Scale (VRS), the Visual Analogue Scale (VAS), the Red Wedge Scale (RWS), and the Facial Pain Scale (FPS). Cognitive function, depression, functional ability in daily life, postoperative sedation and postoperative confusion were assessed with MMSE, GDS, Barthel Index, RASS, and CAM-ICU, respectively. The effects and plasma concentrations of fentanyl and oxycodone were measured in elderly (≥ 75 years) and middle-aged patients (≤ 60 years) and the opioid-sparing effect of pregabalin was studied after cardiac surgery. The VRS pain scores after movement correlated with the Barthel Index. The VRS was most successful in the groups of demented patients (MMSE 17-23, 11-16 and ≤ 10) and in elderly patients on the first day after cardiac surgery. The elderly had a higher plasma concentration of fentanyl at the end of surgery than younger patients. The plasma concentrations of oxycodone were comparable between the groups. Pain intensity on the VRS was lower and the sedation scores were higher in the elderly. Total oxycodone consumption during five postoperative days was reduced by 48% and the CAM-ICU scores were higher on the first postoperative day in the pregabalin group. The incidence of postoperative pain during movement was lower in the pregabalin group three months after surgery. This investigation demonstrates that chronic pain did not seem to impair daily activities in home-dwelling Finnish elderly. The VRS appeared to be applicable for elderly patients with clear cognitive dysfunction (MMSE ≤17) and it was the most feasible pain scale for the early postoperative period after cardiac surgery. After cardiac surgery, plasma concentrations of fentanyl in elderly were elevated, although oxycodone concentrations were at similar level compared to middle-aged patients. The elderly had less pain and were more sedated after doses of oxycodone. Therefore, particular attention must be given to individual dosing of the opioids in elderly surgical patients, who often need a smaller amount for adequate analgesia than middle-aged patients. The administration of pregabalin reduced postoperative oxycodone consumption after cardiac surgery. Pregabalin-treated patients had less confusion, and additionally to less postoperative pain on the first postoperative day and during movement at three months post-surgery. Pregabalin might be a new alternative as analgesic for acute postoperative and chronic pain management in the elderly. Its clinical role and safety remains to be verified in large-scale randomized and controlled studies. In the future, many clinical trials in the older category of patients will be needed to facilitate improvements in health care methods.

Efectos neurovasculares y cognitivos de la administración intracortical del VEGF y el enriquecimiento ambiental durante el desarrollo postnatal de ratas Long Evans

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The use and economic benefits of fibres from sisal hemp (Agave sisalana) leaves as supporting ropes for fishing gear

Sisal hemp (Agave sisalana) leaves were harvested and processed using the beating and decomposition methods. The fibres obtained were washed, dried and finally spurned in to cordage of about 4mm diameter 39 pieces of ropes, each measuring 2 meters were altogether spurned. 30 pieces of these ropes were immersed in water for a period of 24 weeks, 6 were placed in a shaded and airily place and 3 were used for the head and footling of gillnet, sinker line of cast net and the main line of long line. Every other week, the ropes in water and air were tested for its breaking strength using an improved 50kg spring balance. At the end of the experiment, it was found the immersed ropes maintained a tensile strength of over 50kg/F for the first 18 weeks, thereafter; there was a gradual weekly reduction in the strength until the 23rd week when the tensile strength was less than 1kg/F. The cost benefit analysis showed that about 5,3146 tons processed fibers could be obtained fro 1ha. capable of being spenced in to 528300m of 4mm diameter cordage. This paper finally recommended the growth of sisal hemp plants by fisher folks so that there will be constant stock for intermittent harvesting for rope spurning

Analysis of temporal structure in spike trains of visual cortical area MT

The temporal structure of neuronal spike trains in the visual cortex can provide detailed information about the stimulus and about the neuronal implementation of visual processing. Spike trains recorded from the macaque motion area MT in previous studies (Newsome et al., 1989a; Britten et al., 1992; Zohary et al., 1994) are analyzed here in the context of the dynamic random dot stimulus which was used to evoke them. If the stimulus is incoherent, the spike trains can be highly modulated and precisely locked in time to the stimulus. In contrast, the coherent motion stimulus creates little or no temporal modulation and allows us to study patterns in the spike train that may be intrinsic to the cortical circuitry in area MT. Long gaps in the spike train evoked by the preferred direction motion stimulus are found, and they appear to be symmetrical to bursts in the response to the anti-preferred direction of motion. A novel cross-correlation technique is used to establish that the gaps are correlated between pairs of neurons. Temporal modulation is also found in psychophysical experiments using a modified stimulus. A model is made that can account for the temporal modulation in terms of the computational theory of biological image motion processing. A frequency domain analysis of the stimulus reveals that it contains a repeated power spectrum that may account for psychophysical and electrophysiological observations.

Some neurons tend to fire bursts of action potentials while others avoid burst firing. Using numerical and analytical models of spike trains as Poisson processes with the addition of refractory periods and bursting, we are able to account for peaks in the power spectrum near 40 Hz without assuming the existence of an underlying oscillatory signal. A preliminary examination of the local field potential reveals that stimulus-locked oscillation appears briefly at the beginning of the trial.

Social saliency : visual psychophysics and single-neuron recordings in humans

My thesis studies how people pay attention to other people and the environment. How does the brain figure out what is important and what are the neural mechanisms underlying attention? What is special about salient social cues compared to salient non-social cues? In Chapter I, I review social cues that attract attention, with an emphasis on the neurobiology of these social cues. I also review neurological and psychiatric links: the relationship between saliency, the amygdala and autism. The first empirical chapter then begins by noting that people constantly move in the environment. In Chapter II, I study the spatial cues that attract attention during locomotion using a cued speeded discrimination task. I found that when the motion was expansive, attention was attracted towards the singular point of the optic flow (the focus of expansion, FOE) in a sustained fashion. The more ecologically valid the motion features became (e.g., temporal expansion of each object, spatial depth structure implied by distribution of the size of the objects), the stronger the attentional effects. However, compared to inanimate objects and cues, people preferentially attend to animals and faces, a process in which the amygdala is thought to play an important role. To directly compare social cues and non-social cues in the same experiment and investigate the neural structures processing social cues, in Chapter III, I employ a change detection task and test four rare patients with bilateral amygdala lesions. All four amygdala patients showed a normal pattern of reliably faster and more accurate detection of animate stimuli, suggesting that advantageous processing of social cues can be preserved even without the amygdala, a key structure of the “social brain”. People not only attend to faces, but also pay attention to others’ facial emotions and analyze faces in great detail. Humans have a dedicated system for processing faces and the amygdala has long been associated with a key role in recognizing facial emotions. In Chapter IV, I study the neural mechanisms of emotion perception and find that single neurons in the human amygdala are selective for subjective judgment of others’ emotions. Lastly, people typically pay special attention to faces and people, but people with autism spectrum disorders (ASD) might not. To further study social attention and explore possible deficits of social attention in autism, in Chapter V, I employ a visual search task and show that people with ASD have reduced attention, especially social attention, to target-congruent objects in the search array. This deficit cannot be explained by low-level visual properties of the stimuli and is independent of the amygdala, but it is dependent on task demands. Overall, through visual psychophysics with concurrent eye-tracking, my thesis found and analyzed socially salient cues and compared social vs. non-social cues and healthy vs. clinical populations. Neural mechanisms underlying social saliency were elucidated through electrophysiology and lesion studies. I finally propose further research questions based on the findings in my thesis and introduce my follow-up studies and preliminary results beyond the scope of this thesis in the very last section, Future Directions.

Gain characteristics of Er3+-doped phosphate glass fibres

An erbium-doped phosphate glass fibre has been drawn by the rod-in-tube technique in our laboratory. The gain for the Er3+-doped phosphate glass fibre with different pump powers and with different input signal wavelengths is investigated. The 2.2-cm-long fibre, pumped by a single-mode 980-nm fibre-pigtailed laser diode, can provide a net gain per unit length greater than 1.8dB/cm. The pump threshold is about 50 mW at the wavelength of 1534 nm, and below 70 mW at 1550 nm. The gain linewidth of the Er3+-doped phosphate glass fibre is greater than 34 nm and can cover the C band in optical communication networks.

Long-term depression in rat CA1-subicular synapses depends on the G-protein coupled mACh receptors

The subiculum, which is the primary target of CA1 pyramidal neurons and sending efferent fibres to many brain regions, serves as a hippocampal interface in the neural information processes between hippocampal formation and neocortex. Long-term depression (LTD) is extensively studied in the hippocampus, but not at the CA1-subicular synaptic transmission. Using whole-cell EPSC recordings in the brain slices of young rats, we demonstrated that the pairing protocols of low frequency stimulation (LFS) at 3 Hz and postsynaptic depolarization of -50 mVelicited a reliable LTD in the subiculum. The LTD did not cause the changes of the paired-pulse ratio of EPSC. Furthermore, it did not depend on either NMDA receptors or voltage-gated calcium channels (VGCCs). Bath application of the G-protein coupled muscarinic acetylcholine receptors (mAChRs) antagonists, atropine or scopolamine, blocked the LTD, suggesting that mAChRs are involved in the LTD. It was also completely blocked by either the Ca2+ chelator BAPTA or the G-protein inhibitor GDP-beta-S in the intracellular solution. This type of LTD in the subiculum may play a particular role in the neural information processing between the hippocampus and neocortex. (c) 2005 Elsevier Ireland Ltd and the Japan Neuroscience Society. All rights reserved.

Acute behavioural stress facilitates long-term depression in temporoammonic-CAI pathway

Behavioural stress facilitates long-term depression in Schaffer collaterals-CAI pathway, but it is unknown whether it influences long-term depression in temporoammonic fibres-CAI. Here, we report that low-frequency stimulation induced long-term depression

Automated Detection of Concrete Columns from Visual Data

After earthquakes, licensed inspectors use the established codes to assess the impact of damage on structural elements. It always takes them days to weeks. However, emergency responders (e.g. firefighters) must act within hours of a disaster event to enter damaged structures to save lives, and therefore cannot wait till an official assessment completes. This is a risk that firefighters have to take. Although Search and Rescue Organizations offer training seminars to familiarize firefighters with structural damage assessment, its effectiveness is hard to guarantee when firefighters perform life rescue and damage assessment operations together. Also, the training is not available to every firefighter. The authors therefore proposed a novel framework that can provide firefighters with a quick but crude assessment of damaged buildings through evaluating the visible damage on their critical structural elements (i.e. concrete columns in the study). This paper presents the first step of the framework. It aims to automate the detection of concrete columns from visual data. To achieve this, the typical shape of columns (long vertical lines) is recognized using edge detection and the Hough transform. The bounding rectangle for each pair of long vertical lines is then formed. When the resulting rectangle resembles a column and the material contained in the region of two long vertical lines is recognized as concrete, the region is marked as a concrete column surface. Real video/image data are used to test the method. The preliminary results indicate that concrete columns can be detected when they are not distant and have at least one surface visible.

Independence is elusive: set size effects on encoding precision in visual search.

Looking for a target in a visual scene becomes more difficult as the number of stimuli increases. In a signal detection theory view, this is due to the cumulative effect of noise in the encoding of the distractors, and potentially on top of that, to an increase of the noise (i.e., a decrease of precision) per stimulus with set size, reflecting divided attention. It has long been argued that human visual search behavior can be accounted for by the first factor alone. While such an account seems to be adequate for search tasks in which all distractors have the same, known feature value (i.e., are maximally predictable), we recently found a clear effect of set size on encoding precision when distractors are drawn from a uniform distribution (i.e., when they are maximally unpredictable). Here we interpolate between these two extreme cases to examine which of both conclusions holds more generally as distractor statistics are varied. In one experiment, we vary the level of distractor heterogeneity; in another we dissociate distractor homogeneity from predictability. In all conditions in both experiments, we found a strong decrease of precision with increasing set size, suggesting that precision being independent of set size is the exception rather than the rule.

Collapse of a composite beam made from ultra high molecular-weight polyethylene fibres

Hot-pressed laminates with a [0/90]48 lay-up, consisting of 83% by volume of ultra high molecular-weight polyethylene (UHMWPE) fibres, and 17% by volume of polyurethane (PU) matrix, were cut into cantilever beams and subjected to transverse end-loading. The collapse mechanisms were observed both visually and by X-ray scans. Short beams deform elastically and collapse plastically in longitudinal shear, with a shear strength comparable to that observed in double notch, interlaminar shear tests. In contrast, long cantilever beams deform in bending and collapse via a plastic hinge at the built-in end of the beam. The plastic hinge is formed by two wedge-shaped microbuckle zones that grow in size and in intensity with increasing hinge rotation. This new mode of microbuckling under macroscopic bending involves both elastic bending and shearing of the plies, and plastic shear of the interface between each ply. The double-wedge pattern contrasts with the more usual parallel-sided plastic microbuckle that occurs in uniaxial compression. Finite element simulations and analytical models give additional insight into the dominant material and geometric parameters that dictate the collapse response of the UHMWPE composite beam in bending. Detailed comparisons between the observed and predicted collapse responses are used in order to construct a constitutive model for laminated UHMWPE composites. © 2013 Elsevier Ltd.

Comparison of stationary acoustic monitoring and visual observation of finless porpoises

The detection performance regarding stationary acoustic monitoring of Yangtze finless porpoises Neophocaena phocaenoides asiaeorientalis was compared to visual observations. Three stereo acoustic data loggers (A-tag) were placed at different locations near the confluence of Poyang Lake and the Yangtze River, China. The presence and number of porpoises were determined acoustically and visually during each 1-min time bin. On average, porpoises were acoustically detected 81.7 +/- 9.7% of the entire effective observation time, while the presence of animals was confirmed visually 12.7 +/- 11.0% of the entire time. Acoustic monitoring indicated areas of high and low porpoise densities that were consistent with visual observations. The direction of porpoise movement was monitored using stereo beams, which agreed with visual observations at all monitoring locations. Acoustic and visual methods could determine group sizes up to five and ten individuals, respectively. While the acoustic monitoring method had the advantage of high detection probability, it tended to underestimate group size due to the limited resolution of sound source bearing angles. The stationary acoustic monitoring method proved to be a practical and useful alternative to visual observations, especially in areas of low porpoise density for long-term monitoring.

Biologically inspired visual odometer for navigation of a flying robot

Experimental research in biology has uncovered a number of different ways in which flying insects use cues derived from optical flow for navigational purposes, such as safe landing, obstacle avoidance and dead reckoning. In this study, we use a synthetic methodology to gain additional insights into the navigation behavior of bees. Specifically, we focus on the mechanisms of course stabilization behavior and visually mediated odometer by using a biological model of motion detector for the purpose of long-range goal-directed navigation in 3D environment. The performance tests of the proposed navigation method are conducted by using a blimp-type flying robot platform in uncontrolled indoor environments. The result shows that the proposed mechanism can be used for goal-directed navigation. Further analysis is also conducted in order to enhance the navigation performance of autonomous aerial vehicles. © 2003 Elsevier B.V. All rights reserved.