Monitoring the wild black bear's reaction to human and environmental stressors

Background

Bears are among the most physiologically remarkable mammals. They spend half their life in an active state and the other half in a state of dormancy without food or water, and without urinating, defecating, or physical activity, yet can rouse and defend themselves when disturbed. Although important data have been obtained in both captive and wild bears, long-term physiological monitoring of bears has not been possible until the recent advancement of implantable devices.

Results

Insertable cardiac monitors that were developed for use in human heart patients (Reveal® XT, Medtronic, Inc) were implanted in 15 hibernating bears. Data were recovered from 8, including 2 that were legally shot by hunters. Devices recorded low heart rates (pauses of over 14 seconds) and low respiration rates (1.5 breaths/min) during hibernation, dramatic respiratory sinus arrhythmias in the fall and winter months, and elevated heart rates in summer (up to 214 beats/min (bpm)) and during interactions with hunters (exceeding 250 bpm). The devices documented the first and last day of denning, a period of quiescence in two parturient females after birthing, and extraordinary variation in the amount of activity/day, ranging from 0 (winter) to 1084 minutes (summer). Data showed a transition toward greater nocturnal activity in the fall, preceding hibernation. The data-loggers also provided evidence of the physiological and behavioral responses of bears to our den visits to retrieve the data.

Conclusions

Annual variations in heart rate and activity have been documented for the first time in wild black bears. This technique has broad applications to wildlife management and physiological research, enabling the impact of environmental stressors from humans, changing seasons, climate change, social interactions and predation to be directly monitored over multiple years.     

Should all patients receive dual chamber pacing ICDs? The rationale for the DAVID trial

All of the prospective multicenter trials that support the use of implantable defibrillators have used single chamber pacemakers/implantable cardiovertor defibrillators (ICDs). Despite the significantly increased cost of dual chamber pacemaker/ICD devices and the lack of outcome data, these devices accounted for approximately two-thirds of the ICDs implanted in the United States during the 12 months ending April 2001. Dual chamber pacemaker trials have not provided data that would support this trend, but the high incidence of atrial fibrillation, bradycardia, and congestive heart failure, as comorbid conditions, suggest that the situation could be different in the defibrillator patient population. The DAVID (Dual Chamber and VVI Implantable Defibrillator) trial is designed to measure the incremental benefit of dual chamber pacemaker/ICDs.     

Implantable diagnostic and therapeutic devices in children

Many advances have been made in the use of implantable diagnostic and therapeutic devices in adults. In children the indications for and diagnostic and therapeutic value of these devices still have to be determined.Our aim is to provide an overview of the clinical use of diagnostic and therapeutic devices in children. The role of implantable loop recorders (ILR), the feasibility and safety of transvenous pacing in neonates, the value of permanent pacing in children with recurrent syncope or reflex anoxic seizures and the role of implantable cardioverter defibrillator devices are highlighted with relevant case histories.     

Novel technology for the provision of power to implantable physiological devices.

We report the development of a novel technology that enables the wireless transmission of sufficient amounts of power to implantable physiological devices. The system involves a primary unit generating the magnetic field and a secondary pickup unit deriving power from the magnetic field and a power conditioner. The inductively coupled system was able to supply a minimum of 20 mW at all locations and pickup orientations across a rat cage, although much higher power of up to 10 W could be achieved. We hypothesized that it would be possible to use this technology to record a high-fidelity ECG signal in a conscious rat. A device was constructed in which power was utilized to recharge a battery contained within a telemetry device recording ECG signal sampled at 2,000 Hz in conscious rats (200-350 g) living in their home cage. Attributes of the ECG signal (QT, QRS, and PR interval) could be obtained with a high degree of accuracy (<1 ms). ECG and heart rate changes in response to treatment with the beta blocker propranolol and the proarrhythmic alkaloid aconitine were measured. Transmitters were implanted for up to 4 mo, and the characteristic circadian variation in heart rate was recorded. Such technology allows potentially lifetime monitoring without the need for implant refurbishment. The ability to provide suitable power levels to implanted devices without concern to the orientation of the device and without causing heating provides the basis for the development of new devices to record or influence physiological signals in animals or humans over significantly longer time periods than can currently be accommodated.     

Analyte flux through chronically implanted subcutaneous polyamide membranes differs in humans and rats

The rat is commonly used to evaluate physiological responses of subcutaneous tissue to implanted devices. In vivo longevity of various devices and the biocompatibility of biomaterials depend on how adjacent tissue interacts. How closely the rat model predicts the human response has not been well characterized. The objective of this study was to compare rat and human subcutaneous foreign body responses by monitoring the biochemical environment at a polymer-tissue interface over 8 days using microdialysis. Polyamide microdialysis probes were implanted subcutaneously in humans and rats (n = 12). Daily microdialysis samples were analyzed for glucose, lactate, pyruvate, glycerol, and urea. Blood glucose was also monitored. Analyte concentrations differed significantly between rats and humans at the implant-tissue interface. There were also qualitative differences in the 8-day trends. For example, over 8 days, microdialysate glucose increased two- to fourfold in humans but decreased in rats (P < 0.001). This study reveals profound physiological differences at material-tissue interfaces in rats and humans and highlights the need for caution when extrapolating subcutaneous rat biocompatibility data to humans.     

Remote monitoring and follow-up of cardiovascular implantable electronic devices in the Netherlands : An expert consensus report of the Netherlands Society of Cardiology

Remote monitoring of cardiac implanted electronic devices (CIED: pacemaker, cardiac resynchronisation therapy device and implantable cardioverter defibrillator) has been developed for technical control and follow-up using transtelephonic data transmission. In addition, automatic or patient-triggered alerts are sent to the cardiologist or allied professional who can respond if necessary with various interventions. The advantage of remote monitoring appears obvious in impending CIED failures and suspected symptoms but is less likely in routine follow-up of CIED. For this follow-up the indications, quality of care, cost-effectiveneness and patient satisfaction have to be determined before remote CIED monitoring can be applied in daily practice. Nevertheless remote CIED monitoring is expanding rapidly in the Netherlands without professional agreements about methodology, responsibilities of all the parties involved and that of the device patient, and reimbursement. The purpose of this consensus document on remote CIED monitoring and follow-up is to lay the base for a nationwide, uniform implementation in the Netherlands. This report describes the technical communication, current indications, benefits and limitations of remote CIED monitoring and follow-up, the role of the patient and device manufacturer, and costs and reimbursement. The view of cardiology experts and of other disciplines in conjunction with literature was incorporated in a preliminary series of recommendations. In addition, an overview of the questions related to remote CIED monitoring that need to be answered is given. This consensus document can be used for future guidelines for the Dutch profession.     

Patient perspective on remote monitoring of cardiovascular implantable electronic devices: rationale and design of the REMOTE-CIED study

Background

Remote patient monitoring is a safe and effective alternative for the in-clinic follow-up of patients with cardiovascular implantable electronic devices (CIEDs). However, evidence on the patient perspective on remote monitoring is scarce and inconsistent.

Objectives

The primary objective of the REMOTE-CIED study is to evaluate the influence of remote patient monitoring versus in-clinic follow-up on patient-reported outcomes. Secondary objectives are to: 1) identify subgroups of patients who may not be satisfied with remote monitoring; and 2) investigate the cost-effectiveness of remote monitoring.

Methods

The REMOTE-CIED study is an international randomised controlled study that will include 900 consecutive heart failure patients implanted with an implantable cardioverter defibrillator (ICD) compatible with the Boston Scientific LATITUDE® Remote Patient Management system at participating centres in five European countries. Patients will be randomised to remote monitoring or in-clinic follow-up. The In-Clinic group will visit the outpatient clinic every 3–6 months, according to standard practice. The Remote Monitoring group only visits the outpatient clinic at 12 and 24 months post-implantation, other check-ups are performed remotely. Patients are asked to complete questionnaires at five time points during the 2-year follow-up.

Conclusion

The REMOTE-CIED study will provide insight into the patient perspective on remote monitoring in ICD patients, which could help to support patient-centred care in the future.     

Remote monitoring of implanted cardiac devices: a plea for a nationwide exploration

Remote monitoring of implanted cardiac devices is an evolving method for regular checks of their electronic integrity and functioning. The communication with the devices is carried out unsupervised with wireless trans-telephonic or cable-dependent linkage. The interrogation of the device examines several programmed functions and harvests the stored data of numerous events. The collected data constitute the base to decide whether the implanted device is operating properly and can give some information about the physical condition of the device recipient. Preliminary short-term results show favourable effects in terms of safety and cost and time saving as compared with the current face-to-face visits of conventional patient follow-ups. Remote monitoring of implanted devices will extend markedly in the coming years and its development touches many questions ranging from technical accuracy, patient benefit, cost-effectiveness and responsibilities of the provider and receivers of the delivered device data, to the role of the cardiologist and allied professionals and of course privacy rules. In this point of view, these questions are discussed in order to explore the consequences of device remote monitoring with nationwide Trials. (Neth Heart J 2009;17:434–7.)     

An implantable transmitter for monitoring heart rate and respiratory frequency in diving ducks.

An implantable telemetry transmitter is described for monitoring respiratory frequency and heart rate in animal physiological studies. The ECG is transmitted directly while the respiratory signal, derived from the temperature variation of the air in the respiratory tract, modulates the frequency of a subcarrier oscillator. A magnetic switch allows the implanted device to be switched on and off remotely. Details are given of the high packing density achieved by a modified cordwood method of construction. This system is being used to investigate the changes in heart rate and respiratory frequency associated with spontaneous diving in ducks, and typical results are presented.     

一种新型植入式装置无线数据传输方法

提出了一种植入式装置无线数据传输方法,以射频电磁波作为信息传输媒介,实现体内植入式装置与体外程控仪的双向通信。文中提出的＂b it-by-b it＂遥测方式可以显著降低起搏器等植入式装置的功耗,延长其使用寿命。     

Un-LINQed: Spontaneous extrusion of newer generation implantable loop recorders

BackgroundInsertable cardiac monitors (ICMs) are often used for long-term monitoring of cardiac rhythm. The Medtronic’s LINQ Reveal ™ is a new generation wireless, automated, and patient responsive subcutaneous ECG monitoring device. Despite several advantages to its small size we have noted an unusually high incidence of extrusion at our center.Methods& Results: We conducted a retrospective case analysis to review Reveal LINQs implanted at our center. All devices were inserted using the provided insertion tools. Patients with extruded devices were identified and details regarding the site and technique of insertion, incision closure, use of peri-operative antibiotics, and follow-up details were collected. 81 patients underwent 85 Reveal LINQ implants at a tertiary care University Hospital referral center. The most common reason for implant was suspected arrhythmia with or without structural heart disease or unexplained syncope. There were 4 spontaneous extrusions occurring within 7–24 days after insertion with an incidence rate of 4.7%. One extruded device was anchored to subcutaneous tissue, and no pocket/device infections or hematomas were noted.ConclusionsDevice migration and erosion through skin are important potential adverse events for the Reveal LINQ implantable loop recorder. This study reports an unexpectedly high rate of extrusion without infection. The authors suggest that the depth of the incision is the main factor impacting extrusions. Larger studies are recommended, however, and a proposed measure to avoid spontaneous extrusion is the design of a longer manufacturer’s blade in order to increase the depth of the incision and insertion.     

Recent Advances in Nanogenerator‐Driven Self‐Powered Implantable Biomedical Devices

Implantable medical devices (IMDs) have experienced a rapid progress in recent years to the advancement of state‐of‐the‐art medical practices. However, the majority of this equipment requires external power sources like batteries to operate, which may restrict their application for in vivo situations. Furthermore, these external batteries of the IMDs need to be changed at times by surgical processes once expired, causing bodily and psychological annoyance to patients and rising healthcare financial burdens. Currently, harvesting biomechanical energy in vivo is considered as one of the most crucial energy‐based technologies to ensure sustainable operation of implanted medical devices. This review aims to highlight recent improvements in implantable triboelectric nanogenerators (iTENG) and implantable piezoelectric nanogenerators (iPENG) to drive self‐powered, wireless healthcare systems. Furthermore, their potential applications in cardiac monitoring, pacemaker energizing, nerve‐cell stimulating, orthodontic treatment and real‐time biomedical monitoring by scavenging the biomechanical power within the human body, such as heart beating, blood flowing, breathing, muscle stretching and continuous vibration of the lung are summarized and presented. Finally, a few crucial problems which significantly affect the output performance of iTENGs and iPENGs under in vivo environments are addressed.     

Psychological intolerance to implantable cardioverter defibrillator

Background: Implantable cardioverter defibrillators (ICD) are mobile implantable cardiac devices for immediate treatment of live threatening ventricular arrhythmias. However, these devices can affect patients, physiologically, psychologically and have effects on electrical devices. Case report: The case of a 61-year-old patient is reported. The patient came for regular 3-months visits with his ICD and complained about electromagnetic interference with all household electrical appliances, especially refrigerator and digital television set-top box. He described several phantom shocks when he came close to the electrical appliances. He noted the exact times and symptoms of the episodes but the device memory did not record anything. Conclusion: This case demonstrates the rare occurrence of psychological intolerance to implanted ICD shortly after implant. The device was programmed for higher sensitivity. The patient was calmed and reassured about the reprogramming.     

Utilisation of cardiac pacemakers over a 20-year period: Results from a nationwide pacemaker registry

The implantation of cardiac pacemakers has become a well-established therapy for conduction disorders and sinus node dysfunction. In many countries pacemaker registries have been initiated in order to collect information on patient characteristics, trends in numbers and the types of pacemakers used, to identify problematic devices, and for safety monitoring. For this utilisation study the Central Pacemaker Patients Registration (CPPR) from the Netherlands Pacemaker Registry Foundation (CPPR-SPRN) containing data collected for more than 20 years was used. During this period nearly 97,000 first pacemakers were implanted. Analyses show an increase in the rate of implanted devices. The change in pacemaker type from VVI to DDD, followed by biventricular stimulation, is reflected by the number of simultaneously implanted leads, which is partly a consequence of cardiac resynchronisation therapy. Our data demonstrate that indications for implantation and type of pacemaker are comparable with other European countries.     

Factors that Determine Human Acceptance of Black Bears

After being extirpated from their historical distribution, black bears (Ursus americanus) have recolonized eastern Oklahoma, USA. As bears continue to establish populations in the region, understanding the cognitive factors that influence human acceptance of black bears will play an important role in facilitating coexistence. We hypothesized that a variety of variables drawing from the cognitive hierarchy and risk perception frameworks would affect human acceptance of black bears in eastern Oklahoma. We collected data using a mail-back questionnaire administered to residents of eastern Oklahoma between August and November 2018. Perceptions of the current black bear population size, attitudes toward bears, valuing Oklahoma wildlife, behavioral intentions, and level of formal education all positively influenced acceptance of bears. Risk-averse respondents and women were less accepting. Outreach to women and encouraging residents to reduce conflict by adopting bear-safe behaviors may help raise acceptance capacity for black bears. © 2021 The Wildlife Society.     

Subcutaneous implantable infusion device for chronic intravenous pulsatile gonadotropin-releasing hormone treatment

Preliminary data indicate the potential utility of an implantable subcutaneous device that facilitates chronic intravenous infusion of pulsatile gonadotropin-releasing hormone (GnRH) for ovulation induction. GnRH distribution curves were congruent in control monkeys and those with implanted devices. Tissue tolerance was good in this brief trial. These findings suggest that use of this or a similar implantable device be considered for chronic GnRH administration in human pulse therapy.     

无线遥测和刺激技术建立兔房颤模型的探索

目的探索一种在无线遥测和刺激技术基础上的兔房颤模型的制作。方法新西兰兔皮下植入自主研发的植入式遥测刺激器,植入式遥测刺激器的制作是以TI公司（德州仪器）的MSP单片机和TI公司的RF无线收发芯片CC2250为核心开发设计。优化植入系统设计以满足新西兰兔房颤模型建立的探索实验;植入子植入新西兰兔腹部皮下,采集电极留置于左上肢和右上肢腋下皮下,两个刺激电极分别缝合于左心耳和左心房上,通过无线收发采集和刺激信号;实现利用Powerlab生理记录仪连续监测体表I导联心电信号,并通过专用计算机程序刺激软件,发放间歇（刺激2 s,暂停2 s）高频（频率20 Hz）阈上（强度2 mA,脉宽1 ms）刺激,若间歇期内出现房颤,则人为干预中止刺激,若转为窦性心律,则继续刺激。结果植入式遥测刺激器在体内可稳定工作（包括采集模拟心电信号和发放刺激）30 d,植入新西兰兔体内刺激3周后可诱导出房颤,持续时间〉48 h。结论用新西兰兔代替比格犬建立基于无线遥测和刺激基础上的房颤模型是完全可行的,同时也体现了动物福利优化和替代原则。     

Directness of resource use metrics affects predictions of bear body fat gain

Many North American ursids rely on an annual hyperphagic period to obtain fat reserves necessary for winter survival and reproduction. Identifying causes of variation in body fat gain may improve understanding of how bear resource use affects body condition. We used data from southcentral Alaska to model changes in percentage body fat of adult female American black bears (Ursus americanus) in 1998 and 2000 and brown bears (Ursus arctos) in 2000. We used year, proportion of radio locations in different habitats, distance to streams containing salmon (Onchorynchus spp.), and degree of radio location clustering as predictors for black bears and elevation, distance to streams containing salmon, and degree of radio location clustering as predictors for brown bears. Degree of location clustering was the only predictor variable supported by parameter coefficients in black bear models, supporting our hypothesis that metrics of energetics perform better as predictors of body condition than habitat use. With every unit increase in location clustering black bear body fat increased 2 %. No predictor variables influenced variation in brown bear change in body fat. Some variables previously found useful for predicting bear presence (e.g., habitat) were not useful in predicting changes in body fat, an important biological outcome for these species. Rather than assuming fitness benefits of habitat-level selection, we recommend including metrics of energetics that might more directly influence biological outcomes.     

Diagnosing acute liver graft rejection: experimental application of an implantable telemetric impedance device in native and transplanted porcine livers

BACKGROUND AND AIMS: Diagnosis of acute rejection is a complex and persistent problem in liver transplantation. Focused on the use of proprietary impedance technology a porcine liver model was designed to provide immediate information for differentiation of normal and acute rejecting tissue by an implantable telemetric device. METHODS: Electrical impedance was analyzed by electrodes implanted in vitro and in vivo in the liver of pigs, where impedance is derived from measurements of voltage transients produced in response to programmed current pulses. Consequent electric recordings in porcine livers after transplantation and after mere laparotomy were evaluated in relation to biochemical parameters and histological results of liver biopsies. RESULTS: Acute rejection was correctly predicted in all cases and correctly excluded in the remaining 32 biopsy related impedance recordings (P<0.004). Impedance measurements not only correlated with the diagnosis from liver biopsy specimen (r=0.84, P<0.0001) but also exemplified the severity of histological acute rejection. CONCLUSION: Impedance analysis reveals evident physiologic relation of acute liver graft rejection and electrical organ properties. Electrodes implanted in transplanted porcine livers allow running less invasive monitoring and thus early detection of rejection. The technology may have broad value in providing an immediate diagnosis of acute rejection, reducing unnecessary patient anxiety and eliminating the significant expenses associated with multiple referrals, expensive sample handling and tissue analysis.