Development of a cardiovascular magnetic resonance-compatible large animal isolated heart model for direct comparison of beating and arrested hearts.

Cardiac motion results in image artefacts and quantification errors in many cardiovascular magnetic resonance (CMR) techniques, including microstructural assessment using diffusion tensor cardiovascular magnetic resonance (DT-CMR). Here, we develop a CMR-compatible isolated perfused porcine heart model that allows comparison of data obtained in beating and arrested states. Ten porcine hearts (8/10 for protocol optimisation) were harvested using a donor heart retrieval protocol and transported to the remote CMR facility. Langendorff perfusion in a 3D-printed chamber and perfusion circuit re-established contraction. Hearts were imaged using cine, parametric mapping and STEAM DT-CMR at cardiac phases with the minimum and maximum wall thickness. High potassium and lithium perfusates were then used to arrest the heart in a slack and contracted state, respectively. Imaging was repeated in both arrested states. After imaging, tissue was removed for subsequent histology in a location matched to the DT-CMR data using fiducial markers. Regular sustained contraction was successfully established in six out of 10 hearts, including the final five hearts. Imaging was performed in four hearts and one underwent the full protocol, including colocalised histology. The image quality was good and there was good agreement between DT-CMR data in equivalent beating and arrested states. Despite the use of autologous blood and dextran within the perfusate, T2 mapping results, DT-CMR measures and an increase in mass were consistent with development of myocardial oedema, resulting in failure to achieve a true diastolic-like state. A contiguous stack of 313 5-µm histological sections at and a 100-µm thick section showing cell morphology on 3D fluorescent confocal microscopy colocalised to DT-CMR data were obtained. A CMR-compatible isolated perfused beating heart setup for large animal hearts allows direct comparisons of beating and arrested heart data with subsequent colocalised histology, without the need for onsite preclinical facilities.

The heparin-von Willebrand factor interaction and conventional tests of haemostasis - the challenges in predicting bleeding in cardiopulmonary bypass.

Bleeding is a significant complication of cardiopulmonary bypass (CPB), despite routine anticoagulation monitoring. This is likely to be multifactorial. In this prospective, single-centre cohort study of 30 patients undergoing CPB surgery, our aim was to characterise the changes in von Willebrand factor (VWF) function, platelet interaction and the global coagulation changes during and after CPB surgery and to determine whether bleeding can be predicted. Samples were taken at six time points before, during and after CPB surgery. We observed a significant rise in VWF antigen (VWF:Ag) throughout surgery, which continued postoperatively. The absolute VWF collagen-binding assays (VWF:CB) and VWF ristocetin cofactor (VWF:RCo) rose significantly but the VWF:CB/VWF:Ag and VWF:Ag/VWF:RCo fell significantly (P = 0·0015 and P = 0·0143), suggesting loss of large multimers. We detected a non-significant trend to loss of VWF:RCo after heparinisation and a significant recovery after protamine reversal which could reflect a direct heparin effect. There was a significant increase in the R and K times with a fall in alpha angle and maximum amplitude after heparin administration, using heparinase-thromboelastography (TEG). The parameters both significantly improved following protamine (P = 0·007 and P = 0·0054). The activated clotting time (ACT) and heparin anti-Xa level correlated poorly; neither predicted clinically significant bleeding. None of these parameters had a relationship with intraoperative blood loss or requirement for blood product replacement.

Three-dimensional digital mapping of ecosystems: a new era in spatial ecology.

Ecological processes occur over multiple spatial, temporal and thematic scales in three-dimensional (3D) ecosystems. Characterizing and monitoring change in 3D structure at multiple scales is challenging within the practical constraints of conventional ecological tools. Remote sensing from satellites and crewed aircraft has revolutionized broad-scale spatial ecology, but fine-scale patterns and processes operating at sub-metre resolution have remained understudied over continuous extents. We introduce two high-resolution remote sensing tools for rapid and accurate 3D mapping in ecology-terrestrial laser scanning and structure-from-motion photogrammetry. These technologies are likely to become standard sampling tools for mapping and monitoring 3D ecosystem structure across currently under-sampled scales. We present practical guidance in the use of the tools and address barriers to widespread adoption, including testing the accuracy of structure-from-motion models for ecologists. We aim to highlight a new era in spatial ecology that uses high-resolution remote sensing to interrogate 3D digital ecosystems.

Veno-arterial mechanical support as bridge to surgery in a patient with severe aortic regurgitation: a case report.

In this case report, we describe the successful application of veno-arterial extracorporeal membrane oxygenation support in a young patient with severe aortic regurgitation caused by a blocked mechanical valve. In this situation, extracorporeal membrane oxygenation mechanical support was used as a bridge to the prompt replacement of the diseased valve. Aortic regurgitation is commonly recognized as a contraindication to extracorporeal membrane oxygenation support because of the risk of ventricular distension, pulmonary oedema and further organ failure. However, in certain cases and with a rapid decision making, extracorporeal membrane oxygenation can be used as a bridge to treatment and recovery.

A Randomized Controlled Study of the Use of Video Double-Lumen Endobronchial Tubes Versus Double-Lumen Endobronchial Tubes in Thoracic Surgery.

OBJECTIVE: To compare the incidence of fiberoptic bronchoscope (FOB) use (1) during verification of initial placement and (2) for reconfirmation of correct placement following repositioning, when either a double-lumen tube (DLT) or video double-lumen tube (VDLT) was used for lung isolation during thoracic surgery. DESIGN: A randomized controlled study. SETTING: Single-center university teaching hospital. PARTICIPANTS: The study comprised 80 patients who were 18 years or older requiring lung isolation for surgery. INTERVENTIONS: After institutional review board approval, patients were randomized prior to surgery to either DLT or VDLT usage. Attending anesthesiologists placed the Mallinckrodt DLT or Vivasight (ET View Ltd, Misgav, Israel) VDLT with conventional laryngoscopy or video laryngoscopy then verified correct tube position through the view provided with either VDLT external monitor or FOB. MEASUREMENTS AND MAIN RESULTS: Data collected included: sex, body mass index, successful intubation and endobronchial placement, intubation time, confirmation time of tube position, FOB use, quality of view, dislodgement of tube, and ability to forewarn dislodgement of endobronchial cuff and complications. FOB use for verification of final position of the tube (VDLT 13.2% [5/38] v DLT 100% [42/42], p < 0.0001), need for FOB to correct the dislodgement (VDLT 7.7% [1/13] v DLT 100% [14/14], p < 0.0001), dislodgement during positioning (VDLT 61.5% [8/13] v DLT 64.3% [9/14], p = ns), dislodgement during surgery (VDLT 38.5% [5/13] v DLT 21.4% [3/14], p = ns), and ability to forewarn dislodgement of endobronchial cuff (VDLT 18.4% [7/38] v DLT 4.8% [2/42], p = 0.078). CONCLUSION: This study demonstrated a reduction of 86.8% in FOB use, which was a similar reduction found in other published studies.

Investigating fairness in global supply chains: applying an extension of the living wage to the Western European clothing supply chain.

PURPOSE: This paper explores the issue of fairness in global supply chains. Taking the Western European clothing supply chain as a case study, we demonstrate how applying a normative indicator in Social Life Cycle Assessment (SLCA) can contribute academic and practical insights into debates on fairness. To do so, we develop a new indicator that addresses some of the limitations of the living wage for SLCA. METHODS: We extend the standard form of living wage available for developing countries to include income tax and social security contributions. We call this extension 'living labour compensation'. Using publically available data, we estimate net living wages, gross living wages, and living labour compensation rates for Brazil, Russia, India, and China (BRIC) in 2005. We then integrate living labour compensation rates into an input-output framework, which we use to compare living labour compensation and actual labour compensation in the BRIC countries in the Western European clothing supply chain in 2005. RESULTS AND DISCUSSION: We find that in 2005, actual labour compensation in the Western European clothing supply chain was around half of the living labour compensation level, with the greatest difference being in the Agricultural sector. Therefore, we argue that BRIC pay in the Western European clothing supply chain was unfair. Furthermore, our living labour compensation estimates for BRIC in 2005 are ~ 35% higher than standard living wage estimates. Indeed, adding income taxes and employee social security contributions alone increases the living wage by ~ 10%. Consequently, we argue there is a risk that investigations based on living wages are not using a representative measure of fairness from the employee's perspective and are substantially underestimating the cost of living wages from an employer's perspective. Finally, we discuss implications for retailers and living wage advocacy groups. CONCLUSIONS: Living labour compensation extends the living wage, maintaining its strengths and addressing key weaknesses. It can be estimated for multiple countries from publically available data and can be applied in an input-output framework. Therefore, it is able to provide a normative assessment of fairness in complex global supply chains. Applying it to the Western European clothing supply chain, we were able to show that pay for workers in Brazil, Russia, India, and China is unfair, and draw substantive conclusions for practice.

Thresholds of information leakage for speech security outside meeting rooms.

This paper describes an approach to provide speech security outside meeting rooms where a covert listener might attempt to extract confidential information. Decision-based experiments are used to establish a relationship between an objective measurement of the Speech Transmission Index (STI) and a subjective assessment relating to the threshold of information leakage. This threshold is defined for a specific percentage of English words that are identifiable with a maximum safe vocal effort (e.g., "normal" speech) used by the meeting participants. The results demonstrate that it is possible to quantify an offset that links STI with a specific threshold of information leakage which describes the percentage of words identified. The offsets for male talkers are shown to be approximately 10 dB larger than for female talkers. Hence for speech security it is possible to determine offsets for the threshold of information leakage using male talkers as the "worst case scenario." To define a suitable threshold of information leakage, the results show that a robust definition can be based upon 1%, 2%, or 5% of words identified. For these percentages, results are presented for offset values corresponding to different STI values in a range from 0.1 to 0.3.

Remote evaluation of laparoscopic performance using the global operative assessment of laparoscopic skills.

BACKGROUND: Although numerous assessment tools currently exist to evaluate laparoscopic surgical skills, no studies have demonstrated the reliability of such tools when used with telementoring technology. This study aimed to determine the reliability of the Global Operative Assessment of Laparoscopic Skills (GOALS) rating scale for assessing laparoscopic skills remotely and to identify how factors unique to remote assessment such as bandwidth and image quality influence its reliability. METHODS: Four trained observers evaluated 19 participants for their technical performance during a laparoscopic cholecystectomy using the GOALS assessment tool. One observer assessed the study participants directly in the operating room, whereas the three remaining observers were randomly assigned and blinded to a high- (1.5 Mbps), medium- (256 kbps), or low- (64.4 kbps) bandwidth restriction and observed remotely via Skype. The Maryland Visual Comfort Scale was used to evaluate the video quality of the respective connections. RESULTS: The intraclass correlation coefficient (ICC) calculated for the total GOALS score demonstrated a statistically significant correlation of high, medium, and low bandwidths respectively with ICC 0.693 (95 % confidence interval [CI], 0.226-0.883), 0.518 (95 % CI 0.089-0.783), and 0.499 (95 % CI 0.025-0.781). There was a statistically significant difference in the overall perceived visual quality between the high/low (Z = -3.222; P = 0.001) and the medium/low (Z = -3.567; P < 0.001) bandwidth comparison but no difference between the high/medium bandwidths (Z = -0.610; P = 0.542). CONCLUSION: The data suggest that the GOALS assessment tool retains its reliability for intraoperative assessment of laparoscopic skills when used remotely. This is a key requirement in telesimulation programs allowing for structured feedback between the mentor and the mentee. This study quantifies the effect that bandwidth has on the reliability of remote assessment, demonstrating that higher bandwidths improve the utility of these tools.

Right line, right patient, right time: every choice matters.

The field of vascular access has developed significantly over recent decades. It has been adapted to provide a range of techniques for a range of patients much faster than a full appreciation of the risks involved has developed. Improved governance of vascular access procedures in the UK is needed. This is driven by a deeper understanding of risks such as infectious and thrombotic complications, repeated failures of peripheral intravenous (IV) access leading to poor patient experience and treatment inadequacy, and the increasing emphasis on avoiding healthcare-associated infections. The Vessel Health and Preservation (VHP) protocol, which is used to standardise vascular access practice in the US is being evaluated for adoption in the UK. A comprehensive and inclusive approach should be taken to the vascular access needs of all patients.

Flow Experiences in Shopping Activities: Testing Materialistic Goal Orientation as an Antecedent.

Given that flow experiences when shopping can encourage positive brand attitudes and purchase behaviours, consumer psychologists are interested in the antecedents to flow within retail environments. Emerging findings suggest that a materialistic goal orientation can undermine an individual's tendency to have optimal experiences of flow. However, this existing work has been conducted largely within the field of Environmental Psychology and thus focused on flow experiences that occur in more ecologically sustainable activities. We hypothesized that materialism may not have the same flow-limiting effects when participants are engaged in shopping activities, which are more in line with the goals of highly materialistic individuals. Across two studies, we tested the relationship between materialism and the experience of flow during shopping activities using cross-sectional (N = 886) and experimental (N = 140) methods. Contrary to our hypothesis, both studies documented a negative effect of materialism on flow experiences when shopping, and this was not moderated by the type of store browsed. Accordingly, it appears that a materialistic goal orientation limits the extent to which people can have enjoyable flow experiences even during activities which are consistent with the life goals of highly materialistic individuals. We discuss the implications of these findings for wellbeing, marketing, and sustainability.

Finding flow: exploring the potential for sustainable fulfilment.

Materialistic values and lifestyles have been associated with detrimental effects on both personal and planetary health. Therefore, there is a pressing need to identify activities and lifestyles that both promote human wellbeing and protect ecological wellbeing. In this Personal View, we explore the dynamics of a psychological state known as flow, in which people are shown to experience high levels of wellbeing through involvement in challenging activities that require some level of skill, and can often involve less materially intensive activities. By synthesising the results of a series of experience sampling, survey, and experimental studies, we identify optimal activities that are shown to have low environmental costs and high levels of human wellbeing. We also confirm that materialistic values tend to undermine people's ability to experience a flow state. In seeking to understand the reasons for this negative association between materialism and flow experiences, we are drawn towards a key role for what psychologists call self-regulation. We show, in particular, that the tendency to experience a flow state can be limited when self-regulatory strength is low and when people evade rather than confront negative or undesirable thoughts and situations. We reflect on the implications of these findings for the prospect of sustainable and fulfilling lifestyles.

A critique of the marketisation of long-term residential and nursing home care.

Long-term care systems across countries within the Organisation for Economic Co-operation and Development have undergone a progressive marketisation and financialisation in recent decades, characterised by the embedding of neoliberal market values such as competition, consumer choice, and the profit motive. In this Personal View, we argue that these make poor guiding principles for the care sector, identifying the dysfunctional dynamics that arise as a result, and reflecting on the clinical implications of each, with a focus on facility-based care. We outline why providers can scarcely respond to competitive forces without compromising care quality. We explain why the promotion of consumer choice cannot effectively motivate improvements to quality of care. And we explore how privatisation opens the door to predatory financial practices. We conclude by considering how far proposals for reform can take us, ultimately arguing for a rejection of neoliberal market ideology, and calling for sector-wide discussions about what principles would be more fitting for a caring economy.

Self-transcendent experiences as promoters of ecological wellbeing? Exploration of the evidence and hypotheses to be tested.

In recent years, much has been written on the role of different mental states and their potential to influence our way of thinking and, perhaps more importantly, the way we act. With the recent acceleration of environmental and mental health issues, alongside the limited effectiveness of existing interventions, an exploration of new approaches to deliver transformative change is required. We therefore explore the emerging potential of a type of mental state known as self-transcendent experiences (STEs) as a driver of ecological wellbeing. We focus on four types of STEs: those facilitated by experiences of flow, awe, and mindfulness, as well as by psychedelic-induced experiences. Some of these experiences can occur naturally, through sometimes unexpected encounters with nature or during immersion in every-day activities that one intrinsically enjoys, as well as through more intentional practices such as meditation or the administration of psychedelics in controlled, legal settings. We explore the evidence base linking each of the four types of STE to ecological wellbeing before proposing potential hypotheses to be tested to understand why STEs can have such beneficial effects. We end by looking at the factors that might need to be considered if STEs are going to be practically implemented as a means of achieving ecological wellbeing.

The Problematic Role of Materialistic Values in the Pursuit of Sustainable Well-Being.

Strong materialistic values help to maintain consumer capitalism, but they can have negative consequences for individual well-being, for social equity and for environmental sustainability. In this paper, we add to the existing literature on the adverse consequences of materialistic values by highlighting their negative association with engagement in attitudes and actions that support the achievement of sustainable well-being. To do this, we explore the links between materialistic values and attitudes towards sufficiency (consuming "just enough") as well as mindfulness (non-judgmental awareness of the present moment) and flow (total immersion in an activity), which have all been linked to increased well-being and more sustainable behaviours. We present results from three correlational studies that examine the association between materialistic values and sufficiency attitudes (Study 1, n = 310), a multi-faceted measure of mindfulness (Study 2, n = 468) and the tendency to experience flow (Study 3, n = 2000). Results show that materialistic values were negatively associated with sufficiency attitudes, mindfulness, and flow experiences. We conclude with practical considerations and suggest next steps for tackling the problematic aspects of materialism and encouraging the development of sustainable well-being.

Cardiohelp System use in school age children and adolescents at a center with interfacility mobile extracorporeal membrane oxygenation capability.

Cardiohelp System use for pediatric extracorporeal membrane oxygenation (ECMO) beyond the transport setting is sparsely described in literature. We report the use of Getinge's Cardiohelp System in children and integrated utilization of Mobile ECMO Retrieval Team (MERT) at an all-age specialized cardiorespiratory center. Electronic database of all patients under 16 years of age who received ECMO with use of the Cardiohelp System between January 2018 and March 2020 was retrospectively reviewed and analyzed for demographics, set-up, complications, and outcomes. Out of 41 patients, seven patients (four in middle childhood, three in early teenage) with median age of 10 years (range 8.8-15.6) were supported with use of Cardiohelp System. Median weight and height were 34 kg (range 28-53) and 145 cm (range 134-166) respectively. Initial ECMO deployment was veno-arterial (V-A) in five patients and veno-venous (V-V) in two. There were three interhospital transfers by our MERT, and 12 intrahospital transfers for interventions or imaging. The median ECMO therapy was 7 days (range 4-25), with standard 3/8-inch tubing and ECMO flow rate range at 56-100 mL/kg/min (1.89-5.0 LPM). There were two circuit changes and three reconfigurations of support. Two patients received continuous veno-venous hemofiltration via ECMO circuit. The 90-day and 180-day survival rates were 100% (including two heart transplants at day 7 and day 8). There were no transport-related or circuit-related complications during the 1750 h of Cardiohelp use. Cardiohelp System use is safe in pediatric patients for diverse application of ECMO support including inter- and intrahospital transfers.

The power, potential, benefits, and challenges of implementing high-throughput sequencing in food safety systems.

The development and application of modern sequencing technologies have led to many new improvements in food safety and public health. With unprecedented resolution and big data, high-throughput sequencing (HTS) has enabled food safety specialists to sequence marker genes, whole genomes, and transcriptomes of microorganisms almost in real-time. These data reveal not only the identity of a pathogen or an organism of interest in the food supply but its virulence potential and functional characteristics. HTS of amplicons, allow better characterization of the microbial communities associated with food and the environment. New and powerful bioinformatics tools, algorithms, and machine learning allow for development of new models to predict and tackle important events such as foodborne disease outbreaks. Despite its potential, the integration of HTS into current food safety systems is far from complete. Government agencies have embraced this new technology, and use it for disease diagnostics, food safety inspections, and outbreak investigations. However, adoption and application of HTS by the food industry have been comparatively slow, sporadic, and fragmented. Incorporation of HTS by food manufacturers in their food safety programs could reinforce the design and verification of effectiveness of control measures by providing greater insight into the characteristics, origin, relatedness, and evolution of microorganisms in our foods and environment. Here, we discuss this new technology, its power, and potential. A brief history of implementation by public health agencies is presented, as are the benefits and challenges for the food industry, and its future in the context of food safety.

UK Vessel Health and Preservation (VHP) Framework: a commentary on the updated VHP 2020.

BACKGROUND: In 2016, a UK vessel health and preservation (VHP) framework was developed to support healthcare staff to select the most appropriate vascular access device for patients requiring intravenous therapy. The VHP framework was based on available evidence and expert consensus. The VHP was based on available evidence and expert consensus. DEVELOPMENT OF THE VHP 2020 FRAMEWORK: A multidisciplinary team reviewed the original UK VHP framework and considered new published evidence, national and international guidelines and expert opinion. A literature search was performed using Cinahl and Medline, incorporating a variety of terms linked to vascular access devices, assessment and selection. Articles published in and after 2014 in English were included. Twelve articles were found to be relevant including three evidence-based guidelines, two randomised control trials and one systematic review. FINDINGS: Three main studies provided the evidence for the update: the MAGIC study that assessed the appropriateness of peripherally inserted central catheters in patients; a study that utilised the 'A-DIVA scale' to predict the likelihood of difficult venous access; and a study that incorporated an 'I-DECIDED tool' for peripheral intravenous catheter assessment and decision-making for device removal. In addition, published guidelines provided evidence that the original advice on appropriate osmolarity of medicines for peripheral administration needed updating. CONCLUSION: The 2020 UK VHP framework reflects latest evidence-based research and guidelines, providing healthcare staff updated guidance to assist in maintaining good practice in vascular access assessment and device selection and patient safety.

Using critical slowing down indicators to understand economic growth rate variability and secular stagnation.

This paper utilizes Critical Slowing Down (CSD; instability) indicators developed by statistical physics to analyse economic growth rate variability and secular stagnation in historical GDP data. Understanding these phenomena is vital, particularly in advanced economies faced with declining growth rates. Two novel indicators - the autocorrelation (AR1) and the variance - are found particularly useful in providing insight into inter-decadal GDP variability over this period. These indicators are first applied to the Maddison-Project historical dataset, which includes almost a century of data for some 80 countries and almost two centuries of data for 9 countries. They are additionally applied to ~50 years of recent annual data for around 130 countries from the World Bank dataset as well as ~60 years of recent quarterly data for around 20 countries from the OECD dataset. Analysis reveals inter-decadal variability in growth cycles (the recession cycle), highlighting periods of large slow growth cycles and periods of small fast growth cycles. The most commonly occurring pattern is characterised by an increase in CSD from the 1900s to 1940s, a decline in CSD between the 1930s and the 1970s, then a further increase in CSD from the 1960s to 2010. This pattern is significant in ~70% of the advanced economies. CSD indicators may then provide invaluable insights into specific aspects of inter-decadal GDP variability, such as on the nature of the business cycle, secular stagnation and the implicit "restoring forces" of the economy.