Optimal opportunistic screening of atrial fibrillation using pulse palpation in cardiology outpatient clinics: Who and how

Atrial fibrillation (AF) remain a prevalent undiagnosed condition frequently encountered in primary care.We aimed to find the parameters that optimize the diagnostic accuracy of pulse palpation to detect AF. We also aimed to create a simple algorithm for selecting which individuals would benefit from pulse palpation and, if positive, receive an ECG to detect AF.Nurses from four Cardiology outpatient clinics palpated 7,844 pulses according to a randomized list of arterial territories and durations of measure and immediately followed by a 12-lead ECG, which we used as the reference standard. We calculated the sensitivity and specificity of the palpation parameters. We also assessed whether diagnostic accuracy depended on the nurse's experience or on a list of clinical factors of the patients. With this information, we estimated the positive predictive values and false omission rates according to very few clinical factors readily available in primary care (age, sex, and diagnosis of heart failure) and used them to create the algorithm.The parameters associated with the highest diagnostic accuracy were palpation of the radial artery and classifying as irregular those palpations in which the nurse was uncertain about pulse regularity or unable to palpate pulse (sensitivity = 79%; specificity = 86%). Specificity decreased with age. Neither the nurse's experience nor any investigated clinical factor influenced diagnostic accuracy. We provide the algorithm to select the ≥40 years old individuals that would benefit from a pulse palpation screening: a) do nothing in <60 years old individuals without heart failure; b) do ECG in ≥70 years old individuals with heart failure; c) do radial pulse palpation in the remaining individuals and do ECG if the pulse is irregular or you are uncertain about its regularity or unable to palpate it.Opportunistic screening for AF using optimal pulse palpation in candidate individuals according to a simple algorithm may have high effectiveness in detecting AF in primary care

Androgen receptor gene polymorphism influence fat accumulation: a longitudinal study from adolescence to adult age.

To determine the influence of androgen receptor CAG and GGN repeat polymorphisms on fat mass and maximal fat oxidation (MFO), CAG and GGN repeat lengths were measured in 128 young boys, from which longitudinal data were obtained in 45 of them [mean?±?SD: 12.8?±?3.6 years old at recruitment, and 27.0?±?4.8 years old at adult age]. Subjects were grouped as CAG short (CAGS ) if harboring repeat lengths ?21, the rest as CAG long (CAGL ); and GGN short (GGNS ) if GGN repeat lengths ?23, or long if >?23 (GGNL ). CAGS and GGNS were associated with lower adiposity than CAGL or GGNL (P?<?0.05). There was an association between the logarithm of CAG repeats polymorphism and the changes of body mass (r?=?0.34, P?=?0.03). At adult age, CAGS men showed lower accumulation of total body and trunk fat mass, and lower resting metabolic rate (RMR) and MFO per kg of total lean mass compared with CAGL (P?<?0.05). GGNS men also showed lower percentage of body fat (P?<?0.05). In summary, androgen receptor CAG and GGN repeat polymorphisms are associated with RMR, MFO, fat mass, and its regional distribution in healthy male adolescents, influencing fat accumulation from adolescence to adult age

Motivations for innovation in the built environment: new directions for research

Innovation in the built environment involves multiple actors with diverse motivations. Policy-makers find it difficult to promote changes that require cooperation from these numerous and dispersed actors and to align their sometimes divergent interests. Established research traditions on the economics and management of innovation pay only limited attention to stakeholder choices, engagement and motivation. This paper reviews the insights that emerge as research in these traditions comes into contact with work on innovation from sociological and political perspectives. It contributes by highlighting growing areas of research on user involvement in complex innovation, collective action, distributed innovation and transition management. To differing extents, these provide approaches to incorporate the motivations of different actors into theoretical understanding. These indicate new directions for research that promise to enrich understanding of innovation

Association of common genetic variants with risperidone adverse events in a Spanish schizophrenic population

Risperidone non-compliance is often high due to undesirable side effects, whose development is in part genetically determined. Studies with genetic variants involved in the pharmacokinetics and pharmacodynamics of risperidone have yielded inconsistent results. Thus, the aim of this study was to investigate the putative association of genetic markers with the occurrence of four frequently observed adverse events secondary to risperidone treatment: sleepiness, weight gain, extrapyramidal symptoms and sexual adverse events. A series of 111 schizophrenia inpatients were genotyped for genetic variants previously associated with or potentially involved in risperidone response. Presence of adverse events was the main variable and potential confounding factors were considered. Allele 16Gly of ADRB2 was significantly associated with a higher risk of sexual adverse events. There were other non-significant trends for DRD3 9Gly and SLC6A4 S alleles. Our results, although preliminary, provide new candidate variants of potential use in risperidone safety prediction

Entrepreneurial sons, patriarchy and the Colonels' experiment in Thessaly, rural Greece

Existing studies within the field of institutional entrepreneurship explore how entrepreneurs influence change in economic institutions. This paper turns the attention of scholarly inquiry on the antecedents of deinstitutionalization and more specifically, the influence of entrepreneurship in shaping social institutions such as patriarchy. The paper draws from the findings of ethnographic work in two Greek lowland village communities during the military Dictatorship (1967–1974). Paradoxically this era associated with the spread of mechanization, cheap credit, revaluation of labour and clear means-ends relations, signalled entrepreneurial sons’ individuated dissent and activism who were now able to question the Patriarch’s authority, recognize opportunities and act as unintentional agents of deinstitutionalization. A ‘different’ model of institutional change is presented here, where politics intersects with entrepreneurs, in changing social institutions. This model discusses the external drivers of institutional atrophy and how handling dissensus (and its varieties over historical time) is instrumental in enabling institutional entrepreneurship

Palynological evidence for environmental and climatic change in the lower Guadiana valley, Portugal, during the last 13 000 years

Pollen analysis of a 48 m AMS radiocarbon-dated sediment sequence from the Guadiana estuary provides the first record of Lateglacial and Holocene vegetation history in the Algarve province of Portugal. This paper focuses on the record of terrestrial pollen taxa, which document a series of forest expansions and declines during the period 13 000 cal. BP to 1600 cal. BP and provide insights into climate evolution in southwestern Iberia. The main vegetation phases identified in the Guadiana valley are (1) Lateglacial interstadial (Allerød) forest with Quercus and Pinus under a temperate, moist, continental climate; (2) a Younger Dryas forest decline (Quercus) and expansion of pinewoods, xeric scrub and open ground habitats (with Juniperus, Artemisia, Ephedra distachya type, Centaurea scabiosa type) under arid and cold conditions; (3) an early Holocene forest/scrub/open-ground vegetation mosaic developing under a warm, dry and continental climate; (4) a maximum of Quercus forest and thermomediterranean evergreen taxa (Olea, Phillyrea, Pistacia) reflecting a warm, moist oceanic climate between c. 9000 cal. BP and c. 5000 cal. BP; and (5) the expansion of shrublands with Cistaceae and Ericaceae under a drier climatic regime and increasing anthropogenic activity since c. 5000 cal. BP. Holocene episodes of maximum climatic aridity are identified in the record of xerophytic taxa (Juniperus, Artemisia, Ephedra distachya type) centred around 10 200 cal. BP, 7800 cal. BP, 4800 cal. BP, 3100 cal. BP and 1700 cal. BP. Regional comparisons suggest a correlation of arid phases across southern Iberia and northwest Africa, which can be related to abrupt North Atlantic coolings (Bond events).Research Council studentship for WJF (NERC/S/A/2001/06109), with the support of Trinity College and the Department of Geography, University of Cambridg

INSERLAB: una aplicación telemática para determinar la inserción laboral de los egresados andaluces

El presente artículo recoge el trabajo de un grupo de profesores de la Universidad de Jaén y Oviedo para desarrollar una aplicación telemática que permita identificar la inserción laboral de los egresados universitarios. Dicho trabajo tiene su origen en un proyecto de investigación obtenido en la convocatoria del 2004 sobre Grupos de Estudios y Análisis en temas de calidad sobre la Enseñanza Universitaria en Andalucía procedente de la UCUA (Unidad para la Calidad de las Universidades Andaluzas)