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

Vortex nucleation in bose-einstein condensates due to effective magnetic fields

We investigate the rotational properties of a Bose-Einstein condensate (BEC) in an effective magnetic field. The corresponding gauge potential is optically generated, and based on the adiabatic motion of the atoms. We demonstrate that the nucleation of vortices is seeded by instabilities in surface excitations and show that this picture also holds when the applied effective magnetic field is not homogeneous. The eventual configuration of vortices in the cloud depends on the geometry of the applied field

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

Ten years of pulling: Ecosystem recovery after long‐term weed management in Garry oak savanna

Ecosystem restoration is the practice of assisting recovery in degraded ecological communities. The aims of restoration are typically broad, involving the reinstatement of composition, structure, function, and resilience to disturbances. One common restoration tactic in degraded urban systems is to control invasive species, relying on passive restoration for further ecosystem‐level recovery. Here, we test whether this is an effective restoration strategy in Garry oak savanna, a highly threatened and ecologically important community in the North American Pacific Northwest. In urban savanna patches surrounding Victoria, British Columbia, community members have been actively removing aggressive invasive exotic species for over a decade. Based on vegetation surveys from 2007, we tested ecosystem changes in structure, composition, and resilience (i.e., functional redundancy and response diversity) across 10 years of varied management levels. We expected higher levels of invasive species management would correspond with improvements to these ecosystem metrics. However, management explained little of the patterns found over the 10‐year‐period. Woody encroachment was a complicated process of native and exotic invasion, while resilience and compositional changes were most closely tied with landscape connectivity. Thus, though invasive species management may prevent further degradation, active restoration strategies after removal are likely required for recovery of the ecosystem

Trajectory and predictors of quality of life in first episode psychotic mania.

BACKGROUND: Little is known about the trajectory of quality of life (QoL) following a first episode of psychotic mania in bipolar disorder (BD). This 18-month longitudinal study investigated the trajectory of QoL, and the influence of premorbid adjustment and symptoms on 18-month QoL in a cohort of young people experiencing a first episode of psychotic mania. METHODS: As part of an overarching clinical trial, at baseline, sixty participants presenting with a first episode of psychotic mania (BD Type 1 - DSM-IV) completed symptomatic and functional assessments in addition to the Premorbid Adjustment Scale - General Subscale. Symptom measures were repeated at 18-month follow up. QoL was rated using the Quality of Life Scale (QLS) at designated time points. RESULTS: Mean QLS scores at initial measurement (8 weeks) were 61% of the maximum possible score, increasing significantly to 70% at 12 months, and 71.2% at 18-month follow-up. Premorbid adjustment and 18-month depressive symptoms were significantly associated with QoL at 18-month follow-up. LIMITATIONS: Study limitations include the small sample size, inclusion of participants with psychotic mania only, use of measures originally designed for use with schizophrenia spectrum disorders, and lack of premorbid or baseline measurement of QoL. CONCLUSIONS: Results suggest that QoL can be maintained early in BD, and reinforce the importance of assertively treating depressive symptoms throughout the course of this disorder. The emergence of a link between premorbid adjustment and poorer QoL in this cohort highlights the importance of assessing facets of adjustment when planning psychological interventions

Phenotypic blood glutathione concentration and selenium supplementation interactions on meat colour stability and fatty acid concentrations in Merino lambs

The interaction between blood glutathione (GSH) and supplementation of selenium (Se, 2.5 mg/kg diet) on meat colour and fatty acids concentrations was studied. Forty eight Merino lambs selected for high blood GSH (HGSH) or low GSH (LGSH) concentration were used. They were fed individually with or without Se supplement for 8 weeks. There were interactions (P< 0.05) between GSH and Se on the colour stability (as w630 nm/w580 nm ratio) of m. longissimus (LD), m. semimembranosus (SM) and m. semitendinosus. Without Se supplementation the ratio was higher in HGSH than LGSH group. However, the difference was reduced with Se supplement. Polyunsaturated and n-3 fatty acids in SM and LD were higher in HGSH than in LGSH group (P< 0.05), and did not change with Se supplement. Se supplementation increased Se content in LD (P< 0.001) and the lungs (P< 0.05), but had no influence in the heart

Elastic π+p\pi^{+}p and π+π+\pi^{+}\pi^{+} scattering at LHC

We discuss the possibility of measuring leading neutron production at the LHC. These data could be used to extract from it $\pi^+ p$ and $\pi^+\pi^+$ cross-sections. In this note we give some estimates for the case of elastic cross-sections and discuss related problems and prospects.Comment: 26 pages, 25 figures, to be published, minor text correction

Enhancement factor for the electron electric dipole moment in francium and gold atoms

If electrons had an electric dipole moment (EDM) they would induce EDMs of atoms. The ratio of the atomic EDM to the electron EDM for a particular atom is called the enhancement factor, R. We calculate the enhancement factor for the francium and gold atoms, with the results 910 plus/minus 5% for Fr and 260 plus/minus 15% for Au. The large values of these enhancement factors make these atoms attractive for electron EDM measurements, and hence the search for time-reversal invariance violation.Comment: 6 pages, no figures, uses RevTex, reference adde

Long-term health-related quality of life in meningioma survivors: a mixed-methods systematic review

Background Meningiomas account for ~25% of all primary brain tumours. These tumours have a relatively favourable prognosis with ~92% of meningioma patients surviving > 5 years after diagnosis. Yet, patients can report high disease burden and survivorship issues even years after treatment, affecting health-related quality of life (HRQOL). We aimed to systematically review the literature and synthesise evidence on HRQOL in meningioma patients across long-term survival, defined as >2 years post diagnosis. Methods Systematic literature searches were carried out using Medline, EMBASE, CINAHL, PsycINFO, and Web of Science Core Collection. Any published, peer reviewed article with primary quantitative, qualitative, or mixed methods data covering the physical, mental, and/or social aspects of HRQOL of meningioma survivors were included. Narrative synthesis method was used to interpret findings. Results Searches returned 2253 unique publications, of which 21 were included. Of these, N=15 involved quantitative methodology, N=4 mixed methods and N=2 were qualitative reports. Patient sample survival ranged from 2.75–13 years. HRQOL impairment was seen across all domains. Physical issues included persevering symptoms (e.g. headaches, fatigue, vision problems); mental issues comprised emotional burden (e.g., high prevalence of depressive symptoms and anxiety) and cognitive complaints; social issues included role limitations, social isolation, and affected work productivity. Due to study heterogeneity, the impact of treatment on long-term HRQOL remains unclear. Conclusions Findings from this review highlight the areas of HRQOL that can be impacted in long-term survivorship for patients with meningioma. These findings could help raise awareness among clinicians and patients, facilitating support provision