EPILEPSIA, Issue 8 2001
Giancarlo Logroscino
Summary: ,Purpose: Status epilepticus (SE) is a medical emergency associated with a high mortality. Clinical series have suggested that mortality after SE has decreased. No studies have systematically examined trends in incidence, mortality, and case fatality after SE in a well-defined population. Methods: All first episodes of SE receiving medical attention between January 1, 1935, and December 31, 1984, were ascertained through the Rochester Epidemiology Project Records-Linkage System and followed up until death or study termination (February 1, 1996). We calculated incidence rates in the 50-year period (1935,1984), while we considered mortality and case-fatality in the last 30-year period (1955,1984). Results: Incidence of SE increased over time to 18.1/100,000 (1975 through 1984). The increase was related to an increased incidence in the elderly and to the advent of myoclonic SE after cardiac arrest, a condition not seen in the early decades. In the last decade, ,16% of the incidence was due to myoclonic SE. The mortality rates increased from 3.6 per year in the decade 1955,1965 to 4.0/100,000 per year between 1975 and 1984. The 30-day case-fatality (CF) was unchanged, although a trend toward improvement was shown after excluding myoclonic SE. Conclusions: Incidence and mortality rates of SE have increased in the last 30 years. Case fatality remained the same. The increased incidence and mortality are due to the occurrence in the last decade of myoclonic SE after cardiac arrest. The mortality in the elderly was twice that of the youngest age group, across all study periods. Changes in the age and cause distribution of SE over time are responsible for the stable survivorship. There is improvement in survivorship in the last decade when myoclonic SE is excluded. [source]

Geoarchaeology and late glacial landscapes in the western lake superior region, Central North America

GEOARCHAEOLOGY: AN INTERNATIONAL JOURNAL, Issue 1 2007
Christopher L. Hill
The transition from full glacial to interglacial conditions along the southern margin of the Laurentide ice sheet resulted in dramatic changes in landscapes and biotic habitats. Strata and landforms resulting from the Wisconsin Episode of glaciation in the area directly west of Lake Superior indicate a context for late Pleistocene biota (including human populations) connected to ice margins, proglacial lakes, and postglacial drainage systems. Late Glacial landscape features that have the potential for revealing the presence of Paleoindian artifacts include abandoned shorelines of proglacial lakes in the Superior and Agassiz basins and interior drainages on deglaciated terrains. The linkage between Late Pleistocene human populations and Rancholabrean fauna has yet to be demonstrated in the western Lake Superior region, although isolated remains of mammoth ( Mammuthus) have been documented, as well as fluted points assigned to Clovis, Folsom, and Holcombe-like artifact forms. Agate Basin and Hell Gap (Plano-type) artifacts also imply the presence of human groups in Late Glacial landscapes associated with the Agassiz and Superior basins. © 2007 Wiley Periodicals, Inc. [source]

Johnson's Prayerful Puritanism: An Episode in the Life of Milton

MILTON QUARTERLY, Issue 3 2010
Marc Ricciardi
First page of article [source]

Incontinentia Pigmenti: An Extensive Second Episode of a "First-Stage" Vesicobullous Eruption

PEDIATRIC DERMATOLOGY, Issue 1 2000
PH.D., R. L. Van Leeuwen M.D.
[source]

Predictors of Residential Placement Following a Psychiatric Crisis Episode Among Children and Youth in State Custody

AMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 2 2009
Jung Min Park PhD
This study examined the extent and correlates of entry into residential care among 603 children and youth in state custody who were referred to psychiatric crisis services. Overall, 27% of the sample was placed in residential care within 12 months after their 1st psychiatric crisis screening. Among the children and youth placed in residential care, 51% were so placed within 3 months of their 1st crisis screening, with an additional 22% placed between 3 and 6 months after screening. Risk behavior and functioning, psychiatric hospitalization following screening, older age, placement type, and caregiver's capacity for supervision were associated with increased residential placement. The findings highlight the importance of early identification and treatment of behavior and functioning problems following a crisis episode among children and youth in state custody to reduce the need for subsequent residential placement. Having an inpatient psychiatric episode following a crisis episode places children at greater risk for residential placement, suggesting that the hospital is an important point for diversion programs. Children and youth in psychiatric crisis may also benefit from efforts to include their families in the treatment process. [source]

Islamic Modernism, Nationalism, and Fundamentalism: Episode and Discourse , Mansoor Moaddel

THE HISTORIAN, Issue 4 2006
David Owusu-Ansah
No abstract is available for this article. [source]

Eine goldene Episode in der farbenfrohen Geschichte des Fenton-Reagens,

ANGEWANDTE CHEMIE, Issue 32 2010
George
Spannende Untersuchungen zum Fenton-Reagens, das in der Lage ist, Unebenheiten auf einer Goldoberfläche selektiv zu glätten und dadurch katalytische Zentren zu beseitigen, eröffnen neue Einsatzmöglichkeiten: Das Fenton-Reagens könnte genutzt werden, um die Oberflächen von Mikro- und Nanopartikeln aus Gold und anderen Metallen zu verändern, um auf kostengünstigem Weg zu aktiveren Katalysatoren zu gelangen (siehe Abbildung). [source]

Frequency of Seborrheic Keratosis Biopsies in the United States: A Benchmark of Skin Lesion Care Quality and Cost Effectiveness

DERMATOLOGIC SURGERY, Issue 8 2003
Maria I. Duque MD
Background. Most seborrheic keratoses may be readily clinically differentiated from skin cancer, but occasional lesions resemble atypical melanocytic neoplasms. Objective. To evaluate the frequency, cost, and intensity of procedures performed that result in the removal and histopathologic evaluation of seborrheic keratoses. Methods. Episodes of surgical removal of lesions that were identified as seborrheic keratoses by histologic identification were determined using Medicare Current Beneficiary Survey data from 1998 to 1999. These episodes were defined by a histopathology procedure code that is associated with a diagnosis code for seborrheic keratosis. We then identified what procedure(s) generated the histopathology specimen. Biopsy and shave procedures were considered "low intensity," whereas excision and repair procedures were considered "high intensity." Results. Dermatologists managed 85% of all episodes of seborrheic keratoses. Dermatologists managed 89% of seborrheic keratosis episodes using low-intensity procedures compared with 51% by other specialties. For nondermatologists, 46% of the treatment cost ($9 million) to Medicare was generated from high-intensity management compared with 15% by dermatologists ($6 million). Conclusion. There is a significant difference in the management of suspicious pigmented lesions between dermatologists and other specialists. This affects both the cost and quality of care. [source]

Do Crises Induce Reform?

ECONOMICS & POLITICS, Issue 2 2001
Simple Empirical Tests of Conventional Wisdom
We find evidence for the crisis-induces-reform hypothesis at extreme values of the inflation rate and the black market premium. Episodes of extremely high inflation or black market premiums are followed by periods of better performance than episodes of moderately high inflation or black market premiums. We fail to find similar evidence of the crisis hypothesis when crisis is measured as a high current account deficit, a high budget deficit, or a negative per capita growth rate. The pattern of foreign aid disbursements may help explain the results. Foreign aid is reduced at extreme values of inflation or the black market premium, while it is actually increased for more extreme values of the current account deficit and the budget deficit. [source]

Hearing loss in Fabry disease: data from the Fabry Outcome Survey

EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 9 2006
S. Hegemann
Abstract Background, Hearing loss is a common symptom in Fabry disease, but neither its natural course nor its aetiology has been defined precisely. The aim of this study was to provide a detailed epidemiological description of hearing impairment in patients in the Fabry Outcome Survey (FOS), which is the largest available database of Fabry patients. Materials and methods, Questionnaires were completed by 566 Fabry patients, of whom 316 reported ear-related symptoms. Pure-tone audiograms from 86 patients, performed before starting enzyme replacement therapy, were analysed and compared with age- and sex-specific normal values (International Organization for Standardization, ISO 7029). Results, When compared to an age-matched population (ISO 7029), 74% of patients had a threshold elevated above the 95th centile in at least one tested frequency. All frequencies were affected to a similar degree. However, only 14 patients (16%) were clinically affected by hearing impairment according to the age-independent World Health Organization (WHO) classification (mean threshold at 0·5, 1 and 2 kHz worse than 25 dB). Hearing loss was sensorineural in 63 patients (73%) of whom 7 patients (8%) had also a conductive component. One patient had a purely conductive hearing loss. Episodes of sudden hearing loss seemed to occur more frequently than in the general population. Men were affected earlier and more severely than women. Conclusions, Hearing in Fabry disease is significantly worse than in an age-matched general population but leads to clinically relevant hearing impairment in only 16% of cases. It resembles accelerated presbycusis with an additional Fabry-specific strial-type hearing loss. [source]

Dysautonomia after severe traumatic brain injury

EUROPEAN JOURNAL OF NEUROLOGY, Issue 9 2010
H. T. Hendricks
Background:, Dysautonomia after traumatic brain injury (TBI) is characterized by episodes of increased heart rate, respiratory rate, temperature, blood pressure, muscle tone, decorticate or decerebrate posturing, and profuse sweating. This study addresses the incidence of dysautonomia after severe TBI, the clinical variables that are associated with dysautonomia, and the functional outcome of patients with dysautonomia. Methods:, A historic cohort study in patients with severe TBI [Glasgow Coma Scale (GCS) , 8 on admission]. Results:, Seventy-six of 119 patients survived and were eligible for follow-up. The incidence of dysautonomia was 11.8%. Episodes of dysautonomia were prevalent during a mean period of 20.1 days (range 3,68) and were often initiated by discomfort. Patients with dysautonomia showed significant longer periods of coma (24.78 vs. 7.99 days) and mechanical ventilation (22.67 vs. 7.21 days). Dysautonomia was associated with diffuse axonal injury (DAI) [relative risk (RR) 20.83, CI 4.92,83.33] and the development of spasticity (RR 16.94, CI 3.96,71.42). Patients with dysautonomia experienced more secondary complications. They tended to have poorer outcome. Conclusions:, Dysautonomia occurs in approximately 10% of patients surviving severe TBI and is associated with DAI and the development of spasticity at follow-up. The initiation of dysautonomia by discomfort supports the Excitatory: Inhibitory Ratio model as pathophysiological mechanism. [source]

Impact of history or onset of chronic medical conditions on higher-level functional capacity among older community-dwelling Japanese adults

GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 2003
Yoshinori Fujiwara
Background: Many studies have examined the impact of chronic medical conditions on the age-related decline in basic activities of daily living (BADL) and the instrumental activities of daily living (IADL), but less is known concerning the influence of chronic disease on physical, cognitive, social, and economic aspects of higher-level functional capacity. Methods: Subjects comprised 793 and 725 persons aged 65,84 years, living in an urban and a rural Japanese community, respectively. A baseline interview established any history of chronic medical conditions. Four years later, a second interview again assessed chronic disease, and higher-level functional capacity was evaluated using the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence. Results: Multiple logistic regression analysis revealed that declines in total score and/or any of three subscales of the TMIG Index of Competence were significantly associated with a history of chronic disease, the onset of visual impairment and the development of hearing impairment, even after controlling for the subject's age, gender, educational attainment, and baseline TMIG Index of Competence. Episodes of stroke were significantly associated with declines in IADL. Hypertension, diabetes mellitus, and heart disease were also significantly associated with a decrease in functional competence, although each affected a different subscale of the TMIG Index of Competence. Conclusions: The present results underline the importance of controlling chronic medical conditions through a physically active lifestyle and an appropriate medical regimen in order to limit the age-related decline in functional capacity. [source]

Pseudomigraine With Lymphocytic Pleocytosis: A Calcium Channelopathy?

HEADACHE, Issue 8 2003
Clinical Description of 10 Cases, Genetic Analysis of the Familial Hemiplegic Migraine Gene CACNA1A
Objective.,To report the clinical findings of 10 patients diagnosed with pseudomigraine with lymphocytic pleocytosis and the results of mutational analysis of the CACNA1A gene in 8 of these patients. Background.,Pseudomigraine with lymphocytic pleocytosis, also referred to as headache with neurologic deficits and cerebrospinal fluid lymphocytosis (HaNDL), is characterized by episodic transient neurologic dysfunction associated with moderate to severe headache and cerebrospinal fluid lymphocytic pleocytosis. Episodes are recurrent and the condition is self-limiting. The etiology of this sporadic condition remains unknown, but the episodic nature and its ability to be triggered by angiography is somewhat reminiscent of the phenotypic features of familial hemiplegic migraine, a condition caused by mutations in the CACNA1A gene. Design/Methods.,Utilizing retrospective chart review, we describe the clinical features of pseudomigraine with lymphocytic pleocytosis in 10 patients. Whole blood was taken from 8 patients (2 were lost to follow-up) and used for DNA testing. The CACNA1A gene was screened for mutations using heteroduplex analysis and direct DNA sequencing. Results.,Clinical features of pseudomigraine with lymphocytic pleocytosis included transient episodes of weakness, sensory and visual symptoms, aphasia, and confusion lasting minutes up to 4 hours. Sensory symptoms, typically affecting the face and arm, were the most common presentation. Localization of symptoms did not conform to vascular territories. Headache was typically throbbing and most often bilateral. Genetic analysis did not identify any mutations in the CACNA1A gene. Conclusions.,Similarities between familial hemiplegic migraine and pseudomigraine with lymphocytic pleocytosis include recurrent headache with reversible neurologic deficit, cerebrospinal fluid lymphocytic pleocytosis, and triggers such as angiography. Even so, heteroduplex analysis and DNA sequencing failed to identify any sporadic mutations or shared polymorphisms in the exons or the intron/exon boundaries of the CACNA1A gene. These results do not support a role of the CACNA1A gene in the etiology of pseudomigraine with lymphocytic pleocytosis. [source]

Development of an Algorithm to Identify Pregnancy Episodes in an Integrated Health Care Delivery System

HEALTH SERVICES RESEARCH, Issue 2 2007
Mark C. Hornbrook
Objective. To develop and validate a software algorithm to detect pregnancy episodes and maternal morbidities using automated data. Data Sources/Study Setting. Automated records from a large integrated health care delivery system (IHDS), 1998,2001. Study Design. Through complex linkages of multiple automated information sources, the algorithm estimated pregnancy histories. We evaluated the algorithm's accuracy by comparing selected elements of the pregnancy history obtained by the algorithm with the same elements manually abstracted from medical records by trained research staff. Data Collection/Extraction Methods. The algorithm searched for potential pregnancy indicators within diagnosis and procedure codes, as well as laboratory tests, pharmacy dispensings, and imaging procedures associated with pregnancy. Principal Findings. Among 32,847 women with potential pregnancy indicators, we identified 24,680 pregnancies occuring to 21,001 women. Percent agreement between the algorithm and medical records review on pregnancy outcome, gestational age, and pregnancy outcome date ranged from 91 percent to 98 percent. The validation results were used to refine the algorithm. Conclusions. This pregnancy episode grouper algorithm takes advantage of databases readily available in IHDS, and has important applications for health system management and clinical care. It can be used in other settings for ongoing surveillance and research on pregnancy outcomes, pregnancy-related morbidities, costs, and care patterns. [source]

Episodes of alpine heavy precipitation with an overlying elongated stratospheric intrusion: a climatology

INTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 9 2006
Olivia Martius
Abstract This study discusses the role of stratospheric intrusions (determined as potential vorticity (PV) streamers) as upper-level instigators of heavy precipitation along the Swiss Alpine south side (AS) on a climatological timescale. A climatology of streamers is used compiled on the basis of the ECMWF 40-year re-analysis data set (ERA-40). Days of extreme and heavy precipitation along the Swiss AS are determined from an existing observational Alpine precipitation climatology. For these days, the presence of streamers over western Europe as well as their location and orientation is recorded. On 73% of the extreme precipitation days, a streamer is situated over western Europe. The mean spatial frequency distribution of the streamers on the extreme precipitation days exhibits a structure that resembles in its form and location the ,archetypal heavy precipitation streamer' known from case studies. The frequency maximum is situated over southern England and the west coast of France. The same analysis is applied to three sub-domains (Valais, Grisons, Ticino) along the Swiss AS. Significant differences in the location and the orientation of the streamers for the sub-domains are found. The majority of streamers associated with heavy rain in the western-most sub-domain (Valais) are oriented in a cyclonically-sheared fashion, while for the Ticino the streamers are more anti-cyclonically orientated. Differences for events of increasing severity are analysed by comparing the form, location, amplitude (PV), and persistence of the streamers on extreme and heavy precipitation days. The precipitation distribution is shifted to higher intensities for more persistent streamers. There is no detectable difference found in the form parameters, but the southerly moisture flux into the domain is significantly larger during extreme precipitation days than during heavy precipitation days. Likewise, the seasonal variation in the percentage of streamer-related heavy precipitation, which is highest in autumn (85%), can be related to the seasonal variation of southerly moisture fluxes. Copyright © 2006 Royal Meteorological Society. [source]

Hotel NHS and the acute abdomen , admit first, investigate later

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 12 2009
K. Aryal
Summary Aim:, To determine the financial consequences of a policy of admission first, followed by definitive investigation for patients with an admission diagnosis of suspected acute abdomen. Results:, Over a 1-month period, 122 patients were admitted with a suspected surgical diagnosis of acute abdomen (55 men, 67 women); age range 16,95 years (median: 56.5). Based on surgical operation required (n = 36), death after admission (n = 6, three postoperative deaths) and/or severe surgical illness (n = 17), 56 required surgical inpatient admission, while 66 did not. The patients who did not require admission spent significantly shorter time in hospital than those who required admission (median: 5 days vs. 8.5 days; p = 0.0000). Total hospital hotel and investigation cost (not including ITU or theatre costs) for all 122 patients was £330,468. Overall, £205,468 was consumed by these 56 patients who required admission, while £125,000 was spent on 66 patients whose clinical course did not justify admission; 92% of which was spent on hospital hotel costs and 8% on the cost of imaging and/or endoscopy. Discussion and conclusion:, On a national basis, emergency General Surgery admissions account for 1000 Finished Consultant Episodes per 100,000 population. The findings of this study suggest that this equates to a national NHS spend of £650 million each year, for the hotel costs of patients that could arguably avoid surgical admission altogether. Continuing to admit patients with a suspected acute abdomen first and then requesting definitive investigation makes neither clinical nor economic sense. [source]

Hospital admissions for acute painful crisis in Trinidad and Tobago.

INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 5 2006
Are the British Committee for Standards in Haematology (BCSH) guidelines applicable?
Summary We observed consecutive hospital admissions for acute painful crisis (APC) among adults with Sickle Cell Disease (SCD) over a 6-month period in Trinidad and Tobago. Episodes (111) of APC resulted in 82 admissions of 59 patients. The most common site for pain was the trunk. Patients ranged in age from 17 to 53 years (median: 25). Median length of hospital stay was 4 days. Total dose of Pethidine given per admission ranged from 100 to 1650 mg (median: 525). The mean dose of morphine was 70 mg. Six (7%) of patients were readmitted within 10 days of discharge. Twenty-five (30%) of patients had chest pain at presentation of whom 10 (12%) had consolidation on chest X-ray, defining the acute chest syndrome (ACS). There was one death caused by biliary sepsis. The study revealed seemingly low opiate usage for in-hospital treatment of APC with acceptable rates of readmission. The BCSH 2003 guidelines seemed applicable apart for the choice and route of fluid for rehydration and opiate analgesia. [source]

Multilevel investigation of variation in HoNOS ratings by mental health professionals: a naturalistic study of consecutive referrals

INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 3 2004
R. Ecob
Episodes of mental healthcare in specialist psychiatric services often begin with the assessment of clinical and psychosocial needs of patients by healthcare professionals. Particularly for patients with complex needs or severe problems, ratings of clinical and social functioning at the start of each episode of care may serve as a baseline against which subsequent measures can be compared. Currently, little is known about service variations in such assessments on referrals from primary care. We set out to quantify variability in initial assessments performed by healthcare professionals in three CMHTs in Bristol (UK) using the Health of the Nation Outcome Scales (HoNOS). We tested the hypothesis that variations in HoNOS total and sub-scale scores are related to referral source (general practices), healthcare assessor (in CMHTs) and the assessor's professional group. Statistical analysis was performed using multilevel variance components models with cross-classified random effects. We found that variation due to assessor substantially exceeded that due to referral source (general practices). Furthermore, patient variance differed by assessor profession for the HoNOS , Impairment scores. Assessor variance differed by assessor profession for the HoNOS , Social scores. As HoNOS total and subscale scores show much larger variation by assessor than by referral source, investigations of HoNOS scores must take assessors into account. Services should implement and evaluate interdisciplinary training to improve consistency in use of rating thresholds; such initiatives could be evaluated using these extensions of multilevel models. Future research should aim to integrate routine diagnostic data with continuous outcomes to address selection effects (of patients to assessors) better. Copyright © 2004 Whurr Publishers Ltd. [source]

Comparison of the effectiveness and side-effects of tolterodine and oxybutynin in children with detrusor instability

INTERNATIONAL JOURNAL OF UROLOGY, Issue 2 2006
NIZAMETTIN KILIC
Background:, Treatment with anticholinergic agents is the mainstay of therapy for detrusor instability (DI), a chronic and morbid condition characterized by urge urinary incontinence. The aim of this study is to assess the effectiveness and tolerability of tolterodine and oxybutynin in children with DI. Methods:, A total of 60 children with DI were enrolled, 30 (14 male, 16 female, mean age 7.97 ± 2.71 years) in the tolterodine group and 30 (12 male, 18 female, mean age 7.33 ± 2.23 years) in the oxybutynin group. In this prospective study we reviewed data from 60 children followed for at least 6 months. All of the patients in the study population had a history of dysfunctional voiding. Urodynamic investigations were conducted in all of the patients before and after anticholinergic treatment. Episodes of urge urinary incontinence and adverse events were also evaluated. Results:, Improvements in urge incontinence episodes were similar for the children who received tolterodine or oxybutynin. Improvements in the urodynamic parameters were also the same in the two groups. Adverse events were significantly lower in the tolterodine group (13 events in 13 patients) compared to the oxybutynin group (27 events in 20 patients; P = 0.027). Conclusion:, Reductions in urge urinary incontinence episodes were similar with tolterodine and oxybutynin in children with DI. Side-effects were more common with oxybutynin. Treatment of children with DI with tolterodine shows significantly better tolerability and this may enhance children's compliance during long-term treatment. [source]

Comparison of Induced and Spontaneous Atrial Tachyarrhythmias in Patients with a History of Spontaneous Atrial Tachyarrhythmias

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2005
CHRISTIAN G. WOLLMANN M.D.
Introduction: This retrospective study investigated whether induced episodes could be used to predict the morphology of future spontaneous atrial episodes. Methods: Eighty-two patients (64 ± 12 years; 77% male; CAD in 60%; left ventricular ejection fraction 45 ± 16%) with a history of atrial tachycardia or atrial fibrillation (AT/AF) were implanted with a dual-chamber implantable cardioverter defibrillator (ICD) and followed for 6 months. A total of 224 episodes of induced and spontaneous AT/AF were classified into type I, II, and III according to the method of Israel et al. and then compared based on average cycle length (CL) and atrial amplitude. Episodes were also grouped as "pace-terminable" or "nonpace-terminable" based on the CL definition of Gillis et al. Results: The analysis of 121 induced episodes (from 80 patients) and 103 spontaneous episodes (from 43 patients) showed that within each arrhythmia type, there were no significant differences in CL or mean amplitude between induced and spontaneous episodes. Additional analysis of patients that had both induced and spontaneous episodes (n = 41) showed 78% had at least one spontaneous episode that matched the induced episode. Fifty-seven percent of spontaneous episodes were considered to be pace-terminable based on CL. Conclusions: Our data suggest that there is no significant difference between induced and spontaneous episodes of AT/AF of the same type. The majority of patients had at least one spontaneous episode of the same type as the induced episode, showing that induced atrial arrhythmias may be useful in predicting the morphology of future spontaneous episodes and in identifying patients potentially benefiting from atrial antitachycardia pacing. [source]

Characterization of Paroxysmal and Persistent Atrial Fibrillation in the Human Left Atrium During Initiation and Sustained Episodes

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2002
GJIN NDREPEPA M.D.
Characterization of AF in the LA.Introduction: Atrial fibrillation (AF) in the left atrium (LA) is poorly defined in terms of regional differences in the degree of organization, characteristics of paroxysmal and persistent variants, and electrophysiologic events that develop at the onset of episodes. Methods and Results: The study population consisted of 21 patients (15 men and 6 women; mean age 58 ± 9.4 years) with paroxysmal (10 patients) or persistent (11 patients) AF. Mapping of the LA during sustained episodes and the onset of AF was performed with a 64-electrode basket catheter. At the onset of AF, repetitive beats starting with atrial premature complexes and ending with generation of the earliest fibrillatory activity were defined as intermediary rhythm. Patients with paroxysmal AF had longer AF cycle lengths and more pronounced regional differences than patients with persistent AF. In total, AF cycle lengths in the LA in patients with persistent AF were 20% shorter than in patients with paroxysmal AF. Initiation of AF was preceded by an intermediary rhythm of 5.5 ± 2.5 cycles (6.3 ± 2.7 cycles in paroxysmal AF vs 4.2 ± 1.0 cycles in persistent AF; P = 0.026). At the onset of AF, the earliest generators of fibrillatory activity were located more frequently in the posterior wall of the LA. Conclusion: AF in the LA displays substantial regional differences in terms of AF cycle lengths and degree of organization. Patients with persistent AF have shorter cycle lengths and a higher degree of disorganized activity than patients with paroxysmal AF. Intermediary rhythms play an important role in initiation of AF via activation of generator regions in the LA. [source]

Distribution of Patients, Paroxysmal Atrial Tachyarrhythmia Episodes: Implications for Detection of Treatment Efficacy

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2001
WILLIAM F. KAEMMERER Ph.D.
Distribution of Paroxysmal Atrial Tachyarrhythmia Episodes.Introduction: Clinical trials of treatments for paroxysmal atrial tachyarrhythmia (pAT) often compare different treatment groups using the time to first episode recurrence. This approach assumes that the time to the first recurrence is representative of all times between successive episodes in a given patient. We subjected this assumption to an empiric test. Methods and Results: Records of pAT onsets from a chronologic series of 134 patients with dual chamber implantable defibrillators were analyzed; 14 had experienced > 10 pAT episodes, which is sufficient for meaningful statistical modeling of the time intervals between episodes. Episodes were independent and randomly distributed in 9 of 14 patients, but a fit of the data to an exponential distribution, required by the stated assumption, was rejected in 13 of 14. In contrast, a Weibull distribution yielded an adequate goodness of fit in 5 of the 9 cases with independent and randomly distributed data. Monte Carlo methods were used to determine the impact of violations of the exponential distribution assumption on clinical trials using time from cardioversion to first episode recurrence as the dependent measure. In a parallel groups design, substantial loss of power occurs with sample sizes < 500 patients per group. In a cross-over design, there is insufficient power to detect a 30% reduction in episode frequency even with 300 patients. Conclusion: Clinical trials that rely on time to first episode recurrence may be considerably less able to detect efficacious treatments than may have been supposed. Analysis of multiple episode onsets recorded over time should be used to avoid this pitfall. [source]

Meal patterns and meal quality in patients with leg ulcers

JOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 1 2000
U. Wissing
Background Wound healing is a complex process, which requires adequate energy sources, proteins, and specific minerals and vitamins. If an individual is unable to get or to eat the nutrients required, the wound healing process might be disrupted. The aim of this study was to investigate food-related factors, meal patterns and meal quality in relation to nutritional status in elderly out-patients with leg ulcers. Methods Nutritional status was assessed by use of the Mini Nutritional Assessment in 70 patients living in their own homes. Fifty-six of the patients recorded actual meals and snacks over four consecutive days. Meal patterns and meal quality were evaluated with the help of a qualitative classification system, the Food Based Concept for Classification of Eating Episodes. Results Thirty-six patients were classified as well-nourished, 32 were at risk of malnutrition and two were malnourished. More patients in the risk group for malnutrition did not buy their own food, and usually ate alone. Incomplete Meals and Low Quality Snacks were the most common eating types. The patients at risk of malnutrition had significantly fewer prepared Complete Meals than the well-nourished patients. Conclusion The results show a diet and meal quality which hardly meets the requirements for nutrients that are important in wound healing, especially for those patients assessed at risk of malnutrition. [source]

ANTECEDENTS AND CONSEQUENCES OF NEGATIVE MARITAL STRESSORS

JOURNAL OF MARITAL AND FAMILY THERAPY, Issue 2 2002
Annmarie Cano
Many couples seeking therapy report the occurrence of severe, negative marital stressors (e.g., infidelity, threats of marital dissolution). In addition, existing research has demonstrated that these marital stressors precipitate Major Depressive Episodes and psychological symptoms. This longitudinal study examines the antecedents and consequencs of negative marital stressors to help clinicians and researchers develop interventions that might prevent these stressors and their outcomes. Forty-one women completed a semistructured interview and measures of marital discord and depressive symptoms within one month after experiencing a marital stressor (baseline) and at a 16-month follow-up. The results indicate taht baseline marital discord contributes to the occurrence of additional marital stressors during the follow-up period. Although baseline depressive symptoms do not predict additional marital stressors, depressive symtoms along with marital discord predict future depressive symptoms. Finally, baseline marital discord and additional marital stressors contribute to future dissolution. Clinical and research implications are discussed. [source]

Timing relationships between pegmatite emplacement, metamorphism and deformation during the intra-plate Alice Springs Orogeny, central Australia

JOURNAL OF METAMORPHIC GEOLOGY, Issue 9 2008
I. S. BUICK
Abstract In the Harts Range (central Australia), the upper amphibolite facies to lower granulite facies, c. 480,460 Ma Harts Range Metamorphic Complex (HRMC), and the upper amphibolite facies, c. 340,320 Ma Entia Gneiss Complex are cut by numerous, generally peraluminous pegmatites and their deformed equivalents. The pegmatites have previously been interpreted as locally derived partial melts. However, SHRIMP U,Pb monazite and zircon dating of 29 pegmatites or their deformed equivalents, predominantly from the HRMC, reveal that they were emplaced episodically throughout almost the entire duration of the polyphase, c. 450,300 Ma intra-plate Alice Springs Orogeny. Episodes of pegmatite intrusion correlate with the age of major Alice Springs-age structures and with deposition of syn-orogenic sedimentary rocks in the adjacent Centralian Superbasin. Similar Alice Springs ages have not been obtained from anatectic country rocks in the HRMC, suggesting that the pegmatites were not locally derived. Instead, they are interpreted as highly fractionated granites, and imply that much larger parental Alice Springs-age granites exist at depth. The mechanism to allow repeated felsic magmatism in an intraplate setting, where all exposed rock types had a previous high-temperature history, is enigmatic. However, we suggest that episodic underthrusting and dehydration of unmetamorphosed Centralian Superbasin sedimentary rocks allowed crustal fertility to maintained over a c. 140 Ma interval during the intra-plate Alice Springs Orogeny. [source]

Learning science through technological design

JOURNAL OF RESEARCH IN SCIENCE TEACHING, Issue 7 2001
Wolff-Michael Roth
In the course of a decade of research on learning in technology-centered classrooms, my research group has gained considerable understanding of why and how students learn science by designing technology. In this article I briefly review two dimensions in which science and technology share fundamental similarities: (a) the production and transformation of representations and (b, the action-oriented language describing the two domains. Because it is fundamentally problematic to derive what ought to happen in science classrooms from other dimensions, I provide three episodes to illustrate what and how students know and learn science during technological design activities. Episodes and analyses embody the two dimensions previously outlined. Because these episodes are representative of the database established during an extensive research program, I suggest there is sufficient ground for using and investigating science-through-technology curricula. © 2001 John Wiley & Sons, Inc. J Res Sci Teach 38: 768,790, 2001 [source]

Incidence of benign upper respiratory tract infections, HSV and HPV cutaneous infections in inflammatory bowel disease patients treated with azathioprine

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 10 2009
P. SEKSIK
Summary Background, There are few data on the incidence of benign infections (upper respiratory tract infections, herpes lesions and viral warts) during exposure to azathioprine. Aims, To determine the incidence of benign infections in IBD out-patients receiving azathioprine (AZA+) and to look at the influence of leucocyte counts in the onset of these events. Methods, A total of 230 patients were included in a prospective cohort and observed during 207 patient-years. Episodes of benign infections were collected and incidences of benign infections were compared between the AZA+ group and patients without AZA (AZA,). Results, The incidence of upper respiratory tract infections in the cohort was 2.1 ± 2.2 per observation-year. There was no difference between the AZA+ (n = 169) and AZA, (n = 61) groups (2.2 ± 2.3 vs. 2.1 ± 2.1, P = 0.77). The incidence of herpes flares was significantly increased in the AZA+ group compared to the AZA, group (1.0 ± 2.6 vs. 0.2 ± 0.8 per year, P = 0.04). Similarly, there were significantly more patients with appearance or worsening viral warts in the AZA+ group (17.2% (AZA+) vs. 3.3% (AZA,), P = 0.004). Conclusion, This study suggests that the incidence of herpes flares and the appearance or worsening of viral warts are increased in IBD patients receiving AZA. [source]

Erythromycin for the treatment of chronic intestinal pseudo-obstruction: description of six cases with a positive response

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2004
A. V. Emmanuel
Summary Background :,Chronic intestinal pseudo-obstruction, due to intestinal myopathy or neuropathy, is characterized by the signs and symptoms of intestinal obstruction in the absence of true obstruction. Episodes are resistant to medical therapy. Aim :,To determine the value of erythromycin treatment in chronic intestinal pseudo-obstruction. Methods :,All patients with proven chronic intestinal pseudo-obstruction treated with erythromycin were reviewed. Patients with symptomatic benefit are described in detail. Responders were compared with non-responders to identify the factors associated with benefit. Results :,Fifteen consecutive patients (nine females; median age, 37 years; median follow-up, 41 months) were treated with oral erythromycin, 1.5,2.0 g/day. Six patients (three primary visceral myopathy, two normal histology on light microscopy, one visceral myopathy secondary to scleroderma) responded, with decreased pain and vomiting, normalized bowel dysfunction and decreased episodes of ileus. Five of the six patients (83%) who responded to erythromycin were male, compared with two of the nine non-responders (22%) (P = 0.04). Four of the six responders (67%) had histological or immunohistological visceral myopathy, compared with three of the nine patients (33%) who failed to respond. Responders were less likely than non-responders to be taking long-term opiates. Conclusions :,Erythromycin is effective for acute episodes of ileus and chronic symptoms in some patients with chronic intestinal pseudo-obstruction. [source]

Absence of explicit and implicit memory in unconscious patients using a TCI of propofol

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2003
P. Y. Lequeux
Background:, ,Episodes of implicit memory have been described during propofol anaesthesia. It remains unclear whether implicit memory is caused by short periods of awareness or occurs in an unconscious subject. Methods:, Sixty patients were randomized in an experimental group (EG), a control group (CG) and a reference group (RG). Loss of consciousness (LOC) was obtained by progressive stepwise increases of propofol using a target-controlled infusion device (Diprifusor, Alaris Medical Systems, San Diego, CA). A tape containing 20 words was played to the patients in the CG before the start of anaesthesia and to the patients in the EG at a constant calculated concentration of propofol associated with LOC. The tape was not played to the patients in the RG. Three memory tests were performed postoperatively. Results:, Explicit and implicit memories were evidenced in the CG but not in the EG. Conclusion:, In our group of young ASA I/II patients, in the absence of any noxious stimulus, no implicit or explicit memory was found when the calculated concentration of propofol using a Diprifusor was maintained at the level associated with LOC. [source]