Determinants of prognostically relevant intracoronary electrocardiogram ST-segment shift during coronary balloon occlusion

The prognostic relevance of quantitative an intracoronary occlusive electrocardiographic (ECG) ST-segment shift and its determinants have not been investigated in humans. In 765 patients with chronic stable coronary artery disease, the following simultaneous quantitative measurements were obtained during a 1-minute coronary balloon occlusion: intracoronary ECG ST-segment shift (recorded by angioplasty guidewire), mean aortic pressure, mean distal coronary pressure, and mean central venous pressure (CVP). Collateral flow index (CFI) was calculated as follows: (mean distal coronary pressure minus CVP)/(mean aortic pressure minus CVP). During an average follow-up duration of 50 ± 34 months, the cumulative mortality rate from all causes was significantly lower in the group with an ST-segment shift <0.1 mV (n = 89) than in the group with an ST-segment shift ≥0.1 mV (n = 676, p = 0.0211). Factors independently related to intracoronary occlusive ECG ST-segment shift <0.1 mV (r(2) = 0.189, p <0.0001) were high CFI (p <0.0001), intracoronary occlusive RR interval (p = 0.0467), right coronary artery as the ischemic region (p <0.0001), and absence of arterial hypertension (p = 0.0132). "High" CFI according to receiver operating characteristics analysis was ≥0.217 (area under receiver operating characteristics curve 0.647, p <0.0001). In conclusion, absence of ECG ST-segment shift during brief coronary occlusion in patients with chronic coronary artery disease conveys a decreased mortality and is directly influenced by a well-developed collateral supply to the right versus left coronary ischemic region and by the absence of systemic hypertension in a patient's history.

The association between life events and suicide intent in self-poisoners with and without a history of deliberate self-harm: a preliminary study

The associations between life events in the 12 months preceding an episode of self-poisoning resulting in hospital attendance (the index episode), and the suicide intent of this episode were compared in individuals for whom the index episode was their first, episode and in individuals in whom it was a recurrence of DSH. Results indicated a significant interaction between independent life events, repetition status, and gender in the prediction of suicide intent, the association between life events and intent being moderated by repetition status in women only. The results provide preliminary evidence to suggest the presence of a suicidal process in women, in which the impact of negative life events on suicide intent diminishes across episodes.

A Study of the Physical Properties of Low Tin Solders

In 1947, out of the 100,000 long tons of tin con­sumed in the United States, 25,000 tons went into solder. Tin plate took 39,000 tons while babbit, bronze and coll­apsible tubes accounted for approximately 17,000 tons. Solder ranked second to tin plate and required more than the next three major uses combined.

Inverse relationship between fractionated electrograms and atrial fibrosis in persistent atrial fibrillation: combined magnetic resonance imaging and high-density mapping

OBJECTIVES This study sought to evaluate the relationship between fibrosis imaged by delayed-enhancement (DE) magnetic resonance imaging (MRI) and atrial electrograms (Egms) in persistent atrial fibrillation (AF). BACKGROUND Atrial fractionated Egms are strongly related to slow anisotropic conduction. Their relationship to atrial fibrosis has not yet been investigated. METHODS Atrial high-resolution MRI of 18 patients with persistent AF (11 long-lasting persistent AF) was registered with mapping geometry (NavX electro-anatomical system (version 8.0, St. Jude Medical, St. Paul, Minnesota)). DE areas were categorized as dense or patchy, depending on their DE content. Left atrial Egms during AF were acquired using a high-density, 20-pole catheter (514 ± 77 sites/map). Fractionation, organization/regularity, local mean cycle length (CL), and voltage were analyzed with regard to DE. RESULTS Patients with long-lasting persistent versus persistent AF had larger left atrial (LA) surface area (134 ± 38 cm(2) vs. 98 ± 9 cm(2), p = 0.02), a higher amount of atrial DE (70 ± 16 cm(2) vs. 49 ± 10 cm(2), p = 0.01), more complex fractionated atrial Egm (CFAE) extent (54 ± 16 cm(2) vs. 28 ± 15 cm(2), p = 0.02), and a shorter baseline AF CL (147 ± 10 ms vs. 182 ± 14 ms, p = 0.01). Continuous CFAE (CFEmean [NavX algorithm that quantifies Egm fractionation] <80 ms) occupied 38 ± 19% of total LA surface area. Dense DE was detected at the left posterior left atrium. In contrast, the right posterior left atrium contained predominantly patchy DE. Most CFAE (48 ± 14%) occurred at non-DE LA sites, followed by 41 ± 12% CFAE at patchy DE and 11 ± 6% at dense DE regions (p = 0.005 and p = 0.008, respectively); 19 ± 6% CFAE sites occurred at border zones of dense DE. Egms were less fractionated, with longer CL and lower voltage at dense DE versus non-DE regions: CFEmean: 97 ms versus 76 ms, p < 0.0001; local CL: 153 ms versus 143 ms, p < 0.0001; mean voltage: 0.63 mV versus 0.86 mV, p < 0.0001. CONCLUSIONS Atrial fibrosis as defined by DE MRI is associated with slower and more organized electrical activity but with lower voltage than healthy atrial areas. Ninety percent of continuous CFAE sites occur at non-DE and patchy DE LA sites. These findings are important when choosing the ablation strategy in persistent AF.

Testing for Measurement Equivalence in Surveys: Dimensions of Social Trust across Cultural Contexts

Our study evaluates the dimensionality and equivalence of social trust across cultural contexts, using new data from Switzerland and the World Values Survey 2005–2008. Whereas some scholars assert that trust should be regarded as a coherent concept, others claim that trust is better conceived of as a multidimensional concept. In contrast to the conventional dichotomy of the forms of social trust, we identify three distinct forms of trust, namely, particularized, generalized, and identity-based trust. Moreover, we dispute the view that respondents understand the wording of survey questions regarding social trust differently between different cultural contexts, which would imply that comparative research on trust is a pointless endeavor. Applying multiple-group confirmatory factor analysis to the various constructs of social trust, we conclude that one may study relationships among the three forms of trust and other theoretical constructs as well as compare latent means across cultural contexts. Our analyses therefore provide an optimistic outlook for future comparative analyses that investigate forms of social trust across cultural contexts.

Political Depolarization in German Public Opinion, 1980–2010

Little is known about political polarization in German public opinion. This article offers an issue-based perspective and explores trends of opinion polarization in Germany. Public opinion polarization is conceptualized and measured as alignment of attitudes. Data from the German General Social Survey (1980 to 2010) comprise attitudes towards manifold issues, which are classified into several dimensions. This study estimates multilevel models that reveal general and issue- as well as dimension-specific levels and trends in attitude alignment for both the whole German population and sub-groups. It finds that public opinion polarization has decreased over the last three decades in Germany. In particular, highly educated and more politically interested people have become less polarized over time. However, polarization seems to have increased in attitudes regarding gender issues. These findings provide interesting contrasts to existing research on the American public.