Accuracy of diagnosing atrial fibrillation on electrocardiogram by primary care practitioners and interpretative diagnostic software: analysis of data from screening for atrial fibrillation in the elderly (SAFE) trial

Objective To assess the accuracy of general practitioners, practice nurses, and interpretative software in the use of different types of electrocardiogram to diagnose atrial fibrillation. Design Prospective comparison with reference standard of assessment of electrocardiograms by two independent specialists. Setting 49 general practices in central England. Participants 2595 patients aged 65 or over screened for atrial fibrillation as part of the screening for atrial fibrillation in the elderly (SAFE) study; 49 general practitioners and 49 practice nurses. Interventions All electrocardiograms were read with the Biolog interpretative software, and a random sample of 12 lead, limb lead, and single lead thoracic placement electrocardiograms were assessed by general practitioners and practice nurses independently of each other and of the Biolog assessment. Main outcome measures Sensitivity, specificity, and positive and negative predictive values. Results General practitioners detected 79 out of 99 cases of atrial fibrillation on a 12 lead electrocardiogram (sensitivity 80%, 95% confidence interval 71% to 87%) and misinterpreted 114 out of 1355 cases of sinus rhythm as atrial fibrillation (specificity 92%, 90% to 93%). Practice nurses detected a similar proportion of cases of atrial fibrillation (sensitivity 77%, 67% to 85%), but had a lower specificity (85%, 83% to 87%). The interpretative software was significantly more accurate, with a specificity of 99%, but missed 36 of 215 cases of atrial fibrillation (sensitivity 83%). Combining general practitioners' interpretation with the interpretative software led to a sensitivity of 92% and a specificity of 91%. Use of limb lead or single lead thoracic placement electrocardiograms resulted in some loss of specificity. Conclusions Many primary care professionals cannot accurately detect atrial fibrillation on an electrocardiogram, and interpretative software is not sufficiently accurate to circumvent this problem, even when combined with interpretation by a general practitioner. Diagnosis of atrial fibrillation in the community needs to factor in the reading of electrocardiograms by appropriately trained peopl

Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: Screening versus routine practice in detection cluster randomised controlled trial

Objectives : To assess whether screening improves the detection of atrial fibrillation (cluster randomisation) and to compare systematic and opportunistic screening. Design : Multicentred cluster randomised controlled trial, with subsidiary trial embedded within the intervention arm. Setting : 50 primary care centres in England, with further individual randomisation of patients in the intervention practices. Participants : 14,802 patients aged 65 or over in 25 intervention and 25 control practices. Interventions : Patients in intervention practices were randomly allocated to systematic screening (invitation for electrocardiography) or opportunistic screening (pulse taking and invitation for electrocardiography if the pulse was irregular). Screening took place over 12 months in each practice from October 2001 to February 2003. No active screening took place in control practices. Main outcome measure : Newly identified atrial fibrillation. Results : The detection rate of new cases of atrial fibrillation was 1.63% a year in the intervention practices and 1.04% in control practices (difference 0.59%, 95% confidence interval 0.20% to 0.98%). Systematic and opportunistic screening detected similar numbers of new cases (1.62% v 1.64%, difference 0.02%, −0.5% to 0.5%). Conclusion : Active screening for atrial fibrillation detects additional cases over current practice. The preferred method of screening in patients aged 65 or over in primary care is opportunistic pulse taking with follow-up electrocardiography. Trial registration Current Controlled Trials ISRCTN19633732

Effects of quenching on phase transformations and ferroelectric properties of 0.35BCZT-0.65KBT ceramics

© 2019 Elsevier Ltd Solid solutions of 0.35(Ba,Ca)(Zr,Ti)O3-0.65(K0.5Bi0.5)TiO3 (BCZT-KBT) having various Ca and Zr contents were synthesized by solid state reaction. The sintered ceramics exhibited interesting features comprising core-shell type microstructures and relaxor ferroelectric behaviour. The influence of air-quenching on structure and electrical properties has been systematically investigated. The results indicate that the compositional heterogeneity in the shell regions, for the slow-cooled state, was reduced by air quenching. Improvements are evident in ferroelectric tetragonal phase content, accompanied by increased polarisation values and depolarisation temperatures. Comparing the results obtained for two BCZT compositions, it was demonstrated that the stability of the ferroelectric tetragonal phase in slow-cooled BCZT-KBT samples was improved for the ceramic with lower Ca and Zr concentrations, denoted x = 0.06, comparing with that for higher levels, denoted x = 0.15. Furthermore, the electric field-induced ferroelectric state in the quenched ceramic with x = 0.06 was found to be more stable during heating, yielding an enhanced depolarisation temperature

Modelling the future of the Hawaiian honeycreeper : an ecological and epidemiological problem

The Hawaiian honeycreeper (Drepanididae) faces the threat of extinction; this is believed to be due primarily to predation from alien animals, endemic avian malaria (Plasmodium relictum) and climate change. A deterministic SI modelling approach is developed, incorporating these three factors and a metapopulation approach in conjunction with a quasi-equilibrium assumption to simplify the vector populations. This enables the qualitative study of the behaviour of the system. Numerical results suggest that although (partial) resistance to avian malaria may be advantageous for individual birds, allowing them to survive infection, this allows them to become carriers of infection and hence greatly increases the spread of this disease. Predation obviously reduces the life-expectancy of honeycreepers, but in turn this reduces the spread of infection from resistant carriers; therefore the population-level impact of predation is reduced. Various control strategies proposed in the literature are also considered and it is shown that predation control could either help or hinter, depending upon resistance of the honeycreeper species. Captive propagation or habitat restoration may be the best feasible solution to the loss of both heterogeneity within the population and the loss of the species as a whole

How strongly do word reading times and lexical decision times correlate? Combining data from eye movement corpora and megastudies

We assess the amount of shared variance between three measures of visual word recognition latencies: eye movement latencies, lexical decision times and naming times. After partialling out the effects of word frequency and word length, two well-documented predictors of word recognition latencies, we see that 7-44% of the variance is uniquely shared between lexical decision times and naming times, depending on the frequency range of the words used. A similar analysis of eye movement latencies shows that the percentage of variance they uniquely share either with lexical decision times or with naming times is much lower. It is 5 – 17% for gaze durations and lexical decision times in studies with target words presented in neutral sentences, but drops to .2% for corpus studies in which eye movements to all words are analysed. Correlations between gaze durations and naming latencies are lower still. These findings suggest that processing times in isolated word processing and continuous text reading are affected by specific task demands and presentation format, and that lexical decision times and naming times are not very informative in predicting eye movement latencies in text reading once the effect of word frequency and word length are taken into account. The difference between controlled experiments and natural reading suggests that reading strategies and stimulus materials may determine the degree to which the immediacy-of-processing assumption and the eye-mind assumption apply. Fixation times are more likely to exclusively reflect the lexical processing of the currently fixated word in controlled studies with unpredictable target words rather than in natural reading of sentences or texts

Ice stream subglacial access for ice-sheet history and fast ice flow: the BEAMISH Project on Rutford Ice Stream, West Antarctica and initial results on basal conditions

Three holes were drilled to the bed of Rutford Ice Stream, through ice up to 2154 m thick, to investigate the basal processes and conditions associated with fast ice flow and the glacial history of the West Antarctic Ice Sheet. A narrative of the drilling, measuring and sampling activities, as well as some preliminary results and initial interpretations of subglacial conditions, is given. These were the deepest subglacial access holes ever drilled using the hot-water drilling method. Samples of bed and englacial sediments were recovered, and a number of instruments were installed in the ice column and the bed. The ice–bed interface was found to be unfrozen, with an existing, well-developed subglacial hydrological system at high pressure, within ~1% of the ice overburden. The bed itself comprises soft, water-saturated sediments, consistent with previous geophysical interpretations. Englacial sediment quantity varies significantly between two locations ~2 km apart, and possibly over even shorter (~20 m) distances. Difficulties and unusual observations encountered while connecting to the subglacial hydrological system in one hole possibly resulted from the presence of a large clast embedded in the bottom of the ice

Putative ammonia-oxidizing Crenarchaeota in suboxic waters of the Black Sea : a basin-wide ecological study using 16S ribosomal and functional genes and membrane lipids

Author Posting. © Blackwell, 2007. This is the author's version of the work. It is posted here by permission of Blackwell for personal use, not for redistribution. The definitive version was published in Environmental Microbiology 9 (2007): 1001-1016, doi:10.1111/j.1462-2920.2006.01227.x.Within the upper 400 m at western, central, and eastern stations in the world’s largest stratified basin, the Black Sea, we studied the qualitative and quantitative distribution of putative nitrifying Archaea based on their genetic markers (16S rDNA, amoA encoding for the alfa-subunit of archaeal ammonia monooxygenase), and crenarchaeol, the specific glycerol diphytanyl glycerol tetraether (GDGT) of pelagic Crenarchaeota within the Group I.1a. Marine Crenarchaeota were the most abundant Archaea (up to 98% of the total archaeal 16S rDNA copies) in the suboxic layers with oxygen levels as low as 1 μM including layers where previously anammox bacteria were described (Kuypers et al., 2003). Different marine crenarchaeotal phylotypes (both 16S rDNA and amoA) were found at the upper part of the suboxic zone as compared to the base of the suboxic zone and the upper 15-30 m of the anoxic waters with prevailing sulfide concentrations of up to 30 μM. Crenarchaeol concentrations were higher in the sulfidic chemocline as compared to the suboxic zone. These results indicate an abundance of putative nitrifying Archaea at very low oxygen levels within the Black Sea and might form an important source of nitrite for the anammox reaction.This work was supported by a grant from the Netherlands Organization for Scientific Research (VENI Innovational Research Grant nr. 813.13.001 to MJLC), an U. S. National Science Foundation grant OCE0117824 to SGW and the Spinoza award to JSSD, which we greatly acknowledge

Health-Related Quality of Life and All-Cause Mortality among Older Healthy Individuals in Australia and the United States:A Prospective Cohort Study

Published online: 3 January 2021PURPOSE: Previous research has demonstrated that lower health-related quality of life (HRQoL) is associated with higher morbidity and mortality, especially in-patient groups. The association of HRQoL with all-cause mortality in community samples requires further investigation. This study aimed to examine whether HRQoL predicts all-cause mortality in older healthy community-dwelling people from Australia and the United States (U.S.) enrolled in the Aspirin in Reducing Events in the Elderly (ASPREE) trial. We also explored whether this association varies by gender or country. METHOD: A prospective cohort of 19,106 individuals aged 65-98 years, who were without a dementia diagnosis or a known major life-limiting disease, and completed the 12-item short-form-HRQoL at recruitment (2010-2014). They were followed until June 2017. Cox proportional-hazard models were used to determine the association between the physical (PCS) and mental component scores (MCS) of HRQoL and all-cause mortality, adjusting for sociodemographic factors, health-related behaviours and clinical measures. Hazards ratios were estimated for every 10-unit increase in PCS or MCS. RESULTS: There were 1052 deaths over a median 4.7-years (interquartile range 3.6-5.7) of follow-up, with 11.9 events per 1000 person-years. Higher PCS was associated with lower all-cause mortality (HR 0.83, 95% CI 0.77, 0.89) in the entire sample, while higher MCS was associated with lower mortality among U.S. participants only (HR 0.78, 95% CI 0.63, 0.95). Gender differences in the association of either PCS or MCS with mortality were not observed. CONCLUSION: Our large study provides evidence that HRQoL is inversely associated with all-cause mortality among initially healthy older people.Aung Zaw Zaw Phyo, Joanne Ryan, David A. Gonzalez-Chica, Robyn L. Woods, Christopher M. Reid, Mark R. Nelson ... et al

Lubricating Bacteria Model for Branching growth of Bacterial Colonies

Various bacterial strains (e.g. strains belonging to the genera Bacillus, Paenibacillus, Serratia and Salmonella) exhibit colonial branching patterns during growth on poor semi-solid substrates. These patterns reflect the bacterial cooperative self-organization. Central part of the cooperation is the collective formation of lubricant on top of the agar which enables the bacteria to swim. Hence it provides the colony means to advance towards the food. One method of modeling the colonial development is via coupled reaction-diffusion equations which describe the time evolution of the bacterial density and the concentrations of the relevant chemical fields. This idea has been pursued by a number of groups. Here we present an additional model which specifically includes an evolution equation for the lubricant excreted by the bacteria. We show that when the diffusion of the fluid is governed by nonlinear diffusion coefficient branching patterns evolves. We study the effect of the rates of emission and decomposition of the lubricant fluid on the observed patterns. The results are compared with experimental observations. We also include fields of chemotactic agents and food chemotaxis and conclude that these features are needed in order to explain the observations.Comment: 1 latex file, 16 jpeg files, submitted to Phys. Rev.