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Shock
Kinds of Shock Terms modified by Shock Selected AbstractsSEPTIC SHOCK IN AN ELDERLY PATIENT ON DIALYSIS: ENEMA-INDUCED RECTAL INJURY CONFUSING THE CLINICAL PICTUREJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2004Ravi K. Bobba MD No abstract is available for this article. [source] A POST-KEYNESIAN STOCK-FLOW CONSISTENT MODEL FOR DYNAMIC ANALYSIS OF MONETARY POLICY SHOCK ON BANKING BEHAVIOURMETROECONOMICA, Issue 3 2008Edwin Le Heron ABSTRACT We try to make Keynes' approach compatible with an endogenous theory of the money supply. For that purpose, the principle of liquidity preference is generalized within a competitive banking framework. Private banks can impose a monetary rationing independently of the central bank. Then, we analyse the consequences of a monetary policy shock on the financial behaviour of banks. We clarify the dynamic process between the monetary policy and net investment within a Minskyan approach. First, we build a Post-Keynesian stock-flow consistent model with a private-bank sector introducing more realistic features. Second, we perform some simulations. [source] ON-THE-JOB SEARCH, PRODUCTIVITY SHOCKS, AND THE INDIVIDUAL EARNINGS PROCESS,INTERNATIONAL ECONOMIC REVIEW, Issue 3 2010Fabien Postel-Vinay Individual labor earnings observed in worker panel data have complex, highly persistent dynamics. We investigate the capacity of a structural job search model with on-the-job search, wage renegotiation by mutual consent, and i.i.d. productivity shocks to replicate salient properties of these dynamics, such as the covariance structure of earnings, the evolution of individual earnings mean, and variance with the duration of uninterrupted employment, or the distribution of year-to-year earnings changes. Structural estimation of our model on a 12-year panel of highly educated British workers shows that our simple framework produces a dynamic earnings structure that is remarkably consistent with the data. [source] TECHNOLOGY SHOCKS AND ROBUST SIGN RESTRICTIONS IN A EURO AREA SVAR,INTERNATIONAL ECONOMIC REVIEW, Issue 3 2009Gert Peersman We use a model-based identification strategy to estimate the impact of technology shocks on hours worked and employment in the euro area. The sign restrictions applied in the vector autoregression (VAR) analysis are consistent with a large class of dynamic stochastic general equilibrium (DSGE) models and are robust to parameter uncertainty. The results are in line with the conventional Real Business Cycle (RBC) interpretation that hours worked rise as a result of a positive technology shock. By comparing the sign restrictions method to the long-run restriction approach of Galí (Quaterly Journal of Economics,(1992) 709,38), we show that the results do not depend on the stochastic specification of the hours worked series or the data sample but only on the identification scheme. [source] AN ANALYSIS OF MONETARY POLICY SHOCKS IN JAPAN: A FACTOR AUGMENTED VECTOR AUTOREGRESSIVE APPROACH,THE JAPANESE ECONOMIC REVIEW, Issue 4 2007MASAHIKO SHIBAMOTO This paper analyses monetary policy shocks in Japan using a factor augmented vector autoregressive approach. There are three main findings. First, the time lags with which the monetary policy shocks are transmitted vary between the various macroeconomic time series. These include several series that have not been included thus far in standard vector autoregressive analysis, including housing starts and employment indices. Second, a coherent picture of monetary policy effects on the economy is obtained. Third, it is found that monetary policy shocks have a stronger impact on real variables, such as employment and housing starts, than industrial production. [source] TRADING-VOLUME SHOCKS AND STOCK RETURNS: AN EMPIRICAL ANALYSISTHE JOURNAL OF FINANCIAL RESEARCH, Issue 2 2010Zhaodan Huang Abstract We examine high-volume premiums based on weekly risk-adjusted returns. Significant average weekly abnormal high-volume premiums up to 0.50% per week are documented for 1962,2005. Most premiums are generated in the first two weeks and monotonically decline as holding periods are extended. Evidence of reversal is found as the holding periods are extended. Premiums depend on realized turnover in the holding period. The last finding supports the theories of Miller and Merton. Finally, we test whether premiums are compensation for taking additional risk. Negative skewness, idiosyncratic risk, and liquidity risk do not explain the high-volume premiums. [source] LARGE IS BEAUTIFUL: HORIZONTAL MERGERS FOR BETTER EXPLOITATION OF PRODUCTION SHOCKS,THE JOURNAL OF INDUSTRIAL ECONOMICS, Issue 1 2008WEN ZHOU The profitability of horizontal mergers is investigated in a situation in which firms face a production shock and therefore are uncertain about their future costs. I show that, due to production rationalization, small-scale mergers can be profitable if the uncertainty is large. The efficiency gain in production also implies benign welfare consequences. Under cost uncertainty, a profitable merger always improves social welfare if no more than half of the industry's firms are allowed to merge. Finally, I show that the incentives to merge depend on the information structure. Firms are less likely to merge when they possess more information. [source] THE ECONOMIC EFFECTS OF THE MARATHON-ASHLAND JOINT VENTURE: THE IMPORTANCE OF INDUSTRY SUPPLY SHOCKS AND VERTICAL MARKET STRUCTURE,THE JOURNAL OF INDUSTRIAL ECONOMICS, Issue 3 2007CHRISTOPHER T. TAYLOR This study measures the effects of the Marathon/Ashland Petroleum (MAP) joint venture on rack and retail reformulated (RFG) gasoline prices in the four cities where both firms sold RFG before the joint venture. MAP was an early transaction in the recent era of petroleum mergers and resulted in large regional increases in concentration. While wholesale (rack) prices increased in the two cities experiencing the largest change in market structure in the year following the transaction, retail prices did not increase. Our results also highlight the importance of identifying the marginal source of supply in correctly identifying merger effects. [source] THE EFFECTS OF FISCAL SHOCKS ON CONSUMPTION: RECONCILING THEORY AND DATA,THE MANCHESTER SCHOOL, Issue 2 2007GIOVANNI GANELLI Recent research has stressed the inconsistency between empirical evidence and the theoretical prediction of both the standard real business cycle and the New Keynesian models regarding the impact of fiscal shocks on consumption. Some authors have attempted to bridge this gap by relying on assumptions about the effects of government spending on preferences and production, or on deviations from the intertemporal optimizing framework. In this paper we follow a different route. We show that introducing at the same time imperfect competition, sticky prices and deviations from Ricardian equivalence through an overlapping generations model helps to solve the inconsistency between theory and data. Our paper can also be seen in the light of the classic controversy between Keynesians and monetarists on the effectiveness of fiscal policy. From this angle, our model can be considered a reincarnation of the classic work of Blinder and Solow (Journal of Public Economics, Vol. 2 (1973), pp. 319,337). [source] Rapid Onset and Resolution of Cardiogenic Shock in a Patient With PheochromocytomaCONGESTIVE HEART FAILURE, Issue 3 2009Jeffrey A. Shih MD First page of article [source] The Impact of AIDS on Rural Households in Africa: A Shock Like Any Other?DEVELOPMENT AND CHANGE, Issue 4 2002Carolyn Baylies In areas where HIV prevalence is high, household production can be significantly affected and the integrity of households compromised. Yet policy responses to the impact of HIV/AIDS have been muted in comparison to outcomes of other shocks, such as drought or complex political emergencies. This article looks at the reasons for the apparent under,reaction to AIDS, using data from Zambia, and examines recent calls to mitigate the effects of AIDS at household level. Critical consideration is directed at proposals relating to community safety nets, micro,finance and the mainstreaming of AIDS within larger poverty alleviation programmes. It is argued that effective initiatives must attend to the specific features of AIDS, incorporating both an assault on those inequalities which drive the epidemic and sensitivity to the staging of AIDS both across and within households. A multi,pronged approach is advocated which is addressed not just at mitigation or prevention, but also at emergency relief, rehabilitation and development. [source] Abciximab Treatment for Obstructive Prosthetic Aortic and Mitral Valve Thrombosis in the Presence of Large Thrombi, Cardiogenic Shock, and Acute Evolving Embolic StrokeECHOCARDIOGRAPHY, Issue 1 2004Atiar M Rahman M.D., Ph.D. Obstructive thrombosis of left-sided mechanical prosthetic valves is a life-threatening complication. Intravenous thrombolytic therapy is contraindicated due to risk of clot embolization and surgical treatment is often required for hemodynamically unstable patients. We report for the first time the successful use of abciximab in the management of a patient in cardiogenic shock with multiple prosthetic valve obstructive thrombosis and evolving embolic stroke. Serial Doppler echocardiography and cinefluoroscopy demonstrated resolution of thrombi, improvements in transvalvular gradients and improvement in leaflet motion. This observation suggests abciximab should be considered as a therapeutic option in the treatment of obstructed prosthetic heart valves. (ECHOCARDIOGRAPHY, Volume 21, January 2004) [source] Review article: Inotrope and vasopressor use in the emergency departmentEMERGENCY MEDICINE AUSTRALASIA, Issue 5 2009Ainslie Senz Abstract Shock is a common presentation to the ED, with the incidence of septic shock increasing in Australasia over the last decade. The choice of inotropic agent is likely dependent on previous experience and local practices of the emergency and other critical care departments. The relatively short duration of stay in the ED before transfer leaves little room for evaluating the appropriateness of and response to the agent chosen. Delays in transfer to inpatient facilities means that patients receive advanced critical care within the ED for longer, requiring initiation and titration of vasoactive agents in the ED. This article discusses the general concepts of shock and the indicators for inotrope and vasopressor use, revises the various agents available and reviews the current evidence for their use. [source] Tissue Oxygenation Does Not Predict Central Venous Oxygenation in Emergency Department Patients With Severe Sepsis and Septic ShockACADEMIC EMERGENCY MEDICINE, Issue 4 2010Anthony M. Napoli MD Abstract Objectives:, This study sought to determine whether tissue oxygenation (StO2) could be used as a surrogate for central venous oxygenation (ScVO2) in early goal-directed therapy (EGDT). Methods:, The study enrolled a prospective convenience sample of patients aged ,18 years with sepsis and systolic blood pressure <90 mm Hg after 2 L of normal saline or lactate >4 mmol, who received a continuous central venous oximetry catheter. StO2 and ScVO2 were measured at 15-minute intervals. Data were analyzed using a random coefficients model, correlations, and Bland-Altman plots. Results:, There were 284 measurements in 40 patients. While a statistically significant relationship existed between StO2 and ScVO2 (F(1,37) = 10.23, p = 0.002), StO2 appears to systematically overestimate at lower ScVO2 and underestimate at higher ScVO2. This was reflected in the fixed effect slope of 0.49 (95% confidence interval [CI] = 0.266 to 0.720) and intercept of 34 (95% CI = 14.681 to 50.830), which were significantly different from 1 and 0, respectively. The initial point correlation (r = 0.5) was fair, but there was poor overall agreement (bias = 4.3, limits of agreement = ,20.8 to 29.4). Conclusions:, Correlation between StO2 and ScVO2 was fair. The two measures trend in the same direction, but clinical use of StO2 in lieu of ScVO2 is unsubstantiated due to large and systematic biases. However, these biases may reflect real physiologic states. Further research may investigate if these measures could be used in concert as prognostic indicators. ACADEMIC EMERGENCY MEDICINE 2010; 17:349,352 © 2010 by the Society for Academic Emergency Medicine [source] The Use of Impedance Cardiography in Predicting Mortality in Emergency Department Patients With Severe Sepsis and Septic ShockACADEMIC EMERGENCY MEDICINE, Issue 4 2010Anthony M. Napoli MD Abstract Objectives:, Pulmonary artery catheterization poses significant risks and requires specialized training. Technological advances allow for more readily available, noninvasive clinical measurements of hemodynamics. Few studies exist that assess the efficacy of noninvasive hemodynamic monitoring in sepsis patients. The authors hypothesized that cardiac index, as measured noninvasively by impedance cardiography (ICG) in emergency department (ED) patients undergoing early goal-directed therapy (EGDT) for sepsis, would be associated with in-hospital mortality. Methods:, This was a prospective observational cohort study of patients age over 18 years meeting criteria for EGDT (lactate > 4 or systolic blood pressure < 90 after 2 L of normal saline). Initial measurements of cardiac index were obtained by ICG. Patients were followed throughout their hospital course until discharge or in-hospital death. Cardiac index measures in survivors and nonsurvivors are presented as means and 95% confidence intervals (CI). Diagnostic performance of ICG in predicting mortality was tested by receiver operating characteristic (ROC) curve and areas under the ROC curves (AUC) were compared using Wilcoxon test. Results:, Fifty-six patients were enrolled; one was excluded due to an inability to complete data acquisition. The mean cardiac index in nonsurvivors (2.3 L/min·m2, 95% CI = 1.6 to 3.0) was less than that for survivors (3.2, 95% CI = 2.9 to 3.5) with mean difference of 0.9 (95% CI = 0.12 to 1.71). The AUC for ICG in predicting mortality was 0.71 (95% CI = 0.58 to 0.88; p = 0.004). A cardiac index of < 2 L/min·m2 had a sensitivity of 43% (95% CI = 18% to 71%), specificity of 93% (95% CI = 80% to 95%), positive likelihood ratio of 5.9, and negative likelihood ratio of 0.6 for predicting in-hospital mortality. Conclusions:, Early, noninvasive measurement of the cardiac index in critically ill severe sepsis and septic shock patients can be performed in the ED for those who meet criteria for EGDT. There appears to be an association between an initial lower cardiac index as measured noninvasively and in-hospital mortality. ACADEMIC EMERGENCY MEDICINE 2010; 17:452,455 © 2010 by the Society for Academic Emergency Medicine [source] Bilateral Femoral Head Osteonecrosis After Septic Shock and Multiorgan Failure,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 3 2004Mark J Bolland Abstract A case of bilateral femoral head osteonecrosis after septic shock is presented. We suggest that the osteonecrosis was caused by ischemic insults to the proximal femora. The association between septic shock and osteonecrosis has not been previously reported. Introduction: Osteonecrosis is an uncommon disorder characterized by the in situ death of bone. A diverse range of conditions has been associated with osteonecrosis. We present a case of bilateral femoral head osteonecrosis that occurred after an episode of septic shock. Materials and Methods: A 66-year-old woman presented with a left-sided renal stone and a urinary tract infection. Her condition rapidly progressed to a life-threatening illness with septic shock complicated by multiorgan failure, which necessitated prolonged intensive care and inotropic support. She made a full recovery but 3 months later developed bilateral osteonecrosis of the femoral heads requiring bilateral total hip joint replacement. Results and Conclusions: We propose that the osteonecrosis was caused by ischemic insults to the femoral heads as a result of the widespread systemic ischemia that occurred during her initial illness. To our knowledge, septic shock has not been previously described as a cause of osteonecrosis. Clinicians should be aware of this association, particularly in patients presenting with bone pain after episodes of sepsis. [source] Mechanical Circulatory Support for AMI and Cardiogenic ShockJOURNAL OF CARDIAC SURGERY, Issue 4 2010Yasir Abu-Omar D.Phil. The dismal prognosis associated with post-MI cardiogenic shock, allied with surgical and technological advancements, has shifted the treatment paradigm toward wider use of mechanical circulatory support devices (MCSD). Current experience demonstrates that better outcomes may be achieved with early MCSD deployment (prior to the onset of end-organ dysfunction). However, perceived limitations with existing devices mean that they remain infrequently applied. There is an urgent need for increased awareness of MCSD options among clinicians treating post-MI shock patients. (J Card Surg 2010;25:434-441) [source] Mechanical Support for Postcardiotomy Cardiogenic Shock: Has Progress Been Made?JOURNAL OF CARDIAC SURGERY, Issue 4 2010Erik A. Sylvin M.D. A previous review of this topic by our group suggested that regardless of device, only 25% of patients survived to hospital discharge. In the interim, newer technologies have entered the clinical arena. Additional contributions have been made to the literature and new databases are collecting data that are likely to provide more robust guidance for the management of these very complex patients. In this review, we update the experience of mechanical support in the PCCS patient and provide a strategy to maximize survival for a patient who develops PCCS in the community cardiac surgery center. (J Card Surg 2010;25:442-454) [source] Fatal Inappropriate ICD ShockJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2007CHRISTIAN VELTMANN M.D. Introduction: Inappropriate implantable cardioverter defibrillator (ICD) therapy carries a low but relevant risk of ventricular proarrhythmia. In the present case, the extremely rare event of a fatal arrhythmia caused by inappropriate therapy is reported. Dislodgement of the ventricular lead to the level of the tricuspid annulus led to additional sensing of the atrial signal during sinus tachycardia. Spuriously, ventricular fibrillation was sensed and induced inappropriate ICD shocks. The fourth inappropriate shock caused ventricular fibrillation, which was subsequently undersensed by the dislodged lead due to low ventricular amplitudes. The ICD started antibradycardic pacing during ventricular fibrillation. After initial successful resuscitation, the patient died 1 week later due to severe hypoxic brain damage. Although not preventable in the present case, it underlines the necessity of immediate interrogation of the ICD after ICD therapy and deactivation of the ICD in the setting of a dislodged endocardial lead and intensive care monitoring of the patient until revision. [source] Inappropriate Shock and Pacing?JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2003AMIN AL-AHMAD M.D. [source] Implantable Defibrillators in Children: From Whence to ShockJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2001RICHARD A. FRIEDMAN M.D. [source] Acute Alcohol Intoxication During Hemorrhagic Shock: Impact on Host Defense From InfectionALCOHOLISM, Issue 4 2004K. L. Zambell Abstract: Background: Acute alcohol intoxication is a frequent underlying condition associated with traumatic injury. Our studies have demonstrated that acute alcohol intoxication significantly impairs the immediate hemodynamic, metabolic, and inflammatory responses to hemorrhagic shock. This study investigated whether acute alcohol intoxication during hemorrhagic shock would alter the outcome from an infectious challenge during the initial 24 hr recovery period. Methods: Chronically catheterized male Sprague Dawley® rats were randomized to acute alcohol intoxication (EtOH; 1.75 g/kg bolus followed by a constant 15 hr infusion at 250,300 mg/kg/hr) or isocaloric isovolemic dextrose infusion (dex; 3 ml + 0.375 ml/hr). EtOH and dex were assigned to either fixed-volume (50%) hemorrhagic shock followed by fluid resuscitation with Ringer's lactate (EtOH/hem, dex/hem) or sham hemorrhagic shock (EtOH/sham, dex/sham). Indexes of circulating neutrophil function (apoptosis, phagocytosis, oxidative burst) were obtained at baseline, at completion of hemorrhagic shock, and at the end of fluid resuscitation. Bacterial clearance, lung cytokine expression, and myeloperoxidase activity were determined at 6 and 18 hr after an intratracheal challenge with Klebsiella pneumoniae (107 colony-forming units). Results: Mean arterial blood pressure was significantly lower in acute alcohol intoxication-hemorrhagic shock animals throughout the hemorrhagic shock. In sham animals, acute alcohol intoxication alone did not produce significant changes in neutrophil apoptosis or phagocytic activity but significantly suppressed phorbol myristic acid (PMA)-stimulated oxidative burst. Hemorrhagic shock produced a modest increase in neutrophil apoptosis and suppression of neutrophil phagocytic capacity but significantly suppressed PMA-stimulated oxidative burst. Acute alcohol intoxication exacerbated the hemorrhagic shock-induced neutrophil apoptosis and the hemorrhagic shock-induced suppression of phagocytosis without further affecting PMA-stimulated oxidative burst. Fluid resuscitation did not restore neutrophil phagocytosis or oxidative burst. Acute alcohol intoxication decreased (,40%) 3-day survival from K. pneumoniae in hemorrhagic shock animals, impaired bacterial clearance during the first 18 hr postinfection, and prolonged lung proinflammatory cytokine expression. Conclusions: These results demonstrate that the early alterations in metabolic and inflammatory responses to hemorrhagic shock produced by acute alcohol intoxication are associated with neutrophil dysfunction and impaired host response to a secondary infectious challenge leading to increased morbidity and mortality. [source] Influence of the Compositional Profile of Functionally Graded Material on the Crack Path under Thermal ShockJOURNAL OF THE AMERICAN CERAMIC SOCIETY, Issue 7 2001Takao Fujimoto Thermal cracking under a transient-temperature field in a ceramic/metal functionally graded plate is discussed. When the functionally graded plate is cooled from high-temperature, curved or straight crack paths often occur on the ceramic surface. It is shown that the crack paths are influenced by the compositional profile of the functionally graded plate. Transient-thermal stresses are treated as a linear quasi-static thermoelastic problem for a plane strain state. The crack paths are obtained using finite element method with Mode I and Mode II stress intensity factors. [source] Prospective Evaluation of Coagulation in Critically Ill Neonatal FoalsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2009A.I. Bentz Background: Coagulopathy is a potentially underrecognized complication of sepsis and septic shock in critically ill neonatal foals. Hypothesis: Critically ill neonatal foals have abnormalities in coagulation that are associated with disease severity and outcome. Animals: Foals <72 hours old admitted to a neonatal intensive care unit. Methods: Prospective, observational study. Blood was collected at admission, 24, and 48 hours for platelet count, prothrombin time, activated partial thromboplastin time, antithrombin activity and concentrations of fibrin degradation products, and fibrinogen in plasma from all foals. Results: Sixty-three foals were enrolled and classified as Septic Shock (12), Septic (28), and Other (23). At least 1 abnormal value was found in 18/28 (64%) samples from the Septic Shock group, 66/85 (78%) from the Septic group, and 30/59 (51%) from the Other group (P= .01). Coagulopathy (3 or more abnormal values) was present in 7/28 (25%) samples in the Septic Shock group, 14/85 (16%) samples in the Septic group, and 3/59 (5%) samples in the Other group (P= .0028). Clinically detectable bleeding occurred in 8/12 (67%) Septic Shock cases, 11/28 (39%) Septic cases, and 3/23 (13%) Other cases (P= .009). Foals in Septic Shock were 12.7 times more likely to have clinical evidence of bleeding than those in the Other group (95% CI 2.3,70, P= .004). Treatment with fluids or plasma did not have a detectable effect on coagulation values. Conclusions and Clinical Importance: Coagulopathy commonly occurs in critically ill neonatal foals, especially those with sepsis and septic shock. [source] Thermal histories of IVA iron meteorites from transmission electron microscopy of the cloudy zone microstructureMETEORITICS & PLANETARY SCIENCE, Issue 3 2009J. I. GOLDSTEIN Thin sections for TEM analysis were produced by a focused ion beam instrument. Use of the TEM allowed us to avoid potential artifacts which may be introduced during specimen preparation for SEM analysis of high Ni particles <30 nm in size and to identify microchemical and microstructural changes due to the effects of shock induced reheating. No cloudy zone was observed in five of the eight moderately to highly shocked (>13 GPa) IVA irons that were examined in the TEM. Shock induced reheating has allowed for diffusion from 20 nm to 400 nm across kamacite/taenite boundaries, recrystallization of kamacite, and the formation, in Jamestown, of taenite grain boundaries. In the eleven IVA irons with cloudy zone microstructures, the size of the high-Ni particles in the cloudy zone increases directly with increasing bulk Ni content. Our data and the inverse correlation between cooling rate and high-Ni particle size for irons and stony-irons show that IVA cooling rates at 350-200 °C are inversely correlated with bulk Ni concentration and vary by a factor of about 15. This cooling rate variation is incompatible with cooling in a metallic core that was insulated with a silicate mantle, but is compatible with cooling in a metallic body of radius 150 ± 50 km. The widths of the tetrataenite regions next to the cloudy zone correlate directly with high-Ni particle size providing another method to measure low temperature cooling rates. [source] Selective release of D and 13C from insoluble organic matter of the Murchison meteorite by impact shockMETEORITICS & PLANETARY SCIENCE, Issue 3 2007Koichi Mimura We also performed shock experiments on type III kerogen and compared the results of these experiments with the experimental results regarding IOM. The shock selectively released D and 13C from the IOM, while it preferably released H and 12C from the kerogen. The release of these elements from IOM cannot be explained in terms of the isotope effect, whereas their release from kerogen can be explained by this effect. The selective release of heavier isotopes from IOM would be due to its structure, in which D and 13C-enriched parts are present as an inhomogeneity and are weakly attached to the main network. Shock gave rise to a high release of D even at a lower degree of dehydrogenation compared with the stepwise heating of IOM. This effective release of D is probably an inherent result of shock, in which a dynamic high-pressure and high-temperature condition prevails. Thus, shock would effectively control the hydrogen isotope behavior of extraterrestrial organic matter during the evolution of the solar nebula. [source] Wage Hikes as Supply and Demand ShockMETROECONOMICA, Issue 4 2003Jürgen Jerger ABSTRACT Wage hikes affect production costs and hence are usually analysed as supply shocks. There is a long-standing debate, however, about demand effects of wage variations. In this paper, we bring together these two arguments in a Kaldorian model with group-specific saving rates and a production technology that allows for redistribution between workers and entrepreneurs following a wage hike. We thereby pinpoint the conditions under which (a) wage variations affect aggregate demand and (b) the positive demand effects of wage hikes may even overcompensate the negative supply effects on aggregate employment (,purchasing power argument'). We conclude by noting that, whereas demand effects are very likely to occur, the conditions under which the purchasing power argument does indeed hold are very unrealistic. [source] Emergency Ultrasound Diagnosis of Cardiogenic Shock Due to Acute Mitral RegurgitationACADEMIC EMERGENCY MEDICINE, Issue 1 2010Michael B. Stone MD No abstract is available for this article. [source] Shock Coordinated with High Power of Morphology Electrogram Improves Defibrillation Success in Patients with Implantable Cardioverter DefibrillatorsPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2002ALEXANDER BERKOWITSCH BERKOWITSCH, A., et al.: Shock Coordinated with High Power of Morphology Electrogram Improves Defibrillation Success in Patients with Implantable Cardioverter Defibrillators. Animal studies have suggested that the success of defibrillation may depend on the properties of VF waveform obtained from the morphology electrogram (ME) at the time of the shock. The reliable identification of depolarization events in the fibrillatory signal can be achieved using adaptive estimation of the instantaneous signal power (P). The aim of this study was to investigate if a high P of the ME (PME) was related to ventricular DFT and if the upslope in ME can be associated with the depolarization event. A total of 575 VF (mean duration 10 s) episodes recorded and stored during ICD implantation in 77 patients with ventricular arrhythmias were used for analysis. The DFT was defined using a double step-down test. The values of PME immediately before pulse delivery (Pshock) and shock outcomes were registered. The differences between Pshock of successful and failed defibrillation were tested with the Mann-Whitney U test. The relationship between individual medians of Pshock (Pmed) and DFT was analyzed using the Kruskall-Wallis H-test. The coincidence between identified depolarization and upslope in ME was tested using the chi-square test. A P value of 0.05 was set for an error probability. The Pshock in case of failed defibrillation was significantly lower than Pshock in successful cases by the pulses of any strength (P < 0.001). The test revealed a significant inverse correlation between Pmed and DFT with P < 0.001. The depolarization corresponded to the upslope of ME in 85% of cases. This study demonstrated that a high value of instantaneous power of ME indicates the optimal time for shock delivery. The implementation of this algorithm in ICDs may improve the defibrillation efficacy. [source] Atrial Fibrillation Induction and Determination of Atrial Vulnerable Period Using Very Low Energy Synchronized Biatrial Shock in Normal Subjects and in Patients with Atrial FibrillationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 4 2000HUNG-FAT TSE The atrial vulnerable periods (A VP)for shock induction of atrial fibrillation (AF) in humans have not been clearly defined. Furthermore, the safety and efficacy of using low energy biatrial shock delivered transvenously for AF induction are unknown. We tested the safety and efficacy of using very low energy biatrial shocks, delivered between the right atrium and the coronary sinus for AF induction and used this technique to characterize the A VP in nine controls and nine patients with AF. Thirty-volt and 60-V 3/3-ms biphasic shocks were delivered, starting from 50 ms before the atrial effective refractory period with 20-ms increments until the end of the QRS interval to determine the AVP front, AVP end, and the AVP duration. Successful AF induction could be achieved in eight (89%) of the nine controls and in nine (100%) of the nine patients with AF without any complication. In patients with AF, the AVP front started significantly earlier within the QRS complex, and the AVP duration and the AVP duration/QRS percent ratios were also significantly greater as compared to controls. Furthermore, a higher induction shock energy in patients with AF was associated with an increase in AF inducibility and significantly increased the AVP duration and A VP duration/QRS percent ratio as compared to the controls. This study demonstrated the safe and efficacy of delivering a very low energy biatrial shock during the AVP within the R wave for AF induction. The characteristics of A VP in patients with AF were significantly different from normal subjects. [source] | ||||||||||||||||||||||||||||||||||||||||||||||