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Before proceeding to discuss the pre-clinical and clinical uses of pulsatility measures, it is important to understand the techniques for measuring pulsatility in the brain. Three primary techniques have been used to quantify aspects of intracranial pulsatility: continuous ICP monitoring, transcranial Doppler ultrasound (TCD), and magnetic resonance imaging (MRI). ICP monitoring, which is invasive, is used to measure pressure pulsatility and requires placement of a pressure sensor within the brain, either in parenchyma, ventricle, epidural space or the spinal CSF space. In comparison, TCD and MRI provide measures of flow pulsatility and have the distinct advantage of being non-invasive: TCD measures the velocity of blood flow in the large arteries using a transducer placed against the skull, while MRI measures the net flow waveform over the cardiac cycle, within the large intracranial arteries or veins or within well-defined CSF pathways (e.g., the cerebral aqueduct or at the craniocervical junction (CCJ)). Thus, ICP is a pressure-based measure of pulsatility, while TCD and MRI are flow-based. Accordingly, it is important to keep in mind that comparing pulsatility measures across modalities is not always valid, because the methods are not equivalent and assess different aspects of cardiac pulsatility. Examples of single cycle pulse waves using these three methods are illustrated in Figure 3.
Example of time- and frequency-domain pressure recordings. In most clinical applications, data are presented, and analyzed, in the time domain (upper panel). In this case, the pressure is plotted as a function of time. In this example, the mean pressure (5.9 mmHg) as well as the pulse pressure (2.7 mmHg) can be extracted from the plot, although there can be confounding modulation of the pulse pressure from other sources such as respiration. Timing information can be extracted from the difference in timing of the peaks or troughs of the signal compared to the reference waveform (PPG, photoplethysmograph, in this case). In comparison, pressure data analyzed in the frequency domain is represented as a function of frequency (lower panel), and the signal now has well defined cardiac components which are easily separated from the low frequency components such as respiration and can be analyzed independently. Additional information available with frequency-domain analysis is the phase, the frequency-domain analog of timing in the time-domain (not shown). The phase plot allows analysis of timing differences between the ICP and the reference waveform for each identified frequency component.
The output of a TCD measurement is a velocity waveform as a function of time, for the entire recording period which is typically many cardiac cycles. This waveform can then be quantified in terms of the amplitude of the waveform, which is generally expressed as the PI, calculated as (peak systolic velocity - peak diastolic velocity)/mean velocity. Because it is normalized to the mean velocity, this is a measure of relative vascular pulsatility. A relative measure is used because of the difficulty of quantifying absolute velocity in a vessel; the velocity measured can vary dramatically depending on the size of the vessel, and the angle between the transducer and the vessel. PI, however, is insensitive to these experimental details and is a good gauge of changes in arterial pulsatility. One potential issue with PI measures, as compared to absolute pulsatility measures, is the dependence on both pulsatility and mean velocity; an increase in PI may not be strictly due to an increase in pulsatility but may also arise due to a decrease in mean velocity (e.g., decreased blood flow). Another measure frequently used clinically which is related to the PI is the resistive index (RI), defined as (peak systolic velocity - peak diastolic velocity)/peak systolic velocity. The advantage of RI is that it does not require integration of the flow parameter to determine mean velocity. RI has been associated with the probability of requiring a shunt in neonates with post-hemorrhagic hydrocephalus [41], although it is virtually certain that the PI would have made similar predictions in this setting.
ILLUSTRATIONSThe sheaves are beaten with flails . . . . Frontispiece "Cherokee" - my father's place . . . . 4Bonaparte . . . . 7Each field has a small flood-gate called a "trunk" . . . . 9Marcus began work on the breaks . . . . 10"The girls shuffled the rice about with their feet until it was clayed" . . . . 11Near the bridge two negro women are fishing . . . . . 14A request from Wishy's mother, Annette, for something to stop bleeding . . . . 17Green thought it was folly and fussiness . . . . 27She picked her usual thirty-five pounds alone . . . . 31To-day the hands are "toting" the rice into the flats . . . . 34"You see a stack of rice approaching, and you perceive a pair of legs, or a skirt, as the case may be, peeping from beneath" . . . . 35Chloe . . . . 40Front porch - Casa Bianca . . . . 42Elihu was a splendid boatman . . . . 51My little brown maid Patty is a new acquisition and a great comfort, for she is very bright . . . . 53The roughness and plainness of the pineland house . . . . 54The yearly pow-wow at Casa Bianca . . . . 60"Four young girls who are splendid workers" . . . . 62She promised not to war any more . . . . 65"Myself, ma'am, bin most stupid" . . . . . 66A rice field "flowed" . . . . 72The hoe they consider purely a feminine implement . . . . 79The back steps to the pineland house . . . . 84"A very large black hat" . . . . 87Her husband brought her in an ox cart . . . . 93"Old Maum Mary came to bring me a present of sweet potatoes" . . . . 98"Pa dey een 'e baid" . . . . 102One or two hands in the barn-yard . . . . 107A corner of Casa Bianca . . . . . 109 Page xii"Chaney" . . . . 112Five children asked me to let them "hunt tetta" . . . . 120"It is tied into sheaves, which the negroes do very skilfully, with a wisp of the rice itself" . . . . 122"The field with its picturesque workers" . . . . 124"The Ferry" . . . . 132His wife was very stirring . . . . 136Day after day I met Judy coming out of her patch . . . . 138"Old Florinda, the plantation nurse" . . . . 144"Miss Patience, le' me len' yer de money" . . . . 150"Jus' shinin' um up wid de knife-brick" . . . . 159Aphrodite spread a quilt and deposited the party upon it . . . . 164"Then he could talk a-plenty" . . . . 171Chloe is devoted to the chicks - feeds them every two hours . . . . 174Prince Frederick's Pee Dee . . . . 178Prince George Winyah . . . . 180"Eh, eh, I yere say yu cry 'bout chicken" . . . . 187The summer kitchen at Cherokee . . . . 188The winter kitchen at Cherokee . . . . 189The string of excited children . . . . 190I got Chloe off to make a visit to her daughter . . . . 198I really do not miss ice, now that my little brown jug is swung in the well . . . . 200Patty came in . . . . 210"Plat eye!" . . . . 216Goliah cried and sobbed . . . . 225Had Eva to sow by hand a little of the inoculated seed . . . . 232Her little log cottage was as clean as possible . . . . 236The sacred spot with its heavy live oak shadows . . . . 242"I met Dab on the road" . . . . 249Cherokee steps . . . . 250The smoke-house at Cherokee for meat curing . . . . 260Sol's wife, Aphrodite, is a specimen of maternal health and vigor . . . . 262I saw a raft of very fine poplar logs being made . . . . 263Cypress trees . . . . 265She was a simple, faithful soul - always diligent . . . . 270Winnowing house for preparation of seed rice . . . . 272"Patty en Dab en me all bin a eat" . . . . 276Chloe began: "W'en I bin a small gal" . . . . 288I took Chloe to Casa Bianca to serve luncheon . . . . 299 Page xiii"I read tell de komfut kum to me" . . . . 309"Up kum Maum Mary wid de big cake een de wheelbarrer" . . . . 311Gibbie and the oxen . . . . 313In the field - sowing . . . . 317How to lay the breakfast table . . . . 321Joy unspeakable . . . . 326The church in Peaceville . . . . 331Chloe was a great success at the North . . . . 338My old summer home at Pawleys Island . . . . 349The roof of the house on Pawleys Island - from the sand-hills . . . . 352"En de 'omens mek answer en say: 'No, ma'am; we neber steal none' " . . . . 356"Dem all stan' outside de fence" . . . . 367Fanning and pounding rice for household use . . . . 375Pounding rice . . . . 376The rice-fields looked like a great lake . . . . 399Casa Bianca . . . . 422Rice-fields from the highlands . . . . 439"You see I didn't tell no lie" . . . . 442 Page 1A WOMAN RICE PLANTERCHAPTER ICHEROKEE, March 30,1903. 2ff7e9595c
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