Effects of wearing a pressure redistribution belt while lying in a hospital bed

Bedsores (ulcers) are caused by multiple factors which include, but are not limited to; pressure, shear force, friction, temperature, age and medication. Specialised support services, such as specialised mattresses, sheepskin coverings etc., are thought to decrease or relieve pressure, resulting in a lowering of pressure ulcer incidence [3]. The primary aim of this study was to compare the upper/central body pressure distribution between normal lying in a hospital bed versus the use of a pressure redistribution belt. The study involved 16 healthy voluntary subjects lying on a hospital bed with and without wearing the belt. Results showed that the use of a pressure redistribution belt results in reduced pressure peaks and prevents the pressure from increasing over time.

Seismic triggering of submarine slides in soft cohesive soil deposits

The geological profile of many submerged slopes on the continental shelf consists of normally to lightly overconsolidated clays with depths ranging from a few meters to hundreds of meters. For these soils, earthquake loading can generate significant excess pore water pressures at depth, which can bring the slope to a state of instability during the event or at a later time as a result of pore pressure redistribution within the soil profile. Seismic triggering mechanisms of landslide initiation for these soils are analyzed with the use of a new simplified model for clays which predicts realistic variations of the stress-strain-strength relationships as well as pore pressure generation during dynamic loading in simple shear. The proposed model is implemented in a finite element program to analyze the seismic response of submarine slopes. These analyses provide an assessment of the critical depth and estimated displacements of the mobilized materials and thus are important components for the estimation of submarine landslide-induced tsunamis. © 2003 Elsevier B.V. All rights reserved.

Initiation of immersed granular avalanches.

By means of coupled molecular dynamics-computational fluid dynamics simulations, we analyze the initiation of avalanches in a granular bed of spherical particles immersed in a viscous fluid and inclined above its angle of repose. In quantitative agreement with experiments, we find that the bed is unstable for a packing fraction below 0.59 but is stabilized above this packing fraction by negative excess pore pressure induced by the effect of dilatancy. From detailed numerical data, we explore the time evolution of shear strain, packing fraction, excess pore pressures, and granular microstructure in this creeplike pressure redistribution regime, and we show that they scale excellently with a characteristic time extracted from a model based on the balance of granular stresses in the presence of a negative excess pressure and its interplay with dilatancy. The cumulative shear strain at failure is found to be ≃ 0.2, in close agreement with the experiments, irrespective of the initial packing fraction and inclination angle. Remarkably, the avalanche is triggered when dilatancy vanishes instantly as a result of fluctuations while the average dilatancy is still positive (expanding bed) with a packing fraction that declines with the initial packing fraction. Another nontrivial feature of this creeplike regime is that, in contrast to dry granular materials, the internal friction angle of the bed at failure is independent of dilatancy but depends on the inclination angle, leading therefore to a nonlinear dependence of the excess pore pressure on the inclination angle. We show that this behavior may be described in terms of the contact network anisotropy, which increases with a nearly constant connectivity and levels off at a value (critical state) that increases with the inclination angle. These features suggest that the behavior of immersed granular materials is controlled not only directly by hydrodynamic forces acting on the particles but also by the influence of the fluid on the granular microstructure.

Medium change monitoring using ambient seismic noise and coda wave interferometry: examples from intraplate NE Brazil and the Mid-Atlantic Ridge

This thesis presents and discusses the results of ambient seismic noise correlation for two different environments: intraplate and Mid-Atlantic Ridge. The coda wave interferometry method has also been tested for the intraplate data. Ambient noise correlation is a method that allows to retrieve the structural response between two receivers from ambient noise records, as if one of the station was a virtual source. It has been largely used in seismology to image the subsurface and to monitor structural changes associated mostly with volcanic eruptions and large earthquakes. In the intraplate study, we were able to detect localized structural changes related to a small earthquake swarm, which main event is mR 3.7, North-East of Brazil. We also showed that the 1-bit normalization and spectral whitening result on the loss of waveform details and that the phase auto-correlation, which is amplitude unbiased, seems to be more sensitive and robust for our analysis of a small earthquake swarm. The analysis of 6 months of data using cross-correlations detect clear medium changes soon after the main event while the auto-correlations detect changes essentially after 1 month. It could be explained by fluid pressure redistribution which can be initiated by hydromechanical changes and opened path ways to shallower depth levels due to later occurring earthquakes. In the Mid-Atlantic Ridge study, we investigate structural changes associated with a mb 4.9 earthquake in the region of the Saint Paul transform fault. The data have been recorded by a single broadband seismic station located at less than 200 km from the Mid-Atlantic ridge. The results of the phase auto-correlation for a 5-month period, show a strong co-seismic medium change followed by a relatively fast post-seismic recovery. This medium change is likely related to the damages caused by the earthquake’s ground shaking. The healing process (filling of the new cracks) that lasted 60 days can be decomposed in two phases, a fast recovery (70% in ~30 days) in the early post-seismic stage and a relatively slow recovery later (30% in ~30 days). In the coda wave interferometry study, we monitor temporal changes of the subsurface caused by the small intraplate earthquake swarm mentioned previously. The method was first validated with synthetics data. We were able to detect a change of 2.5% in the source position and a 15% decrease of the scatterers’ amount. Then, from the real data, we observed a rapid decorrelation of the seismic coda after the mR 3.7 seismic event. This indicates a rapid change of the subsurface in the fault’s region induced by the earthquake.

Medium change monitoring using ambient seismic noise and coda wave interferometry: examples from intraplate NE Brazil and the Mid-Atlantic Ridge

This thesis presents and discusses the results of ambient seismic noise correlation for two different environments: intraplate and Mid-Atlantic Ridge. The coda wave interferometry method has also been tested for the intraplate data. Ambient noise correlation is a method that allows to retrieve the structural response between two receivers from ambient noise records, as if one of the station was a virtual source. It has been largely used in seismology to image the subsurface and to monitor structural changes associated mostly with volcanic eruptions and large earthquakes. In the intraplate study, we were able to detect localized structural changes related to a small earthquake swarm, which main event is mR 3.7, North-East of Brazil. We also showed that the 1-bit normalization and spectral whitening result on the loss of waveform details and that the phase auto-correlation, which is amplitude unbiased, seems to be more sensitive and robust for our analysis of a small earthquake swarm. The analysis of 6 months of data using cross-correlations detect clear medium changes soon after the main event while the auto-correlations detect changes essentially after 1 month. It could be explained by fluid pressure redistribution which can be initiated by hydromechanical changes and opened path ways to shallower depth levels due to later occurring earthquakes. In the Mid-Atlantic Ridge study, we investigate structural changes associated with a mb 4.9 earthquake in the region of the Saint Paul transform fault. The data have been recorded by a single broadband seismic station located at less than 200 km from the Mid-Atlantic ridge. The results of the phase auto-correlation for a 5-month period, show a strong co-seismic medium change followed by a relatively fast post-seismic recovery. This medium change is likely related to the damages caused by the earthquake’s ground shaking. The healing process (filling of the new cracks) that lasted 60 days can be decomposed in two phases, a fast recovery (70% in ~30 days) in the early post-seismic stage and a relatively slow recovery later (30% in ~30 days). In the coda wave interferometry study, we monitor temporal changes of the subsurface caused by the small intraplate earthquake swarm mentioned previously. The method was first validated with synthetics data. We were able to detect a change of 2.5% in the source position and a 15% decrease of the scatterers’ amount. Then, from the real data, we observed a rapid decorrelation of the seismic coda after the mR 3.7 seismic event. This indicates a rapid change of the subsurface in the fault’s region induced by the earthquake.

The importance of surface pressure changes in the response of the atmosphere to zonally-symmetric thermal and mechanical forcing

he classical problem of the response of a balanced, axisymmetric vortex to thermal and mechanical forcing is re-examined, paying special attention to the lower boundary condition. The correct condition is DΦ/Dt = 0, where Φ is the geopotential and D/Dt the material derivative, which explicitly accounts for a mass redistribution as part of the mean-flow response. This redistribution is neglected when using the boundary condition Dp/Dt = 0, which has conventionally been applied in this problem. It is shown that applying the incorrect boundary condition, and thereby ignoring the surface pressure change, leads to a zonal wind acceleration δū/δt that is too strong, especially near the surface. The effect is significant for planetary-scale forcing even when applied at tropopause level. A comparison is made between the mean-flow evolution in a baroclinic life-cycle, as simulated in a fully nonlinear, primitive-equation model, and that predicted by using the simulated eddy fluxes in the zonally-symmetric response problem. Use of the correct lower boundary condition is shown to lead to improved agreement.

Postoperative splanchnic blood flow redistribution in response to fluid challenges in the presence and absence of endotoxemia in a porcine model

We hypothesized that fluid administration may increase regional splanchnic perfusion after abdominal surgery-even in the absence of a cardiac stroke volume (SV) increase and independent of accompanying endotoxemia. Sixteen anesthetized pigs underwent abdominal surgery with flow probe fitting around splanchnic vessels and carotid arteries. They were randomized to continuous placebo or endotoxin infusion, and when clinical signs of hypovolemia (mean arterial pressure, <60 mmHg; heart rate, >100 beats · min(-1); urine production, <0.5 mL · kg(-1) · h(-1); arterial lactate concentration, >2 mmol · L(-1)) and/or low pulmonary artery occlusion pressure (target 5-8 mmHg) were present, they received repeated boli of colloids (50 mL) as long as SV increased 10% or greater. Stroke volume and regional blood flows were monitored 2 min before and 30 min after fluid challenges. Of 132 fluid challenges, 45 (34%) resulted in an SV increase of 10% or greater, whereas 82 (62%) resulted in an increase of 10% or greater in one or more of the abdominal flows (P < 0.001). During blood flow redistribution, celiac trunk (19% of all measurements) and hepatic artery flow (15%) most often decreased, whereas portal vein (10%) and carotid artery (7%) flow decreased less frequently (P = 0.015, between regions). In control animals, celiac trunk (30% vs. 9%, P = 0.004) and hepatic artery (25% vs. 11%, P = 0.040) flow decreased more often than in endotoxin-infused pigs. Accordingly, blood flow redistribution is a common phenomenon in the postoperative period and is only marginally influenced by endotoxemia. Fluid management based on SV changes may not be useful for improving regional abdominal perfusion.

Ankle joint pressure changes in a pes cavovarus model: supramalleolar valgus osteotomy versus lateralizing calcaneal osteotomy

BACKGROUND: A fixed cavovarus foot deformity can be associated with anteromedial ankle arthrosis due to elevated medial joint contact stresses. Supramalleolar valgus osteotomies (SMOT) and lateralizing calcaneal osteotomies (LCOT) are commonly used to treat symptoms by redistributing joint contact forces. In a cavovarus model, the effects of SMOT and LCOT on the lateralization of the center of force (COF) and reduction of the peak pressure in the ankle joint were compared. METHODS: A previously published cavovarus model with fixed hindfoot varus was simulated in 10 cadaver specimens. Closing wedge supramalleolar valgus osteotomies 3 cm above the ankle joint level (6 and 11 degrees) and lateral sliding calcaneal osteotomies (5 and 10 mm displacement) were analyzed at 300 N axial static load (half body weight). The COF migration and peak pressure decrease in the ankle were recorded using high-resolution TekScan pressure sensors. RESULTS: A significant lateral COF shift was observed for each osteotomy: 2.1 mm for the 6 degrees (P = .014) and 2.3 mm for the 11 degrees SMOT (P = .010). The 5 mm LCOT led to a lateral shift of 2.0 mm (P = .042) and the 10 mm LCOT to a shift of 3.0 mm (P = .006). Comparing the different osteotomies among themselves no significant differences were recorded. No significant anteroposterior COF shift was seen. A significant peak pressure reduction was recorded for each osteotomy: The SMOT led to a reduction of 29% (P = .033) for the 6 degrees and 47% (P = .003) for the 11 degrees osteotomy, and the LCOT to a reduction of 41% (P = .003) for the 5 mm and 49% (P = .002) for the 10 mm osteotomy. Similar to the COF lateralization no significant differences between the osteotomies were seen. CONCLUSION: LCOT and SMOT significantly reduced anteromedial ankle joint contact stresses in this cavovarus model. The unloading effects of both osteotomies were equivalent. More correction did not lead to significantly more lateralization of the COF or more reduction of peak pressure but a trend was seen. CLINICAL RELEVANCE: In patients with fixed cavovarus feet, both SMOT and LCOT provided equally good redistribution of elevated ankle joint contact forces. Increasing the amount of displacement did not seem to equally improve the joint pressures. The site of osteotomy could therefore be chosen on the basis of surgeon's preference, simplicity, or local factors in case of more complex reconstructions.

The Effect of Open-Irrigated Radiofrequency Catheter Ablation of Atrial Fibrillation on Left Atrial Pressure and B-Type Natriuretic Peptide

Background Open-irrigated radiofrequency catheter ablation (oiRFA) of atrial fibrillation (AF) imposes a volume load and risk of pulmonary edema. We sought to assess the effect of volume administration during ablation on left atrial (LA) pressure and B-type natriuretic peptide (BNP). Methods LA pressure was measured via transseptal sheath at the beginning and end of 44 LA ablation procedures in 42 patients. BNP plasma levels were measured before and after 10 procedures. Results A median of 3,255 (interquartile range [IQR], 2,014)-mL saline was administered during the procedure. During LA ablation, the median fluid balance was +1,438 (IQR, 1,109) mL and LA pressure increased by median 3.7 (IQR, 5.9) mm Hg (P < 0.001). LA pressure did not change in the 19 procedures with furosemide administration (median ΔP = −0.3 [IQR, 7.1] mm Hg, P = 0.334). The correlation of LA pressure and fluid balance was weak (rs = 0.383, P = 0.021). BNP decreased in all four procedures starting in AF or atrial tachycardia and then converting to sinus rhythm (P = 0.068), and increased in all six procedures starting and finishing in sinus rhythm (P = 0.028). After ablation, symptomatic volume overload responding to diuresis occurred in three patients. Conclusions A substantial intravascular volume load during oiRFA can be absorbed with little change in LA pressure, such that LA pressure is not a reliable indicator of the fluid balance. Subsequent redistribution of the volume load imposes a risk after the procedure. Conversion to sinus rhythm may improve ability to acutely accommodate the volume load.