QT peak prolongation predicts cardiac death following stroke

Cardiac death has been linked in many populations to prolongation of the QT interval (QTe). However, basic science research suggested that the best estimate of the time point when repolarisation begins is near the T-wave peak. We found QT peak (QTp) was longer in hypertensive subjects with LVH. A prolonged “depolarisation” phase, rather than “repolarisation” (T peak to T end) might therefore account for the higher incidence of cardiac death linked to long QT. Hypothesis: We have tested the hypothesis that QT peak (QTp) prolongation predicts cardiac death in stroke survivors. Methods and Results: ECGs were recorded from 296 stroke survivors (152 male), mean age 67.2 (SD 11.6) approximately 1 year after the event. Their mean blood pressure was 152/88 mmHg (SD 29/15mmHg). These ECGs were digitised by one observer who was blinded to patient outcome. The patients were followed up for a median of 3.3 years. The primary endpoint was cardiac death. A prolonged heart rate corrected QT peak (QTpc) of lead I carried the highest relative risk of death from all cause as well as cardiac death, when compared with the other more conventional QT indices. In multivariate analyses, when adjusted for conventional risk factors of atherosclerosis, a prolonged QTpc of lead I was still associated with a 3-fold increased risk of cardiac death. (adjusted relative risk 3.0 [95% CI 1.1 - 8.5], p=0.037). Conclusion: QT peak prolongation in lead I predicts cardiac death after strok

Towards understanding the clinical significance of QT peak prolongation: a novel marker of myocardial ischemia independently demonstrated in two prospective studies

Background: QT peak prolongation identified patients at risk of death or non-fatal MI. We tested the hypothesis that QT peak prolongation might be associated with significant myocardial ischaemia in two separate cohorts to see how widely applicable the concept was. Methods and Results: In the first study, 134 stroke survivors were prospectively recruited and had 12-lead ECGs and Nuclear myocardial perfusion scanning. QT peak was measured in lead I of a 12-lead ECG and heart rate corrected by Bazett’s formula (QTpc). QTpc prolongation to 360ms or more was 92% specific at diagnosing severe myocardial ischaemia. This hypothesis-generating study led us to perform a second prospective study in a different cohort of patients who were referred for dobutamine stress echocardiography. 13 of 102 patients had significant myocardial ischaemia. Significant myocardial ischaemia was associated with QT peak prolongation at rest (mean 354ms, 95% CI 341-367ms, compared with mean 332ms, 95% CI 327-337ms in those without significant ischaemia; p=0.002). QT peak prolongation to 360ms or more was 88% specific at diagnosing significant myocardial ischaemia in the stress echocardiography study. QT peak prolongation to 360ms or more was associated with over 4-fold increase odds ratio of significant myocardial ischaemia. The Mantel- Haenszel Common Odds Ratio Estimate=4.4, 95% CI=1.2-16.0, p=0.023. Conclusion: QT peak (QTpc) prolongation to 360ms or more should make us suspect the presence of significant myocardial ischaemia. Such patients merit further investigations for potentially treatable ischaemic heart disease to reduce their risk of subsequent death or non-fatal MI

Wave- and tidally-driven flow and sediment flux across a fringing coral reef : southern Molokai, Hawaii

This paper is not subject to U.S. copyright. The definitive version was published in Continental Shelf Research 24 (2004): 1397-1419, doi:10.1016/j.csr.2004.02.010.The fringing coral reef off the south coast of Molokai, Hawaii is currently being studied as part of a US Geological Survey (USGS) multi-disciplinary project that focuses on geologic and oceanographic processes that affect coral reef systems. For this investigation, four instrument packages were deployed across the fringing coral reef during the summer of 2001 to understand the processes governing fine-grained terrestrial sediment suspension on the shallow reef flat (h=1 m) and its advection across the reef crest and onto the deeper fore reef. The time–series measurements suggest the following conceptual model of water and fine-grained sediment transport across the reef: Relatively cool, clear water flows up onto the reef flat during flooding tides. At high tide, more deep-water wave energy is able to propagate onto the reef flat and larger Trade wind-driven waves can develop on the reef flat, thereby increasing sediment suspension. Trade wind-driven surface currents and wave breaking at the reef crest cause setup of water on the reef flat, further increasing the water depth and enhancing the development of depth-limited waves and sediment suspension. As the tide ebbs, the water and associated suspended sediment on the reef flat drains off the reef flat and is advected offshore and to the west by Trade wind- and tidally- driven currents. Observations on the fore reef show relatively high turbidity throughout the water column during the ebb tide. It therefore appears that high suspended sediment concentrations on the deeper fore reef, where active coral growth is at a maximum, are dynamically linked to processes on the muddy, shallow reef flat

Building the Holocene clinothem in the Gulf of Papua: An ocean circulation study

This paper investigates the role that tidal and wind-driven flows and buoyant river plumes play in the development of the Holocene clinothem in the Gulf of Papua. Time series data from bottom tripods and a mooring were obtained at four locations near the mouth of the Fly River during portions of 2003 and 2004. Flows in the Gulf of Papua during calendar year 2003 were hindcast every 3 h using the Navy Coastal Ocean Model (NCOM) with boundary conditions from the Navy Atmospheric Prediction System, the east Asian seas implementation of NCOM, and the OTIS Tidal Inversion System. Results show that tidal flows on the modern clinoform are strong and are landward and seaward directed. Peak spring tidal velocities can provide the shear stresses necessary to keep sediment up to sand size in motion as the wind-driven and baroclinic currents distribute it from the river mouths across and along the shelf in two circulation states. During the monsoon season, the clinoform topset is swept by a seaward surface flow and landward bottom flow, reflecting river plumes and coastal upwelling. Seaward, this structure evolves into a SW directed surface current over the clinothem foreset with accompanying landward directed near-bed currents that trend obliquely up the foreset to the WSW over much of the clinothem. During the trade wind season, the inner and outer topset are swept by NE directed, contour-parallel surface currents, underneath which lie obliquely landward near-bed currents. These modeled flows and complex gyres in shallow water coupled with wave- and current-supported gravity flows or river floods can explain the form, internal clinoform shapes, and mineralogy of the modern Gulf of Papua clinothem

Changes in wave climate over the northwest European shelf seas during the last 12,000 years

Because of the depth attenuation of wave orbital velocity, wave-induced bed shear stress is much more sensitive to changes in total water depth than tidal-induced bed shear stress. The ratio between wave- and tidal-induced bed shear stress in many shelf sea regions has varied considerably over the recent geological past because of combined eustatic changes in sea level and isostatic adjustment. In order to capture the high-frequency nature of wind events, a two-dimensional spectral wave model is here applied at high temporal resolution to time slices from 12 ka BP to present using paleobathymetries of the NW European shelf seas. By contrasting paleowave climates and bed shear stress distributions with present-day conditions, the model results demonstrate that, in regions of the shelf seas that remained wet continuously over the last 12,000 years, annual root-mean-square (rms) and peak wave heights increased from 12 ka BP to present. This increase in wave height was accompanied by a large reduction in the annual rms wave- induced bed shear stress, primarily caused by a reduction in the magnitude of wave orbital velocity penetrating to the bed for increasing relative sea level. In regions of the shelf seas which remained wet over the last 12,000 years, the annual mean ratio of wave- to (M-2) tidal-induced bed shear stress decreased from 1 (at 12 ka BP) to its present-day value of 0.5. Therefore compared to present- day conditions, waves had a more important contribution to large-scale sediment transport processes in the Celtic Sea and the northwestern North Sea at 12 ka BP

Does oral sodium bicarbonate therapy improve function and quality of life in older patients with chronic kidney disease and low-grade acidosis (the BiCARB trial)? Study protocol for a randomized controlled trial

Date of acceptance: 01/07/2015 © 2015 Witham et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Acknowledgements UK NIHR HTA grant 10/71/01. We acknowledge the financial support of NHS Research Scotland in conducting this trial.Peer reviewedPublisher PD

Quantity, composition, and source of sediment collected in sediment traps along the fringing coral reef off Molokai, Hawaii

This paper is not subject to U.S. copyright. The definitive version was published in Marine Pollution Bulletin 52 (2006): 1034-1047, doi:10.1016/j.marpolbul.2006.01.008.Sediment traps were used to evaluate the frequency, cause, and relative intensity of sediment mobility/resuspension along the fringing coral reef off southern Molokai (February 2000–May 2002). Two storms with high rainfall, floods, and exceptionally high waves resulted in sediment collection rates > 1000 times higher than during non-storm periods, primarily because of sediment resuspension by waves. Based on quantity and composition of trapped sediment, floods recharged the reef flat with land-derived sediment, but had a low potential for burying coral on the fore reef when accompanied by high waves. The trapped sediments have low concentrations of anthropogenic metals. The magnetic properties of trapped sediment may provide information about the sources of land-derived sediment reaching the fore reef. The high trapping rate and low sediment cover indicate that coral surfaces on the fore reef are exposed to transient resuspended sediment, and that the traps do not measure net sediment accumulation on the reef surface