Community Dynamics and Crime in Rural West Virginia Communities

There is a tendency for sociologists and criminologists to study crime in urban contexts rather than in rural areas and places outside small towns. Therefore, some suspect that theories of urban crime do not necessarily fit these rural areas. For example, collective efficacy in urban neighborhoods has been found to be inversely related to crime and fear of crime. In rural areas, this connection has been difficult to study because rural places are structured differently than urban neighborhoods. In this study, we expand the notions of collective efficacy in neighborhoods by introducing community dynamics. We show how latent psychodynamic processes that occur in rural places affect the likelihood that crime will occur and that residents will be fearful. Using a social media survey of residents in rural West Virginia, we examine the impact of local community dynamics on the risk of crime and fear of crim

Minimizing right ventricular pacing in patients with sinus node disease and prolonged PQ interval: The impact on exercise capacity

Background: Several clinical and experimental studies have shown that unnecessary right ventricular pacing in sinus node disease can be detrimental. Inter- and intra-ventricular asyn­chrony imposed by right ventricular pacing may cause reduction in contractility and relaxation of left ventricle, worsening mitral regurgitation, regional redistribution of myocardial perfusion and oxygen consumption, and asymmetrical hypertrophy of left ventricular wall. In some patients, sinus node disease coexists with impaired atrioventricular conduction. The optimal pacing mode in this population is not determined. Minimizing right ventricular pacing can preserve inter- and intra-ventricular synchrony. On the other hand, longer atrioventricular delay may cause atrioventricular asynchrony. The aim of this study was to prospectively assess the impact of minimizing right ventricular pacing in patients with DDD pacemaker implanted for sinus node disease and prolonged PQ interval on exercise capacity, cardiac function and quality of life. Methods: The study enrolled 50 consecutive patients with prolonged PQ interval who were implanted with DDD pacemaker because of sinus node disease. Each patient was treated alternately with 2 pacing modes in random order for 4-month periods: conventional dualchamber pacing and dual-chamber minimal ventricular pacing (prolonged atrioventricular delay). At the end of each phase the following tests were performed: cardiopulmonary exercise testing, echocardiographic evaluation and quality of life assessment (SF36). Results: There was no significant relationship between pacing mode and cardiopulmonary parameters, echocardiographic parameters and quality of life. Conclusions: Sequential atrioventricular pacing may be a reasonable choice for treating patients with sinus node disease and prolonged PQ interval.

Long-term reproducibility of microvolt T-wave alternans in patients after cardioverter-defibrillator implantation

Background: Microvolt T-wave alternans (MTWA) is a promising method for noninvasive assessment of arrhythmic risk. Recent studies have shown good immediate reproducibility of T-wave alternans. Little is known about it during the long term. The aim of the study was to prospectively evaluate the long-term reproducibility of MTWA in a group of patients after ICD implantation. Methods: The study group consisted of 22 patients: 21 male and 1 female, aged 63.0 ± 7.6 years. Nineteen of them had a history of myocardial infarction and 3 had non-ischemic cardiomyopathy. Ejection fraction was 34.7 ± 10.0. T-wave alternans was measured during treadmill tests and additionally in 6 patients during implantation cardioverter-defibrillator device pacing. We received 30 reports of MTWA available for analysis. The second test was performed after 11.8 ± 3.3 months (range 7-16) using the same protocol. Results: Of the 30 tests, 12 were positive, 2 negative and 9 indeterminate in both tests. The results were concordant in 23 tests (76.66%) (Kappa 0.602). Of the initial positive tests, only one became negative in the second test and 4 became indeterminate. Of the initial negative tests, none became positive and none became indeterminate. Of the initial indeterminate tests, one became positive and one negative. At the same time, there were no significant differences between QRS, QTc and ejection fraction between the first and second tests. Only the heart rate in the second test was greater than in the first. Conclusions: The results suggest that microvolt T-wave alternans measurement is stable over a long period. It is probably not worth examining the status of MTWA after several months, at least if patients are in the chronic stage of their disease. (Cardiol J 2007; 14: 561-567)

Czy obniżenie odcinka ST w czasie częstoskurczu nadkomorowego wskazuje na niedokrwienie serca?

W pracy przedstawiono przypadek 57-letniego mężczyzny z utajonym zespołem WPW, u którego w czasie długotrwałego częstoskurczu nadkomorowego o częstości 194/min wystąpił typowy ból dławicowy z cechami niedokrwienia w EKG. W koronarografii stwierdzono prawidłowy obraz tętnic wieńcowych. Po wykonaniu ablacji dodatkowej drogi przewodzenia częstoskurcze i bóle dławicowe nie nawracały. Obecność znamiennych dla niedokrwienia zmian ST w czasie częstoskurczu nadkomorowego nie wiąże się z występowaniem przewlekłej choroby wieńcowej. (Folia Cardiol. 2005; 12: 71–76

Czy obniżenie odcinka ST w czasie częstoskurczu nadkomorowego wskazuje na niedokrwienie serca?

W pracy przedstawiono przypadek 57-letniego mężczyzny z utajonym zespołem WPW, u którego w czasie długotrwałego częstoskurczu nadkomorowego o częstości 194/min wystąpił typowy ból dławicowy z cechami niedokrwienia w EKG. W koronarografii stwierdzono prawidłowy obraz tętnic wieńcowych. Po wykonaniu ablacji dodatkowej drogi przewodzenia częstoskurcze i bóle dławicowe nie nawracały. Obecność znamiennych dla niedokrwienia zmian ST w czasie częstoskurczu nadkomorowego nie wiąże się z występowaniem przewlekłej choroby wieńcowej. (Folia Cardiol. 2005; 12: 71–76

ST-segment elevation in the recovery phase of nuclear exercise stress test with 99mTc-sestamibi in a patient with critical RCA stenosis and subtle systolic dysfunction in speckle tracking imaging

An asymptomatic Caucasian male patient underwent coronaryartery disease diagnostics. Standard exercise treadmilltest was inconclusive, and Holter ECG study didn’t show anysignificant abnormalities. Considering the high risk of ischemicheart diseasenuclear exercise stress test was performed,which revealed ST-segment elevation in the recovery phase ofthe treadmill exercise test. Single photon emission computedtomography (SPECT/CT) showed myocardial perfusion abnormalitiesin the inferior and lateral walls of the left ventricle. Furthermore,speckle tracking imaging showed subtle left ventricle dysfunction. Finally critical stenosis in the second segment ofright coronary artery was diagnosed in coronary angiography

Resolution of exercise oscillatory ventilation with adaptive servoventilation in patients with chronic heart failure and Cheyne−Stokes respiration: preliminary study

Background: Exercise oscillatory ventilation (EOV) is a common pattern of breathing in heart failure (HF) patients, and indicates a poor prognosis. Aim: To investigate the effects of adaptive servoventilation (ASV) on ventilatory response during exercise. Methods: We studied 39 HF patients with left ventricular ejection fraction (LVEF) &#163; 45. Cardiorespiratory polygraphy, cardiopulmonary exercise testing (CPET), echocardiography, and measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration were performed. Twenty patients with Cheyne-Stokes respiration and apnoea&#8211;hypopnoea index (AHI) &#8805; 15/h were identified. Of these, 11 patients were successfully titrated on ASV and continued therapy. In the third month of ASV treatment, polygraphy, CPET, echocardiography, and measurement of NT-proBNP concentration were performed again. Results: The EOV was detected at baseline in 12 (31%) HF patients, including eight (67%) who underwent ASV. The EOV was associated with significantly lower LVEF, peak oxygen uptake (VO2), and ventilatory anaerobic threshold (VAT), and a significantly higher left ventricular diastolic diameter (LVDD), slope of ventilatory equivalent for carbon dioxide (VE/VCO2), AHI, central AHI and NT-proBNP concentration. In seven patients with EOV, reversal of EOV in the third month of ASV therapy was observed; only in one patient did EOV persist (p = 0.0156). Conclusions: The EOV can be reversed with ASV therapy. The EOV in association with central sleep apnoea and Cheyne- -Stokes respiration (CSA/CSR) is prevalent in HF patients and correlates with severity of the disease. Kardiol Pol 2011; 69, 12: 1266&#8211;1271Wstęp: Periodyczne oddychanie jest częstym zjawiskiem u pacjentów z przewlekłą niewydolnością serca (HF). Występuje ono nie tylko w czasie snu, ale i podczas wysiłku. Periodyczne oddychanie w czasie wysiłku (EOV) jest silnym predykatorem śmiertelności z przyczyn sercowych u pacjentów z HF. Adaptoserwowentylacja (ASV) jest nową metodą leczenia osób z oddychaniem typu Cheyne-Stokesa. Wykazano, że znacznie redukuje ona centralne bezdechy senne i normalizuje patologiczny tor oddychania w czasie snu. Cel: Celem badania była ocena wpływu ASV na tor oddychania w czasie wysiłku. Metody: Do badania włączono 39 pacjentów z przewlekłą HF, z frakcją wyrzutową lewej komory (LVEF) &#163; 45%. U wszystkich chorych wykonano badanie poligraficzne, ergospirometryczną próbę wysiłkową, badanie echokardiograficzne i oznaczono stężenie N-końcowego propeptydu natriuretycznego typu B (NT-proBNP). Oddychanie typu Cheyne-Stokesa i wskaźnik AHI (apnea&#8211;hypopnea) > 15/h stwierdzono u 20 (51%) pacjentów. U 11 spośród nich skutecznie wdrożono leczenie ASV. W 3. miesiącu terapii ponownie wykonano badanie poligraficzne, ergospirometryczną próbę wysiłkową, badanie echokardiograficzne i oznaczono stężenie NT-proBNP. Wyniki: U 12 (31%) pacjentów z HF stwierdzono EOV, w tym u 8 (67%) leczonych ASV. Chorzy z EOV w porównaniu z osobami z prawidłowym torem oddychania w czasie wysiłku charakteryzowali się istotnie niższą LVEF, szczytowym pochłanianiem tlenu (VO2), progiem beztlenowym oraz istotnie większym rozkurczowym wymiarem lewej komory, nachyleniem VE/VCO2, AHI, centralnym AHI i stężeniem NT-proBNP. W 3. miesiącu terapii ASV stwierdzono ustąpienie EOV u 7 pacjentów, tylko u 1 osoby nie zaobserwowano poprawy w zakresie toru oddychania (p = 0,0156). Wśród pozostałych parametrów ergospirometrycznych tylko puls tlenowy istotnie wzrósł. Szczytowe pochłanianie tlenu i próg beztlenowy nieznacznie się poprawiły, ale różnice te nie osiągnęły istotności statystycznej. U wszystkich pacjentów leczonych ASV stwierdzono normalizację toru oddychania w czasie snu i zmniejszenie AHI do < 5/h. Ponadto w trakcie leczenia ASV zaobserwowano znamienne zwiększenie LVEF i istotną redukcję stężenia NT-proBNP. Wnioski: Badanie pokazuje oryginalne zjawisko normalizacji toru oddychania w czasie wysiłku u pacjentów z centralnym bezdechem sennym leczonych ASV. Na podstawie powyższych danych nie można jednak wnioskować bezpośrednio o znaczeniu klinicznym tej obserwacji. Wpływ ustąpienia EOV w czasie leczenia ASV na rokowanie odległe wymaga przeprowadzenia dalszych badań. Również ze względu na ograniczenia tego badania (krótki okres obserwacji, mała grupa badana) jego wyniki wymagają potwierdzenia w kolejnych pracach. Kardiol Pol 2011; 69, 12: 1266&#8211;127

Predicting survival in out-of-hospital cardiac arrest patients undergoing targeted temperature management: The Polish Hypothermia Registry Risk Score

Background: Prompt reperfusion and post-resuscitation care, including targeted temperature management(TTM), improve survival in out-of-hospital cardiac arrest (OHCA) patients. To predict inhospital mortality in OHCA patients treated with TTM, the Polish Hypothermia Registry Risk Score (PHR-RS) was developed. The use of dedicated risk stratification tools may support treatment decisions.Methods: Three hundred seventy-six OHCA patients who underwent TTM between 2012 and 2016 were retrospectively analysed and whose data were collected in the Polish Hypothermia Registry. A multivariatelogistic regression model identified a set of predictors of in-hospital mortality that were used to develop a dedicated risk prediction model, which was tested for accuracy.Results: The mean age of the studied population was 59.2 ± 12.9 years. 80% of patients were male, 73.8% had shockable rhythms, and mean time from cardiac arrest (CA) to cardiopulmonary resuscitation (CPR) was 7.2 ± 8.6 min. The inputs for PHR-RS were patient age and score according to the Mild Therapeutic Hypothermia (MTH) Scale. Criteria for the MTH score consisted of time from CA to CPR above 10 min, time from CA to the return of spontaneous circulation above 20 min, in-hospital CA, unwitnessed CA, and non-shockable rhythm, each counted as 1 point. The predictive value of PHR-RS was expressed as an area under the curve of 0.74.Conclusions: PHR-RS is one of the simplest and easiest models to use and enables a reliable prediction of in-hospital mortality in OHCA patients treated with TTM