“Wait and See” Approach to the Emergency Department Cardioversion of Acute Atrial Fibrillation

Objective. Acute atrial fibrillation often spontaneously resolves. This study aimed to investigate the outcomes and satisfaction of an evidence-based ED protocol employing a “wait and see” approach. Methods. A prospective observational cohort study of adult patients presenting to the Emergency Department with stable acute atrial fibrillation was performed. Patients were excluded if they were considered to be unstable, need hospitalization, or poor candidates for ED procedural sedation. Routine care was provided on the index visit, and suitable candidates were discharged and asked to return to the ED the following day for possible electrical cardioversion. Outcome measures included spontaneous reversion to sinus rhythm, success of cardioversion, length of stay, adverse event and return visits for AF within 30 days, and patient satisfaction. Results. Thirty five patient encounters were analysed over a 21-month period. Twenty two of the 35 patients (63%) had spontaneous resolution of atrial fibrillation upon presentation for potential cardioversion. All of the remaining patients underwent successful cardioversion to normal sinus rhythm without significant adverse events recorded. No patients required hospitalization. Three patients (9%) returned to the ED within 30 days for recurrence of atrial fibrillation. All patients were reported to be “very satisfied” with this approach. Conclusion. A “wait and see” approach to the ED electrical cardioversion of atrial fibrillation showed that almost two-thirds of patients had spontaneous resolution without requiring cardioversion or observation in the ED or hospital. All patients were successfully reverted to normal sinus rhythm and had a high degree of satisfaction

Case Studies in Thin Client Acceptance

Thin Client technology boasts an impressive range of financial, technical and administrative benefits. Combined with virtualisation technology, higher bandwidth availability and cheaper high performance processors, many believe that Thin Clients have come of age. But despite a growing body of literature documenting successful Thin Client deployments there remains an undercurrent of concern regarding user acceptance of this technology and a belief that greater efforts are required to understand how to integrate Thin Clients into existing, predominantly PC-based, deployments. It would be more accurate to state that the challenge facing the acceptance of Thin Clients is a combination of architectural design and integration strategy rather than a purely technical issue. Careful selection of services to be offered over Thin Clients is essential to their acceptance. Through an evolution of three case studies the user acceptance issues were reviewed and resolved resulting in a 92% acceptance rate of the final Thin Client deployment. No significant bias was evident in our comparison of user attitudes towards desktop services delivered over PCs and Thin Clients

Dilaton Contact Terms in the Bosonic and Heterotic Strings

Dilaton contact terms in the bosonic and heterotic strings are examined following the recent work of Distler and Nelson on the bosonic and semirigid strings. In the bosonic case dilaton two-point functions on the sphere are calculated as a stepping stone to constructing a `good' coordinate family for dilaton calculations on higher genus surfaces. It is found that dilaton-dilaton contact terms are improperly normalized, suggesting that the interpretation of the dilaton as the first variation of string coupling breaks down when other dilatons are present. It seems likely that this can be attributed to the tachyon divergence found in \TCCT. For the heterotic case, it is found that there is no tachyon divergence and that the dilaton contact terms are properly normalized. Thus, a dilaton equation analogous to the one in topological gravity is derived and the interpretation of the dilaton as the string coupling constant goes through.Comment: 44 pages, Figures now included. This replacement version includes the 7 figures as PostScript files appended to the end and the macros to insert them into the text. Also some typos in intermediate formulae were correcte

Biomarker responses to weaning stress in beef calves

The study objective was to investigate the physiological effects of weaning on beef calves and identify a panel of blood-based welfare biomarkers. On the day (d) of weaning (d 0), 16 spring-born, singlesuckled, beef bull calves that previously grazed with their dams at pasture, were assigned to one of two treatments: (1) control (n = 8), calves were loose-housed with their dam, (2) weaned (n = 8), calves were abruptly separated from their dam and loose-housed. Jugular blood was collected on d −4, 0, 1, 2, 3, 7, and 14 relative to weaning (d 0) and assayed for inflammatory and steroid variables. Total leukocyte counts were measured in whole blood. It is concluded that neutrophil number is a robust biomarker of stress and that plasma CXCL8 is a sensitive indicator of stress in weaned and control calves. In future studies, these two biomarkers should be central to the characterisation of stress responses

Principles for Responsibility Sharing: Proximity, Culpability, Moral Accountability, and Capability

In this Essay, we explore how responsibility based on culpability, moral accountability, and capability can improve the current regime that rests on responsibility by proximity. In doing so, we draw on the 2017 Model International Mobility Convention (MIMC), a model convention drafted by a commission of independent experts and currently supported as a project of the Carnegie Council for Ethics in International Affairs

Latent structure of the hospital anxiety and depression scale: a 10 year systematic review

Objective: To systematically review the latent structure of the Hospital Anxiety and Depression scale (HADS). Methods: A systematic review of the literature was conducted across Medline, ISI Web of Knowledge, CINAHL, PsycINfo and EmBase databases spanning articles published between May 2000 and May 2010. Studies conducting latent variable analysis of the HADS were included. Results: Twenty-five of the 50 reviewed studies revealed a two-factor structure, the most commonly found HADS structure. Additionally, five studies revealed unidimensional, 17 studies revealed three-factor, and two studies revealed fourfactor structures. One study provided equal support for two- and three-factor structures. Different latent variable analysis methods revealed correspondingly different structures: exploratory factor analysis studies revealed primarily twofactor structures, confirmatory factor analysis studies revealed primarily threefactor structures, and item response theory studies revealed primarily unidimensional structures. Conclusion: The heterogeneous results of the current review suggest that the latent structure of the HADS is unclear, and dependent on statistical methods invoked. While the HADS has been shown to be an effective measure of emotional distress, its inability to consistently differentiate between the constructs of anxiety and depression means that its use needs to be targeted to more general measurement of distres

Characterisation of physiological and immunological responses in beef cows to abrupt weaning and subsequent housing

peer-reviewedBackground: Weaning involves the permanent separation of the calf from the dam and has been shown to be stressful for both. The objectives of this study were to characterise the effect of i) abrupt weaning and ii) subsequent housing on the extended physiological and immunological responses of beef cows. At weaning (day (d) 0, mean age of calf (s.d.) 212 (24.5) d), cows were abruptly separated from their calves and returned to the grazing area. After 35 d at pasture, cows were housed in a slatted floor shed and offered grass silage ad libitum plus a mineral-vitamin supplement daily. Rectal body temperature was recorded and blood samples were obtained on i) d 0 (weaning), 2, 7, 14, 21, 28, 35 and subsequently on ii) d 0 (housing), 2, 7, 14 and 21 for physiological, haematological and immunological measurements. Results: Post-weaning, concentration of cortisol and dehydroepiandrosterone were unchanged (P > 0.05). Rectal body temperature, neutrophil number and neutrophil: lymphocyte ratio increased (P 0.05). On d 2 post-housing, neutrophil number and neutrophil: lymphocyte ratio increased (P < 0.05), whereas lymphocyte number and concentrations of dehydroepiandrosterone, fibrinogen and non-esterified fatty acid decreased (P < 0.05) compared with pre-housing baseline. Concentration of haptoglobin increased (P < 0.05) on d 14 to 21 post-housing. Conclusions: A transitory increase in neutrophil number and decrease in lymphocyte number, increased neutrophil:lymphocyte ratio coupled with decreased interferon-γ production, and increased concentration of acute phase proteins indicate a stress response in cows post-weaning, whereas post-housing, changes were less marked.Teagasc Walsh Fellowship; John Hume Scholarship (E.M. Lynch