Opportunistic detection of atrial fibrillation using blood pressure monitors: a systematic review

Background: Atrial Fibrillation (AF) affects around 2% of the population and early detection is beneficial, allowing patients to begin potentially life-saving anticoagulant therapies. Blood pressure (BP) monitors may offer an opportunity to screen for AF. Aim: To identify and appraise studies which report the diagnostic accuracy of automated BP monitors used for opportunistic AF detection. Methods: A systematic search was performed of the Medline, Medline-in-process and Embase literature databases. Papers were eligible if they described primary studies of the evaluation of a BP device for AF detection, were published in a peer reviewed journal and reported values for the sensitivity and specificity. Included studies were appraised using the QUADAS-2 tool to assess their risk of bias and applicability to opportunistic AF detection. Values for the sensitivity and specificity of AF detection were extracted from each paper and compared. Results and Conclusion: We identified seven papers evaluating six devices from two manufacturers. Only one study scored low risk in all of the QUADAS-2 domains. All studies reported specificity greater than 85% and six reported sensitivity greater than 90%. The studies showed that blood pressure devices with embedded algorithms for detecting arrhythmias show promise as screening tools for AF, comparing favourably with manual pulse palpation. But the studies used different methodologies and many were subject to potential bias. More studies are needed to more precisely define the sensitivity and specificity of opportunistic screening for AF during blood pressure measurement before its clinical utility in the population of interest can be assessed fully

Accuracy of pulse interval timing in ambulatory blood pressure measurement

Blood pressure (BP) monitors rely on pulse detection. Some blood pressure monitors use pulse timings to analyse pulse interval variability for arrhythmia screening, but this assumes that the pulse interval timings detected from BP cuffs are accurate compared with RR intervals derived from ECG. In this study we compared the accuracy of pulse intervals detected using an ambulatory blood pressure monitor (ABPM) with single lead ECG. Twenty participants wore an ABPM for three hours and a data logger which synchronously measured cuff pressure and ECG. RR intervals were compared with corresponding intervals derived from the cuff pressure tracings using three different pulse landmarks. Linear mixed effects models were used to assess differences between ECG and cuff pressure timings and to investigate the effect of potential covariates. In addition, the maximum number of successive oscillometric beats detectable in a measurement was assessed. From 243 BP measurements, the foot landmark of the oscillometric pulse was found to be associated with fewest covariates and had a random error of 9.5 ms. 99% of the cuff pressure recordings had more than 10 successive detectable oscillometric beats. RR intervals can be accurately estimated using an ABPM

Reduced leakage current in Josephson tunnel junctions with codeposited barriers

Josephson junctions were fabricated using two different methods of barrier formation. The trilayers employed were Nb/Al-AlOx/Nb on sapphire, where the first two layers were epitaxial. The oxide barrier was formed either by exposing the Al surface to O2 or by codepositing Al in an O2 background. The codeposition process yielded junctions that showed the theoretically predicted subgap current and no measurable shunt conductance. In contrast, devices with barriers formed by thermal oxidation showed a small shunt conductance in addition to the predicted subgap current.Comment: 3 pages, 4 figure

Cognition and Economic Outcomes in the Health and Retirement Survey

Dimensions of cognitive skills are potentially important but often neglected determinants of the central economic outcomes that shape overall well-being over the life course. There exists enormous variation among households in their rates of wealth accumulation, their holdings of financial assets, and the relative risk in their chosen asset portfolios that have proven difficult to explain by conventional demographic factors, the amount of bequests they receive or anticipating giving, and the level of economic resources of the household. These may be cognitively demanding decisions at any age but especially so at older ages. This research examines the association of cognitive skills with wealth, wealth growth, and wealth composition for people in their pre and post-retirement years.

An Investigation of sexuality and life satisfaction of institutionalized aged

One concern of this study is sexuality among the aged, since every person, regardless of age, is a sexual being. Society, however, has been slow to recognize this fact and has not accepted sexual activity among the aged. Along with the lack of social sanctioning, elderly persons are very susceptible to the myriad of myths, half-truths, misinformation, and incomplete data which affect their attitudes toward sexuality. Furthermore, older persons are susceptible to negative stereotypes of themselves as sexual beings. However, the effect of actual sexual activity upon overall life satisfaction among the aged has yet to be determined. Because there has been no empirical evidence concerning this, the degree of relationship between sexual activity and life satisfaction remains unknown. Since human beings remain sexual throughout life, and a large proportion of the elderly are institutionalized, this study will focus attention on the relationship between life satisfaction and sexuality among the institutionalized aged. It is important for social workers to explore these concepts, as empirically validated knowledge can be used as guidelines for professional values and practice

Football Banning Orders: The Highly Effective Cornerstone of a Preventative Strategy?

The chapter examines the development, use and effectiveness of football banning orders in the UK, comparing their use in England to address issues of football 'hooliganism' with their distinct evolution in Scotland to address concerns around sectarian disorder

Calibration of GENEActiv accelerometer wrist cut-points for the assessment of physical activity intensity of pre-school aged children

This study sought to validate cut-points for use of wrist worn GENEActiv accelerometer data, to analyse preschool children’s (4 to 5 year olds) physical activity (PA) levels via calibration with oxygen consumption values (VO2). This was a laboratory based calibration study. Twenty-one preschool children, aged 4.7 ± 0.5 years old, completed six activities (ranging from lying supine to running) whilst wearing the GENEActiv accelerometers at two locations (left and right wrist), these being the participants’ non-dominant and dominant wrist, and a Cortex face mask for gas analysis. VO2 data was used for the assessment of criterion validity. Location specific activity intensity cut points were established via Receiver Operator Characteristic curve (ROC) analysis. The GENEActiv accelerometers, irrespective of their location, accurately discriminated between all PA intensities (sedentary, light, and moderate and above), with the dominant wrist monitor providing a slightly more precise discrimination at light PA and the non-dominant at the sedentary behaviour and moderate and above intensity levels (Area Under the Curve (AUC) for non-dominant = 0.749-0.993, compared to AUC dominant = 0.760-0.988). Conclusion: This study establishes wrist-worn physical activity cut points for the GENEActiv accelerometer in pre-schoolers.N/