Pre-programmed Values Research Articles

Effects of aquatic versus land-based exercise on irisin and fibroblast growth factor 21 expression and triiodothyronine and free fatty acid levels in elderly women.

This study investigated the impacts of exercise on irisin and fibroblast growth factor 21 (FGF-21) expression, as well as triiodothyronine (T3 ) and free fatty acid (FFA) levels in elderly women. Thirty women aged 65 to 70 years (10 per group) were randomly assigned to aquatic exercise, land exercise, and control groups. The aquatic and land groups engaged in 3 exercise sessions per week (60 min/session) for 16 weeks. The intensity was progressively increased every 4 weeks. Irisin and FGF-21 levels significantly increased in the aquatic exercise group. In the posttest, the aquatic exercise group had the highest irisin levels. Significant findings were observed for irisin and FGF-21 for the main effect between aquatic and band exercise groups (p<0.05 for both), the main effect between measurement times (p<0.01 and p<0.001, respectively), and the interaction effect (p<0.05 and p<0.001, respectively). The irisin level was significantly higher in the aquatic than in the land group 30 minutes after the last session (p<0.05). In both exercise groups, T3 levels were significantly higher 30 minutes after the final session (p<0.05) than before the program. The FFA level was significantly higher in the aquatic exercise group than the others. In the aquatic group, FFA levels were significantly higher 30 minutes after both the first (p<0.01) and the last (p<0.001) session compared to pre-program values. Differences in exercise type and environment can promote fat metabolism by stimulating hormonal changes that induce brown fat activity and browning.

Implantable vagus nerve stimulation system performance is not affected by internal or external defibrillation shocks

PurposeAutonomic regulation therapy (ART) for heart failure (HF) is delivered using vagus nerve stimulation (VNS), and has been associated with improvement in cardiac function and HF symptoms. VNS is delivered using an implantable pulse generator (IPG) and a lead placed around the cervical vagus nerve. Because HF patients may receive concomitant cardiac defibrillation therapy, testing was conducted to determine the effect of defibrillation (DF) on VNS system performance.MethodsNormal swine (n = 4) with VNS system implants on the right cervical vagus nerve received sequential defibrillation shocks with three defibrillation systems: an implantable cardioverter defibrillator (ICD), a subcutaneous ICD (S-ICD), and an external cardioverter defibrillator (ECD). Each system delivered a series of bipolar high-energy shocks and reverse-polarity high-energy shocks.ResultsThe specified cardiac defibrillation shocks were delivered successfully from each of the three defibrillation systems to all animals. After each shock series, interrogation of the IPG confirmed that software and data were unchanged from pre-programmed values. After all of the defibrillation shocks were delivered, the IPGs underwent and passed comprehensive electrical testing demonstrating proper system function. No shifts in IPG parameters or ART system failures were observed, and histologic evaluation of the vagus nerve revealed no anatomic changes.ConclusionsImplantable VNS systems were tested in vivo for immunity to defibrillation via ICD, S-ICD, and ECD, and were found to be unaffected by a series of high-energy defibrillation shocks. These results confirm that ART systems are capable of continuing to function after defibrillation and the cervical vagus nerve is anatomically unaffected.

Effect of defibrillation on the performance of an implantable vagus nerve stimulation system

BackgroundVagus Nerve Stimulation (VNS) delivers Autonomic Regulation Therapy (ART) for heart failure (HF), and has been associated with improvement in cardiac function and heart failure symptoms. VNS is delivered using an implantable pulse generator (IPG) and lead with electrodes placed around the cervical vagus nerve. Because HF patients may receive concomitant cardiac defibrillation therapy, testing was conducted to determine the effect of defibrillation (DF) on the VNS system.MethodsDF testing was conducted on three ART IPGs (LivaNova USA, Inc.) according to international standard ISO14708-1, which evaluated whether DF had any permanent effects on the system. Each IPG was connected to a defibrillation pulse generator and subjected to a series of high-energy pulses.ResultsThe specified series of pulses were successfully delivered to each of the three devices. All three IPGs passed factory electrical tests, and interrogation confirmed that software and data were unchanged from the pre-programmed values. No shifts in parameters or failures were observed.ConclusionsImplantable VNS systems were tested for immunity to defibrillation, and were found to be unaffected by a series of high-energy defibrillation pulses. These results suggest that this VNS system can be used safely and continue to function after patients have been defibrillated.

Effect of Defibrillation on the Performance of an Implantable Vagus Nerve Stimulation System

Background Vagus Nerve Stimulation delivers Autonomic Regulation Therapy (ART) for heart failure (HF), and in a pilot study has been associated with improvement in heart rate, heart rate variability, left ventricular function, 6-minute walk distance, NYHA class, and quality of life. VNS is delivered using an implantable pulse generator (IPG) and a lead placed around the cervical vagus nerve. Because patients with HF may receive concomitant cardiac defibrillation therapy, testing was conducted to determine the effect of defibrillation (DF) upon the VNS system. Methods DF testing was conducted on three Model 103 IPGs, which have identical hardware to the VITARIA™ system used to deliver ART for HF. DF testing evaluated whether DF had any permanent effects on the VNS system, and that programmed software settings and data capture were recoverable through reprogramming. Testing was conducted according to the methodology specified in the international standard ISO 14708-1 for active implantable medical devices. All of the testing equipment was verified to be in proper working order with current calibration. Each IPG was connected to a defibrillation pulse generator (MegaPulse Defib) and subjected to a series of voltage spikes, monophasic pulses, and biphasic pulses. The pulse amplitude was 140 V, and was connected to the device through a 300 Ω resistor. For each application of energy, three positive-polarity pulses were delivered 20 seconds apart, followed by a 60-second pause, and three negative-polarity pulses 20 seconds apart (Figure). Results The specified series of high-energy pulses were successfully delivered to each of the three devices. All three IPGs passed the electrical tests, and interrogation confirmed that software and data were unchanged from the pre-programmed values. No shifts in parameters or failures were observed. Conclusions Implantable VNS systems equivalent to VITARIA were tested for immunity to defibrillation, and were found to be unaffected by a series of high-energy defibrillation pulses. These results suggest that this VNS system can be used safely and continue to function after patients have been defibrillated.

Hand Gesture to Speech and Text Conversion Device

Sign language and facial expressions are the major means of communication for the speech flawed people. General people can understand the facial expression to an extent but cannot understand the sign language. Dumb people are unable to express their thoughts to normal humans. To reduce this gap of communication, this paper presents an electronic system which will help the mute people to exchange their ideas with the normal person in emergency situations. The system consists of a glove that can be worn by the subject which will convert the hand ges-tures to speech and text. The message displayed will also help deaf people to understand their thoughts. This prototype involves raspberry pi 3 as the micro-controller along with the flex sensors, accelerometer sensor. The resistance of the flex sensor changes due to the bending moment of the fingers of the subject. The accelerometer measures the angular displacement of the wrist along the y-axis. The microcontroller takes the input from the two sensors and matches it with the pre-programmed values and plays the respective message. The system makes use of python and its libraries for microcontroller programming.

Problem-based learning in a multidisciplinary group enhances clinical decision making by medical students: a randomized controlled trial.

The effect of multidisciplinary education on clinical decision making by medical students is not well known. Twenty of fourth, fifth or sixth year medical students were randomly assigned to multidisciplinary groups (MultiG, n = 7) with two medical, pharmacy and nursing students or medical student groups (MedG, n = 10) with six medical students only and given a two-day PBL program using evidence-based medicine (EBM) methodology. The main outcome measure is clinical decision making by medical students for the case, measured by a 100 mm visual analog scale (VAS). Additional patient information requested and self-evaluation of the PBL program were also measured. Correct answers to assess clinical epidemiology knowledge increased significantly in both groups (4.1 to 9.9 points in MultiG, p < 0.001: 3.6 to 9.7 points in MedG, p = 0.002), while scores at baseline and post-program were not significantly different. The number of additional patient information cards requested was not significantly different (p = 0.10). After the program, the VAS for clinical decision making was significantly different (54 mm and 89 mm, p = 0.013), although preprogram values for both groups were similar. Pharmacy and nursing students may have potential to change the clinical decision making by medical students.

The Shell Disability Management Program: A Five-Year Evaluation of the Impact on Absenteeism and Return-on-Investment

To evaluate the impact of the Shell Disability Management Program (DMP) on U.S. manufacturing employee absenteeism. We estimated absence episodes and days lost per employee from 2004 to 2008 compared to pre-program values in 2002, and productivity gains from transitional duty (TD). Between 2002 and 2008, absence episodes/100 employees decreased from 37.4 to 25.7 among hourly workers but increased from 9.7 to 13.1 among staff employees. Days lost per employee decreased from 7.4 to 5.2 for hourly employees and were virtually unchanged for staff employees. TD resulted in 6042 days saved in 2006 and 11,438 days in 2008, with direct cost savings of more than $4.1 million from 2006 to 2008. The Shell DMP emphasizes absence tracking, timely return-to-work, and facilitation of TD. Absenteeism decreased significantly after DMP implementation, particularly among hourly employees, with an estimated 2.4:1 return-on-investment.

Autonomic dysreflexia during a bowel program in patients with cervical spinal cord injury.

The purpose of the present study was to investigate the relationship between bowel maneuvers and autonomic dysreflexia (AD) in patients with cervical spinal cord injuries (CSCI). Fifteen consecutive, clinically stable patients with CSCI participated. We evaluated changes in blood pressure (BP), pulse rate (PR) and classic symptoms of AD before, during and after a bowel program involving the manual removal of stool in lateral recumbency. The insertion of rectal medication induced a significant increase in systolic BP, which persisted during additional digital rectal stimulation. Furthermore, the manual removal of stool induced AD, with maximal increases of systolic BP (169.1(+-)19.5 mmHg, mean(+-)SD). However, the insertion of a finger into the anus after the end of stool flow did not cause a further increase in systolic BP. Systolic BP recovered to pre-program values within 5 min after defecation. Our study demonstrated that the combined effects of rectal and/or anal sphincter distension and uninhibited rectal contraction in response to the manual removal of stool might induce AD. We recommend avoiding, if at all possible, the manual removal of stool in order to prevent AD in patients with CSCI.

Outcome of a Dietitian Managed Multidisciplinary Diabetes Education Program

The MDDEP consisted of four 3-hour weekly educational sessions provided by a health care team composed of 8 disciplines. Nutrition intervention included three 1-hour group sessions: 1) basic diabetic diet principles using The First Step in Diabetes Meal Planning; 2) individual meal planning using the Exchange Lists for Meal Planning; and 3) dining-out and sick-day management. Glycemic control and blood lipids were evaluated upon entering the MDDEP and at 3, 6, and 12-month intervals following completion of the program. There were 125 participants. The mean age was 59±10.7 yrs (29 - 82 yrs), 59.2% female, 41.8% male with 6% type 1 and 94% type 2 DM. Paired t-tests were used to compare mean data at each visit to preprogram values. Self-care knowledge scores improved significantly: pre-test: 72.2±15.3%, post-test: 86.4±10.7% (p=0.0001). Changes in glycemic control were 7.9±1.9% at entrance, 7.2±1.4% (p=0.0001) at visit 2, and 7.3±1.3% (p=0.03) at visit 2. Reductions in blood lipids also occurred. Changes in weight were not significant. Participants entering the program with lab values in the highest risk categories had the most significant improvement after the MDDEP. Individuals with high-risk values for Total-chol., LDL-choI., and HgA 1c significantly improved by visits 1 and 2, but declined towards preprogram values by visit 3. A MDDEP is effective in improving metabolic control. Revitalizing participants at regular 6-month intervals through reeducation and re-evaluation of self-care monitoring practices is needed to maintain improvements. The dietitian is invaluable in coordinating and monitoring a successful diabetes education program.

A dynamic cadaver model of the stance phase of gait: performance characteristics and kinetic validation

Objective. This study was undertaken to evaluate the performance of a new dynamic laboratory model of the stance phase of gait. Design. Five cadaver feet were repetitively tested in the apparatus. Background. Typical biomechanical investigations of cadaver feet simply place a static load on the tibia. The present system was designed to better simulate the changing in-vivo loading environment of the foot and ankle during gait. Methods. The device mimics the behavior of the tibia, foot, and ankle from heel-strike to toe-off by reproducing the physiologic actions of five extrinsic foot muscles and physiologic motion at the proximal tibia. To verify its utility, cadaver gait simulations were conducted while measuring applied muscle forces, ground reaction forces, and plantar pressures. Results. Dynamic muscle forces were consistently delivered to within 10% of pre-programmed values. Dynamic measurements of ground reaction forces and plantar pressure were similar to those measured in healthy human subjects. Peak vertical ( y), foreaft ( x) and medio-lateral ( z) forces were 110, 18, and 4% of body weight respectively. Compressive force in the tibial shaft reached 410% of body weight.

The AERX aerosol delivery system.

We describe the AERX aerosol delivery system, a new, bolus inhalation device that is actuated at preprogrammed values of inspiratory flow rate and inhaled volume. We report on its in vitro characterization using a particular set of conditions used in pharmacokinetic and scintigraphic studies. Multiple doses of aerosol were delivered from single use collapsible plastic containers containing liquid formulation. The aerosol was generated by forcing the formulation under pressure through an array of 2.5 micron holes. Air was drawn through the device at 70 LPM, and the aerosol was collected onto a filter or Andersen cascade impactor. The emitted dose was quantified from the filter collection data, and the particle size distribution was obtained from the best fit log-normal distribution to the impactor data. 57.0 +/- 5.9% of the dose of drug placed as an aqueous solution in the 45 microL collapsible container was delivered as an aerosol (n = 40). The best fit size distribution had an MMAD = (2.95 +/- 0.06) microns and a geometric standard deviation sigma g = 1.24 +/- 0.01 (n = 6). The AERX aerosol delivery system generates a nearly monodisperse aerosol with the properties required for efficient and repeatable drug delivery to the lung.

Silicon MBE apparatus for uniform high-rate deposition on standard format wafers

The design and operation of a second generation silicon MBE apparatus are described. A large sample loading interlock permits rapid introduction of standard format 3–4-in.-diam silicon and sapphire substrates. Silicon and metallic species are deposited from dual e-beam evaporation sources at rates of up to 1/3 μm/min. Dopants are introduced by evaporation from conventional Knudsen cells or by simultaneous, low energy ion implantation. Silicon, metal and ionized dopant fluxes are directly sensed and regulated to within ∠1% of preprogrammed values. Rotation of the substrate yields deposition uniformity of ?1% across a 3-in. wafer. The system includes instrumentation for low and high energy electron diffraction, Auger electron spectroscopy and residual gas analysis.

Results of a Comprehensive Rehabilitation Program Physiologic and Functional Effects on Patients With Chronic Obstructive Pulmonary Disease

Forty-two patients with chronic obstructive pulmonary disease participated in a comprehensive inpatient rehabilitation program. Criteria for a safe, maximum treadmill exercise regimen were established; all patients pursued this regimen for six weeks, without complications, even though 31 of 39 patients showed a decline in PaO2 with exercise. Postprogram O2 consumption, minute ventilation, heart rate, and respiratory rate were significantly reduced during exercise when compared with preprogram values. Sixteen of 29 patients improved in terms of dyspnea class; an additional 11 of these 29 improved with regard to activities of daily living. Most patients who improved physiologically also improved functionally. Patients able to tolerate higher levels of treadmill exercise initially had the greatest improvement in postcourse exercise performance. The data suggest that precourse functional and exercise classification is useful in selecting candidates who will receive the greatest functional benefits from participation in rehabilitative programs.

Use of Matched Airborne Omega Receivers For Rendezvous

Automatic airborne Omega receivers are rapidly becoming available for military, civil, and general aviation aircraft. The transmitter network will offer worldwide cover in 1974/75. Consequently a universal reference environment will be available to facilitate rendezvous navigation, and production sensors will be already fitted in some aircraft, or economically obtainable. Differential Omega operation for terminal and rendezvous navigation has been discussed and studied for some time; the problems with its implementation have not been with the technical merit of the scheme, but rather with the methods of obtaining and disseminating the propagation correction information. For pure rendezvous navigation, both normal and differential corrections could be omitted, however, this approach would negate the operational advantages of the receivers for enroute navigation, and make ambiguity resolution on a 3- frequency system impossible. By using receivers with matched propagation corrections the conflict can be avoided, and rendezvous to the order of 200 yards obtained, retaining optimal enroute capability. The receivers need not be of the same make, model, or price class, provided a controlled match of propagation prediction characteristics is obtained. While present automatic receivers tend to use a variety of proprietary techniques for propagation correction, and the simpler receivers to use tables or preprogrammed values, the prediction data all basically comes from the same source: the NavOceano programme and conductivity map. It is therefore practical to make fully-automatic airborne Omega receivers, covering a wide price and performance range, with matched propagation models and thus near-ideal rendezvous performance, at no sacrifice in enroute performance. With the continuing improvement in prediction knowledge, and the common use of this knowledge by several manufacturers, an equally good match between receivers of different makes is considered a reasonable goal.