Non-invasive and non-occlusive blood pressure estimation via a chest sensor

The clinical demand for a device to monitor Blood Pressure (BP) in ambulatory scenarios with minimal use of inflation cuffs is increasing. Based on the so-called Pulse Wave Velocity (PWV) principle, this paper introduces and evaluates a novel concept of BP monitor that can be fully integrated within a chest sensor. After a preliminary calibration, the sensor provides non-occlusive beat-by-beat estimations of Mean Arterial Pressure (MAP) by measuring the Pulse Transit Time (PTT) of arterial pressure pulses travelling from the ascending aorta towards the subcutaneous vasculature of the chest. In a cohort of 15 healthy male subjects, a total of 462 simultaneous readings consisting of reference MAP and chest PTT were acquired. Each subject was recorded at three different days: D, D+3 and D+14. Overall, the implemented protocol induced MAP values to range from 80 ± 6 mmHg in baseline, to 107 ± 9 mmHg during isometric handgrip maneuvers. Agreement between reference and chest-sensor MAP values was tested by using intraclass correlation coefficient (ICC = 0.78) and Bland-Altman analysis (mean error = 0.7 mmHg, standard deviation = 5.1 mmHg). The cumulative percentage of MAP values provided by the chest sensor falling within a range of ±5 mmHg compared to reference MAP readings was of 70%, within ±10 mmHg was of 91%, and within ±15mmHg was of 98%. These results point at the fact that the chest sensor complies with the British Hypertension Society (BHS) requirements of Grade A BP monitors, when applied to MAP readings. Grade A performance was maintained even two weeks after having performed the initial subject-dependent calibration. In conclusion, this paper introduces a sensor and a calibration strategy to perform MAP measurements at the chest. The encouraging performance of the presented technique paves the way towards an ambulatory-compliant, continuous and non-occlusive BP monitoring system.

Le purpura thrombotique thrombocytopénique - un diagtnostic méconnu

Le purpura thrombotique thrombocytopénique (PTT) est un diagnostic caractérisé par une hémolyse micro-angiopathique, se traduisant par la présence d’une thrombocytopénie et d’une schizocytose au frottis sanguin. Une déficience de l’enzyme ADAMTS13, enzyme protéolytique du facteur de von Willebrand (vWF), a été caractérisée comme cause pathogénique. L’importance de l’examen visuel du frottis sanguin dans le cadre d’une suspicion clinique ou hématologique d’un PTT est soulignée car il semble que le PTT soit sous-diagnostiqué, surtout parmi les enfants et jeunes adultes. Des superpositions avec le syndrome hémolytique et urémique associé aux diarrhées (SHU D+) et le syndrome hémolytique et urémique atypique (SHUa) sont discutées. Une revue actuelle des démarches diagnostiques, des options thérapeutiques et des facteurs pronostiques du PTT et des SHU est finalement proposée.

Exploration von Resilienzen und Ressourcen bei Veränderungssprüngen

In Therapien, welche den Behandlungsverlauf präzise aufzeichnen, sind starke und nachhaltige Veränderungssprünge häufig, besonders in der ersten Therapiephase. Veränderungssprünge können sich in den individuellen Symptomen der Patienten, aber auch in allen anderen Lebensbereichen Praxis-Anleitung der WHO-Gesundheitsdefinition (WHO 1948) manifestieren. Die vorliegende Praxisanleitung bietet einen Explorationsleitfaden, wie Veränderungssprünge für die weitere Therapie genutzt werden können. Der Leitfaden umfasst (1) die Exploration der Veränderungssituation, (2) das Herausarbeiten von generalisierter Selbstwirksamkeit und Vertrauensaufbau und (3) den Transfer für die weiterführende Therapie.

P-T-t estimation of syn-kinematic strain in low-grade quartz-feldspar bearing rocks using thermodynamic modeling and 40Ar/39Ar dating techniques: example of the Plan-de-Phasy shear zone unit (Briançonnais Zone, Western Alps)

Pressure–Temperature–time (P–T–t) estimates of the syn-kinematic strain at the peak-pressure conditions reached during shallow underthrusting of the Briançonnais Zone in the Alpine subduction zone was made by thermodynamic modelling and 40Ar/39Ar dating in the Plan-de-Phasy unit (SE of the Pelvoux Massif, Western Alps). The dated phengite minerals crystallized syn-kinematically in a shear zone indicating top-to-the-N motion. By combining X-ray mapping with multi-equilibrium calculations, we estimate the phengite crystallization conditions at 270 ± 50 °C and 8.1 ± 2 kbar at an age of 45.9 ± 1.1 Ma. Combining this P–T–t estimate with data from the literature allows us to constrain the timing and geometry of Alpine continental subduction. We propose that the Briançonnais units were scalped on top of the slab during ongoing continental subduction and exhumed continuously until collision.

Characteristics, home ranges and population estimates of narwhals (Monodon monoceros) around Baffin Island

Twenty-one narwhals tagged in 2003 and 2004 in Admiralty Inlet showed a different summer distributional pattern than previous narwhal-tracking studies from Somerset Island, Eclipse Sound and Melville Bay. The migration of the narwhals tracked from Admiralty Inlet moved out through Lancaster Sound 15 days earlier (P <0.0001) than the narwhals summering around Eclipse Sound, whereas the Admiralty Inlet narwhals reached the mouths of Eclipse Sound 18 days later (P <0.0001) than the Eclipse Sound summering population. The winter range of the Admiralty Inlet narwhals overlapped with the winter range of narwhals from Melville Bay and Eclipse Sound in central southern Baffin Bay and Northern Davis Strait, but not with the winter range of narwhals from Somerset Island that wintered further north. Distribution size of range, and population size did not appear to be related. An example of considerable year to year variation between area of summer and winter distribution in the 2 years was believed to be related to the sample size and number of pods of whales tagged, rather than to differences in sex or age classes.

(Table 1) Movement parameters of nine adult female snowy owls (Bubo scandiacus) tracked during the winter period 07/08 and 08/09 around Hudson Strait, Canada

Top predators of the arctic tundra are facing a long period of very low prey availability during winter and subsidies from other ecosystems such as the marine environment may help to support their populations. Satellite tracking of snowy owls, a top predator of the tundra, revealed that most adult females breeding in the Canadian Arctic overwinter at high latitudes in the eastern Arctic and spend several weeks (up to 101 d) on the sea-ice between December and April. Analysis of high-resolution satellite images of sea-ice indicated that owls were primarily gathering around open water patches in the ice, which are commonly used by wintering seabirds, a potential prey. Such extensive use of sea-ice by a tundra predator considered a small mammal specialist was unexpected, and suggests that marine resources subsidize snowy owl populations in winter. As sea-ice regimes in winter are expected to change over the next decades due to climate warming, this may affect the wintering strategy of this top predator and ultimately the functioning of the tundra ecosystem.

Body sizes and dive characteristics of narwhals (Monodon monoceros) from Kakiak Point and Melville Bay (2005-2007)

We report on wintertime data collected from Baffin Bay and northern Davis Strait, a major gateway linking the Arctic with the subpolar North Atlantic, using narwhals (Monodon monoceros) as an oceanographic sampling platform. Fourteen narwhals were instrumented with satellite-linked time-depth-temperature recorders between 2005 and 2007. Transmitters collected and transmitted water column temperature profiles from each dive between December and April, where >90% of maximum daily dive depths reached the bottom. Temperature measurements were combined with 15 helicopter-based conductivity-temperature-depth (CTD) casts taken in April 2007 across central Baffin Bay and compared with hydrographic climatology values used for the region in Arctic climate models. Winter temperature maxima for whale and CTD data were in good agreement, ranging between 4.0°C and 4.6°C in inshore and offshore Baffin Bay and in Davis Strait. The warm Irminger Water was identified between 57°W and 59°W (at 68°N) between 200 and 400 m depths. Whale data correlated well with climatological temperature maxima; however, they were on average 0.9°C warmer ±0.6°C (P < 0.001). Furthermore, climatology data overestimated the winter surface isothermal layer thickness by 50-80 m. Our results suggest the previously documented warming in Baffin Bay has continued through 2007 and is associated with a warmer West Greenland Current in both of its constituent water masses. This research demonstrates the feasibility of using narwhals as ocean observation platforms in inaccessible Arctic areas where dense sea ice prevents regular oceanographic measurements and where innate site fidelity, affinity for winter pack ice, and multiple daily dives to >1700 m offer a useful opportunity to sample the area.

Effectiveness of improved cookstoves to reduce indoor air pollution in developing countries. The case of the Cassamance Natural Subregion, Western Africa

The Spanish NGO "Alianza por la Solidaridad" has installed improved cookstoves in 3000 households during 2012 and 2013 to improve energy efficiency reducing fuelwood consumption and to improve indoor air quality. The type of cookstoves were Noflaye Jeeg and Noflaye Jaboot and were installed in the Cassamance Natural Subregion covering part of Senegal, The Gambia and Guinea-Bissau. The Technical University of Madrid (UPM) has conducted a field study on a sample of these households to assess the effect of improved cookstoves on kitchen air quality. Measurements of carbon monoxide (CO) and fine particle matter (PM2.5) were taken for 24-hr period before and after the installation of improved cookstoves. The 24-hr mean CO concentrations were lower than the World Health Organization (WHO) guidelines for Guinea-Bissau but higher for Senegal and Gambia, even after the installation of improved cookstoves. As for PM2.5 concentrations, 24-hr mean were always higher than these guidelines. However, improved cookstoves produced significant reductions on 24-hr mean CO and PM2.5 concentrations in Senegal and for mean and maximum PM2.5 concentration on Gambia. Although this variability needs to be explained by further research to determine which other factors could affect indoor air pollution, the study provided a better understanding of the problem and envisaged alternatives to be implemented in future phases of the NGO project.

Des Horaz Brief an die Pisonen, oder, über die Dichtkunst, als Einleitung in die Aesthetik, für Schulen und für gebildete Überhaupt.

Latin and German in parallel columns.