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Obesity is a risk factor for chronic venous disease. However, the mechanisms behind this association are poorly understood. We tested the hypothesis that obese subjects have a higher diurnal leg volume increase compared with non-obese subjects.In this prospective cohort study including obese (body mass index, BMI ≥30 kg m(-)(2)) and non-obese (BMI ≤25 kg m(-)(2)) subjects without venous insufficiency, lower leg volume was assessed by optoelectronic volumetry in the morning and in the evening. All subjects underwent duplex ultrasound and light reflection rheography (venous pump power and venous refill time, VRT) to investigate lower extremity venous function. A pedometer was carried between the morning and evening visit to assess the daily number of footsteps. A backward multivariable linear regression model was used to determine factors associated with diurnal lower leg volume increase.Forty-two limbs in 24 obese subjects and 29 limbs in 15 non-obese subjects were analyzed. Obese subjects had larger common femoral vein diameters (17.1±2.4 vs 15.5±2.4 mm, P0.01) and slower peak, mean and minimal velocities (25.1±10.6 vs 44.3±14.3 cm s(-1); 6.8±2.4 vs 12.7±5.6 cm s(-1); -0.2±6.4 vs -6.3±11.9 cm s(-1); P0.01 for all) than non-obese subjects. VRT was shorter in obese subjects (40.5±15.0 vs 51.0±12.1 s, P0.01) and decreased significantly in the course of the day only in obese subjects (P0.01). Obesity, male gender, CEAP (Clinical-Etiology-Anatomy-Pathophysiology) class, total time between the two visits and difference between morning and evening VRT were positively associated with higher lower leg volume increase; morning VRT and the total number of footsteps showed a negative association (P0.04 for all).Obesity was found to be an independent predictor of higher diurnal leg volume increase. One potential mechanism is a progressive failure of venous valve function in the course of the day in obese subjects.

Optical fibre fabric developed by Brochier® Technologies Company is studied for water treatment field application. By TiO2 deposition on this type of textile, the interaction between photocatalyst and UV irradiation can be strongly improved. Indeed the internal irradiation promotes the absorption of light. However, the problem is the ageing of optical fibres induced by UV exposure in the presence of TiO2 coating. Two different optical fibre fabrics were compared in term of optical ageing properties. One optical fabric was coated by TiO2 only; the other fabric was protected by a silica layer before being coated by a photocatalyst. Irradiance measurements of local light emission along ageing process were carried out and were fitted with a theoretical expression of the phenomenon. Macroscopic observations were related to microscopic behaviour on the surface of the fabric. Optical Microscopy (OM) before and after UV exposure confirm the theoretical model suggesting that the ageing induce an increase of existing holes besides appearing of new holes. These measurements show an important ageing under UV irradiation of the fabrics not protected by a SiO2 layer, leading to inhomogeneous light distribution at the surface of the textile. In presence of SiO2 layer between fabrics and TiO2 layer, no ageing was observed. Moreover, as SiO2 is transparent to UV, the photocatalyst activity does not change.

Contracting non-governmental organizations (NGOs) has been shown to increase health service delivery output considerably over relatively short time frames in low-income countries, especially when applying performance-related pay as a stimulus. A key concern is how to manage the transition back to government-operated systems while maintaining health service delivery output levels. In this paper we describe and analyse the transition from NGO-managed to government-managed health services over a 3-year period in a health district in Cambodia with a focus on the level of health service delivery. Data are derived from four sources, including cross-sectional surveys and health management and financial information systems. The transition was achieved by focusing on all the building blocks of the health care system and ensuring an acceptable financial remuneration for the staff members of contracted health facilities. The latter was attained through performance subsidies derived from financial commitment by the central government, and revenue from user fees. Performance management had a crucial role in the gradual handover of responsibilities. Not all responsibilities were handed back to government over the case study period-notably the development of performance indicators and targets and the performance monitoring.

To test whether quantitative stress echocardiography using contrast-based myocardial blood flow (MBF, ml x min(-1) x g(-1)) measurements can detect coronary artery disease in humans.48 patients eligible for pharmacological stress testing by myocardial contrast echocardiography (MCE) and willing to undergo subsequent coronary angiography were prospectively enrolled in the study. Baseline and adenosine-induced (140 microg x kg(-1) x min(-1)) hyperaemic MBF was analysed according to a three-coronary-artery-territory model. Vascular territories were categorised into three groups with increasing stenosis severity defined as percentage diameter reduction by quantitative coronary angiography.Myocardial blood flow reserve (MBFR)-that is, the ratio of hyperaemic to baseline MBF, was obtained in 128 (89%) territories. Mean (SD) baseline MBF was 1.073 (0.395) ml x min(-1) x g(-1) and did not differ between territories supplied by coronary arteries with mild (50% stenosis), moderate (50%-74% stenosis) or severe (or=75% stenosis) disease. Mean (SD) hyperaemic MBF and MBFR were 2.509 (1.078) ml x min(-1) x g(-1) and 2.54 (1.03), respectively, and decreased linearly (r2 = 0.21 and r2 = 0.39) with stenosis severity. ROC analysis revealed that a territorial MBFR1.94 detectedor=50% stenosis with 89% sensitivity and 92% specificity.Quantitative stress testing based on MBF measurements derived from contrast echocardiography is a new method for the non-invasive and reliable assessment of coronary artery disease in humans.

AIMS: Myocardial blood flow (MBF) is the gold standard to assess myocardial blood supply and, as recently shown, can be obtained by myocardial contrast echocardiography (MCE). The aims of this human study are (i) to test whether measurements of collateral-derived MBF by MCE are feasible during elective angioplasty and (ii) to validate the concept of pressure-derived collateral-flow assessment. METHODS AND RESULTS: Thirty patients with stable coronary artery disease underwent MCE of the collateral-receiving territory during and after angioplasty of 37 stenoses. MCE perfusion analysis was successful in 32 cases. MBF during and after angioplasty varied between 0.060-0.876 mL min(-1) g(-1) (0.304+/-0.196 mL min(-1) g(-1)) and 0.676-1.773 mL min(-1) g(-1) (1.207+/-0.327 mL min(-1) g(-1)), respectively. Collateral-perfusion index (CPI) is defined as the rate of MBF during and after angioplasty varied between 0.05 and 0.67 (0.26+/-0.15). During angioplasty, simultaneous measurements of mean aortic pressure, coronary wedge pressure, and central venous pressure determined the pressure-derived collateral-flow index (CFI(p)), which varied between 0.04 and 0.61 (0.23+/-0.14). Linear-regression analysis demonstrated an excellent agreement between CFI(p) and CPI (y=0.88 x +0.01; r(2)=0.92; P

Objectives: We sought to test whether myocardial blood flow (MBF) can be quantified by myocardial contrast echocardiography (MCE) using a volumetric model of ultrasound contrast agent (UCA) kinetic...

Mode detection in online handwritten documents refers to the process of distinguishing different types of contents, such as text, formulas, diagrams, or tables, one from another. In this paper a new approach to mode detection is proposed that uses bidirectional long-short term memory (BLSTM) neural networks. The BLSTM neural network is a novel type of recursive neural network that has been successfully applied in speech and handwriting recognition. In this paper we show that it has the potential to significantly outperform traditional methods for mode detection, which are usually based on stroke classification. As a further advantage over previous approaches, the proposed system is trainable and does not rely on user-defined heuristics. Moreover, it can be easily adapted to new or additional types of modes by just providing the system with new training data.

For historical documents, available transcriptions typically are inaccurate when compared with the scanned document images. Not only the position of the words and sentences are unknown, but also the correct image transcription may not be matched exactly. An error-tolerant alignment is needed to make the document images amenable to browsing and searching in digital libraries. In this paper, we propose a novel multi-pass alignment method based on Hidden Markov Models (HMM) that combines text line recognition, string alignment, and keyword spotting to cope with word substitutions, deletions, and insertions in the transcription. In a segmentation-free approach, transcriptions of complete pages are aligned with sequences of text line images. On the Parzival data set, results are reported for several degrees of artificial distortions. Both the accuracy and the efficiency of the proposed system are promising for real-world applications.

Spotting keywords in handwritten documents without transcription is a valuable method as it allows one to search, index, and classify such documents. In this paper we show that keyword spotting based on bi-directional Long Short-Term Memory (BLSTM) recurrent neural nets can successfully be applied on online handwritten documents with non-text content. It even works without preprocessing steps such as text vs. non-text distinction and text line extraction. We also propose a modification that can improve the precision with little effort.

Animal experiments have shown that the coronary circulation is pressure distensible, i.e., myocardial blood volume (MBV) increases with perfusion pressure. In humans, however, corresponding measurements are lacking so far. We sought to quantify parameters reflecting coronary distensibility such as MBV and coronary resistance (CR) during and after coronary angioplasty. Thirty patients with stable coronary artery disease underwent simultaneous coronary perfusion pressure assessment and myocardial contrast echocardiography (MCE) of 37 coronary arteries and their territories during and after angioplasty. MCE yielded MBV and myocardial blood flow (MBF; in ml·min−1·g−1). Complete data sets were obtained in 32 coronary arteries and their territories from 26 patients. During angioplasty, perfusion pressure, i.e., coronary occlusive pressure, and MBV varied between 9 and 57 mmHg (26.9 ± 11.9 mmHg) and between 1.2 and 14.5 ml/100 g (6.7 ± 3.7 ml/100 g), respectively. After successful angioplasty, perfusion pressure and MBV increased significantly ( P < 0.001 for both) and varied between 64 and 118 mmHg (93.5 ± 12.8 mmHg) and between 3.7 and 17.3 ml/100 g (9.8 ± 3.4 ml/100 g), respectively. Mean MBF increased from 31 ± 20 ml·min−1·g−1 during coronary occlusion, reflecting collateral flow, to 121 ± 33 ml·min−1·g−1 ( P < 0.01), whereas mean CR, i.e., the ratio of perfusion pressure and MBF, decreased by 20% ( P < 0.001). In conclusion, the human coronary circulation is pressure distensible. MCE allows for the quantification of CR and MBV in humans.

In this paper we propose a new strategy for combining the outputs of several alignment systems. Based on the word boundaries retrieved from a number of individual alignment systems, the new boundaries are estimated. We investigate three strategies for this estimation. First, the mean value of the individual boundaries is taken, second the median is selected, and third, confidence values of the alignment systems are considered. We apply the combination strategies on a word mapping system for historical handwritten manuscripts. After some preprocessing and normalizing steps, three differently trained hidden Markov model based handwriting recognizers are applied to the text lines in forced alignment mode. As a result, the positions of the word boundaries are obtained. In in a number of experiments it is shown that a combination strategy based on the median outperforms the others and all individual alignment systems with a word mapping rate of about 95%.

Building recognition systems for historical documents is a difficult task. Especially, when it comes to medieval scripts. The complexity is mainly affected by the poor quality and the small quantity of the data available. In this paper we apply an HMM based recognition system to medieval manuscripts from the 13th century written in Middle High German. The recognition system, which was originally developed for modern scripts, has been adapted to medieval scripts. Beside the data processing, one of the major challenges is to create a suitable language model. Because of the lack of appropriate independent text corpora for medieval languages, the language model has to be created on the base of a rather small number of manuscripts only. Due to the small size of the corpus, optimizing the language model parameters can quickly lead to the problem of overfitting. In this paper we describe a strategy to integrate all available information into the language model and to optimize the language model parameters without suffering from this problem.

Note: 204 Reference SAMLAB-ARTICLE-1999-020doi:10.1002/(SICI)1096-9918(199905/06)27:5/6 3.0.CO;2-V Record created on 2009-05-12, modified on 2016-08-08

In this paper we propose a novel approach to th tion of on-line handwritten text lines based on dynamic programming. We try to find the paths with the minimum cost between two consecutive text lines. Most steps of the proposed algorithm are based on off-line information. Hence the method can also be applied to off-line documents after a few minor changes. In our experiments we show that this dynamic programming based approach is better than a common on-line segmentation procedure.

The ischaemic cascade1 describes the temporal sequence of pathophysiological events initiated by an imbalance between myocardial oxygen supply and demand. Depending on severity and duration, an ischaemic episode may manifest as metabolic disturbance, mechanical dysfunction, electrical changes, angina pectoris or, ultimately, as myocardial infarction. Although being the primary sequelae of coronary artery disease (CAD), quantitative relationships between myocardial perfusion changes and their consequences such as metabolic, mechanical or electrical dysfunction are not well defined. In particular, the existence of an absolute perfusion threshold preventing short-term ischaemia has not been investigated so far. Percutaneous coronary intervention (PCI) provides an elegant model to deal with this issue in patients with CAD. During angioplasty, myocardial blood supply is diminished below normal depending on the collateral supply from adjacent vascular regions. Absolute perfusion or myocardial blood flow (MBF, ml/min/g) can be obtained from positron emission tomography and, of late, from myocardial contrast echocardiography (MCE).2 However, only MCE is applicable during PCI owing to its mobility and short acquisition time. Our study aimed to determine the absolute perfusion threshold that prevents myocardial ischaemia using MBF measurements by contrast echocardiography during angioplasty in humans. Twenty eight consecutive patients with stable CAD eligible for PCI …

AIMS: The adaptation of the myocardial microcirculation in humans to pathologic and physiologic stress has not been examined in vivo so far. We sought to test whether the relative blood volume (rBV) measured by myocardial contrast echocardiography (MCE) can differentiate between left ventricular (LV) hypertrophy (LVH) in hypertensive heart disease and athlete's heart. METHODS AND RESULTS: Four groups were investigated: hypertensive patients with LVH (n = 15), semi-professional triathletes with LVH (n = 15), professional football players (n = 15), and sedentary control individuals without cardiovascular disease (n = 15). MCE was performed at rest and during adenosine-induced hyperaemia. The rBV (mL mL(-1)), its exchange frequency (beta, min(-1)), and myocardial blood flow (mL min(-1) g(-1)) were derived from steady state and refill sequences of ultrasound contrast agent. Hypertensive patients had lower rBV (0.093 +/- 0.013 mL mL(-1)) than triathletes (0.141 +/- 0.012 mL mL(-1), P < 0.001), football players (0.129 +/- 0.014 mL mL(-1), P < 0.001), and sedentary individuals (0.126 +/- 0.018 mL mL(-1), P < 0.001). Conversely, the exchange frequency (beta) was significantly higher in hypertensive patients (11.3 +/- 3.8 min(-1)) than in triathletes (7.4 +/- 1.8 min(-1)), football players (7.7 +/- 2.3 min(-1)), and sedentary individuals (9.0+/-2.5 min(-1)). An rBV below 0.114 mL mL(-1) distinguished hypertensive patients and triathletes with a sensitivity of 93% and a specificity of 100%. CONCLUSION: Pathologic and physiologic LVH were differentiated non-invasively and accurately by rBV, a measure of vascularisation assessed by MCE.

Cantilevers with integrated tip and piezoelectric layer (zinc oxide, ZnO) for actuation and detection have been microfabricated using monocrystalline silicon as the bulk material. Arrays of five levers and cantilevers with two independent ZnO layers have also been obtained. The levers have been mechanically and electrically characterized. Dynamic mode and contact mode atomic force microscopy (AFM) images were achieved using the integrated piezoelectric layer of these levers as a vertical deflection sensor.

Arrays of cantilevers with integrated self-sharpening tips and self-exciting piezoelectric sensors have been fabricated using monocrystalline silicon micromachining. During the fabrication process, tips are first formed with a wet etching technique allowing a good homogeneity of tip shape over a whole wafer and then protected with a local thick silicon dioxide layer. Single cantilevers have been used to achieve atomic force microscopy images of grids with periods of 0.25, 1, and 5 μm and with height differences of 100, 15, and 180 nm, respectively.

Silicon bulk micro machining allows the batch fabrication of miniaturized xy-stages integrating a tip for atomic force sensing, via hole for optical detection and electrostatic comb actuators for lateral scanning. In this paper we present a device which integrates a large tip (about 50 /spl mu/m high) with high aspect ratio (1.7:1) on the central stage, improving thus significantly the access to the sample to be scanned. In spite of the mass increase due to the larger tip dimensions, measured resonance frequencies remain high enough (several kHz) to make the device insensitive to the environmental noise.

Self sharpening tips have been integrated on arrays of cantilevers provided with self exciting piezoelectric sensors (ZnO) by using monocrystalline silicon micromachining. Atomic force microscopy (AFM) images of grids with periods of 0.25 /spl mu/m, 1 /spl mu/m and 5 /spl mu/m and with height differences of 100 nm, 15 nm and 180 nm respectively have been achieved with single cantilevers.

Introduction The recently described angiographic BCIS-1 Myocardial Jeopardy Score (BCIS JS) was designed to classify the extent of coronary artery disease (CAD). It provides a semi quantitative estimate of the amount of myocardium at risk as a result of severe coronary stenoses (0=no jeopardy; 12=maximum jeopardy). Advantages include ease of use and universal applicability including classification of left main stem disease and CABG. However anatomic tests, including the BCIS JS, do not incorporate myocardial ischaemia and scar, which are important for management and prognosis. Cardiac magnetic resonance (CMR) imaging allows reliable assessments of myocardial ischaemia and scar in a single examination and was used to examine the functional relevance of the BCIS JS. Methods 60 consecutive patients with angina and known or suspected CAD referred for diagnostic x-ray coronary angiography underwent CMR examination at a single UK centre. CMR included standard functional and scar imaging and also high-resolution k-t accelerated adenosine stress and rest perfusion imaging at 1.5T (40 patients) or 3T (20 patients). Expert observers blinded to the clinical data analysed the angiographic and CMR data. The BCIS JS was calculated from visual analysis of the coronary angiogram. CMR perfusion and scar data were segmented according to the standard 17-segment model excluding the apex. Segments were subdivided into equal endo- and epicardial sub-segments, each assigned 3% of the total myocardial volume and classified as normal, ischaemia or scar. Myocardial ischaemia and scar burden were calculated and correlated with the BCIS JS individually and as a combined score (Abstract 124 figure 1). Results Patient characteristics are summarised in the Abstract 124 table 1. 2 patients were excluded (1 claustrophobia; 1 incomplete imaging data). Mean interval ± SD between CMR and coronary angiography was 40±47 days. 13 patients (22%) with no history of myocardial infarction had CMR evidence of prior infarction. There was a strong correlation between the BCIS JS and myocardial ischaemic burden: Pearson9s r=0.75, p Conclusions The BCIS JS correlated well with ischaemic burden on CMR. A BCIS JS ≥6 predicts the prognostically important ischaemic threshold of 10% with high specificity. As expected, the correlation is imperfect which is likely to be a result of difficulty predicting haemodynamic effects of angiographically moderate disease, microvascular disease and limitations of CMR imaging.

The use of laser in arthroscopy is the result of historical developments, and its evolution follows the course common to most new technologies, with particular relevance to the concept of minimally invasive surgery. The gradual introduction of new laser beams such als neodymium, holmium, and erbium — the latter still at the experimental stage — has allowed the development of fiberoptics and made it possible to use these lasers in arthroscopy surgery.

This project involves the following. Five tall buildings, eight blocks, each of eight storeys, three 4 storey blocks, and a number of one or two storey buildings, which serve various auxiliary purposes. The space and plastic quality of the total project is outstanding, and also the ground distribution, and interaction between green zones, playing grounds, commercial zones and other specialised zones of the project., El conjunto construido comprende los siguientes edificios: cinco rascacielos; ocho bloques de 8 plantas de altura —destinadas a viviendas—desarrollados linealmente; tres edificios de 4 plantas; y una serie de construcciones, de uno y dos pisos, destinadas a diferentes fines. Es de resaltar, en el mismo, su acertada composición en planta y volumétrica, y la amplitud y variación de las zonas verdes, de juegos y comerciales, dispuestas en los sitios más adecuados.

Recent developments and advances in micro-electro-mechanical systems for nanometer-scale applications such as scanning force microscopy are presented. The microfabrication of tools so small that they enable access to the nanoworid, such as tips, flexible cantilevers, integrated deflection sensors and nanoactuators will be described. Bulk and surface micromachining of mono or polycrystalline silicon, extended by aligned-wafer-bonding, etch-back and sacrificial-iayer-etching steps are major fabrication steps used. Experiments on prototypes show that these devices are promising for use as ultra-sensitive stand-alone local probe micro-instruments.

Esophagogastric ulcers were induced in swine by sequential inoculation with ova or larvae of Ascaris suum [ 1, 61. In one study large ulcers developed in the stomachs of 15 swine given an oral inoculation of embryonated ova. Two weeks later they were given either a second oral inoculation of ova or an injection of ascarid larvae via a mesenteric vein. Five control swine did not develop lesions. In another study, 25 pigs that were inoculated when 8 weeks old with embryonated ascarid ova were given a second inoculum of ova 15 days later. At autopsy, 4 to 10 days after the second inoculation, epithelial thickening, erosions and ulcers in the pars esophugea of the stomach were found. Three pigs given a single inoculum and two controls were free of lesions. The development of esophagogastric ulcers also has been related to a spontaneous second invasion by ascarid larvae when a group of 3-month-old pigs was moved to a new location. These pigs also had lesions of ascaridiasis of the liver and lung. Pigs left in their original location remained healthy [5]. Based upon these observations [ I , 5, 61, the development of gastric ulcers in swine has been attributed to an immune mechanism such as occurs with a second invasion by ascarids, or when production of histamine is increased by trauma to liver and lungs during migration of ascarid larvae. If this relationship were an important factor in the development of gastric ulcers in swine under field conditions. it should be substantiated by autopsy records. Autopsy records from the Institute of Animal Pathology, University of Berne, from 197 I to 1976 were reviewed. During this period 11,784 swine were examined. These pigs were mainly from farms of the Swiss pig health service, and most were less than 3 months old. The methods of study have been described [2]. The chief and secondary diagnoses of each pig according to the “standard nomenclature of veterinary diseases and operations” [7] were transferred to veterinary case abstract forms of the World Health Organization (WHO). These data were recorded at the WHO Center in Geneva, Switzerland, and analysed by the Chi-square test. Lesions of the esophageal region included hyperkeratosis, parakeratosis, erosions, acute and chronic ulcers, and scars that sometimes had obliterated the esophageal opening. If adult worms were found in the gut or if there were evidence of interstitial hepatitis (milk spots) a diagnosis of ascaridiasis was made. Lung lesions were not recorded. Of the 11,784 reviewed, 654 had lesions of the pars esophagea and 1.216 were infested by ascarids. Lesions of the stomach were combined with ascaridiasis in 121 pigs (P < 0.001). This result is a statistical pitfall because the two diseases d o not occur with a constant probability in each pig. An earlier study [3] had shown that the greatest frequency of gastric lesions and of ascaridiasis was in swine 3 to 6 months old. The 5,405 autopsies during 1971 to 1973 were further analysed by age groups. In pigs 0 to 4 weeks old (1,778 autopsies) few lesions were seen; in pigs 4 to 8 weeks old (2,503 autopsies) 86 had gastric lesions and 271 had ascaridiasis, but the two were combined in only 15 pigs, a weakly significant association (P < 0.05). In 757 pigs 8 to 12 weeks old, gastric lesions were found in 74 and ascaridiasis in 233, with the two combined in only 21, which was not significant statistically. In 292 pigs 3 to 6 months old, 79 had gastric lesions and 115 had ascaridiasis, but the two were combined in only 24, which was not significant statistically. The small group of pigs (75) over 6 months old was not analysed.