Are patients admitted to emergency departments with regular supraventricular tachycardia (SVT) treated appropriately?

Regular supraventricular tachycardia (SVT) is frequently encountered in clinical practice. Guidelines are available from the National Service Framework (NSF) for the treatment of patients attending emergency departments (ED) with SVT. These recommend a thyroid-function test (TFT) and arrhythmia electrocardiography (ECG), and referral to a heart-rhythm specialist on discharge. Hospital admission is rarely required. In our multicentre study, we examined the implementation of these guidelines among patients attending the ED with SVT. Only 34% of patients had specialist referrals, with an average wait of 50.3 days (the majority of delays resulted from referral requests from general practitioners). A history of previous SVT, the mode of tachycardia termination, patient age and/or comorbidities were similar for the 27 (23.5%) patients who were admitted overnight. Of these, 15 (13%) of the total 115 patients who attended ED with regular SVT were referred for Holter monitoring despite having ECGs demonstrating arrhythmia. Low referral rates, unnecessary investigations and admissions indicate a need for improvement for better patient care and to minimise healthcare costs. We have formulated a standard operating procedure, which will be available via the College of Emergency Medicine website

Identification of the factors associated with outcomes in a condition management programme

<p>Background: A requirement of the Government’s Pathways to Work (PtW) agenda was to introduce a Condition Management Programme (CMP). The aim of the present study was to identify the differences between those who engaged and made progress in this telephone-based biopsychosocial intervention, in terms of their health, and those who did not and to determine the client and practitioner characteristics and programme elements associated with success in a programme aimed at improving health.</p> <p>Methods: Data were obtained from the CMP electronic spreadsheets and clients paper-based case records. CMP standard practice was that questionnaires were administered during the pre- and post-assessment phases over the telephone. Each client’s record contains their socio-demographic data, their primary health condition, as well as the pre- and post-intervention scores of the health assessment tool administered. Univariate and multivariate statistical analysis was used to investigate the relationships between the database variables. Clients were included in the study if their records were available for analysis from July 2006 to December 2007.</p> <p> Results: On average there were 112 referrals per month, totalling 2016 referrals during the evaluation period. The majority (62.8%) of clients had a mental-health condition. Successful completion of the programme was 28.5% (575 “completers”; 144 “discharges”). Several factors, such as age, health condition, mode of contact, and practitioner characteristics, were significant determinants of participation and completion of the programme. The results showed that completion of the CMP was associated with a better mental-health status, by reducing the number of clients that were either anxious, depressed or both, before undertaking the programme, from 74% to 32.5%.</p> <p>Conclusions: Our findings showed that an individual's characteristics are associated with success in the programme, defined as completing the intervention and demonstrating an improved health status. This study provides some evidence that the systematic evaluation of such programmes and interventions could identify ways in which they could be improved.</p&gt

Growth in densely populated Asia: implications for primary product exporters

Economic growth and integration in Asia is rapidly increasing the global economic importance of the region. To the extent that this growth continues and is strongest in natural resource-poor Asian economies, it will add to global demand for imports of primary products, to the benefit of (especially nearby) resource-abundant countries. How will global production, consumption and trade patterns change by 2030 in the course of such economic developments and structural changes? We address this question using the GTAP model and Version 8.1 of the 2007 GTAP database, together with supplementary data from a range of sources, to support projections of the global economy from 2007 to 2030 under various scenarios. Factor endowments and real gross domestic product are assumed to grow at exogenous rates, and trade-related policies are kept unchanged to generate a core baseline, which is compared with an alternative slower growth scenario. We also consider the impact of several policy changes aimed at increasing China's agricultural self-sufficiency relative to the 2030 baseline. Policy implications for countries of the Asia-Pacific region are drawn out in the final section

Modulation of emotional appraisal by false physiological feedback during fMRI

BACKGROUND James and Lange proposed that emotions are the perception of physiological reactions. Two-level theories of emotion extend this model to suggest that cognitive interpretations of physiological changes shape self-reported emotions. Correspondingly false physiological feedback of evoked or tonic bodily responses can alter emotional attributions. Moreover, anxiety states are proposed to arise from detection of mismatch between actual and anticipated states of physiological arousal. However, the neural underpinnings of these phenomena previously have not been examined. METHODOLOGY/PRINCIPAL FINDINGS We undertook a functional brain imaging (fMRI) experiment to investigate how both primary and second-order levels of physiological (viscerosensory) representation impact on the processing of external emotional cues. 12 participants were scanned while judging face stimuli during both exercise and non-exercise conditions in the context of true and false auditory feedback of tonic heart rate. We observed that the perceived emotional intensity/salience of neutral faces was enhanced by false feedback of increased heart rate. Regional changes in neural activity corresponding to this behavioural interaction were observed within included right anterior insula, bilateral mid insula, and amygdala. In addition, right anterior insula activity was enhanced during by asynchronous relative to synchronous cardiac feedback even with no change in perceived or actual heart rate suggesting this region serves as a comparator to detect physiological mismatches. Finally, BOLD activity within right anterior insula and amygdala predicted the corresponding changes in perceived intensity ratings at both a group and an individual level. CONCLUSIONS/SIGNIFICANCE Our findings identify the neural substrates supporting behavioural effects of false physiological feedback, and highlight mechanisms that underlie subjective anxiety states, including the importance of the right anterior insula in guiding second-order "cognitive" representations of bodily arousal state

Modulation of emotional appraisal by false physiological feedback during fMRI

BACKGROUND James and Lange proposed that emotions are the perception of physiological reactions. Two-level theories of emotion extend this model to suggest that cognitive interpretations of physiological changes shape self-reported emotions. Correspondingly false physiological feedback of evoked or tonic bodily responses can alter emotional attributions. Moreover, anxiety states are proposed to arise from detection of mismatch between actual and anticipated states of physiological arousal. However, the neural underpinnings of these phenomena previously have not been examined. METHODOLOGY/PRINCIPAL FINDINGS We undertook a functional brain imaging (fMRI) experiment to investigate how both primary and second-order levels of physiological (viscerosensory) representation impact on the processing of external emotional cues. 12 participants were scanned while judging face stimuli during both exercise and non-exercise conditions in the context of true and false auditory feedback of tonic heart rate. We observed that the perceived emotional intensity/salience of neutral faces was enhanced by false feedback of increased heart rate. Regional changes in neural activity corresponding to this behavioural interaction were observed within included right anterior insula, bilateral mid insula, and amygdala. In addition, right anterior insula activity was enhanced during by asynchronous relative to synchronous cardiac feedback even with no change in perceived or actual heart rate suggesting this region serves as a comparator to detect physiological mismatches. Finally, BOLD activity within right anterior insula and amygdala predicted the corresponding changes in perceived intensity ratings at both a group and an individual level. CONCLUSIONS/SIGNIFICANCE Our findings identify the neural substrates supporting behavioural effects of false physiological feedback, and highlight mechanisms that underlie subjective anxiety states, including the importance of the right anterior insula in guiding second-order "cognitive" representations of bodily arousal state

Partial-wave analysis of the eta pi+ pi- system produced in the reaction pi-p --> eta pi+ pi- n at 18 GeV/c

A partial-wave analysis of 9082 eta pi+ pi- n events produced in the reaction pi- p --> eta pi+ pi- n at 18.3 GeV/c has been carried out using data from experiment 852 at Brookhaven National Laboratory. The data are dominated by J^{PC} = 0^{-+} partial waves consistent with observation of the eta(1295) and the eta(1440). The mass and width of the eta(1295) were determined to be 1282 +- 5 MeV and 66 +- 13 Mev respectively while the eta(1440) was observed with a mass of 1404 +- 6 MeV and width of 80 +- 21 MeV. Other partial waves of importance include the 1++ and the 1+- waves. Results of the partial wave analysis are combined with results of other experiments to estimate f1(1285) branching fractions. These values are considerably different from current values determined without the aid of amplitude analyses.Comment: 22 pages, 8 figure

A low-lying scalar meson nonet in a unitarized meson model

A unitarized nonrelativistic meson model which is successful for the description of the heavy and light vector and pseudoscalar mesons yields, in its extension to the scalar mesons but for the same model parameters, a complete nonet below 1 GeV. In the unitarization scheme, real and virtual meson-meson decay channels are coupled to the quark-antiquark confinement channels. The flavor-dependent harmonic-oscillator confining potential itself has bound states epsilon(1.3 GeV), S(1.5 GeV), delta(1.3 GeV), kappa(1.4 GeV), similar to the results of other bound-state qqbar models. However, the full coupled-channel equations show poles at epsilon(0.5 GeV), S(0.99 GeV), delta(0.97 GeV), kappa(0.73 GeV). Not only can these pole positions be calculated in our model, but also cross sections and phase shifts in the meson-scattering channels, which are in reasonable agreement with the available data for pion-pion, eta-pion and Kaon-pion in S-wave scattering.Comment: A slightly revised version of Zeitschrift fuer Physik C30, 615 (1986

Analysis of charmonium production at fixed-target experiments in the NRQCD approach

We present an analysis of the existing data on charmonium hadro-production based on non-relativistic QCD (NRQCD) calculations at the next-to-leading order (NLO). All the data on J/psi and psi' production in fixed-target experiments and on pp collisions at low energy are included. We find that the amount of color octet contribution needed to describe the data is about 1/10 of that found at the Tevatron

Quantum Smoluchowski equation: Escape from a metastable state

We develop a quantum Smoluchowski equation in terms of a true probability distribution function to describe quantum Brownian motion in configuration space in large friction limit at arbitrary temperature and derive the rate of barrier crossing and tunneling within an unified scheme. The present treatment is independent of path integral formalism and is based on canonical quantization procedure.Comment: 10 pages, To appear in the Proceedings of Statphys - Kolkata I

Brief Report: Attenuated Emotional Suppression of the Attentional Blink in Autism Spectrum Disorder: Another Non-Social Abnormality?

Twenty-five individuals with Autism Spectrum Disorder and 25 typically developed individuals participated in an Attentional Blink paradigm to determine whether emotional words would capture attention similarly in the two groups. Whilst the emotionality of words facilitated attention in typical comparison participants, this effect was attenuated in the ASD group. The magnitude of the emotional modulation of attention in ASD also correlated significantly with participants’ VIQ, which was not observed for the comparison group. Together these observations replicate and extend the findings of Corden et al. (J Autism Develop Disord 38:1072–1080, 2008) and implicate abnormalities in emotional processes outside the broader context of social cognition in ASD. We discuss our findings in relation to possible abnormalities in amygdala function that may underlie the disorder