Search

The development of atrial flutter and fibrillation (AFL/AF) in patients with pre-capillary pulmonary hypertension has been associated with an increased risk of morbidity and mortality. Rate and rhythm control strategies have not been directly compared. Eighty-four patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) with new-onset AFL/AF were identified in the ASPIRE registry. First, baseline characteristics and rates of sinus rhythm (SR) restoration of 3 arrhythmia management strategies (rate control, medical rhythm control and DC cardioversion, DCCV) in an early (2009–13) and later (2014–19) cohort were compared. Longer-term outcomes in patients who achieved SR versus those who did not were then explored. Sixty (71%) patients had AFL and 24 (29%) AF. Eighteen (22%) patients underwent rate control, 22 (26%) medical rhythm control and 44 (52%) DCCV. SR was restored in 33% treated by rate control, 59% medical rhythm control and 95% DCCV (p < 0.001). Restoration of SR was associated with greater improvement in functional class (FC) and Incremental Shuttle Walk Distance (p both <0.05). It also independently predicted superior survival (3-year survival 62% vs 23% in those remaining in AFL/AF, p < 0.0001). In addition, FC III/IV independently predicted higher mortality (HR 2.86, p = 0.007). Right atrial area independently predicted AFL/AF recurrence (OR 1.08, p = 0.01). DCCV was generally well tolerated with no immediate major complications. Restoration of SR is associated with superior functional improvement and survival in PAH/CTEPH compared with rate control. DCCV is generally safe and is more effective than medical therapy at achieving SR. • Atrial arrhythmias increase morbidity and mortality in pulmonary hypertension • Restoration of sinus rhythm leads to improved functional status and survival • DC cardioversion is a safe and effective initial strategy to achieve rhythm control [ABSTRACT FROM AUTHOR]

The New Zealand Reanalysis (NZRA) is the first high-resolution convection-permitting atmospheric regional reanalysis model over Aotearoa New Zealand (NZ). NZRA has a spatial horizontal grid spacing of 1.5km and is forced using data from the Bureau of Meteorology Atmospheric high-resolution Regional Reanalysis for Australia (BARRA-R) with approximately 12km horizontal grid spacing. This paper outlines the development of NZRA, including the numerical weather forecast model and driving model. In addition, the performance of NZRA is compared against BARRA-R and global reanalysis products (ERAInterim and ERA5) and validated against observational data collected during June-July 2014 as part of the Deep Propagating Gravity Wave Experiment (DEEPWAVE) field campaign. The results demonstrate that dynamically downscaling BARRA-R to NZRA considerably enhances the wind and temperature predictions, particularly capturing well the diurnal temperature cycle, wind speeds above 95th percentile, and gust wind speeds over the high elevation regions of NZ. In addition, NZRA provides better estimates of total precipitation over the North Island, Canterbury region, West Coast and the southern part of the South Island compared to the Virtual Climate Station Network (VCSN) gridded observation-based product, other reanalyses and NIWA's operational convective-scale forecast model, NZCSM, as was run in 2014. [ABSTRACT FROM AUTHOR]

Background: Military members report higher instances of trauma exposure and subsequent posttraumatic stress disorder (PTSD) relative to civilians. Encounters with children in war and conflict settings may have particularly unsettling consequences. However, the nature of these consequences has yet to be systematically examined. Objective: This systematic review sought to identify and document deployment-related encounters with children and associated outcomes reported by military personnel, as well as identify any current training programs, policies, or procedures in place regarding encountering children during deployment. Method: A total of 17 studies with 86 independent samples were included. Analyses were based primarily on qualitative data. Results: Based on the review, 77 military personnel samples documented their experiences encountering children during deployment. Most commonly, child encounters included armed children, porters/human shields, suicide bombers, and ambiguous interactions. Outcomes from encountering children during deployment were diverse, occurring both during the encounter, and described by many as persisting years following the exposure. Consequences of encounters as described by military personnel included: hesitation to complete mission objectives, mental health concerns, moral struggles, social isolation, and sleep disturbances. Of the 86 included reports, only nine provided information regarding training at any stage (pre-, during, or post-deployment) in relation to encountering children. Much of the available information underscored the lack of training, with six reports highlighting the lack of pre-deployment training and five reports describing the lack of policies, including rules of engagement, as they relate to encountering children during deployment. Only two reports described post-deployment procedures made available to military personnel following exposure to children while on deployment. Conclusions: Results from this review will be used to identify available research, develop and support training initiatives, and increase awareness regarding implications of encountering children during deployment. We further provide recommendations regarding research needs, policy implementation, and current training gaps. A systematic review that identified and documented deployment-related encounters with children and associated outcomes reported by military personnel, as well as identified current training programs, policies, or procedures in place regarding encountering children during deployment. The review found child encounters included armed children, porters/human shields, suicide bombers and ambiguous interactions with consequences, described by military personnel, of mental health concerns, moral struggles (e.g. loss of faith), sleep disturbances, social isolation, and inability to work. Available data showcased a lack of training, lack of policies, and lack of post-deployment interventions. [ABSTRACT FROM AUTHOR]

Objective. Capture-recapture analysis was used to more accurately quantify the admission rate for acute pancreatitis in a regional hospital setting, in comparison to the usual method of case ascertainment. Reasons for differences in capture for the various methods were also sought. Methods. Admissions for acute pancreatitis were enumerated over a 40-month period using three data sources: hospital classification of admission diagnoses, prospective case identification, and receipt of diagnosis-specific pathology specimens. Capture-recapture analysis was applied with log-linear modelling to account for likely dependency between data sources. Covariates were noted to explain capture probability by the various data sources and for eventual stratification in the analysis process. Results. For the census period, there were 304 admissions after merging of data sources, giving a crude admission rate of 7.6 per month. Crude ascertainment rates for discharge records and prospective identification were 44% and 52% respectively. Following log-linear modelling, total admissions more than doubled to 644 (adjusted admission rate 16.1 per month). Of the covariates considered, admissions of less than three days' duration and those occurring in December and January were significantly associated with increased capture by the hospital discharge records data source. Conclusions. In this clinical setting, admissions for acute pancreatitis are grossly underestimated by the standard case ascertainment method. The reasons for this are not clear. Hospital discharge records are nevertheless more effective than prospective case ascertainment for certain cases, such as brief admissions and those in holiday periods. What is known about the topic? Capture-recapture analysis was originally developed in animal ecology, but has since been used to estimate both prevalent and incident cases of human disease. What does this paper add? This study exposes possible deficiencies in the single-source case ascertainment methods used by most hospitals to enumerate incident cases. It is the first time that capture-recapture techniques have been used to estimate acute pancreatitis admissions. What are the implications for practitioners? To obtain accurate admissions estimates for diseases such as acute pancreatitis, capture-recapture analysis with multiple data sources is advisable. One possible solution may be to conduct intermittent prospective censuses to complement existing retrospective ascertainment methods. On a more general level, clinical staff should be better trained to provide more accurate and detailed information in case records. [ABSTRACT FROM AUTHOR]

The article announces the need of "The Lancet" medical journal for clinical studies relevant to respiratory medicine.

The article invites authors to submit their research papers related to regenerative medicines to publish in the periodical.

A letter to the editor is presented commenting on how history taking is being taught to medical students in Great Britain.

A letter to the editor is presented in response to the article "Wiring a nation: putting knowledge into action," by M. Nylenna et al published in the March 20, 2010 issue, which is about the Norwegian Electronic Health Library.

Cites a study by David A. Sinclair and colleagues on biological activity of yeast Saccharomyces cerevisiae. Role of enzyme Pnc1 in environmental stress, metabolic energy and lifespan of the yeast; Significance of nicotinamide in the experiments on Saccharomyces.

Discusses the results of a study of proto-oncogenes on the three-dimensional structure of the DNA-binding domain of c-Myc protein and its obligate DNA-binding partner protein Max. Description of the structures; Findings of an x-ray crystallographic analysis regarding the formation of dimers by Myc-Mac and Mad-Max; Details on th asymmetric unit of Myc-Max dimers.

Decribes the two types of fiber of vertebrate skeletal muscle. Involvement of nuclear proteins in controlling genes that participate in energy metabolism in mammalian cells; Protein expression in mouse skeletal muscles; Use of standardized electrically induced contraction.

Introduces a series of articles concerning the chemistry and biology of RNA, published in the July 11, 2002 issue of the 'Nature' journal.

Examines the molecular events causing the disease of gastric cancer worldwide, and particularly in Asian population. Reference to a study published in the April 5, 2002 issue of the periodical 'Cell,' by Suk-Chul Bae, Yoshiaki Ito and colleagues; Findings related to the characteristics of cancer cells.

Background: This study was undertaken to improve assessment practice on OSCEs through collaboration across geographically dispersed medical schools in Australia. Methods: A total of eleven OSCE stations were co-developed by four medical schools and used in summative 2011 and 2012 examinations for the assessment of clinical performance in the early clinical and exit OSCEs in each school’s medical course. Partial Credit Rasch Model was used to evaluate the psychometric properties of the shared OSCE data. Evaluation of the quality assurance reports was used to determine the beneficial impact of the collaborative benchmarking exercise on learning and teaching outcomes. Results: The data for each examination demonstrated sufficient fit to the Rasch model with infit mean square values ranging from 0.88 to 0.99. Person separation (1.25–1.63) indices indicated good reliability. Evaluation of perceived benefits showed that the benchmarking process was successful as it highlighted common curriculum areas requiring specific focus and provided comparable data on the quality of teaching at the participating medical schools. Conclusion: This research demonstrates the validity of the psychometric data and benefits of evaluating clinical competence across medical schools without the enforcement of a prescriptive national curriculum or assessment. [ABSTRACT FROM AUTHOR]