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Sudden
Terms modified by Sudden Selected AbstractsA SUDDEN AND TEMPORARY EPISODE OF ALTERED MENTAL STATUS: A CASE REPORTJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2005Benedetta Boari MD No abstract is available for this article. [source] Esophageal Causes of Sudden and Unexpected DeathJOURNAL OF FORENSIC SCIENCES, Issue 2 2006Roger W. Byard M.D. ABSTRACT: Gastrointestinal conditions are uncommon causes of sudden and/or unexpected death as compared to cardiovascular diseases, motor vehicle trauma, or suicide, and may involve an array of fatal mechanisms. Lethal esophageal conditions are encountered even less often, the manifestations of which include acute upper airway occlusion from tumors or foreign material, intraluminal hemorrhage from vascular abnormalities, or perforation with fistula formation resulting in hemorrhage and sepsis. When encountered at autopsy, a particular condition may also be a manifestation of a disease that does not primarily involve the esophagus. For this reason, a detailed autopsy investigation is required for evidence of systemic or remote disease when lesions are found within the esophagus. In this report, possible life-threatening esophageal conditions are reviewed with a description of lethal mechanisms, mention of rare associated diseases, and comment on difficulties that may arise at autopsy in the evaluation of such cases. [source] Bradycardia and asystolic cardiac arrest during spinal anaesthesia: A report of five casesACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2000R. Z. Løvstad Sudden, severe bradycardia/asystolic cardiac arrest are considered infrequent, but are certainly the most serious complications of spinal anaesthesia. We report four cases of primary asystole and one of severe bradycardia in young to middle-aged, healthy patients scheduled for minor surgery at the day surgery unit. Bradycardia/asystole were not related to respiratory depression or hypoxaemia/hypercarbia; they occurred at different time intervals after the onset of spinal anaesthesia (10,70 min) and, apparently, were not dependent on the level of sensory block, which varied between T3 and T8. One patient was nauseated seconds before the asystole, otherwise there was no warning signs. All the patients were easily resuscitated with the prompt administration of atropine and ephedrine and, in the case of cardiac arrest, cardiac massage and ventilation with oxygen. One patient was treated with a small dose of adrenaline. Four patients had the surgery, as planned; one had the surgery postponed. All the patients were discharged from hospital in good health and did not suffer any sequelae. [source] Attitudes of the American Public toward Organ Donation after Uncontrolled (Sudden) Cardiac DeathAMERICAN JOURNAL OF TRANSPLANTATION, Issue 3 2010M. L. Volk Concerns about public support for organ donation after cardiac death have hindered expansion of this practice, particularly rapid organ recovery in the context of uncontrolled (sudden) cardiac death (uDCD). A nationally representative Internet-based panel was provided scenarios describing donation in the context of brain death, controlled cardiac death and uncontrolled cardiac death. Participants were randomized to receive questions about trust in the medical system before or after the rapid organ recovery scenario. Among 1631 panelists, 1049 (64%) completed the survey. Participants expressed slightly more willingness to donate in the context of controlled and uncontrolled cardiac death than after brain death (70% and 69% vs. 66%, respectively, p < 0.01). Eighty percent of subjects (95% CI 77,84%) would support having a rapid organ recovery program in their community, though 83% would require family consent or a signed donor card prior to invasive procedures for organ preservation. The idea of uDCD slightly decreased trust in the medical system from 59% expressing trust to 51% (p = 0.02), but did not increase belief that a signed donor card would interfere with medical care (28% vs. 32%, p = 0.37). These findings provide support for the careful expansion of uDCD, albeit with formal consent prior to organ preservation. [source] Cardiac Arrhythmias Triggered by Sudden and Dynamic EffortsANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2010Emanuel C. Furtado M.D. Background: Some arrhythmias are triggered only during exercise. The aim of this study is to describe the frequency and type of arrhythmia induced by a standardized protocol of sudden and dynamic exercise, which tends to reflect routine situations of efforts (e.g., climbing stairs), and compare with those found on maximal cardiopulmonary exercise test (CPET). Methods: A total of 2329 subjects (1594 men) aged 9,91 years (mean 52 years, SD ± 16) were submitted to a standardized protocol of sudden and dynamic exercise (4-second exercise test [4sET]) prior to a CPET. A continuous digital electrocardiogram (ECG) was recorded during 4sET and CPET, and later reviewed and interpreted by the same physician (who supervised all the procedures). Results: A total of 1125 subjects (43%) had cardiac arrhythmias during one or both procedures. About 57% of the arrhythmias were supraventricular, but 47 subjects (2% of all subjects) presented more complex arrhythmias including 43 cases of nonsustained supraventricular tachycardia and four nonsustained ventricular tachycardia. While arrhythmias were more often exposed by the CPET (P < 0.01), in 221 cases (10% of the total sample) of arrhythmias they were only induced by 4sET; these included four cases of nonsustained supraventricular tachycardia. Conclusion: 4sET-induced arrhythmias tend to be simple and were always short-lasting. In some cases, ECG recording during 4sET showed arrhythmias that would not be induced by a progressive maximal exercise test. Different situations of exercise, sudden and short versus maximal and progressive, tend to generate different arrhythmic responses and possibly complementary clinical implications. Ann Noninvasive Electrocardiol 2010;15(2):151,156 [source] Prognosis and Mechanism of Death in Treated Heart Failure: Data From the Placebo Arm of Val-HeFTCONGESTIVE HEART FAILURE, Issue 3 2006Jay N. Cohn MD The magnitude of benefit on mortality of combined angiotensin-converting enzyme inhibitor (ACEI) and ,-blocker (BB) therapy for heart failure cannot be reliably assessed from prospective randomized trials of individual drugs with intent-to-treat analysis. The placebo arm of the Valsartan Heart Failure Trial (Val-HeFT) included patients who remained on background therapy with ACEIs, BBs, neither, or both. The outcomes in these four subgroups should provide a better guide to mortality benefit. Overall mortality (mean follow-up, 23 months) was 31.6% in those receiving neither neurohormonal blocker, 29% and 39% lower in those on ACEIs or BBs, respectively, and 62% lower (11.9% mortality) in those receiving both drugs. In the neither neurohormonal inhibitor group, 48% of the heart failure-related deaths were adjudicated as sudden, whereas in the group receiving ACEIs and BBs, 79% of the deaths were sudden, and pump failure mortality was only 1% per year. The combination of ACEIs and BBs exerts a greater mortality reduction than suggested from clinical trials and reduces pump failure mortality to 1% per year. [source] Differentiating Large-scale Surge versus Daily SurgeACADEMIC EMERGENCY MEDICINE, Issue 11 2006J. Lee Jenkins MD This breakout session at the Academic Emergency Medicine 2006 Consensus Conference examined how baseline overcrowding impedes the ability of emergency departments to respond to sudden, unexpected surges in demand for patient care. Differences between daily and catastrophic surge were discussed, and the need to invoke a hospital-wide response to surge was explored. [source] Myocardial perfusion imaging and cardiac events in a cohort of asymptomatic patients with diabetes living in southern FranceDIABETIC MEDICINE, Issue 4 2006A. Sultan Abstract Aims, To assess the association between abnormal stress myocardial perfusion imaging (MPI) and cardiac events (CE) in asymptomatic patients with diabetes and with , 1 additional risk factor. Predictors of abnormal stress MPI were also evaluated. Methods, Four hundred and forty-seven consecutive patients who underwent stress MPI were prospectively followed for 2.1 [0.5,4.1] years for the subsequent occurrence of hard CE (myocardial infarction and sudden or coronary death) and soft CE (unstable angina and ischaemic heart failure requiring hospitalization). Re-vascularization procedures performed as a result of the screening protocol were not included in the analysis. Results, Follow-up was successful in 419 of 447 patients (94%), of whom 71 had abnormal MPI at baseline. Medical therapy was intensified in all subjects and especially in those with abnormal MPI. Twenty-three patients with abnormal MPI underwent a re-vascularization procedure. CEs occurred in 14 patients, including six of 71 patients (8.5%) with abnormal MPI and eight of 348 patients (2.3%) with normal MPI (P < 0.005). Only two patients developed a hard CE and 12 a soft CE. In multivariate analysis, abnormal MPI was the strongest predictor for CEs [odds ratio (OR) (95% CI) = 5.6 (1.7,18.5)]. Low-density lipoprotein cholesterol , 3.35 mmol/l [OR (95% CI) = 7.3; 1.5,34.7] and age > median [OR (95% CI) = 6.0 (1.2,28.6)] were additional independent predictors for CE. The independent predictors for abnormal MPI were male gender, plasma triglycerides , 1.70 mmol/l, creatinine clearance < 60 ml/min and HbA1c > 8%, with male gender the strongest [OR (95% CI) = 4.0 (1.8,8.8)]. Conclusions, Asymptomatic patients with diabetes in this study had a very low hard cardiac event rate over an intermediate period. This could be explained by the effects of intervention or by the low event rate in the background population. Randomized studies of cardiac heart disease screening are required in asymptomatic subjects with diabetes to determine the effectiveness of this intervention. Diabet. Med. (2006) [source] Effects of a sustained heroin shortage in three Australian StatesADDICTION, Issue 7 2005Louisa Degenhardt ABSTRACT Background In early 2001 in Australia there was a sudden and dramatic decrease in heroin availability that occurred throughout the country that was evidenced by marked increases in heroin price and decreases in its purity. Aim This study examines the impact of this change in heroin supply on the following indicators of heroin use: fatal and non-fatal drug overdoses; treatment seeking for heroin dependence; injecting drug use; drug-specific offences; and general property offences. The study was conducted using data from three Australian States [New South Wales (NSW), Victoria (VIC) and South Australia (SA)]. Methods Data were obtained on fatal and non-fatal overdoses from hospital emergency departments (EDs), ambulance services and coronial systems; treatment entries for heroin dependence compiled by State health departments; numbers of needles and syringes distributed to drug users; and data on arrests for heroin-related incidents and property-related crime incidents compiled by State Police Services. Time-series analyses were conducted where possible to examine changes before and after the onset of the heroin shortage. These were supplemented with information drawn from studies involving interviews with injecting drug users. Results After the reduction in heroin supply, fatal and non-fatal heroin overdoses decreased by between 40% and 85%. Despite some evidence of increased cocaine, methamphetamine and benzodiazepine use and reports of increases in harms related to their use, there were no increases recorded in the number of either non-fatal overdoses or deaths related to these drugs. There was a sustained decline in injecting drug use in NSW and VIC, as indicated by a substantial drop in the number of needles and syringes distributed (to 1999 levels in Victoria). There was a short-lived increase in property crime in NSW followed by a sustained reduction in such offences. SA and VIC did not show any marked change in the categories of property crime examined in the study. Conclusions Substantial reductions in heroin availability have not occurred often, but in this Australian case a reduction had an aggregate positive impact in that it was associated with: reduced fatal and non-fatal heroin overdoses; reduced the apparent extent of injecting drug use in VIC and NSW; and may have contributed to reduced crime in NSW. All these changes provide substantial benefits to the community and some to heroin users. Documented shifts to other forms of drug use did not appear sufficient to produce increases in deaths, non-fatal overdoses or treatment seeking related to those drugs. [source] Cardiac Dysrhythmia Associated with the Immediate Postictal State after Maximal Electroshock in Freely Moving RatEPILEPSIA, Issue 4 2002Olivier Darbin Summary: ,Purpose: Cardiac autonomic changes accompany complex partial seizures and generalized tonic,clonic seizures, and participate, at least partially, in the sudden and unexpected death in epilepsy (SUDEP). The analysis of the heart rate variability (HRV) is one of the simplest ways of providing insight into autonomic functions. The entropy quantifies the repetition of complex patterns in a signal and refers to systems randomness, regularity, and predictability. Clinical investigations have reported that entropy decreases in patients with a high risk of sudden cardiac death. The goal of this study was to evaluate the effects of the maximal electroshock (MES) on the entropy of HRV, monitored in the immediate postictal stage in the model of the freely moving rat. Methods: Entropy changes were correlated with the high and low frequencies of spectral analysis, which reflect the participation of the sympathetic and parasympathetic activities. Results: MES-induced arrhythmia is characterized by an HRV increase, an imbalance in favor of the parasympathetic activity, and a decrease in the entropy. Entropy decrease was restricted to the duration of the arrhythmia, suggesting that the postictal arrhythmia may be associated with a higher risk of lethal cardiac complications. Nevertheless, entropy changes did not correlate with spectral changes. Conclusions: The results suggest that the imbalance demonstrated in the spectral domain explains only partially the contribution of each autonomic system in the complexity of the heart rate during the postictal state. [source] Epileptic Seizures after Treatment with ThiocolchicosideEPILEPSIA, Issue 8 2001Pier Luigi De Riu Summary: ,Purpose: To report the occurrence of epileptic seizures in humans, closely related to the use of the centrally acting muscle relaxant thiocolchicoside. Methods: Description of three case histories. Results: Two patients, affected with complex-partial seizures, sometimes secondarily generalized, receiving antiepileptic therapy, were seizure free for 7 and 9 years, respectively. They had the reappearance of tonic,clonic seizures few days after the continued use of thiocolchicoside, at a cumulative dose of the drug of 52 mg and 76 mg, respectively. The third patient was brain damaged and without a history of seizures. He had a sudden, convulsive seizure a few minutes after 4 mg intramuscular thiocolchicoside. Conclusions: Our case histories indicate that thiocolchicoside has a powerful epileptogenic activity. This drug should be avoided in patients with epilepsy or acute brain injury and possible disruption of the blood,brain barrier. [source] Supply control and harm reduction: lessons from the Australian heroin ,drought'ADDICTION, Issue 1 2003Don Weatherburn ABSTRACT Aims, To examine the effects of supply-side drug law enforcement on the dynamics of the Australian heroin market and the harms associated with heroin. Setting, Around Christmas 2000, heroin users in Sydney and other large capital cities in Australia began reporting sudden and significant reductions in the availability of heroin. The changes, which appear to have been caused at least in part by drug law enforcement, provided a rare opportunity to examine the potential impact of such enforcement on the harm associated with heroin. Design, Data were drawn from a survey of 165 heroin users in South-Western Sydney, Australia; from the Drug Use Monitoring in Australia (DUMA) project; from NSW Health records of heroin overdoses; and from the Computerized Operational Policing System (COPS) database. Findings, Heroin price increased, while purity, consumption and expenditure on the drug decreased as a result of the shortage. The fall in overall heroin use was accompanied by a significant reduction in the rate of overdose in NSW. However, the health benefits associated with the fall in overdose may have been offset by an increase in the use of other drugs (mainly cocaine) since the onset of the heroin shortage. There does not appear to have been any enduring impact on crime rates as a result of the heroin ,drought'. Conclusion, Supply control has an important part to play in harm reduction; however, proponents of supply-side drug law enforcement need to be mindful of the unintended adverse consequences that might flow from successfully disrupting the market for a particular illegal drug. [source] Temporal and spatial responses of British Columbia steelhead (Oncorhynchus mykiss) populations to ocean climate shiftsFISHERIES OCEANOGRAPHY, Issue 1 2000Welch The pattern of temporal change in recruitment of steelhead trout (Oncorhynchus mykiss) entering the ocean between 1963 and 1990 was geographically coherent in all regions of British Columbia. A major increase in recruitment was evident for smolts entering the ocean after 1977. Subsequently, an out-of-phase response occurred after 1990, indicating that the effect of a possible 1990 regime shift had both temporal and geographical structure. Steelhead entering northern regions had increasing recruitment, while steelhead entering southern BC coastal regions had sharply decreasing recruitment. The evidence clearly indicates that the overall recruitment response since 1977 was primarily shaped by changes in marine (not freshwater) survival. Similar sudden changes in adult recruitment also appear to be occurring for other species of Pacific salmon in BC and Oregon, such as coho (O. kisutch), which appear to occur suddenly and show considerable persistence. A possible explanation for the change is that ocean productivity declined in coastal regions of southern BC after 1990, reducing the marine growth of juvenile salmon. The Bakun upwelling index shows a pattern of geographical coherence along the west coast of North America that could in principle explain the observed pattern of changes in recruitment. However, no evidence for a temporal shift in this index occurring around 1977 and 1990 is apparent. The reason for the sudden and persistent decline in ocean survival is therefore uncertain. [source] Timing of spawning and glochidial release in Scottish freshwater pearl mussel (Margaritifera margaritifera) populationsFRESHWATER BIOLOGY, Issue 12 2003Lee C. Hastie Summary 1. The timing of reproduction was investigated in six Scottish freshwater pearl mussel populations from 1993 to 2002. Gravid females were examined and the release of mussel larvae (glochidia) was monitored. 2. Annual spawning (oviposition) and spat (glochidial release) events occurred during June to July and June to September, respectively. 3. Between-river differences in timing seem to be related to water temperature. Mussels in the warmest rivers tend to spawn and spat first, and vice-versa. 4. Thermal variations also seem to influence the timing of reproduction within rivers, which can be delayed by several weeks during cold years. At least 3000°-days occur between annual episodes of glochidial release. 5. The timing of spawning is determined gradually, probably by a thermal summation effect. 6. The release stage occurs as a sudden, synchronised event, with most of the glochidia spat over 1,2 days, indicating that it is triggered by an environmental cue. Sudden changes in water temperature and/or river level often result in spats, and the underlying mechanism may be respiratory. [source] Rethinking Law and Violence: The Domestic Violence (Prevention) Bill in India, 2002GENDER & HISTORY, Issue 3 2004Rajeswari Sunder Rajan This essay focuses on the controversy generated by recent proposed legislation on domestic violence in India. An alternative draft bill on domestic violence prepared by the feminist legal NGO, the Lawyers' Collective, and supported by women's groups nationally, includes a demand that victims of domestic violence (usually wives) be permitted by law to continue to occupy the domestic home, a demand that the Government bill has refused to include. This demand is theoretically informed by a politics of space. Bodies and space are linked, to the extent that each is an abstraction without the concept of the other to ground it. The feminist legal proposal challenges property-as-absolute-(male) ownership by conceptualising the household as, instead, shared domestic space. The proposal does not dissimulate common sense , it is conscious of being radical, in part at least because it demystifies the ,domestic' as an ideological construct and offers it instead realistically and minimally as simply an alternative to destitution. The recognition that there are no support structures for dependant women outside the family (such as, for example, state-sponsored welfare institutions), so that destitution can be both sudden and real for women of any class and circumstances, has led to the conceptualisation of a law that formulates a right to shared space as one that makes no claim to shared ownership , while at the same time questioning the other's absolute property right. Despite the limited nature of the claim it makes, this proposal has been viewed as threatening by Indian law-makers. [source] Bombed and Silenced: Foreign Witnesses of the Air War in GermanyGERMAN LIFE AND LETTERS, Issue 4 2009Oliver Lubrich ABSTRACT Non-German accounts of the air war from inside Germany, 1939,1945, offer perspectives and evidence that are very distinct from what most German authors have been able to contribute. Yet they have not been registered in the recent debates about representations of German suffering in testimonies and literature (initiated by W. G. Sebald ten years ago). By looking at five issues specific to non-German writing, the present article proposes to open up the debate to these new voices: (1) Foreign experiences are distinctively sudden, open, ambivalent, dynamic and, by contrast, sharper in perception. (2) International reports are historical documents that have a particular value for understanding contemporary expectations, relative information and shifting judgments on the Allied bombing campaign. (3) Writers like Curzio Malaparte, Louis-Ferdinand Céline, Kurt Vonnegut or Marie Vassiltchikov developed rhetorical and poetical means for representing the destruction without succumbing to the faults that Sebald diagnosed in most German writers, who repressed, stylised or banalised it. (4) Unlike many of their contemporary German counterparts, most international authors dealt with the uncanny aesthetics of an air raid without aestheticising it. (5) Finally, the article attempts an explanation for why international witnesses have not been heard n the politicised German debates. Their tendency to overemphasise introspection and moralism over comparative philology and historiography may have made many Germans deaf to the voices of foreigners. [source] The development and implementation of the Pathway for Improving the Care of the Dying in general medical wardsINTERNAL MEDICINE JOURNAL, Issue 10 2009K. Jackson Abstract The majority of deaths in Australia occur in general hospital wards and most are neither sudden nor unexpected. The Pathway for Improving the Care of the Dying (PICD) is an adaptation of the Liverpool Care Pathway to the Australian healthcare setting (or ,to Australian conditions') and is designed to help ensure a ,good death' for patients dying outside the palliative care system. PICD consists of a series of prompts, guidelines, revised medical and nursing care plans and a number of medication algorithms. [source] Influence of particle shape and angularity on the behaviour of granular materials: a numerical analysisINTERNATIONAL JOURNAL FOR NUMERICAL AND ANALYTICAL METHODS IN GEOMECHANICS, Issue 14 2003C. Nouguier-Lehon Abstract This paper analyses the influence of grain shape and angularity on the behaviour of granular materials from a two-dimensional analysis by means of a discrete element method (Contact Dynamics). Different shapes of grains have been studied (circular, isotropic polygonal and elongated polygonal shapes) as well as different initial states (density) and directions of loading with respect to the initial fabric. Simulations of biaxial tests clearly show that the behaviour of samples with isotropic particles can be dissociated from that of samples with anisotropic particles. Indeed, for isotropic particles, angularity just tends to strengthen the behaviour of samples and slow down either local or global phenomena. One of the main results concerns the existence of a critical state for isotropic grains characterized by an angle of friction at the critical state, a critical void ratio and also a critical anisotropy. This critical state seems meaningless for elongated grains and the behaviour of samples generated with such particles is highly dependent on the direction of loading with respect to the initial fabric. The study of local variables related to fabric and particle orientation gives more information. In particular, the coincidence of the principal axes of the fabric tensor with those of the stress tensor is sudden for isotropic particles. On the contrary, this process is gradually initiated for elongated particles. Copyright © 2003 John Wiley & Sons, Ltd. [source] When Small Is Different: Some Recent Advances in Concepts and Applications of Nanoscale Phenomena,ADVANCED MATERIALS, Issue 5 2007G. Hodes Abstract Reduction in size often does more than simply make things smaller. There are many properties of materials that undergo qualitative, often sudden, changes below a certain size scale. This Report first describes some of these size-dependent properties. Following this general description, recent developments in a number of selected topics in nanoscience are covered. These topics are: luminescence from Au nanoparticles; Si (and related) nanoparticle luminescence; modification of optical absorption by surface adsorption on nanoparticles; and transistors (and some other devices) based on nanotubes and nanowires. [source] Molecular clocks keep dispersal hypotheses afloat: evidence for trans-Atlantic rafting by rodentsJOURNAL OF BIOGEOGRAPHY, Issue 2 2010Diane L. Rowe Abstract Aim, In order to resolve disputed biogeographical histories of biota with Gondwanan continental distributions, and to assess the null hypothesis of vicariance, it is imperative that a robust geological time-frame be established. As an example, the sudden and coincident appearance of hystricognath rodents (Rodentia: Hystricognathi) on both the African and South American continents has been an irreconcilable controversy for evolutionary biologists, presenting enigmas for both Gondwanan vicariance and Late Eocene dispersal hypotheses. In an attempt to resolve this discordance, we aim to provide a more robust phylogenetic hypothesis and improve divergence-date estimates, which are essential to assessing the null hypothesis of vicariance biogeography. Location, The primary centres of distribution are in Africa and South America. Methods, We implemented parsimony, maximum-likelihood and Bayesian methods to generate a phylogeny of 37 hystricognath taxa, the most comprehensive taxonomic sampling of this group to date, on the basis of two nuclear gene regions. To increase phylogenetic resolution at the basal nodes, these data were combined with previously published data for six additional nuclear gene regions. Divergence dates were estimated using two relaxed-molecular-clock methods, Bayesian multidivtime and nonparametric rate smoothing. Results, Our data do not support reciprocal monophyly of African and South American lineages. Indeed, Old World porcupines (i.e. Hystricomorpha) appear to be more closely related to New World lineages (i.e. Caviomorpha) than to other Old World families (i.e. Bathyergidae, Petromuridae and Thryonomyidae). The divergence between the monophyletic assemblage of South American lineages and its Old World ancestor was estimated to have occurred c. 50 Ma. Main conclusions, Our phylogenetic hypothesis and divergence-date estimates are strongly at odds with Gondwanan-vicariance isolating mechanisms. In contrast, our data suggest that transoceanic dispersal has played a significant role in governing the contemporary distribution of hystricognath rodents. Molecular-clock analyses imply a trans-Tethys dispersal event, broadly confined to the Late Cretaceous, and trans-Atlantic dispersal within the Early Eocene. Our analyses also imply that the use of the oldest known South American rodent fossil as a calibration point has biased molecular-clock inferences. [source] Enhanced Predictive Power of Quantitative TWA during Routine Exercise Testing in the Finnish Cardiovascular StudyJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2009MIKKO MINKKINEN B.M.S. Introduction: We examined whether quantification of T-wave alternans (TWA) enhances this parameter's capacity to evaluate the risk for total and cardiovascular mortality and sudden cardiac death (SCD). Methods and Results: The Finnish Cardiovascular Study (FINCAVAS) enrolled consecutive patients (n = 2,119; 1,342 men and 777 women) with a clinically indicated exercise test with bicycle ergometer. TWA (time domain-modified moving average method) was analyzed from precordial leads, and the results were grouped in increments of 10 ,V. Hazard ratios (HR) for total and cardiovascular mortality and SCD were estimated for preexercise, routine exercise, and postexercise stages. Cox regression analysis was performed. During follow-up of 47.1 ± 12.9 months (mean ± standard deviation [SD]), 126 patients died: 62 were cardiovascular deaths, and 33 of these deaths were sudden. During preexercise, TWA , 20 ,V predicted the risk for total and cardiovascular mortality (maximum HR >4.4 at 60 ,V, P < 0.02 for both). During exercise, HRs of total and cardiovascular mortality were significant when TWA measured ,50 ,V, with 90 ,V TWA yielding maximum HRs for total and cardiovascular death of 3.1 (P = 0.03) and 6.4 (P = 0.002), respectively. During postexercise, TWA ,60 ,V indicated risk for total and cardiovascular mortality, with maximum HR of 3.4 at 70 ,V (P = 0.01) for cardiovascular mortality. SCD was strongly predicted by TWA levels ,60 ,V during exercise, with maximum HR of 4.6 at 60 ,V (P = 0.002), but was not predicted during pre- or postexercise. Conclusion: Quantification of TWA enhances its capacity for determination of the risk for total and cardiovascular mortality and SCD in low-risk populations. Its prognostic power is superior during exercise compared to preexercise or postexercise. [source] An Analysis of Possible Mechanisms of Unexpected Death Occurring in Hydatid Disease (Echinococcosis)JOURNAL OF FORENSIC SCIENCES, Issue 4 2009Roger W. Byard M.B.B.S. Abstract:, Most cases of hydatid disease in human populations are due to Echinococcus granulosus. The hydatid life cycle involves passage between definitive hosts such as dogs and intermediate hosts such as sheep. Humans become accidental intermediate hosts following ingestion of food or water contaminated with eggs or by contact with infected dogs. Although hydatid disease may remain asymptomatic, occasional cases of sudden and unexpected death present to autopsy. Causes of rapid clinical decline involve a wide range of mechanisms including anaphylaxis (with or without cyst rupture), cardiac outflow obstruction or conduction tract disturbance, pulmonary and cerebral embolism, pericarditis, cardiac tamponade, myocardial ischemia, pulmonary hypertension, peritonitis, hollow organ perforation, intracerebral mass effect, obstructive hydrocephalus, seizures, cerebral ischemia/infarction, and pregnancy complications. The autopsy assessment of cases therefore requires careful examination of all organ systems for characteristic cystic lesions, as multiorgan involvement is common, with integration of findings so that possible mechanisms of death can be determined. Measurement of serum tryptase and specific IgE levels should be undertaken for possible anaphylaxis. [source] Esophageal Causes of Sudden and Unexpected DeathJOURNAL OF FORENSIC SCIENCES, Issue 2 2006Roger W. Byard M.D. ABSTRACT: Gastrointestinal conditions are uncommon causes of sudden and/or unexpected death as compared to cardiovascular diseases, motor vehicle trauma, or suicide, and may involve an array of fatal mechanisms. Lethal esophageal conditions are encountered even less often, the manifestations of which include acute upper airway occlusion from tumors or foreign material, intraluminal hemorrhage from vascular abnormalities, or perforation with fistula formation resulting in hemorrhage and sepsis. When encountered at autopsy, a particular condition may also be a manifestation of a disease that does not primarily involve the esophagus. For this reason, a detailed autopsy investigation is required for evidence of systemic or remote disease when lesions are found within the esophagus. In this report, possible life-threatening esophageal conditions are reviewed with a description of lethal mechanisms, mention of rare associated diseases, and comment on difficulties that may arise at autopsy in the evaluation of such cases. [source] Association of Pepino mosaic virus with Tomato CollapseJOURNAL OF PHYTOPATHOLOGY, Issue 7-8 2005S. Soler-Aleixandre Abstract Since 1998 collapse of tomato plants has been producing significant losses in protected tomato crops along the Spanish Mediterranean coast. Affected plants show sudden and progressive wilt followed by total collapse and death. Analysis of the distribution and accumulation of Pepino mosaic virus (PepMV) in collapsed and non-collapsed plants and the presence of the virus in all analysed collapsed plants suggests a relationship of this Potexvirus with tomato collapse. The fact that collapse does not occur on PepMV-free farms reinforces this hypothesis. PepMV-infected plants showed a necrotic area in the vascular system, mainly in the basal area of the stem. This necrosis was more pronounced in collapsed plants and in the areas with higher viral concentration. Our hypothesis is that tomato collapse would be associated with necrosis of the vascular system caused by PepMV accumulation. [source] Evolution of capital structure in east Asia,corporate inertia or endeavours?JOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES A (STATISTICS IN SOCIETY), Issue 1 2010Nigel Driffield Summary., The paper examines the capital structure adjustment dynamics of listed non-financial corporations in seven east Asian countries before, during and after the crisis of 1997,1998. Our methodology allows for speeds of adjustment to vary, not only among firms, but also over time, distinguishing between cases of sudden and smooth adjustment. Whereas, compared with firms in the least affected countries, average leverages were much higher, generalized method-of-moments analysis of the Worldscope panel data suggests that average speeds of adjustment were lower in the worst affected countries. This holds also for the severely financially distressed firms in some worst affected countries, though the trend reversed in the post-crisis period. These findings have important implications for the regulatory environment as well as access to market finance. [source] Physiologic reactivity to startling tones in female vietnam nurse veterans with PTSDJOURNAL OF TRAUMATIC STRESS, Issue 5 2007Margaret A. Carson Posttraumatic stress disorder (PTSD) is associated with larger heart rate (HR), skin conductance (SC), and eyeblink responses to sudden, loud tones. The present study tested this association in female nurse veterans with PTSD related to witnessing patients' death, severe injury and/or suffering during their Vietnam service. Nurses with current, past but not current, or who never had PTSD listened to 15 consecutive 95-dB, 500-ms, 1000-Hz tones with sudden onsets, while HR, SC, and eyeblink responses were measured. Nurses with current PTSD produced significantly larger averaged HR, but not SC or eyeblink responses across tone trials. A larger HR response to loud tones is one of the most robust physiologic findings in PTSD and may reflect increased defensive responding. [source] Registered nurse-administered propofol sedation for endoscopyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2004S. C. Chen Summary Propofol has several attractive properties that render it a potential alternative sedative agent for endoscopy. Compared with meperidine and midazolam, it has an ultra-short onset of action, short plasma half-life, short time to achieve sedation, faster time to recovery and discharge, and results in higher patient satisfaction. Shorter times to achieve sedation enhance efficiency in the endoscopy unit. Multiple studies have documented the safe administration of propofol by non-anaesthesiologists. Administration by registered nurses is more cost-effective than administration by anaesthesiologists. However, the administration of propofol by a registered nurse supervised only by the endoscopist is controversial because the drug has the potential to produce sudden and severe respiratory depression. More information is needed on how training nurses and endoscopists should proceed to give propofol, as well as the optimal level of monitoring to ensure the safety of nurse-administered propofol. [source] Kinetics of Demixing and Remixing Transitions in Aqueous Solutions of Poly(N -isopropylacrylamide): A Temperature-Jump 1H NMR StudyMACROMOLECULAR CHEMISTRY AND PHYSICS, Issue 21 2006Pavel V. Yushmanov Abstract Summary: The time course of the coil-to-globule collapse and intermolecular aggregation of poly(N -isopropylacrylamide) in aqueous solution upon exceeding the lower critical solution temperature (LCST) are investigated by temperature-jump 1H NMR spectroscopy. After the temperature jump, we record the time dependences of (i) the mobile fraction of the polymer chain as revealed by the intensity of the liquid-like NMR signal, (ii) the local mobility of those chains as revealed by the transverse relaxation time T2, and (iii) their self-diffusion coefficient D. The same data are also reported at their temperature-dependent long-time limits. The results suggest a sudden, faster than one second, collapse and intermolecular aggregation into globules and a slower reorganization/redistribution of the individual chains among and within the globular and mobile states. We found that all molecular changes are reversible if the temperature remains less than ca. 6,8 K above the LCST for less than a few minutes; under those conditions, experiments upon sudden temperature quench below the LCST show that the aggregates disintegrate and swell into coils in less than a few seconds. 1H NMR signal intensity of the methyl groups of 1 wt.-% PNIPAM dissolved in 0.1 M NaCl solution in D2O in a temperature-jump experiment from 300 to 312 K. The data were recorded by the 90°,,,(180°,2, -)n -detection of the CPMG pulse sequence. [source] Hypoplasia of the arcuate nucleus and maternal smoking during pregnancy in sudden unexplained perinatal and infant deathNEUROPATHOLOGY, Issue 4 2004Anna Maria Lavezzi Maternal smoking during pregnancy is the most important risk factor for sudden perinatal and infant death in more industrialized countries. The frequent observation of hypoplasia of the arcuate nucleus in the brainstem of these victims prompted the verification of whether maternal cigarette smoking could be related to defective development of this nucleus during intrauterine life, by affecting the expression of specific genes involved in its developmental process. In serial sections of the brainstem of 54 cases of sudden and unexplained fetal and infant deaths (13 stillbirths, 7 neonatal deaths and 34 sudden infant death syndrome (SIDS) victims), morphological and morphometrical analysis was used to observe the different structural alterations of the arcuate nucleus (bilateral hypoplasia, monolateral hypoplasia, partial hypoplasia, delayed neuronal maturation and decreased neuronal density) detected in 24 cases (44%). Correlating this finding with smoking in pregnancy, a significantly increased incidence of cytoarchitectural alterations of the arcuate nucleus was found in stillborns and SIDS victims with smoker mothers compared to victims with non-smoker mothers. Moreover, the observation of a wide range of developing morphological defects of the arcuate nucleus related to maternal smoking led to the hypothesis that the constituents of the gas phase in cigarette smoke could directly affect the expression of genes involved in the development of this nucleus, such as the homeobox En-2 gene. [source] Verlaine's La bonne chanson and Romances sans parolesORBIS LITERARUM, Issue 5 2006The Vortical Link In Verlaine's La bonne chanson, the path to the lady involves centripetal circling, proceeding by degrees, toward an ever closer encounter, in hopes of achieving synthesis with her at the stillpoint of a vortex. Two episodes, located like elliptical dual centers, result in two outcomes: the first, a sudden, centrifugal reversal flinging him violently away, signifying the lady's rejection; the second, an apparently successful but short-lived fusion, as the poet's measured centrifugal withdrawing, this time of his own accord, portrays. By the time Romances sans paroles opens, estrangement from the lady has increased, but a harmonious intimacy has developed between the poet and a male companion, and the poet's bisexuality is reflected by various gender relations and shifts. His open avowal of a homosexual affair is a shock that upsets the delicate balance between conflicting desires that had been, until now, precariously maintained, resulting in the violent, vertiginous vortex that tears things apart. Although the vortex is, as phenomenon and symbol, reversible, whirling centripetally toward a calm union at the center or centrifugally away toward the furious chaos at the periphery, it is the destructive centrifuge that prevails in these works, ending all tensions and conflicts by annihilating them. [source] | ||||||||||||||||||||||||||||||||||||||||||||||