Prognostic significance of exercise-induced premature ventricular complexes: a systematic review and meta-analysis of observational studies

BACKGROUND: Exercise-induced premature ventricular complexes (EI-PVCs) are common during exercise stress tests. Their optimal management and prognostic significance remain uncertain. AIM: To perform meta-analysis of observational studies on the prognostic significance of EI-PVCs. METHODS: A search was conducted on Medline and Embase. Inclusion criteria were observational studies comparing the prognosis of patients with and without EI-PVCs whilst exclusion criteria were studies without confounder adjustment and studies with zero endpoints. Composite endpoints included all-cause mortality, cardiac mortality and cardiovascular events. Relative risk of endpoints were analysed with random effects model. Meta-regression and sensitivity analysis were performed. RESULTS: Ten studies were included. In asymptomatic patients who had no clinical evidence of heart disease, EI-PVCs were associated with a pooled risk ratio of 1.82 (95% CI 1.44 to 2.30) of developing adverse cardiovascular events over 16 years. The corresponding pooled RR for patients with symptomatic heart disease was 1.36 (95% CI 1.18 to 1.57) over 5.4 years. Sensitivity analysis: only EI-PVCs on the recovery phase of an exercise test, not during exercise, had adverse prognostic significance. CONCLUSIONS: EI-PVCs are correlated with a higher risk of all cause death or cardiovascular events in the long term. This risk is elevated in asymptomatic patients without clinical heart disease and in patients with symptomatic heart disease. The fact that only EI-PVCs during recovery, and not during exercise, have poor prognostic value suggests that autonomic dysfunction may play a role in this association. Further studies are needed to see if autonomic manipulation by drugs or catheter-based methods can improve the poor prognosis associated with EI-PVCs

PSR J0737-3039B: A probe of radio pulsar emission heights

In the double pulsar system PSR J0737-3039A/B the strong wind produced by pulsar A distorts the magnetosphere of pulsar B. The influence of these distortions on the orbital-dependent emission properties of pulsar B can be used to determine the location of the coherent radio emission generation region in the pulsar magnetosphere. Using a model of the wind-distorted magnetosphere of pulsar B and the well defined geometrical parameters of the system, we determine the minimum emission height to be ~ 20 neutron star radii in the two bright orbital longitude regions. We can determine the maximum emission height by accounting for the amount of deflection of the polar field line with respect to the magnetic axis using the analytical magnetic reconnection model of Dungey and the semi-empirical numerical model of Tsyganenko. Both of these models estimate the maximum emission height to be ~ 2500 neutron star radii. The minimum and maximum emission heights we calculate are consistent with those estimated for normal isolated pulsars.Comment: 29 pages, 14 figures, Accepted by ApJ on 3 March 201

Adult liver transplantation in the congenital absence of inferior vena cava

Whereas congenital absence of inferior vena cava observed in paediatric population more often than not, as an isolated or syndromic variety, this is seldom encountered in adult liver transplant recipients. There appear few sporadic reports in the literature on experience of such anomaly in adults. Given the rarity of situation, surprising encounters of such anomalies may pose challenge to the unprepared transplant surgeon and unfavourable outcomes may even have resulted in under-reportage of this condition. In this brief report we document our recent experience with two such cases and this is supplemented with extensive reference to the literature on classification of such anomalies with the endeavour to document implications of such in the adult liver transplant setting. (C) 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved

Exploring the interplay between Buddhism and career development : a study of highly skilled women workers in Sri Lanka

This article adopts a socio cultural lens to examine the role of Buddhism in highly skilled women workers’ careers in Sri Lanka. While Buddhism enabled women’s career development by giving them strength to cope with difficult situations in work, it also seemed to restrict their agency and constrain their career advancement. Based on our findings, we argue that being perceived as a good Buddhist woman worked as a powerful form of career capital for the respondents in our sample, who used their faith to combat gender disadvantage in their work settings

Profiling of shelter campers, their attitudes, and perceptions towards environmental impacts of campsite use and management: Evidence from national parks of Sri Lanka

There is a dearth of research describing the campsite user segment and in assessing camp-site users’ perceptions of the bio-physical impacts of campsite use in Sri Lanka. Using a structured questionnaire, we evaluated campsite user characteristics, visitor motivations, behaviors, and how visitor experience is affected by visible biophysical impacts at campsites. Based on underlying visitor motivations derived through a Factor Analysis and Cluster Analysis, we identified three distinct segments of campsite users: Eco-tourists, Prestige seekers, and Adventure seekers. Results indicate that the overall cleanliness of the campsite is an important attribute that affects the visitor experience. The Ecotourist segment reported environmentally desired motives, attitudes and behaviours. However, majority of campsite users belong to the Prestige-seeker and Adventure-seeker segments. Prestige seekers in particular demand better facilities and proper maintenance of campsites. Additionally, Prestige seekers are more attractive as a market segment to target because they are high-income, well-educated individuals with pro-environmental attitudes and behaviors. Recommended management actions include increasing visitor awareness, monitoring, zonation of activity areas, and enforcement of park campsite user policies to ensure enhanced visitor experience

Use of Natural Graphite for an Energy Storage Device

Ever growing high concerns over use of safe and low cost devices have provided a substantial attention on natural materials. As such natural graphite which has been deeply integrated into numerous applications is being received a consideration to be used for electrochemical devices. The main objective of this study is to explore the suitability of Sri Lankan natural graphite to serve in electrochemical double layer capacitors (EDLCs). In order to uplift the safety of the device, a gel polymer electrolyte was used instead of a liquid electrolyte. Two identical electrodes were consisted with Sri Lankan natural graphite as the active material and polyvinylidenefluoride as the binder. To prepare the electrolyte, polyvinylidenefluoride co hexafluoropropylene and magnesium perchlorate were used as the polymer and the salt respectively. Cyclic voltammetry test results show that single electrode specific capacitance is depending on the potential window. The percentage reduction of capacitance with continuous cycling was about 28%. Nyquist plot of EDLC further confirm the capacitive nature at low frequency

Scoping recreational disturbance of shorebirds to inform the agenda for research and management in Tropical Asia

In addition to scoping the impacts of the four most reported sources of recreational disturbance on shorebirds, this study also advances the concept of Tropical Asia (TA) to collectively describe tourist destinations in the ecologically and geopolitically diverse part of the planet that incorporates the tourism megaregion of South and Southeast Asia. At a time of growing global concern about the rapid decline of shorebird populations, many governments in TA are embracing and capitalising on the exponential growth in demand for coastal recreation and tourism across the region. This political response is partly driven by efforts to deliver economic development, aligned to the United Nations Sustainable Development Goals, in order to secure the livelihoods of people living in less developed coastal areas. However, the rapid increase in visitor numbers and the development of infrastructure to support the booming demand for coastal tourism destinations in TA are further exacerbating the pressures on shorebird populations across the region. Despite these growing pressures and the wealth of research reporting on shorebird populations across the Asian flyways, this scoping study identified surprisingly little research that reports on the recreational disturbance of shorebirds in TA. While undertaken to inform future research, this study also provides a synthesis of management strategies reported in the global literature into a set of management recommendations for coastal destinations in TA