Arne Larsson Fig. He had been hospitalised with complete heart block and frequent Stokes-Adams attacks for 6 months. He was having 20 to 30 attacks daily and his prognosis was poor. Treatment was maximised with ephedrine, pentymal, atropine, isoprenaline, caffeine, digoxin and whisky. Else Marie was the patient's wife who pleaded with Elmqvist and Senning to help her hopelessly ill husband. She had read press reports about ongoing experiments with electrical stimulation of the heart and hounded down the two scientists for a solution that did not yet exist: an implantable pacemaker.
Senning recounts his encounter with this lady: "An energetic, beautiful woman entered my lab on the 6 th October and told me that I had to implant a pacemaker into her husband. I told her we had not completed our experimental series and we did not have a pacemaker for human clinical implantation.
That day she drove several times from Elmquist's electronic lab and back and finally convinced us. To avoid publicity, the implantation was done in the evening when the operating rooms were empty. Via a left-sided thoracotomy two suture electrodes were implanted into the myocardium and tunnelled to the pacemaker box placed in the abdominal wall. The first pacemaker implanted functioned only a few hours but the second one implanted in the same patient had better longevity. Presumably, I had damaged the output transistor or capacitance with the catheter and I did not have the other one which was in the lab.
The patient and relatives were happy if the patient survived. The second pacemaker functioned well for about 1 week before suddenly showing a decrease in the ECG pacing stimulus size: suggesting probable lead fracture rather than pulse generator malfunction. The pulse generator delivered impulses at an amplitude of 2 volts and a pulse width of 1. The pulse rate was fixed at a constant rate of 70 to 80 beats per minute.
The energy utilised was minimised since Elmqvist managed to obtain a few of the first silicon transistors imported into Sweden. These were more efficient than the older germanium transistors. With them Elmqvist designed a stable and efficient blocking oscillator with a small power consumption Fig. The first transistor forms a repetitive blocking oscillator whose pulses are fed to the base of the second transistor. Several types of primary battery cells could have been used. The Ruben-Mallory cells with zinc as the anode and mercuric-oxide as the depolarizer were a possible choice Fig.
They had been invented during World War II for army field telephones.
Although the cell potential remained constant, these cells had a short lifetime and released hydrogen gas at the zinc anode. The effect of this gas in a cell encapsulated in plastic was not known. For these reasons, nickel-cadmium rechargeable cells were then chosen. Two cells of 60 mAh each were sealed, encapsulated and connected in series. Recharging was accomplished inductively.
A coil antenna with a diameter of about 50 mm was connected to the cells via a silicon diode. This was inductively coupled across the patient's skin to a large external flexible coil 25 cm in diameter attached to the patient's abdomen with adhesive tape. Recharging was accomplished by a kHz radio frequency current generated by an external mains-powered vacuum tube device connected to the external coil. The pacemaker required charging once a week for 12 hours.
The entire unit was entirely hand-made Fig. These were encapsulated in a new epoxy resin Araldite produced by Ciba-Geigy, which had excellent biocompatibility. The approximate diameter and thickness became 55 mm and 16 mm respectively, according to the dimensions of the ever so popular shoe polish can from Kiwi Fig. Elmquist in fact produced two such units using these cans as moulds! These first units had two electrode wires, each consisting of a twinned, stainless steel suture wire with polyethylene insulation.
The distal ends of the wires were sewn into the myocardium to act as pacing electrodes. The proximal ends were hard-wired to the pulse generator circuit. It was estimated that the electrode had to withstand about 10 5 bends per day Fig. Rune Elmqvist soon ceased his involvement in pacing but remained active in other areas of medical technology. He died in , aged Ake Senning remained very active in the field of cardiac surgery.
He died in at the age of Arne Larsson survived both the engineer as well as the surgeon who had saved his life Fig. He required five lead systems and 22 pulse generators of 11 different models until his death on December 28 th aged 86 of a malignancy totally unrelated to his conduction tissue disease or his pacemaker system. Wilson Greatbatch was an electrical engineer teaching at the University of Buffalo where he was working on an oscillator to aid in the recording of tachycardias. He accidentally discovered the way to make an implantable pacemaker Fig.
William Chardack was chief of surgery at Buffalo's Veteran's Hospital at the time. In Dr. Chardack, Greatbatch had finally found a surgeon who believed in the viability of an implantable pacemaker. On May 7, , Greatbatch brought what would become the world's first implantable pacemaker to the animal lab at the hospital.
There, Chardack and another surgeon, Dr. Andrew Gage, exposed the heart of a dog to which they touched the two pacing wires. The heart proceeded to beat in synchrony with the device. The three looked at each other. Their feelings were best expressed by Dr. The three - Greatbatch and Drs. Chardack and Gage - became known as the bow tie team. I wear bow ties because long ties get in the way when I am soldering. Over the first two years experiments were made with animals. In , Greatbatch patented the implantable pacemaker, and William Chardack reported the first success in a human with this unit in The procedure was completed in June on a year old man in complete heart block Fig.
Chardack first implanted the lead and when threshold stabilised implanted the pulse generator. The patient survived uneventfully for 2 years before his death from natural causes. In , Chardack, Gage and Greatbatch reported a series of 15 patients who had pacemakers implanted. Greatbatch later invented the long-life corrosion-free lithium-iodine battery to power the pacemaker Fig.
The early pacing technology of the 's and 's was a spin-off from the research and development of World War II and Cold War eras. Faulty batteries, body fluids leaking into the encasement and broken leads caused numerous pacemaker failures that required emergency surgery. The main difficulty however was the lead.
It was soon obvious that the myocardial wire was unsuitable as a long-term electrode. Stimulation threshold increased after a few weeks until exit block developed and no more capture was possible. Moreover, the wire could not resist the enormous repetitive mechanical stresses of bending. These technical problems contributed to the delay in the widespread use of implanted pacemakers for several years.
Tight collaboration between engineers, physicians and patients was the fundamental driving force for the growth of a significant global industry. Well over 2 million pacemakers have been implanted worldwide since ! Earl Bakken co-founder of Medtronic Inc. Siemens then acquired Pacesetter Inc. Jude Medical in Other investigators followed a different line of approach in designing self-contained implantable pacemakers: inductive coupling Fig.
A pair of electrodes were sutured to the epicardium and connected to a coil antenna located subcutaneously. Minimal or no circuitry was implanted and no internal batteries were needed. This coil antenna was inductively coupled to an external coil taped to the patient's intact skin. This external coil was connected in turn to a transistorised pulse generator powered by an external battery. The electronic components, relatively unreliable at this time, were therefore located entirely outside the body. Glenn, Mauro, Longo, Lavietes and Mackay's technique utilised a radio-frequency oscillator.
Later versions of this system included triple-helix, silicone insulated endocardial leads and rate-control via an external knob which the patient himself could modify at will. Atrial pacing with this device was used in Inductively-coupled pacemakers proved to be very successful with several hundreds of implants and survival rates of over 10 years Fig. These devices were extensively used in the Birmingham UK region for a number of years, being produced by the Lucas factory, more commonly known for its automotive electrical products until taken over by Bosch.
One particular disadvantage of this device was that its removal for example, for bathing could result in bradycardia and syncope. They continued to be used until well into the 's and several patients with later generation pacemakers still have the implanted coils from their original devices. Paul and Norman Roth Chief Engineer at Medtronic implanted a bipolar stainless steel electrode to pace a patient suffering from post-myocardial infarction complete heart block Fig.
The lead consisted of a pair of stainless steel wires secured in a silicone rubber base Fig. This consisted of four thin bands of stainless steel wound around a core of polyester braid and insulated with soft polyethylene Fig. It was estimated to resist over million flex cycles, hence lasting for at least 6 years. The unipolar epicardial stimulation electrode was a platinium disc, 8mm in diameter and insulated at the back. The Elema Fig. The maket prospects were perceived to be poor! Pacemakers were considered as an expensive service to prominent customers with little commercial value.
The external charging system was too complicated especially for elderly patients. Elmqvist constructed the Elema pacemaker in Fig. Ruben-Mallory zinc-mercury oxide cells were used as the power source thus eliminating the need for periodic recharging of the previously utilised nickel-cadmium cells.
Other models were implanted with similar success in by Zoll et al Fig. The technique for inserting permanent transvenous bipolar pacing electrodes was developed in by Parsonnet et al. Pacemaker and lead technology continued to develop rapidly to make these devices reliable, automatic and flexible in the therapy they provide. The therapeutic end-point shifted from saving life to enhancing its quality and simplifying follow-up. Electrotherapy has become socially accepted and its indications are extending also to non-cardiac pathology: Parkinson's Disease, pain-control, drug delivery.
Transvenous leads replaced epicardial leads. Pacemakers and their leads could be implanted without a thoracotomy and without general anaesthesia. The lithium-iodine battery was developed to replace the mercury oxide-zinc battery that had been used till then. This resulted in greatly increased pacemaker longevity Figs. In an American-made radioisotope pacemaker was implanted by Parsonnet et al. These nuclear pacemakers had an expected life of 20 years but went out of fashion mainly due to the need for extensive regulatory paperwork Fig.
Titanium casing was developed to enclose the battery and circuitry. This replaced the epoxy resin and silicone rubber that was previously utilised to encase the internal components of the pacemaker.
Pacemakers were made non-invasively programmable in the mid's. Using a radio-frequency telemetry link, most pacing parameters could be adjusted to follow the changing clinical needs of the patient. By the end of the 70's dual-chamber pacemakers were developed to pace and sense in both atria and ventricles. Synchronised timing made it possible to preserve the atrial contrbution to ventricualar filling as well as to track the intrinsic atrial rate.
In the early 's steroid-eluting leads were developed. These eluted steroid from their tip and hence decreased the inflammatory response evoked by the presence of the lead tip acting as a foreign body. Consequently, the early rise of capture threshold was blunted and safety was enhanced Fig. In , Zoll patented and re-introduced a transcutaneous external pacemaker with a longer pulse width of 40 ms and a larger electrode surface area of 80 cm 2.
This reduced the current necessary to capture the heart and thus improved patient comfort. This method of pacing could be applied very rapidly as a bridge to a the establishment of pacing via the transvenous route. In the mid's rate-responsive pacemakers were designed. A tiny sensor within the pacemaker box detected body movement and used this as a surrugate measure of activity.
Signals from the sensor were filtered and applied to an algorithm to alter the pacing rate up or down. Thus, pacing rate would change according to the patient's activity level. Microprocessor-driven pacemakers appeared. These became very complex devices capable of detecting and storing events utilising several algorithms.
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They delivered therapy and modified their internal pacing parameters according to the changing needs of the patient in an automatic manner. The rate-response pattern also adjusted itself automatically to the patient's activity level Fig. Bi-ventricular pacing for heart failure was introduced. An additional specially-designed lead was introduced via the coronary sinus to the epicardial surface of the left ventricle. Learning how to sleep well again can greatly reduce the impact of stress and pain.
Improving your sleep requires retraining your body to fall asleep and stay asleep longer. One of the best-known methods of doing this is sleep hygiene. Sleep hygiene simply means making sure that you are going to sleep under the optimum conditions e. The aim is to make it as easy as possible for sleep to occur naturally.
Stress management is also an important strategy for restoring sleep. How can you sleep soundly knowing that something terrible might be about to happen any moment or feeling that your life is out of control? You must neutralize any present stressors which may be interfering with your sleep.
This could mean deciding on a course of action to resolve a stressful situation, practicing relaxation before going to sleep, or just writing out your thoughts and feelings before going to bed. In this case, you may need to develop a new sleeping routine, based on letting your body dictate when and where you sleep, as opposed to trying too hard to sleep normally. Instead, you sleep where and when you can. Last but not least, medication can be helpful in addressing sleeping problems. To summarize, there are six strategies for improving sleep;. Below you will find detailed instructions on how to implement these strategies.
These strategies are designed to remove any obstacles to sleep, and maximize your ability to sleep. The ultimate goal is to facilitate restful if not normal sleep. But the main thing is try and create the conditions where you can get as much sleep as you can, regardless of how much pain you may be experiencing.
As with changing any stress-related disturbances to normal functioning, it may take time for your body to return to normal, so you will need to be patient. Sleep hygiene involves creating the right conditions for sleep to happen naturally. Sometimes, sleeping problems can be exacerbated by your surroundings or routine.
Noise, light, timing, even the type of mattress you have, can all affect your ability to fall asleep and stay asleep. These are guidelines and my not be practical for everybody. Review this list and see if there is anything you can do to make it easier for your body to fall asleep. As stated, you cannot relax and fall asleep if you are worried about your safety or that something bad is going to happen.
Beyond obvious considerations of physical security, try to make your bedroom into a place where you can shut the door on your worries and cares. Create a mental boundary between your place of sleep and the rest of your life. Know that you cannot sleep and think about your problems at the same time. In fact, some research suggests that if you stop thinking and get some sleep, you are more likely to find solutions to your problems. Our systems, particularly the adrenal glands, do most of their recharging between11pmand1am.
In addition, your gallbladder dumps toxins during this same period. If you are awake, the toxins back up into the liver, which then backs up into your entire system and causes further disruption to your health. Before the widespread use of electricity, people would go to bed soon after sundown, as most animals do, and which nature intended for humans as well. Try to avoid setting your alarm for earlier than6am. Prepare the night before if getting up at6amwill be a rush for you.
If you must get up before 6am, reset your body clock by ensuring darkness and quiet for an early-to-bed schedule and waking up to bright lights.
Metronome | Revolvy
Remember, sunrise is the trigger for your body clock. Try to go to bed at roughly the same time every night.
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Try to have a bed-time routine wherein you give your mind and body time to wind down in preparation for sleep and you create a pattern of going to sleep at roughly the same time every night. A cool, dark environment is best. Keep your bedroom at a comfortable temperature and minimise noise or distractions. It is better to read something relaxing than watch TV before going to bed. A comfortable mattress is also important. A recent study showed that in some people caffeine is not metabolised efficiently and therefore they can feel the effects long after consuming it.
So an afternoon cup of coffee or even tea will keep some people from falling asleep. Alcohol may help you to get to sleep but it will cause you to wake up throughout the night. Warm baths not showers before bedtime can help. When body temperature is raised in the late evening it will fall at bedtime, facilitating sleep. Some people find the sound of white noise or nature sounds, such as the ocean or forest, to be soothing for sleep. Exercise is thought to be conducive to sleep, but preferably not too close to bedtime, i.
If you cannot get to sleep for more than 30 minutes get out of bed and do something boring in dim light until you are sleepy. Do not lie awake worrying. Stress management means dealing with any current stressors which are keeping you awake at night. The kinds of stressful situations which can inhibit sleep include unresolved trauma, chronic pain, illness, relationship problems and any situation which poses a threat to your goals and security.
But you can acquire the knowledge, confidence and support to help you overcome whatever threats or challenges are facing you. You should have found the activities from the safety and support chapter helpful in this regard. It can be helpful to review the stressful situation from a problem-solving point of view.
Is the stressful situation something you have any control over? Do you have all the information you might need to know how to resolve that situation? Are you holding on to any self-limiting attitudes or beliefs which might be holding you prisoner to this situation? Is there any reasonable action that you can take to ameliorate the threat or improve your situation? If the situation is not one that you can control, and assuming you have done everything you possibly can to resolve it, what is the point of continuing to worry?
Stress management also involves knowing how to manage the stressful feelings associated with the stressful situation. This could mean talking to a friend, practicing meditation or relaxation, changing your self-talk, exercising or taking up a hobby or some combination of the above. Sometimes stress can be caused by our expectations; if we can learn to look at the stressful situation differently, this can change how it makes us feel.
Louise could not accept that her role within the family had changed. After talking with her counsellor, Louise remembered why she got hurt at work in the first place; because she was trying to support her family. The realization that all along she had been doing her best for her family helped Louise to feel less bad about what had happened. As we have seen, one of the main effects of stress and pain is increased physiological arousal.
Practising relaxation or self-hypnosis at bed-time can reduce tension and facilitate sleep. Relaxation helps create a buffer between the stress of the day and the letting go that is necessary for restful sleep at night. That is just one question asked in this playful documentary about the titular LA store and its unlikely proprietors. Best friends Izzy, Anuka, and Fiona have a pact to lose their virginity before the summer break. Produced by Jared Leto, Emma Ludbrook. Filmed in all 50 states over the course of a single Fourth of July, this collaborative documentary project explores our collective national beliefs, culminating in a vivid, contradictory, kaleidoscopic portrait of who we are as a nation.
Goldie , directed and written by Sam De Jong. Produced by Luca Borghese, Ben Howe. Goldie takes care of her sisters while their mom is in prison, but her true dream is stardom. Lost Bayou , directed by Brian C. Produced by Kenneth Reynolds, Brian C. Produced by Krista Parris, Cara Marcous. An Amazon Studios release. Produced by Bruno Nahon, Caroline Nataf. Her plans are upended when her ex-lover shows up with the six-year-old son she left behind. Presented in partnership with Venice Days.
As authorities try to beat the clock before the instrument disappears forever, their chase leads them to an unexpected suspect. Produced by Noah Lang. Video Pat is a mudding enthusiast who must question his passion—and maybe his entire way of life—when the last mudhole in Orlando is shut down. Two Brooklyn teenage prodigies, C. Walker and Sebastian Thomas, build make-shift time machines to save C. Kaden is a world-class ski jumper in Canada, pining for a lost love.
Khai is a corporate executive in Shanghai, drawn to a new coworker with a secret. The two men go about their lives, without knowing that they are connected. Standing at a crossroads, Frank must look to his past to shape his perspective on this monumental decision. Wild Rose , directed by Tom Harper. Written by Nicole Taylor. Produced by Faye Ward. A NEON release. A Netflix release. Opening Night selection. In Fabric , directed and written by Peter Strickland. Produced by Andy Starke. British auteur Peter Strickland follows The Duke of Burgundy with a dazzling sensory overload of genre film pastiche in a fresh package: the dreamlike saga of a cursed scarlet dress that passes through the lives of several characters.
Once again, Strickland unites disorienting cinematic trickery with deadpan comedy to astonishing results. As World Cup fever hits Mexico in , two middle class teens discover an underground culture of experimentation with sex, drugs, and art. This Is Not Berlin is a film that crosses narrative and formal boundaries with the same thrilling abandon that its characters do emotional and experiential ones.
The Weekend , directed and written by Stella Meghie. Martha , directed and written by Selina Miles. Produced by Daniel Joyce. In s New York, photographer Martha Cooper captured some of the first images of graffiti at a time when the city had declared war on this new artform. Decades later, Cooper has become an influential godmother to a global movement of street artists.
For 20 years, indie record store Other Music was a beloved and influential hub of independent music culture. Featuring Vampire Weekend, The Strokes, and Interpol, the film reminds us that the community and spirit of the much-loved destination will live on.
Insomnia: 6 strategies to sleep better
The Projectionist , directed by Abel Ferrara. Produced by Christos V. Konstantakopoulos, Michael M. With Nicolas Nicolaou, Abel Ferrara. Bliss , directed and written by Joe Begos. In need of creative inspiration, a professionally stagnant and hard-partying Los Angeles artist recklessly indulges in a series of drug binges. As the narcotics fly out of control, so does her newfound and inexplicable, yet unquenchable, craving for blood. Knives and Skin , directed and written by Jennifer Reeder.
How stress affects your sleep
Produced by Brian Hieggelke, Jan Hieggelke. Produced by David Lawson Jr. Dealing with a girlfriend suddenly leaving is tough enough. With Jeremy Gardner. Ask Dr. Ruth , directed by Ryan White. Plain-spoken and thickly accented, Dr. Ruth Westheimer became a household name in the s by transforming the way Americans talk and think about sexuality. At 90, Dr. Ruth reflects on her life from Holocaust survivor to celebrity sex therapist.
Produced by April Lamb. Maybe record an audio diary of her daily survival strategy in this post-apocalyptic podcast from filmmaker Aaron Katz with Jenny Slate. Produced by Bud Johnston, Jesse Moss. Advancements in neurotechnology are revolutionizing what it means to be human. Following three subjects who undergo brain interface treatment, I AM HUMAN examines the ethical quandaries in brain exploration and simulated cognitive evolution.
Andres Lozano. Inna De Yard , directed and written by Peter Webber. With one of the most memorably stunning voices that has ever hit the airwaves, Linda Ronstadt burst onto the s folk rock music scene in her early twenties. A poignant bio-doc of a truly one-of-a-kind artist. A CNN Films release. After the Premiere Screening: A master class conversation with sound designers and editors from the film including Oscar — winners Ben Burtt and Gary Rydstrom.
The story of how hip hop changed fashion, leading to the stratospheric and global rise of street wear. It is a journey of African American creativity and the limitless possibilities of a cultural movement on a global scale. After the Premiere Screening: A special musical performance inspired by the film. It influences elections and sways outcomes—gerrymandering has become a hot-button political topic and symbol for everything broken about the American electoral process.
But there are those on the front lines fighting to change the system. Produced by David Silver. But the grind of performing and the pressure of the title proves that heavy is the head that wears the tiara. Following the shock commutation of her sentence, whistleblower and trans woman Chelsea Manning prepares to leave an all-male military prison in Kansas and transition to living life for the first time as a free woman.
A Showtime release. La Noria , directed and written by Carlos Baena. Spain — New York Premiere. A young boy who loves to draw and build ferris wheels encounters strange creatures that turn his life upside down. With English subtitles. PeiXes , directed and written by Juan C.
In Spanish with English subtitles. Mind My Mind , directed and written by Floor Adams. Netherlands — International Premiere. How skin became color, color became race, and race became power. Or… the relationship of Sally Hemings and Thomas Jefferson in an animated musical. Norway — North American Premiere.
In Norwegian with English subtitles. Storm , directed and written by Will Kindrick. An unexpected user is accidentally launched through a series of turbulent splash portals when his government enforced dating app malfunctions in his bathtub. Bunker Burger , directed and written by Adam Yorke.
Canada — World Premiere, Short Narrative. The members of an underground, post-apocalyptic bunker invite a psychologist from the radioactive and chaotic surface to audition for a place to live among them. Flyby , directed and written by Jesse Mittelstadt. When a passing asteroid begins to affect how people perceive time, one man struggles to keep up with a life that is quickly disappearing into the future. Unregistered , directed by Sophia Banks, written by Erin Dignam. Unregistered is a narrative short film following a new couple navigating analog and digital connections in the not-too-distant future of a dystopian Los Angeles.
The Shipment, directed and written by Bobby Bala. Unable to afford repairs to his old broken ship, a struggling interplanetary transporter and his daughter are stranded on a wretched spaceport as his morality is put to the test. This Perfect Day , directed and written by Lydia Rui. Australia — World Premiere, Short Narrative. Across the street, a music store is closing.
Ponyboi , directed and written by River Gallo. Ponyboi, an intersex sex-worker, looks for love and to escape his seedy life in New Jersey.
Madison’s Metronome: The Sovereign Physician of Our Passions
Through an encounter with the man of his dreams, Ponyboi discovers his worth. War Paint , directed by J. Doler, Taylor Bracewell, written by J. War Paint is a reverse first-person narrative telling the true story of Joe, a veteran of the Vietnam war. The film follows him as he enlists, prepares, and heads off to war. With J.
Street Flame , directed and written by Katherine Propper. Following the death of their friend, a crew of skaters and motley street teens imagine their own rituals to commemorate her on their own terms. Driving Lessons , directed and written by Marziyeh Riahi. According Iranian law, Bahareh must have her traditional, chauvinistic husband accompany her on driving lessons so she and her instructor will not be alone. In Persian with English subtitles. Maja, a six-year-old Serbian girl, has a difficult time interacting with the other kids—and she ends up being misunderstood and lonesome.