How medical practice evolves: Learning to treat failing hearts with an implantable device

In this article we propose that medical practice evolves as a result of progress along three different pathways: improvement in the ability to develop effective medical technologies, learning in medical practice, and advances in biomedical scientific understanding of disease. The relative importance of these three pathways varies from case to case, and often they interact strongly. More specifically, we argue here that in cases of therapeutic innovation where a new medical technology is involved the advance in medical practice is driven largely by the ability to develop and use effective medical artifacts and the interactive sequence among these interdependent pathways often starts with what is learned in practice and not in science. While we state this argument in general, we develop it in detail in a longitudinal and contextual case study of the emergence and evolution of a treatment for advanced heart failure based on an implantable device, the Left Ventricular Assist Device (LVAD). Our findings show that an essential aspect of the evolution of the LVAD therapy is collective and cumulative learning that requires experience that only can be gained through the actual use of LVADs. We discuss the theoretical and policy implications that follow from our understanding of how medical practice evolves for research on the evolution of medical practices and new medical technologies, and policies about the evaluation of rapidly moving medical practices and clinical research involved in their advancement.     

The dynamics of the impact and coalescence of droplets on a solid surface

A simple experimental setup to study the impact and coalescence of deposited droplets is described. Droplet impact and coalescence have been investigated by high-speed particle image velocimetry. Velocity fields near the liquid-substrate interface have been observed for the impact and coalescence of 2.4 mm diameter droplets of glycerol∕water striking a flat transparent substrate in air. The experimental arrangement images the internal flow in the droplets from below the substrate with a high-speed camera and continuous laser illumination. Experimental results are in the form of digital images that are processed by particle image velocimetry and image processing algorithms to obtain velocity fields, droplet geometries, and contact line positions. Experimental results are compared with numerical simulations by the lattice Boltzmann method.     

Adaptive output feedback neural network control of uncertain non-affine systems with unknown control direction

This paper deals with the problem of adaptive output feedback neural network controller design for a SISO non-affine nonlinear system. Since in practice all system states are not available in output measurement, an observer is designed to estimate these states. In comparison with the existing approaches, the current method does not require any information about the sign of control gain. In order to handle the unknown sign of the control direction, the Nussbaum-type function is utilized. In order to approximate the unknown nonlinear function, neural network is firstly exploited, and then to compensate the approximation error and external disturbance a robustifying term is employed. The proposed controller is designed based on strict-positive-real (SPR) Lyapunov stability theory to ensure the asymptotic stability of the closed-loop system. Finally, two simulation studies are presented to demonstrate the effectiveness of the developed scheme.     

Immunoproteomic analysis of secretory proteins ofAspergillus fumigatus with specific IGE immunoreactivity

Allergenic/antigenic proteins are known to induce Type I and Type III hypersensitivity reactions leading to allergic bronchopulmonary aspergillosis (ABPA) in immunocompetent host. The common structural features or intrinsic properties of the allergens/antigens leading to allergenicity in a host are not well understood. In the current report, comparative analysis of proteins on two dimensional gel electrophoresis (2D-3) and specific IgE immunoblots ofA. fumigatus secretory proteins (1^st, 2^nd and 3^rd week culture filtrate proteins) was carried out. We observed a total of 159 proteins in 1^st, 2^nd and 3^rd week culture filtrates ofA. fumigatus. Specific IgE immunoreactivity was observed in 75 proteins with different intensity. Third week culture filtrate showed maximum number of proteins, 142, and specific IgE immunoreactive proteins, 65. MALDI-TOF analysis resulted in putative identification of two allergens as hypothetical protein YBL057c fromSaccharomyces cereviseae and unnamed protein product fromDebaryomyces hansenii (similar to IPF14568 ofCandida albicans). Identification of a repertoire of specific IgE immunoreactive proteins will facilitate the studies on structure-function relationship of these proteins relevant for diagnosis and pathogenesis.     

The information seeking behaviour of the users of digital scholarly journals

The article employs deep log analysis (DLA) techniques, a more sophisticated form of transaction log analysis, to demonstrate what usage data can disclose about information seeking behaviour of virtual scholars – academics, and researchers. DLA works with the raw server log data, not the processed, pre-defined and selective data provided by journal publishers. It can generate types of analysis that are not generally available via proprietary web logging software because the software filters out relevant data and makes unhelpful assumptions about the meaning of the data. DLA also enables usage data to be associated with search/navigational and/or user demographic data, hence the name ‘deep’. In this connection the usage of two digital journal libraries, those of EmeraldInsight, and Blackwell Synergy are investigated. The information seeking behaviour of nearly three million users is analyzed in respect to the extent to which they penetrate the site, the number of visits made, as well as the type of items and content they view. The users are broken down by occupation, place of work, type of subscriber (“Big Deal”, non-subscriber, etc.), geographical location, type of university (old and new), referrer link used, and number of items viewed in a session.     

Evaluation of Surfactants-Assisted Folic Acid-Loaded Pectin Submicrospheres: Characterization and Hemocompatibility Assay

Folic acid is used for preventing and treating multiple diseases and disorders, administered in the form of oral supplements. The present research work was aimed to study the influence of two non-ionic surfactants Poloxamer and Tween 80 (Polysorbate 80) on pectin submicrospheres formulations. Typical natural polymer pectin was used to encapsulate folic acid by cross linking method. The resultant submicrospheres contributed to improve the aqueous solubility to enhance the bioavailability of folic acid. During investigation, it was observed that pectin polymers influenced kinetics of the rate of reaction more intensively than the surfactants. The physical phenomenon caused the change in their size, shape and chemistry of pectin polymers transforming into submicrospheres in aqueous condition. The characteristic differences of submicrospheres were assessed by scanning electron microscopy, differential scanning calorimetry and Fourier-transform infrared spectroscopy. The average diameters of the submicrospheres ranged between 250 and 500 nm. The encapsulation efficiency of submicrospheres ranged between 80 and 96 %. The characteristic swelling behavior of lyophilized submicrospheres was influenced by the ratio of pectin polymers and folic acid used in the formulations. The submicrospheres systems exhibited controlled release of folic acid due to the pH-dependent solubility of pectin polymers in aqueous medium. The submicrospheres showed good haemocompatibility suggesting them to be promising candidates for oral delivery.     

Study of adenosine deaminase activity in various arthritic conditions

Aim of present study was to compare the adenosine deaminase (ADA) activity in various types of arthritis conditions with synovial effusion. No. significant difference was observed in ADA activity in serum of control and study groups but results have shown a definite pattern of ADA activity in synovial fluid in various arthritic conditions. The highest value of ADA activity was observed in synovial fluid of patients with tubercular arthritis followed by rheumatoid, septic, osteo and post traumatic arthritis. Thus measurement of ADA activity in synovial fluid can be used as a parameter of differential diagnosis of arthritis specially tubercular in initial stages.     

A biochemical study on the effect of Riboflavin on cataractous rat lenses. II Proteins and Glutathione

Proteins and glutathione (GSH) levels were estimated in the experimental groups. Levels of both proteins and glutathione in the control and the treated groups were found to be significantly decreased compared to the normal group. The results show that supplementation of riboflavin has beneficial effect by alleviating the oxidant injuries to GSH and proteins, which are involved in the maintenance of transparency and protection of thiol groups of the lens. Thus, riboflavin has an active role in the lens metabolism and has a potential to improve the metabolic activity of the cataractous lenses.