Predictive models of syncope causes in an outpatient clinic

The investigation of unexplained syncope remains a challenging clinical problem. In the present study we sought to evaluate the diagnostic value of a standardized work-up focusing on non invasive tests in patients with unexplained syncope referred to a syncope clinic, and whether certain combinations of clinical parameters are characteristic of rhythmic and reflex causes of syncope. METHODS AND RESULTS: 317 consecutive patients underwent a standardized work-up including a 12-lead ECG, physical examination, detailed history with screening for syncope-related symptoms using a structured questionnaire followed by carotid sinus massage (CSM), and head-up tilt test. Invasive testings including an electrophysiological study and implantation of a loop recorder were only performed in those with structural heart disease or traumatic syncope. Our work-up identified an etiology in 81% of the patients. Importantly, three quarters of the causes were established non invasively combining head-up tilt test, CSM and hyperventilation testing. Invasive tests yielded an additional 7% of diagnoses. Logistic analysis identified age and number of significant prodromes as the only predictive factors of rhythmic syncope. The same two factors, in addition to the duration of the ECG P-wave, were also predictive of vasovagal and psychogenic syncope. These factors, optimally combined in predictive models, showed a high negative and a modest positive predictive value. CONCLUSION: A standardized work-up focusing on non invasive tests allows to establish more than three quarters of syncope causes. Predictive models based on simple clinical parameters may help to distinguish between rhythmic and other causes of syncope

Skin Cancer Prevention Strategy and Action Plan (PDF 455KB)

Northern Ireland may not enjoy the sunniest climate in the world, or even in the UK, however, in spite of this we have witnessed a significant rise in the incidence of melanoma skin cancer cases in recent years - from 80 cases in 1984 to 282 in 2009 (the latest year for which published figures are available). In relation to non-melanoma skin cancers, there are approximately 2,850 new cases here each year, making it the most common type of cancer diagnosed in Northern Ireland. åÊ The rise in the number of skin cancer cases is alarming. We know that the increase in this particular type of cancer is global and not just confined to our part of the world. We also know there are many factors involved: the significant rise in people travelling on foreign sun holidays; more leisure time being spent out of doors; and damage caused to the ozone layer to name but a few. åÊ Substantial progress in the area of skin cancer awareness raising and prevention has been made through the previous “Melanoma Strategy” which was developed in 1997. However, the unfortunate reality is that we will continue to see rising rates of skin cancer for some time to come as a result of many years of overexposure to the sun before skin cancer prevention programmes were developed. Until we can reverse this trend through effective campaigning and awareness raising, early detection will be key to bringing down mortality rates. While the 1997 strategy was right for its time, there have been many developments since then, necessitating a new strategy to reflect today’s position. åÊ For example, recent studies about the importance of vitamin D have highlighted the need for balance in sun safety messages. This new strategy is not about stopping people from enjoying the sun and its many benefits. Rather, it is about encouraging people to take proportionate measures to prevent overexposure. åÊ åÊ

Regional Health and Social Care Personal and Public Involvement Forum: Annual Update Report 2013/14

The Regional HSC PPI Annual Report for 2013/14 provides an up-date of the work of the Forum and outlines the key areas that have been progressed including the development of PPI standards and the advancement of a generic PPI awareness raising and training programme.

Copper, zinc and manganese in soils of two watersheds in Santa Catarina with intensive use of pig slurry

Systematic pig slurry application to crop soils may lead to the accumulation of heavy metals in regions with intensive pig raising. The aim of this study was to evaluate the accumulation of Cu, Zn and Mn in soils under systematic pig slurry application. For this purpose, soil samples were collected from two of the most representative watersheds of Santa Catarina where the predominant activity is pig raising. In each watershed, 12 properties were chosen to evaluate the different systems of pig husbandry (complete cycle (CC), farrowing (FaU) and finishing units (FiU)). Based on information of the producers, soil samples were collected in areas with and without systematic manure application. To determine the total Cu, Zn and Mn content in soils and manure, a methodology proposed by the Environmental Protection Agency of the United States (USEPA), method nº 3050B, was used. For the available heavy metal content, Cu and Zn was extracted with HCl 0.1 mol L-1 and Mn with KCl 1 mol L-1. Data were subjected to multivariate analysis, using the canonical discriminant analysis to identify the metals that best differentiate the soils studied within each swine housing system. Successive pig slurry applications cause an increase in Cu, Zn and Mn availability in the soil and this indicates the need for monitoring of the metal concentrations over time. The critical values of Cu in the soil can be reached and exceeded more rapidly than Zn. The results showed that the soil type may be one of the attribute underlying the determination of public policies in pig raising and waste management because soils such as Inceptisols were shown to be more prone to possible contamination since they may more rapidly reach total critical Cu levels.

Stepwise evaluation of syncope: a prospective population-based controlled study.

BACKGROUND: Evaluation of syncope remains often unstructured. The aim of the study was to assess the effectiveness of a standardized protocol designed to improve the diagnosis of syncope. METHODS: Consecutive patients with syncope presenting to the emergency departments of two primary and tertiary care hospitals over a period of 18 months underwent a two-phase evaluation including: 1) noninvasive assessment (phase I); and 2) specialized tests (phase II), if syncope remained unexplained after phase I. During phase II, the evaluation strategy was alternately left to physicians in charge of patients (control), or guided by a standardized protocol relying on cardiac status and frequency of events (intervention). The primary outcomes were the diagnostic yield of each phase, and the impact of the intervention (phase II) measured by multivariable analysis. RESULTS: Among 1725 patients with syncope, 1579 (92%) entered phase I which permitted to establish a diagnosis in 1061 (67%) of them, including mainly reflex causes and orthostatic hypotension. Five-hundred-eighteen patients (33%) were considered as having unexplained syncope and 363 (70%) entered phase II. A cause for syncope was found in 67 (38%) of 174 patients during intervention periods, compared to 18 (9%) of 189 during control (p<0.001). Compared to control periods, intervention permitted diagnosing more cardiac (8%, vs 3%, p=0.04) and reflex syncope (25% vs 6%, p<0.001), and increased the odds of identifying a cause for syncope by a factor of 4.5 (95% CI: 2.6-8.7, p<0.001). Overall, adding the diagnostic yield obtained during phase I and phase II (intervention periods) permitted establishing the cause of syncope in 76% of patients. CONCLUSION: Application of a standardized diagnostic protocol in patients with syncope improved the likelihood of identifying a cause for this symptom. Future trials should assess the efficacy of diagnosis-specific therapy.

Building Beyond Limits : Fantastic Collisions Between Bodies and Machines in French and English Fin-de-Siècle Literature

«Construire hors limite: collisions fantastiques entre corps et machines dans la littérature fin-de-siècle française et anglaise» explore un ensemble de textes qui ont surgi à la fin du dix-neuvième siècle en réponse et en réaction à la fulgurante évolution de l’environnement scientifique et technologique, et qui considèrent la relation entre l’homme et la machine en fantasmant sur la zone grise où ils s’intersectent. Les principaux textes étudiés comprennent L’Ève future de Villiers de l’Isle-Adam, Le Surmâle d’Alfred Jarry, Trilby de George Du Maurier, Le Château des Carpathes de Jules Verne, ainsi qu’une sélection de contes dont nous pouvons qualifier de «contes à appareils», notamment «La Machine à parler» de Marcel Schwob. Utilisant la théorie des systèmes comme base méthodologique, cette dissertation cherche à réinterpréter les textes de la fin du dix-neuvième siècle qui naviguent les limites de l’humain et du mécanique et les surfaces sensibles où ils se touchent et interagissent en les réinscrivant dans un projet plus vaste de construction d’identité qui défie le temps chronologique et les échelles mathématiques. Le lien entre la théorie des systèmes et l’architecture – comme méthode d’organisation d’espace blanc en espace habitable – est exploré dans le but de comprendre la manière dont nous façonnons et interprétons le néant à l’origine de l’identité individuelle, et par association collective, en pratiquant littéralement la schématisation et la construction du corps. Des auteurs tels Villiers et Jarry imaginent la construction du corps comme une entreprise scientifique nécessairement fondée et réalisée avec les matériaux et les technologies disponibles, pour ensuite démanteler cette proposition en condamnant le corps technologique à la destruction. La construction d’une identité amplifiée par la technologie prend donc des proportions prométhéennes perpétuellement redessinées dans des actes cycliques de rasage (destruction) et d’érection (édification), et reflétées dans l’écriture palimpsestique du texte. L’intégrité du corps organique étant mis en question, le noyau même de ce que signifie l’être (dans son sens de verbe infinitif) humain pourrait bien s’avérer, si l’on considère la correspondance entre perte de voix et état pathologique dans les textes de Du Maurier, Verne et Schwob, être une structure des plus précaires, distinctement hors sens (unsound).

Solvent-dependent modulation of metal–metal electronic interactions in a dinuclear cyanoruthenate complex: a detailed electrochemical, spectroscopic and computational study

The dinuclear complex [{Ru(CN)4}2(μ-bppz)]4− shows a strongly solvent-dependent metal–metal electronic interaction which allows the mixed-valence state to be switched from class 2 to class 3 by changing solvent from water to CH2Cl2. In CH2Cl2 the separation between the successive Ru(II)/Ru(III) redox couples is 350 mVand the IVCT band (from the UV/Vis/NIR spectroelectrochemistry) is characteristic of a borderline class II/III or class III mixed valence state. In water, the redox separation is only 110 mVand the much broader IVCT transition is characteristic of a class II mixed-valence state. This is consistent with the observation that raising and lowering the energy of the d(π) orbitals in CH2Cl2 or water, respectively, will decrease or increase the energy gap to the LUMO of the bppz bridging ligand, which provides the delocalisation pathway via electron-transfer. IR spectroelectrochemistry could only be carried out successfully in CH2Cl2 and revealed class III mixed-valence behaviour on the fast IR timescale. In contrast to this, time-resolved IR spectroscopy showed that the MLCTexcited state, which is formulated as RuIII(bppz˙−)RuII and can therefore be considered as a mixed-valence Ru(II)/Ru(III) complex with an intermediate bridging radical anion ligand, is localised on the IR timescale with spectroscopically distinct Ru(II) and Ru(III) termini. This is because the necessary electron-transfer via the bppz ligand is more difficult because of the additional electron on bppz˙− which raises the orbital through which electron exchange occurs in energy. DFT calculations reproduce the electronic spectra of the complex in all three Ru(II)/Ru(II), Ru(II)/Ru(III) and Ru(III)/Ru(III) calculations in both water and CH2Cl2 well as long as an explicit allowance is made for the presence of water molecules hydrogen-bonded to the cyanides in the model used. They also reproduce the excited-state IR spectra of both [Ru(CN)4(μ-bppz)]2– and [{Ru(CN)4}2(μ-bppz)]4− very well in both solvents. The reorganization of the water solvent shell indicates a possible dynamical reason for the longer life time of the triplet state in water compared to CH2Cl2.

A realization of the q-deformed harmonic oscillator: rogers-Szegö and Stieltjes-Wigert polynomials

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

The effect of manual therapy on masseter muscle pain and spasm

Introduction: Orofacial pain and pain in the muscles of mastication are frequent symptoms of temporomandibular disorder. The masseter is the closet masticatory muscle to the surface and has the function of raising and retracting the mandible. This muscle has considerable strength and is one of the main muscles involved in the shredding of food It is therefore of utmost importance in the masticatory cycle and generally the most affected by pain and spasms. Objectives: The aim of the present study was to analyze the effect of manual therapy with transversal and circular movements on pain and spasm in the masseter muscle, using electromyography and a visual analogue pain scale (VAPS). Eight women who experienced pain upon palpation of the masseter greater than 6 on the VAPS were selected for participation in the study, which employed electromyography and a VAPS for assessment, followed by manual oral physiotherapy and reevaluation. Results: The statistical analysis revealed a reduction in pain, but there was no significant difference in electromyographic activity (p < 0.05). Conclusion: It was concluded that massage therapy was effective on pain symptoms, but was not capable of altering the electrical activity of the masseter muscle.

Matrix Support in Mental Health: Achievements and Limits in Primary Health Care

Changes in mental health care in the city of Fortaleza (Northeastern Brazil) have a recent historical and political process. Compared to other municipalities of the State of Ceara, which in the early 1990s were already pioneers in the process, Fortaleza has not implemented the changes due to the interests of psychiatric hospitals, of psychiatric outpatient clinics of the public network, and because of the difficulty in managing the new mental health devices and equipment present in Primary Care. In the municipality, the reorganization of mental health actions and services has required that the Primary Care Network faces the challenge of assisting mental health problems with the implementation of Matrix Support. In light of this context, we aimed to evaluate Matrix Support in mental health in Primary Care Units and to identify achievements and limitations in the Primary Care Units with Matrix Support. This study used a qualitative approach and was carried out by means of a case study. We interviewed twelve professionals from the Family Health Teams of four Units with implemented Matrix Support. The analysis of the information reveals that access, decision making, participation and the challenges of implementing Matrix Support are elements that are, in a dialectic way, weak and strong in the reorganization of services and practices. The presence of Matrix Support in Primary Care highlights the proposal of dealing with mental health within the network in the municipality. The process has not ended. Mobilization, awareness-raising and qualification of Primary Care have to be enhanced constantly, but implementation has enabled, to the service and professionals, greater acceptance of mental health in Primary Care.

Reshaping Rural Extension: Learning for Sustainability (LforS): An Integrative and Learning-Based Advisory Approach for Rural Extension with Small-Scale Farmers

This publication offers concrete suggestions for implementing an integrative and learning-oriented approach to agricultural extension with the goal of fostering sustainable development. It targets governmental and non-governmental organisations, development agencies, and extension staff working in the field of rural development. The book looks into the conditions and trends that influence extension today, and outlines new challenges and necessary adaptations. It offers a basic reflection on the goals, the criteria for success and the form of a state-of-the-art approach to extension. The core of the book consists of a presentation of Learning for Sustainability (LforS), an example of an integrative, learning-oriented approach that is based on three crucial elements: stakeholder dialogue, knowledge management, and organizational development. Awareness raising and capacity building, social mobilization, and monitoring & evaluation are additional building blocks. The structure and organisation of the LforS approach as well as a selection of appropriate methods and tools are presented. The authors also address key aspects of developing and managing a learning-oriented extension approach. The book illustrates how LforS can be implemented by presenting two case studies, one from Madagascar and one from Mongolia. It addresses conceptual questions and at the same time it is practice-oriented. In contrast to other extension approaches, LforS does not limit its focus to production-related aspects and the development of value chains: it also addresses livelihood issues in a broad sense. With its focus on learning processes LforS seeks to create a better understanding of the links between different spheres and different levels of decision-making; it also seeks to foster integration of the different actors’ perspectives.

Syncope

Syncope is defined as an acute, brief and transient loss of consciousness and postural tone with spontaneous and complete recovery. Neurovascular ultrasound has contributed to elucidate the underlying mechanism of different types of syncope. In routine diagnostic work-up of patients with syncope, however, neurovascular ultrasound is not among the first line tools. In particular, an ultrasound search for occlusive cerebro-vascular disease is of limited value because cerebral artery obstruction is a very rare and questionable cause of syncope. Transcranial Doppler sonography monitoring of the cerebral arteries is useful in the diagnostic work-up of patients with suspicion of postural related, cerebrovascular, cough and psychogenic syncope, and in some cases for differentiating focal epileptic seizures from transient ischemic attacks and migraine with aura.

Acute alcohol ingestion and sympathetic neural responses during orthostatic stress in humans

Acute alcohol consumption has been reported to decrease mean arterial pressure (MAP) during orthostatic challenge, a response that may contribute to alcohol-mediated hypotension and eventually syncope. Muscle sympathetic nerve activity (MSNA) increases during orthostatic stress to help maintain MAP, yet the influence of alcohol on MSNA during orthostatic stress has not been determined. We hypothesized that alcohol ingestion would blunt arterial blood pressure and MSNA responses to progressive lower body negative pressure (LBNP). MAP, MSNA, and heart rate (HR) were recorded during progressive LBNP (-5, -10, -15, -20, -30, and -40 mmHg; 3 min/stage) in 30 subjects(age 24 ± 1 yrs). After an initial progressive LBNP protocol (pre-treatment), subjects were randomly assigned to consume alcohol (0.8g ethanol/kg body mass; n=15) or placebo (n=15) and then repeated the progressive LBNP protocol (post-treatment). Alcohol increased (drug × treatment, P ≤ 0.05) resting HR (59 ± 2 to 65 ± 2 beats/min) and MSNA (13 ± 3 to 19 ± 4 bursts/min) when compared to placebo. While alcohol increased MAP (83 ± 2 to 87 ± 2 mmHg), these increases were also observed with placebo (82 ± 2 to 88 ± 1 mmHg; treatment, P < 0.05; drug × treatment, P > 0.05). During progressive LBNP, a prominent decrease in MAP was observed after alcohol (drug × time × treatment, P < 0.05), but not placebo. There was also a significant attenuated response in forearm vascular resistance (FVR) during progressive LBNP (drug × time × treatment, P < 0.05). MSNA and HR increased during all LBNP protocols, but there were no differences between treatments or groups (drugs). In summary, acute alcohol ingestion induces an attenuation in blood pressure response during an orthostatic challenge, possibly due to the effect that alcohol has on impairing peripheral blood vessel constriction.

Evaluating the use of IT by the third party logistics in South East Asia to achieve competitive advantage and its future trend

As the number of using 3PL providers are increasing rapidly in recent years, 3PL providers play a major role in the logistics industry. Due to customers demands are raising and changing, it has facilitated 3PL providers to invest IT systems that could meet customer requirements and create competitive advantage. The use of IT systems could assist 3PL providers to achieve supply chain visibility and enhance supply chain collaboration with business partners. In this paper, it is mainly focus on the Europe and Far East 3PL providers in terms of current and future IT systems, IT motivators and barriers, as well as the future supply chain demands that address by IT systems. The common IT system that implemented in both regions is information technology, which is mainly used to collaborate and share information with supply chain partners. Some of the common motivations and barriers were existed and 3PL providers need to be understood. Given the future demands of IT implementation and supply chain collaboration, IT systems such as RFID and integration systems would be strongly focus in the future. The suggestion about the advanced integration system such as business process management (BPM) could be the next key IT systems in the future logistics industry. © 2012 AICIT.

Heritage Language Maintenance and Biliteracy Development for Immigrants' Children: A Study of Chinese Immigrants' Family Language Policy and Biliteracy Practices

This study reports on research that examines the family language policy (FLP) and biliteracy practices of middle-class Chinese immigrant families in a metropolitan area in the southwest of the U.S. by exploring language practices pattern among family members, language and literacy environment at home, parents’ language management, parents’ language attitudes and ideologies, and biliteracy practices. In this study, I employed mixed methods, including survey and interviews, to investigate Chinese immigrant parents’ FLP, biliteracy practices, their life stories, and their experience of raising and nurturing children in an English-dominant society. Survey questionnaires were distributed to 55 Chinese immigrant parents and interviews were conducted with five families, including mothers and children. One finding from this study is that the language practices pattern at home shows the trend of language shift among the Chinese immigrants’ children. Children prefer speaking English with parents, siblings, and peers, and home literacy environment for children manifests an English-dominant trend. Chinese immigrant parents’ language attitudes and ideologies are largely influenced by English-only ideology. The priority for learning English surpasses the importance of Chinese learning, which is demonstrated by the English-dominant home literacy practices and an English-dominant language policy. Parents invest more in English literacy activities and materials for children, and very few parents implement Chinese-only policy for their children. A second finding from this study is that a multitude of factors from different sources shape and influence Chinese immigrants’ FLP and biliteracy practices. The factors consist of family-related factors, social factors, linguistic factors, and individual factors. A third finding from this study is that a wide variety of strategies are adopted by Chinese immigrant families, which have raised quite balanced bilingual children, to help children maintain Chinese heritage language (HL) and develop both English and Chinese literacy. The close examination and comparison of different families with English monolingual children, with children who have limited knowledge of HL, and with quite balanced bilingual children, this study discovers that immigrant parents, especially mothers, play a fundamental and irreplaceable role in their children’s HL maintenance and biliteracy development and it recommends to immigrant parents in how to implement the findings of this study to nurture their children to become bilingual and biliterate. Due to the limited number and restricted area and group of participant sampling, the results of this study may not be generalized to other groups in different contexts.