Wearable technology for bio-chemical analysis of body fluids during exercise

This paper details the development of a textile based fluid handling system with integrated wireless biochemical sensors. Such research represents a new advancement in the area of wearable technologies. The system contains pH, sodium and conductivity sensors. It has been demonstrated during on-body trials that the pH sensor has close agreement with measurements obtained using a reference pH probe. Initial investigations into the sodium and conductivity sensors have shown their suitability for integration into the wearable system. It is thought that applications exist in personal health and sports performance and training.

Impediments to eye transplantation: ocular viability following optic-nerve transection or enucleation

Maintenance of ocular viability is one of the major impediments to successful whole-eye transplantation. This review provides a comprehensive understanding of the current literature to help guide future studies in order to overcome this hurdle. A systematic multistage review of published literature was performed. Three specific questions were addressed: (1) Is recovery of visual function following eye transplantation greater in cold-blooded vertebrates when compared with mammals? (2) Is outer retina function following enucleation and reperfusion improved compared with enucleation alone? (3) Following optic-nerve transection, is there a correlation between retinal ganglion cell (RGC) survival and either time after transection or proximity of the transection to the globe? In a majority of the studies performed in the literature, recovery of visual function can occur after whole-eye transplantation in cold-blooded vertebrates. Following enucleation (and reperfusion), outer retinal function is maintained from 4 to 9 h. RGC survival following optic-nerve transection is inversely related to both the time since transection and the proximity of transection to the globe. Lastly, neurotrophins can increase RGC survival following optic-nerve transection. This review of the literature suggests that the use of a donor eye is feasible for whole-eye transplantation.

An exploratory tool for analysis of forage and livestock production options

The Grain & Graze Whole-Farm Model was developed as a simple modelling tool to identify better strategies to improve the income of farmers and overcome grassland degradation. Using information on farm structure, crop and forage production systems, livestock production systems and variable costs involved in all enterprises, maximum whole-farm gross margins are obtained for an optimum or a prescribed mix of enterprises. The incorporation of production systems for different rainfall scenarios enables climatic risks and water use efficiencies of different enterprises to be investigated. Model simulations demonstrated the potential improvements that could be achieved in dollar water use efficiency ($WUE), by changes in management and/or changes in enterprise. The design of the model makes it a valuable tool for evaluating new systems, as it easy to develop new crop, pasture and livestock systems. Innovative farming systems such as pasture cropping and alley farming are included in the model.

Absence of association of asporin polymorphisms and osteoarthritis susceptibility in US Caucasians

OBJECTIVE

An association between osteoarthritis (OA) and functional polymorphisms in the aspartic acid (d) repeat of the asporin (ASPN) gene was reported in Japanese and Han Chinese populations. The aim of this study was to assess the association of variants in the ASPN gene with the presence of radiographic hand and/or knee OA in a US Caucasian population.

METHODS

Ten single nucleotide polymorphisms (SNPs) within the ASPN gene were genotyped in 775 affected siblings with radiographically confirmed hand and/or knee OA, and the allelic, genotypic and haplotypic association results were examined.

RESULTS

One variant (SNP RS7033979) showed nominal evidence of association with both hand OA (P=0.042) and knee OA (P=0.032). Four additional SNPs showed nominal evidence of association with knee OA only. These associations were only observed with genotypic tests; the corresponding allelic and haplotype tests did not corroborate the single-point association results.

CONCLUSION

These data suggest that polymorphisms within ASPN are not a major influence in susceptibility to hand or knee OA in US Caucasians.

Do all epistaxis patients with a nasal pack need admission? A retrospective study of 116 patients managed in accident and emergency according to a peer reviewed protocol

Introduction: Epistaxis is the most common nasal emergency and if nasal packing is required this commonly results in admission.

Methods: A literature search could find no published (UK) protocols for the management of this common condition in accident and emergency (A&E) departments. This paper presents a retrospective review of 116 patients with epistaxis, following implementation of the new peer reviewed protocol in June 2004.

Results: Apart from cautery, 62 had nasal packing inserted. Only 17 required admission. Forty-six patients were discharged with nasal packing in situ and only seven (16 per cent) returned due to bleeding. The overall return rate was 11 per cent.

Discussion: We feel this is a safe and logical protocol. Compared to mandatory admission after nasal pack insertion, we saved 39 admissions in five months. There were also the added benefits to patients of being able to recuperate at home rather than in hospital and avoidance of the risk of hospital acquired infection.

Initial development and testing of a novel foam-based pressure sensor for wearable sensing

Background

This paper provides an overview of initial research conducted in the development of pressure-sensitive foam and its application in wearable sensing. The foam sensor is composed of polypyrrole-coated polyurethane foam, which exhibits a piezo-resistive reaction when exposed to electrical current. The use of this polymer-coated foam is attractive for wearable sensing due to the sensor's retention of desirable mechanical properties similar to those exhibited by textile structures.

Methods

The development of the foam sensor is described, as well as the development of a prototype sensing garment with sensors in several areas on the torso to measure breathing, shoulder movement, neck movement, and scapula pressure. Sensor properties were characterized, and data from pilot tests was examined visually.

Results

The foam exhibits a positive linear conductance response to increased pressure. Torso tests show that it responds in a predictable and measurable manner to breathing, shoulder movement, neck movement, and scapula pressure.

Conclusion

The polypyrrole foam shows considerable promise as a sensor for medical, wearable, and ubiquitous computing applications. Further investigation of the foam's consistency of response, durability over time, and specificity of response is necessary.

Wearable Sensors? What is there to sense?

This paper provides an overview of research conducted in the development of ambulatory devices for wearable sensing applications. Two configurations of wearable sensing are shown, the first a wearable chemosensor in a wrist-watch configuration, and the second a textile with an integrated foam sensor. The foam sensor is composed of polypyrrole-coated polyurethane foam, which exhibits a piezo-resistive response when exposed to electrical current. The potential of wearable sensing is discussed using these examples to illustrate the relevant concerns.

Unexpected complexity in the haplotypes of commonly used inbred strains of laboratory mice

Investigation of sequence variation in common inbred mouse strains has revealed a segmented pattern in which regions of high and low variant density are intermixed. Furthermore, it has been suggested that allelic strain distribution patterns also occur in well defined blocks and consequently could be used to map quantitative trait loci (QTL) in comparisons between inbred strains. We report a detailed analysis of polymorphism distribution in multiple inbred mouse strains over a 4.8-megabase region containing a QTL influencing anxiety. Our analysis indicates that it is only partly true that the genomes of inbred strains exist as a patchwork of segments of sequence identity and difference. We show that the definition of haplotype blocks is not robust and that methods for QTL mapping may fail if they assume a simple block-like structure.

Closing the feedback loop: an audit of the use of imiquimod for the treatment of genital warts

A retrospective case-note audit of 74 patients with 81 treatment episodes of anogenital warts with imiquimod from April 1999 until July 2000 was performed. The majority of patients had failed to clear their warts with other treatments, had recurrences after other treatments, or had other medical problems complicating their genital wart treatment. The overall clinically confirmed complete clearance rate was 33%. This is lower than other published data, but may be so because it includes patients with immunosuppression and difficult-to-treat warts. The complete clearance rate in immunocompetent patients was 37%. In addition, in this audit of clinical practice 17% of the patients did not return for full response to be assessed. The complete clearance rate in those who were able to tolerate treatment and who returned for follow-up was 45%. Based on the results of the audit we have extended the indications for the use of imiquimod in the clinic treatment guidelines. Patients are now offered imiquimod if six or more episodes of other treatments fail to give a good response. Earlier treatment with imiquimod is also offered to those patients with recurrent anogenital warts, and it is recommended as a first-line therapy for patients with multiple keratinized warts.

A Comparison of GluR-A-Deficient and Wild-Type Mice on a Test Battery Assessing Sensorimotor, Affective, and Cognitive Behaviors

Previous studies have demonstrated a spatial working memory deficit in glutamate receptor (GluR)-A (GluR1) AMPA receptor subunit knockout mice. The present study evaluated male and female wild-type and GluR-A-/- mice on a test battery that assessed sensorimotor, affective, and cognitive behaviors. Results revealed a behavioral phenotype more extensive than previously described. GluR-A-/- mice were hyperactive, displayed a subtle lack of motor coordination, and were generally more anxious than wild-type controls. In addition, they showed a deficit in spontaneous alternation, consistent with previous reports of a role for GluR-A-dependent plasticity in hippocampus-dependent, spatial working memory. Although changes in motor coordination or anxiety cannot explain the dissociations already reported within the spatial memory domain, it is clear that they could significantly affect interpretation of results obtained in other kinds of behavioral tasks.

Simultaneous modified Evans blue dye procedure and video nasal endoscopic evaluation of the swallow

OBJECTIVE

To investigate the results of the modified Evans blue dye test (MEBD) aspiration detection rate to the video nasal endoscopic examination of the swallow (VEES) during simultaneous studies with direct viewing of the subglottis through the tracheostomy site opening by means of endoscopy.

STUDY DESIGN

Prospective, consecutive.

METHODS

Fifteen consecutive simultaneous MEBD and VEES studies were completed on patients with tracheostomies at an acute care rehabilitation hospital over a 4-month period. All patients were referred to the swallowing center for a video nasal endoscopic examination who had known or suspected dysphagia.

RESULTS

Aspiration was present in 53% (8) of the studies as documented by the VEES. The MEBD showed an overall 50% false-negative error rate for the detection of aspiration as compared with the VEES. The MEBD identified aspiration in 67% of patients who aspirated more than trace amounts but failed to identify aspiration of trace amounts (0%).

CONCLUSION

The results of the current investigation suggest that the MEBD, at best, should be viewed only as a screening tool for the presence of gross amounts of aspiration in patients with a tracheostomy.

New mother groups as a social network intervention: consumer and maternal and child health nurse perspectives

Maternal and child health nurses in two outer urban local government areas in Melbourne, Australia were interviewed about how they facilitated first-time parent groups. Groups were offered to all first time mothers and almost two thirds of mothers joined a group. The groups ran for approximately eight sessions and provided infant-focussed parent education and social contact. Women who joined the groups were followed up 18 months to two years later to determine the degree to which these groups continued to meet on their own accord and the extent to which they had become self-sustaining social networks. The study found a very high level of continuation, suggesting that providing such programs may be an important vehicle for enhancing social support during the transition to parenthood and thus be a useful primary prevention strategy.

Refractive changes caused by hypoxia after laser in situ keratomileusis surgery

OBJECTIVE

To determine whether hypoxia induces refractive changes in subjects who have had laser in situ keratomileusis (LASIK) refractive surgery.

DESIGN

Prospective paired eye clinical trial.

PARTICIPANTS

There were 20 LASIK subjects (40 eyes) and 20 myopic non-LASIK controls (40 eyes).

INTERVENTION

Each subject had one eye exposed to ocular surface hypoxia (humidified nitrogen) by use of an airtight goggle system at sea level for 2 hours. The other eye was simultaneously exposed to humidified, compressed air (21% oxygen) with the same airtight goggle system.

MAIN OUTCOME MEASURES

Keratometry, cycloplegic refraction, and pachymetry were compared before and after exposure by use of repeated measures analysis of variance.

RESULTS

A significant myopic shift (P: < 0.01) occurred in LASIK corneas exposed to hypoxia compared with myopic control subjects. A significant increase in corneal thickening occurred symmetrically in both LASIK and control subjects exposed to hypoxia. There was a trend toward corneal steepening (keratometry) in LASIK subjects, but this was not statistically significant.

CONCLUSIONS

These results suggest that ocular surface hypoxia induces a myopic shift in LASIK subjects.

Speech perception deficits in poor readers: a reply to Denenberg's critique

We reply to Denenberg's (1999) recent critique of our work (Mody, Studdert-Kennedy, & Brady, 1997). Denenberg mounted two main lines of criticism, one concerning characteristics of the population sampled for the experimental group, and the other a statistical critique, concerning (a) violation of parametric assumptions for use of the F distribution and (b) our supposed acceptance of the null hypothesis of no differences between experimental and control groups. We show that the first criticism stemmed from a misunderstanding of the experimental hypothesis and that the second can be answered by both parametric and nonparametric comparisons across conditions within the experimental group, without reference to the control group. Thus, our original conclusion stands: The difficulty with rapid /ba/-/da/ discrimination that some children with reading impairment may experience does not stem from difficulty in discriminating the rapid spectral transitions at stop-vowel syllable onsets.

Difficult airway equipment in English emergency departments

The need for tracheal intubation in the emergency department is often unpredictable and precipitous in nature. When compared with the operating room, a higher incidence of difficult intubation is observed. There are currently no accepted guidelines with respect to the stocking of difficult airway equipment in the emergency department. We have conducted a telephone survey to determine the availability of equipment for the management of the difficult airway in English emergency departments. Overall, the majority of units held a curved laryngoscope blade (100%), gum elastic bougie (99%) and surgical airway device (98%). Of alternative devices for ventilation, a laryngeal mask airway was kept by 65% of departments, a needle cricothyroidostomy kit by 63% and an oesophageal-tracheal twin-lumen airway (Combitube) by 18%. Of alternative devices for intubation, fewer than 10% held a retrograde intubating kit, intubating laryngeal mask, bronchoscope or lighted stylet. Seventy-four per cent of departments held an end-tidal carbon dioxide detector.

Increased left ventricular mass index and nocturnal systolic blood pressure in patients with Type 2 diabetes mellitus and microalbuminuria

AIMS

To compare left ventricular mass (LVM) index and function in patients with Type 2 diabetes mellitus with and without microalbuminuria and to investigate the clinical determinants of left ventricular hypertrophy.

METHODS

Echocardiography, electrocardiography and 24-h ambulatory blood pressure monitoring were performed in microalbuminuric (n = 29) and normoalbuminuric (n = 29) patients with Type 2 diabetes and no clinical evidence of heart disease. Groups were individually matched for age, sex and diabetes duration and smoking status.

RESULTS

LVM index (62 (34-87) vs. 52 (33-89) g/m2.7, P = 0.04) and LVH prevalence, using two out of three definitions, were greater in patients with microalbuminuria (LVM/height2.7: 72 vs. 59%, P = 0.27, LVM/height: 66 vs. 38%, P = 0.04, LVM/body surface area: 59 vs. 31%, P = 0.03). Night-time systolic blood pressure (126 (99-163) vs. 120 (104-157) mmHg, P = 0.005) and the night/day systolic blood pressure ratio (0.92 (0.08) vs. 0.88 (0.06), P = 0.04) were higher in those with microalbuminuria. Systolic and diastolic function were similar in both groups. Linear regression analyses showed that body mass index (BMI) was significantly related to loge LVM index (R2 = 11.8%, P = 0.005) and a relationship with night/day systolic blood pressure was also suggested (R2 = 4.6%, P = 0.057).

CONCLUSIONS

In patients with Type 2 diabetes, LVH is more common and severe in those with microalbuminuria. Its presence may be related to raised night/day systolic blood pressure ratio and is significantly related to BMI. The high prevalence of LVH strengthens the case for echocardiographic screening in Type 2 diabetes to identify high risk patients who might benefit from aggressive cardiovascular risk factor intervention.

Axonal transport and distribution of immunologically distinct kinesin heavy chains in rat neurons

The functional significance of biochemical and immunochemical heterogeneity in neuronal kinesin remains uncertain. Confocal laser scanning microscopy, cytofluorimetric scanning, and immunoblots were used for quantitative analyses of axonal transport and cellular distribution of immunochemically distinct kinesin heavy chain isoforms (H1 and H2) in rat peripheral nerve and spinal cord. H1 and H2 immunoreactivities (IR) were observed in axons proximal to a crush as early as 1 hr after the crush operation and increased linearly with time, consistent with fast axonal transport of both. Only approximately 10% of the proximal accumulations of H1-IR and H2-IR accumulated distal to the crush, in contrast to synaptophysin-IR (approximately 70%). H2-IR was widely present in peripheral nervous system and virtually colocalized with synaptic vesicle proteins synaptophysin, synaptobrevin I, and SNAP-25 and two neuropeptides [calcitonin gene-related peptide (CGRP) and substance P (SP)], although H2-IR was weaker in spinal cord terminals. In contrast, H1-IR appeared preferentially enriched in large axons, probably motor and large sensory neurons, which contained synaptophysin-IR, synaptobrevin I-IR, SNAP-25-IR, and CGRP-IR. However, H1-IR was weak or absent from SP-containing thin and medium-sized axons. In addition, H1-IR appeared to be absent from spinal cord nerve terminals. H1- and H2-IR kinesins are both transported with fast axonal transport, and comparatively small amounts of kinesins are retrogradely transported. H2 was widely distributed in motor, sensory, and sympathetic neurons, whereas H1 was enriched in large motor and sensory neurons.

Treatment of cutaneous lesions of xanthoma disseminatum with a CO2 laser

We describe a case of a 15-year-old African American girl with widespread papulonodular lesions of xanthoma disseminatum especially in the periorbital area and on the flexural surfaces of the neck, axillae, arms, and legs. There were no mucosal lesions. An initial trial in the distant past of liquid nitrogen cryotherapy resulted in partial shrinking of cutaneous lesions but was too painful for the patient. She then underwent surgical excision of bilateral eyelid lesions with improvement, but additional procedures were deemed impractical when considering the great number and size of the lesions. Consequently we treated the patient with a carbon dioxide (CO2) laser with excellent results. The relatively great speed at which the CO2 laser procedure can be performed has made the removal of multiple lesions in each session possible. Additional advantages included precise vaporization of lesions, hemostasis during the operative procedure, and minimal postoperative pain and edema.

Electrophysiological properties of the recipient atrial remnant after human orthotopic cardiac transplantation

AIMS

The recipient atrial remnant has been used as a control in studies ofchronotropic response following orthotopic cardiac transplantation and as a trigger for the donor heart. It is not known, however, whether its function is normal. We investigated the electrophysiological properties of the recipient atrial remnant.

METHODS AND RESULTS

Fifty patients were studied, mean age 49 years (range 20-63) and mean time post-orthotopic cardiac transplantation of 31 months (range 1-107). Recipient atrial rhythm, spontaneous cycle length and sinus node function were determined. Atrial fibrillation/flutter was identified in 10/50 (20%). Of those in sinus rhythm, significant bradycardia was present in 12/40 (30%). The mean spontaneous cycle length was 929+/-188 ms. Three patients demonstrated variable atrial electrocardiogram morphology and a further three patients had marked variations in resting cycle length. The sinus node function was abnormal in 2/34 (6%).

CONCLUSIONS

Only 56% recipient atria had normal sinus rhythm, with 21% of these demonstrating features consistent with a wandering atrial pacemaker. The recipient atrial remnant is not normal in the majority of transplant recipients and should be used with caution in studies involving its use as a control or as a trigger for the donor heart.