European society of hypertension position paper on ambulatory blood pressure monitoring.

Ambulatory blood pressure monitoring (ABPM) is being used increasingly in both clinical practice and hypertension research. Although there are many guidelines that emphasize the indications for ABPM, there is no comprehensive guideline dealing with all aspects of the technique. It was agreed at a consensus meeting on ABPM in Milan in 2011 that the 34 attendees should prepare a comprehensive position paper on the scientific evidence for ABPM.This position paper considers the historical background, the advantages and limitations of ABPM, the threshold levels for practice, and the cost-effectiveness of the technique. It examines the need for selecting an appropriate device, the accuracy of devices, the additional information and indices that ABPM devices may provide, and the software requirements.At a practical level, the paper details the requirements for using ABPM in clinical practice, editing considerations, the number of measurements required, and the circumstances, such as obesity and arrhythmias, when particular care needs to be taken when using ABPM.The clinical indications for ABPM, among which white-coat phenomena, masked hypertension, and nocturnal hypertension appear to be prominent, are outlined in detail along with special considerations that apply in certain clinical circumstances, such as childhood, the elderly and pregnancy, and in cardiovascular illness, examples being stroke and chronic renal disease, and the place of home measurement of blood pressure in relation to ABPM is appraised.The role of ABPM in research circumstances, such as pharmacological trials and in the prediction of outcome in epidemiological studies is examined and finally the implementation of ABPM in practice is considered in relation to the issue of reimbursement in different countries, the provision of the technique by primary care practices, hospital clinics and pharmacies, and the growing role of registries of ABPM in many countries.

Towards storage and access of electronic theses: A proposal of its organisation for the Consortium of Catalan Libraries

Els objectius d'aquest informe són realitzar un estudi de la tècnica en la digitalització, l'emmagatzematge i l'accés a les tesis doctorals electròniques, per tal de fer una proposta d’organització al Consorci de Biblioteques Universitàries de Catalunya (CBUC). Actualment, tot i que existeixen diverses iniciatives a Europa, és als EUA on la digitalització de tesis doctorals s’ha desenvolupat més amb la creació de la Networked Digital Library for Theses and Dissertation (NDLTD), i ha estat qui ha definit els estàndards en aquest camp. En el següent informe es planteja i es recomana al CBUC l’adhesió institucional a l’NDLTD per poder gaudir de la seva experiència.

Hand-in-hand advances in biomedical engineering and sensorimotor restoration.

BACKGROUND: Living in a multisensory world entails the continuous sensory processing of environmental information in order to enact appropriate motor routines. The interaction between our body and our brain is the crucial factor for achieving such sensorimotor integration ability. Several clinical conditions dramatically affect the constant body-brain exchange, but the latest developments in biomedical engineering provide promising solutions for overcoming this communication breakdown. NEW METHOD: The ultimate technological developments succeeded in transforming neuronal electrical activity into computational input for robotic devices, giving birth to the era of the so-called brain-machine interfaces. Combining rehabilitation robotics and experimental neuroscience the rise of brain-machine interfaces into clinical protocols provided the technological solution for bypassing the neural disconnection and restore sensorimotor function. RESULTS: Based on these advances, the recovery of sensorimotor functionality is progressively becoming a concrete reality. However, despite the success of several recent techniques, some open issues still need to be addressed. COMPARISON WITH EXISTING METHOD(S): Typical interventions for sensorimotor deficits include pharmaceutical treatments and manual/robotic assistance in passive movements. These procedures achieve symptoms relief but their applicability to more severe disconnection pathologies is limited (e.g. spinal cord injury or amputation). CONCLUSIONS: Here we review how state-of-the-art solutions in biomedical engineering are continuously increasing expectances in sensorimotor rehabilitation, as well as the current challenges especially with regards to the translation of the signals from brain-machine interfaces into sensory feedback and the incorporation of brain-machine interfaces into daily activities.

Disseny pràctic d'un transmissor d'àudio complert utilitzant una modulació AM

RESUM Un transmissor d’AM (modulació per amplitud), utilitza una de les moltes tècniques de modulació existents avui en dia. És molta la importància que té la modulació de senyals i aquests en són alguns exemples: -Facilita la propagació del senyal per cable o per aire. -Ordena l’espectre, distribuint Canals a les diferents informacions. -Disminueix la dimensió de les antenes. -Optimitza l’ample de banda de cada canal. -Evita interferències entre Canals. -Protegeix la informació de les degradacions per soroll. -Defineix la qualitat de la informació transmesa. L’objectiu principal d’aquest treball, serà realitzar un transmissor d’AM utilitzant components electrònics disponibles al mercat. Això es realitzarà mitjançant diversos procediments de disseny. Es realitzarà un procediment de disseny teòric, tot utilitzant els “datasheets” dels diferents components. Es realitzarà un procediment de disseny mitjançant la simulació, gràcies al qual es podrà provar el disseny del dispositiu i realitzar-ne algunes parts impossibles a reproduir teòricament. I finalment es realitzarà el dispositiu a la pràctica. Entre les conclusions més rellevants obtingudes en aquest treball, voldríem destacar la importància de la simulació per poder dissenyar circuits de radiofreqüència. En aquest treball s’ha demostrat que gràcies a una bona simulació, el primer prototip de dispositiu creat ens ha funcionat a la perfecció. D’altre banda, també comentar la importància d’un disseny adequat d’antena per poder aprofitar al màxim el rendiment del nostre dispositiu. Per concloure, la realització d’un aparell transmissor aporta unes nocions equilibrades d’electrònica i telecomunicacions importants per al disseny de dispositius de comunicació.

Disseny i implementació d'una web administrable i d'una aplicació per dispositius mòbils

En la societat en què vivim cada vegada agafen més importància les pàgines web, ja que és una eina d’informació molt útil i ràpida de consultar. Per això, no s’entén que una activitat empresarial sigui del tipus que sigui, no tingui representació a la xarxa. No és necessari que l’activitat en qüestió hagi de vendre productes a través d’Internet, sinó que simplement aquesta representació pot ajudar a donar a conèixer l’empresa i a ampliar la cartera de clients. De la mateixa manera, els dispositius mòbils també s’estan convertint en una eina important en la societat d’avui en dia i una bona aplicació pot aportar-te un avantatge en moltes de les feines diàries de les persones. D’aquestes idees sorgeix el projecte de fer la web i l’aplicació pel centre de fisioteràpia Fisioripoll. La web serviria per tenir un lloc a la xarxa on donar-se a conèixer i poder captar nous clients, i l’aplicació funcionaria com a eina pel propi centre, seria una espècie d’agenda electrònica per saber les hores que tens reservades els pròxims dies. Per aconseguir un bon funcionament de la web, s’ha demanat que la pàgina sigui administrable en els seus continguts. És a dir, que els propis gestors del centre puguin canviar els texts, les imatges dels diferents apartats i gestionar les reserves dels clients. En canvi, l’aplicació serà només una eina de consulta i no s’hauria de gestionar res. Per tal de dur a terme aquesta web s’ha tingut en compte utilitzar eines de programació de distribució lliure com és el llenguatge PHP, la base de dades MySQL, jQuery, el framework Phonegap per tal de poder construir una web i una aplicació amb cost de programari nul.

Transcatheter aortic valve implantation in failed bioprosthetic surgical valves.

IMPORTANCE: Owing to a considerable shift toward bioprosthesis implantation rather than mechanical valves, it is expected that patients will increasingly present with degenerated bioprostheses in the next few years. Transcatheter aortic valve-in-valve implantation is a less invasive approach for patients with structural valve deterioration; however, a comprehensive evaluation of survival after the procedure has not yet been performed. OBJECTIVE: To determine the survival of patients after transcatheter valve-in-valve implantation inside failed surgical bioprosthetic valves. DESIGN, SETTING, AND PARTICIPANTS: Correlates for survival were evaluated using a multinational valve-in-valve registry that included 459 patients with degenerated bioprosthetic valves undergoing valve-in-valve implantation between 2007 and May 2013 in 55 centers (mean age, 77.6 [SD, 9.8] years; 56% men; median Society of Thoracic Surgeons mortality prediction score, 9.8% [interquartile range, 7.7%-16%]). Surgical valves were classified as small (≤21 mm; 29.7%), intermediate (>21 and <25 mm; 39.3%), and large (≥25 mm; 31%). Implanted devices included both balloon- and self-expandable valves. MAIN OUTCOMES AND MEASURES: Survival, stroke, and New York Heart Association functional class. RESULTS: Modes of bioprosthesis failure were stenosis (n = 181 [39.4%]), regurgitation (n = 139 [30.3%]), and combined (n = 139 [30.3%]). The stenosis group had a higher percentage of small valves (37% vs 20.9% and 26.6% in the regurgitation and combined groups, respectively; P = .005). Within 1 month following valve-in-valve implantation, 35 (7.6%) patients died, 8 (1.7%) had major stroke, and 313 (92.6%) of surviving patients had good functional status (New York Heart Association class I/II). The overall 1-year Kaplan-Meier survival rate was 83.2% (95% CI, 80.8%-84.7%; 62 death events; 228 survivors). Patients in the stenosis group had worse 1-year survival (76.6%; 95% CI, 68.9%-83.1%; 34 deaths; 86 survivors) in comparison with the regurgitation group (91.2%; 95% CI, 85.7%-96.7%; 10 deaths; 76 survivors) and the combined group (83.9%; 95% CI, 76.8%-91%; 18 deaths; 66 survivors) (P = .01). Similarly, patients with small valves had worse 1-year survival (74.8% [95% CI, 66.2%-83.4%]; 27 deaths; 57 survivors) vs with intermediate-sized valves (81.8%; 95% CI, 75.3%-88.3%; 26 deaths; 92 survivors) and with large valves (93.3%; 95% CI, 85.7%-96.7%; 7 deaths; 73 survivors) (P = .001). Factors associated with mortality within 1 year included having small surgical bioprosthesis (≤21 mm; hazard ratio, 2.04; 95% CI, 1.14-3.67; P = .02) and baseline stenosis (vs regurgitation; hazard ratio, 3.07; 95% CI, 1.33-7.08; P = .008). CONCLUSIONS AND RELEVANCE: In this registry of patients who underwent transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic valves, overall 1-year survival was 83.2%. Survival was lower among patients with small bioprostheses and those with predominant surgical valve stenosis.

On the role of non-equilibrium focal points as coordination devices

Considering a pure coordination game with a large number of equivalentequilibria, we argue, first, that a focal point that is itself not a Nash equilibriumand is Pareto dominated by all Nash equilibria, may attract the players'choices. Second, we argue that such a non-equilibrium focal point may act asan equilibrium selection device that the players use to coordinate on a closelyrelated small subset of Nash equilibria. We present theoretical as well asexperimental support for these two new roles of focal points as coordinationdevices.

Animal Tissue Response To Mid-Term Electronic Modular Artificial Sphincter Implantation

Introduction and objectives: The AMS 800TM is considered the gold standard for sphincter replacement. However, the one-ring design can erode the urethra and lead to severe complications. A mechanism that could alternatively compress successive segments of the urethra would limit such deleterious outcome. We report 12 weeks animal urethral tissue analysis following implantation of a new modular artificial sphincter. METHODS: The device is composed by three parts: the contractile unit, two rings and an integrated microprocessor. The contractile unit is made of Nitinol fibers. The rings are placed around the urethra to control the flow of urine by squeezing the urethra. They work in a sequential alternative mode and are controlled by a microprocessor connected to an external computer. The computer can reveal specific failure of device components. The device was impkanted in eight male sheep. The rings were positioned around the urethra and the control unit was placed 5cm away. The device was working twenty hours per day; it was open 10min. per hour to allow urination. The animals were sacrificed after 12 weeks. The urethra and the tissues surrounding the control unit were macroscopically and microscopically examined. Two transversal sections crossing the sphincter and two transversal sections crossing the urethra alone were obtained and stained with modified Paragon after resin embedding. Urethra was also embedded in paraffin. The first section was stained with safranin-hematoxylin-eosin, the second section was stained with Masson's Trichrome and the remaining eight sections were available for immunolabelling of the macrophages.Results: The chronic study went uneventful. No clinical infection or pain was observed. The computer registered no specific failure in ring function, Nitinol wires and tube connectors. At explantation, except for a slight grade of lymphocytes in two out of eight specimens, no urethral stricture or atrophy could be observed. Immunohistochemistry confirmed the absence of macrophages. Tissue structure and organization of the urethra with and without artificial sphincter were similar. No migration of the device was observed.Conclusions: The study clearly showed no tissue damage or inflammation of the urethra. Electronic design, preservation of urethral vascularisation and adjustability after implantation are the key ideas to improve the actual AUS. Further studies will be carried out to evaluate this potential.

Chest pulse-wave velocity: a novel approach to assess arterial stiffness.

Pulse-wave velocity (PWV) is considered as the gold-standard method to assess arterial stiffness, an independent predictor of cardiovascular morbidity and mortality. Current available devices that measure PWV need to be operated by skilled medical staff, thus, reducing the potential use of PWV in the ambulatory setting. In this paper, we present a new technique allowing continuous, unsupervised measurements of pulse transit times (PTT) in central arteries by means of a chest sensor. This technique relies on measuring the propagation time of pressure pulses from their genesis in the left ventricle to their later arrival at the cutaneous vasculature on the sternum. Combined thoracic impedance cardiography and phonocardiography are used to detect the opening of the aortic valve, from which a pre-ejection period (PEP) value is estimated. Multichannel reflective photoplethysmography at the sternum is used to detect the distal pulse-arrival time (PAT). A PTT value is then calculated as PTT = PAT - PEP. After optimizing the parameters of the chest PTT calculation algorithm on a nine-subject cohort, a prospective validation study involving 31 normo- and hypertensive subjects was performed. 1/chest PTT correlated very well with the COMPLIOR carotid to femoral PWV (r = 0.88, p < 10 (-9)). Finally, an empirical method to map chest PTT values onto chest PWV values is explored.

Informe sobre el segon DLM-Forum on electronic records

El DLM-Forum on Electronic Records és un fòrum internacional multidisciplinari, organitzat per la Comissió Europea, que té per objectiu impulsar els projectes per a la millora de la gestió dels documents electrònics en les organitzacions i per a la conservació d'aquests a llarg termini. Al mateix temps, el DLM-Forum esdevé un punt de referència bàsic per a la coordinació de les polítiques de gestió dels documents electrònics que es porten a terme als estats membres de la Unió Europea, per a l'establiment d'estàndards de gestió i de conservació a escala comunitària, i per a la implicació dels agents del sector privat en la recerca de solucions a la problemàtica dels documents electrònics. El present informe exposa l'origen d'aquesta iniciativa, en descriu les dues edicions celebrades fins ara i les perspectives de futur del fòrum.

Electronic thesis and dissertations conference, University of Pittsburgh, 10-12 de junio de 2009

El pasado mes de junio se celebró en Pittsburgh, EE.UU., el duodécimo simposio internacional sobre tesis electrónicas: Electronic Thesis and Dissertations Conference (ETD2009). Fue organizado por Networked Digital Library of Theses and Dissertations (NDLTD). La mayoría de los ponentes explicaron las experiencias de su propia universidad. Además, hubo expertos invitados entre los cuales se pueden destacar Stevan Harnad (Univ. Southampton), Karla Hahn (Association of Research Libraries) y Deanna Marcum (Library of Congress). Estos simposios pretenden promover la adopción, creación, uso, difusión y preservación de las tesis electrónicas. De hecho, el éxito ha sido tal, que algunas universidades ya prescinden de la copia en papel para el depósito y preservación del documento. Un caso reciente es el de la University of Albany cuya nueva política, anunciada durante el simposio, consiste en que a partir de setiembre del 2009 ya no requiere el depósito de una copia impresa de las tesis aprobadas en aquella universidad.

Electronic journals, scholarly communication and libraries

The recent surge in scientific electronic journals began when libraries began having access to the WWW in the mid-1990s. The shift from paper to digital has affected the traditional alignment and role of the primary "stakeholders" -mainly authors, publishers, universities and libraries. The author offers a brief review of the history of the scholarly journal followed by the evolution of e-journals in during the past two decades. The article then focuses on the implications that these have had on traditional library processes and services such as selection, acquisitions, cataloguing, storage, preservation and user services. In the conclusion the author speculates on the long term effect of Web-based publishing on the format of the traditional scholarly journal as it has existed for over 300 years.

Librarians' perceptions on the use of electronic resources at Catalan academic libraries: results of a focus group

The aim of this paper is to expand on previous quantitative and qualitative research into the use of electronic information resources and its impact on the information behaviour of academics at Catalan universities.