CPR training in households of patients with chest pain

The objectives of this study are to (1) quantify prior cardiopulmonary resuscitation (CPR) training in households of patients presenting to the Emergency Department (ED) with or without chest pain or ischaemic heart disease (IHD); (2) evaluate the willingness of household members to undertake CPR training; and (3) identify potential barriers to the learning and provision of bystander CPR. A cross-sectional study was conducted by surveying patients presenting to the ED of a metropolitan teaching hospital over a 6-month period. Two in five households of patients presenting with chest pain or IHD had prior training in CPR. This was no higher than for households of patients presenting without chest pain or IHD. Just under two in three households of patients presenting with chest pain or IHD were willing to participate in future CPR classes. Potential barriers to learning CPR included lack of information on CPR classes, perceived lack of intellectual and/or physical capability to learn CPR and concern about causing anxiety in the person at risk of cardiac arrest. Potential barriers to CPR provision included an unknown cardiac arrest victim and fear of infection. The ED provides an opportunity for increasing family and community capacity for bystander intervention through referral to appropriate training. (C) 2003 Published by Elsevier Science Ireland Ltd.

Focused, eight-element transceive phased array coil for parallel magnetic resonance imaging of the chest-theoretical considerations

A new transceive system for chest imaging for MRI applications is presented. A focused, eight-element transceive torso phased array coil is designed to investigate transmitting a focused radiofrequency field deep within the torso and to enhance signal homogeneity in the heart region. The system is used in conjunction with the SENSE reconstruction technique to enable focused parallel imaging. A hybrid finite-difference-time-domain/method-of-moments method is used to accurately predict the radiofrequency behavior inside the human torso. The simulation results reported herein demonstrate the feasibility of the design concept, which shows that radiofrequency field focusing with SENSE reconstruction is theoretically achievable. (c) 2005 Wiley-Liss, Inc.

Cognitive asymmetry in employee emotional reactions to leadership behaviors

This article is predicated on the idea that leaders shape workplace affective events. Based on Affective Events Theory (AET), I argue that leaders are sources of employee positive and negative emotions at work. Certain leader behaviors displayed during interactions with their employees are the sources of these affective events. The second theoretical underpinning of the article is the Asymmetry Effect of emotion. Consistent with this theory, employees are more likely to recall negative incidents than positive incidents. In a qualitative study, evidence that these processes exist in the workplace was found. Leader behaviors were sources of positive or negative emotional responses in employees; employees recalled more negative incidents than positive incidents, and they recalled them more intensely and in more detail than positive incidents. Consequently, leaders may need to exercise their emotional intelligence to generate emotional uplifts to overcome the hassles in the workplace that employees seem to remember so vividly. (c) 2006 Elsevier Inc. All rights reserved.

Does colonization asymmetry matter in metapopulations?

Despite the considerable evidence showing that dispersal between habitat patches is often asymmetric, most of the metapopulation models assume symmetric dispersal. In this paper, we develop a Monte Carlo simulation model to quantify the effect of asymmetric dispersal on metapopulation persistence. Our results suggest that metapopulation extinctions are more likely when dispersal is asymmetric. Metapopulation viability in systems with symmetric dispersal mirrors results from a mean field approximation, where the system persists if the expected per patch colonization probability exceeds the expected per patch local extinction rate. For asymmetric cases, the mean field approximation underestimates the number of patches necessary for maintaining population persistence. If we use a model assuming symmetric dispersal when dispersal is actually asymmetric, the estimation of metapopulation persistence is wrong in more than 50% of the cases. Metapopulation viability depends on patch connectivity in symmetric systems, whereas in the asymmetric case the number of patches is more important. These results have important implications for managing spatially structured populations, when asymmetric dispersal may occur. Future metapopulation models should account for asymmetric dispersal, while empirical work is needed to quantify the patterns and the consequences of asymmetric dispersal in natural metapopulations.

Cardiac syndrome X: relevance of arterial pressure waveform analysis to patients with chest pain and normal coronary arteries

We report the case study of a 68-year-old female with cardiac syndrome X presenting with abnormal pressure waveforms and a hypertensive response to exercise with ST-segment depression. After amlodipine treatment, pressure waveform morphology was significantly improved, exercise testing was normal and symptoms had resolved. This case emphasizes the potential clinical value of arterial waveform analysis.

Incremental cost-effectiveness of exercise echocardiography vs. SPECT imaging for the evaluation of stable chest pain

Aims Technological advances in cardiac imaging have led to dramatic increases in test utilization and consumption of a growing proportion of cardiovascular healthcare costs. The opportunity costs of strategies favouring exercise echocardiography or SPECT imaging have been incompletely evaluated. Methods and results We examined prognosis and cost-effectiveness of exercise echocardiography (n=4884) vs. SPECT (n=4637) imaging in stable, intermediate risk, chest pain patients. Ischaemia extent was defined as the number of vascular territories with echocardiographic wall motion or SPECT perfusion abnormalities. Cox proportional hazard models were employed to assess time to cardiac death or myocardial infarction (MI). Total cardiovascular costs were summed (discounted and inflation-corrected) throughout follow-up. A cost-effectiveness ratio = 2% annual event risk), SPECT ischaemia was associated with earlier and greater utilization of coronary revascularization (P < 0.0001) resulting in an incremental cost-effectiveness ratio of $32 381/LYS. Conclusion Health care policies aimed at allocating limited resources can be effectively guided by applying clinical and economic outcomes evidence. A strategy aimed at cost-effective testing would support using echocardiography in low-risk patients with suspected coronary disease, whereas those higher risk patients benefit from referral to SPECT imaging.

Hemispheric asymmetry of neuroticism in the prediction of disinhibited work performance

Disinhibition is usually defined as a combination of high extraversion and high neuroticism or high extraversion and low neuroticism. The hypothesis that neuroticism interacts with aural preference (preferred-ear for listening) in the prediction of everyday types of disinhibited behaviour is tested. The importance of aural preference rests on the assumption that it is a readily available proxy measure of contra-hemispheric preference such that a left aural preference is indicative of right hemispheric preference and vice versa. Since the left hemisphere acts to initiate approach behaviour, the hypothesis investigates a model in which preference for the left hemisphere, together with high neuroticism, provides an alternative mechanism of disinhibition. This study provides evidence of the mechanism in the predicdon of disinhibited telesales performance.

Distortion product otoacoustic emissions in school children: Effects to gender, ear asymmetry and handedness

Accurate interpretation of distortion product otoacoustic emission (DPOAE) data cannot be made without realizing the effects of non-pathological factors on DPOAEs. The present study aimed to examine the effects of ear asymmetry, gender and handedness on DPOAEs obtained from school children. One thousand and three children (528 boys and 475 girls) with a mean age of 6.2 years (SD = 0.4, range = 5.2 7.9 years) were tested in a quiet room at their schools using the GSI-60 DPOAE system. The stimuli consisted of two pure tones of different frequencies f1 and f2 presented at 65 and 55dB SPL respectively. A DP-gram was obtained for each ear with f2 varying from 1.1 to 6.0 kHz and the ratio of f2/f1 being kept at 1.21. The signal-to-noise ratios (SNR) (DPOAE amplitude minus the mean noise floor) at the tested frequencies 1.1, 1.5, 1.9, 2.4, 3.0, 3.8, 4.8, and 6.0 kHz were measured. The results revealed a small, but significant difference in SNR between ears, with right ears showing a higher mean SNR than left ears at 1.9, 3.0, 3.8 and 6.0 kHz. At these frequencies, the difference in mean SNR between ears was less than 1 dB. A significant gender effect was also found, with girls exhibiting a higher SNR than boys at 3.8, 4.8 and 6.0 kHz. The difference in mean SNR, as a result of the gender effect, was about 1 to 2 dB at these frequencies. The results from the present study indicated no significant difference in mean SNR between left-handed and right-handed children for all tested frequencies. In conclusion, these non-pathological characteristics of DPOAEs should be considered in the interpretation of DPOAE results for school children.