Unexplained syncope--is screening for carotid sinus hypersensitivity indicated in all patients aged >40 years?

OBJECTIVE: To determine the frequency, age distribution and clinical presentation of carotid sinus hypersensitivity (CSH) among 373 patients (age range 15-92 years) referred to two autonomic referral centres during a 10-year period. METHODS: Carotid sinus massage (CSM) was performed both supine and during 60 degree head-up tilt. Beat-to-beat blood pressure, heart rate and a three-lead electrocardiography were recorded continuously. CSH was classified as cardioinhibitory (asystole > or = 3 s), vasodepressor (systolic blood pressure fall > or = 50 mm Hg) or mixed. All patients additionally underwent autonomic screening tests for orthostatic hypotension and autonomic failure. RESULTS: CSH was observed in 13.7% of all patients. The diagnostic yield of CSM was nil in patients aged < 50 years (n = 65), 2.4% in those aged 50-59 years (n = 82), 9.1% in those aged 60-69 years (n = 77), 20.7% in those aged 70-79 years (n = 92) and reached 40.4% in those > 80 years (n = 57). Syncope was the leading clinical symptom in 62.8%. In 27.4% of patients falls without definite loss of consciousness was the main clinical symptom. Mild and mainly systolic orthostatic hypotension was recorded in 17.6%; evidence of sympathetic or parasympathetic dysfunction was found in none. CONCLUSIONS: CSH was confirmed in patients > 50 years, the incidence steeply increasing with age. The current European Society of Cardiology guidelines that recommend testing for CSH in all patients > 40 years with syncope of unknown aetiology may need reconsideration. Orthostatic hypotension was noted in some patients with CSH, but evidence of sympathetic or parasympathetic failure was not found in any of them.

Epidemiological, social, diagnostic and economic evaluation of population screening for genital chlamydial infection

OBJECTIVES: To investigate epidemiological, social, diagnostic and economic aspects of chlamydia screening in non-genitourinary medicine settings. METHODS: Linked studies around a cross-sectional population-based survey of adult men and women invited to collect urine and (for women) vulvovaginal swab specimens at home and mail these to a laboratory for testing for Chlamydia trachomatis. Specimens were used in laboratory evaluations of an amplified enzyme immunoassay (PCE EIA) and two nucleic acid amplification tests [Cobas polymerase chain reaction (PCR), Becton Dickinson strand displacement amplification (SDA)]. Chlamydia-positive cases and two negative controls completed a risk factor questionnaire. Chlamydia-positive cases were invited into a randomised controlled trial of partner notification strategies. Samples of individuals testing negative completed psychological questionnaires before and after screening. In-depth interviews were conducted at all stages of screening. Chlamydia transmission and cost-effectiveness of screening were investigated in a transmission dynamic model. SETTING AND PARTICIPANTS: General population in the Bristol and Birmingham areas of England. In total, 19,773 women and men aged 16-39 years were randomly selected from 27 general practice lists. RESULTS: Screening invitations reached 73% (14,382/19,773). Uptake (4731 participants), weighted for sampling, was 39.5% (95% CI 37.7, 40.8%) in women and 29.5% (95% CI 28.0, 31.0%) in men aged 16-39 years. Chlamydia prevalence (219 positive results) in 16-24 year olds was 6.2% (95% CI 4.9, 7.8%) in women and 5.3% (95% CI 4.4, 6.3%) in men. The case-control study did not identify any additional factors that would help target screening. Screening did not adversely affect anxiety, depression or self-esteem. Participants welcomed the convenience and privacy of home-sampling. The relative sensitivity of PCR on male urine specimens was 100% (95% CI 89.1, 100%). The combined relative sensitivities of PCR and SDA using female urine and vulvovaginal swabs were 91.8% (86.1, 95.7, 134/146) and 97.3% (93.1, 99.2%, 142/146). A total of 140 people (74% of eligible) participated in the randomised trial. Compared with referral to a genitourinary medicine clinic, partner notification by practice nurses resulted in 12.4% (95% CI -3.7, 28.6%) more patients with at least one partner treated and 22.0% (95% CI 6.1, 37.8%) more patients with all partners treated. The health service and patients costs (2005 prices) of home-based postal chlamydia screening were 21.47 pounds (95% CI 19.91 pounds, 25.99) per screening invitation and 28.56 pounds (95% CI 22.10 pounds, 30.43) per accepted offer. Preliminary modelling found an incremental cost-effectiveness ratio (2003 prices) comparing screening men and women annually to no screening in the base case of 27,000 pounds/major outcome averted at 8 years. If estimated screening uptake and pelvic inflammatory disease incidence were increased, the cost-effectiveness ratio fell to 3700 pounds/major outcome averted. CONCLUSIONS: Proactive screening for chlamydia in women and men using home-collected specimens was feasible and acceptable. Chlamydia prevalence rates in men and women in the general population are similar. Nucleic acid amplification tests can be used on first-catch urine specimens and vulvovaginal swabs. The administrative costs of proactive screening were similar to those for opportunistic screening. Using empirical estimates of screening uptake and incidence of complications, screening was not cost-effective.

La Yeguada volcanic complex, western Panama : an assessment of the geologic hazards using new 40AR/39Ar Ages

La Yeguada volcanic complex is one of three Quaternary volcanic centers in Panama, and is located on the southern slope of the Cordillera Central mountain range in western Panama, province of Veraguas. To assess potential geologic hazards, this study focused on the main dome complex near the village of La Laguna and also examined a cinder cone 10 km to the northwest next to the village of Media Luna. Based on newly obtained 40Ar/39Ar ages, the most recent eruption occurred approximately 32 000 years ago at the Media Luna cinder cone, while the youngest dated eruption at the main dome complex occurred 0.357 ± 0.019 Ma, producing the Castillo dome unit. Cerro Picacho is a separate dome located 1.5 km east of the main complex with a date of 4.47 ± 0.23 Ma, and the El Satro Pyroclastic Flow unit surrounds the northern portion of the volcanic complex and has an age of 11.26 ± 0.17 Ma. No Holocene (10 000 years ago to present) activity is recorded at the La Yeguada volcanic complex and therefore, it is unlikely to produce another eruption. The emergence of a new cinder cone is a possibility, but the associated hazards tend to be low and localized, and this does not pose a significant threat to the small communities scattered throughout the area. The main geologic hazard at the La Yeguada volcanic complex is from landslides coming off the many steep slopes.

Eruptive history of Maderas volcano using new 40Ar/39Ar ages and geochemical analyses

Maderas volcano is a small, andesitic stratovolcano located on the island of Ometepe, in Lake Nicaragua, Nicaragua with no record of historic activity. Twenty-one samples were collected from lava flows from Maderas in 2010. Selected samples were analyzed for whole-rock geochemical data using ICP-AES and/or were dated using the 40Ar/39Ar method. The results of these analyses were combined with previously collected data from Maderas as well as field observations to determine the eruptive history of the volcano and create a geologic map. The results of the geochemical analyses indicate that Maderas is a typical Central American andesitic volcano similar to other volcanoes in Nicaragua and Costa Rica and to its nearest neighbor, Concepción volcano. It is different from Concepción in one important way – higher incompatible elements. Determined age dates range from 176.8 ± 6.1 ka to 70.5 ± 6.1 ka. Based on these ages and the geomorphology of the volcano which is characterized by a bisecting graben, it is proposed that Maderas experienced two clear generations of development with three separate phases of volcanism: initial build-up of the older cone, pre-graben lava flows, and post-graben lava flows. The ages also indicate that Maderas is markedly older than Concepción which is historically active. Results were also analyzed regarding geologic hazards. The 40Ar/39Ar ages indicate that Maderas has likely been inactive for tens of thousands of years and the risk of future volcanic eruptions is low. However, earthquake, lahar and landslide hazards exist for the communities around the volcano. The steep slopes of the eroded older cone are the most likely source of landslide and lahar hazards.

Same Same but Different: Returning to Vietnam after 40 Years

Dan Cornell returned to Vietnam in 2012, more than 40 years after he was stationed there. From 1970-1971, Dan spent time flying around Vietnam and the neighboring countries in a large, CH-47 helicopter. There was not much time to think about what he was doing or why. In spite of this, Dan managed to become enticed bu this country so different from his own. This presentation features videos and photos from his 8-week trip.

Remaining lifetime and absolute 10-year probabilities of osteoporotic fracture in Swiss men and women

SUMMARY: Remaining lifetime and absolute 10-year probabilities for osteoporotic fractures were determined by gender, age, and BMD values. Remaining lifetime probability at age 50 years was 20.2% in men and 51.3% in women and increased with advancing age and decreasing BMD. The study validates the elements required to populate a Swiss-specific FRAX model. INTRODUCTION: Switzerland belongs to high-risk countries for osteoporosis. Based on demographic projections, burden will still increase. We assessed remaining lifetime and absolute 10-year probabilities for osteoporotic fractures by gender, age and BMD in order to populate FRAX algorithm for Switzerland. METHODS: Osteoporotic fracture incidence was determined from national epidemiological data for hospitalised fractured patients from the Swiss Federal Office of Statistics in 2000 and results of a prospective Swiss cohort with almost 5,000 fractured patients in 2006. Validated BMD-associated fracture risk was used together with national death incidence and risk tables to determine remaining lifetime and absolute 10-year fracture probabilities for hip and major osteoporotic (hip, spine, distal radius, proximal humerus) fractures. RESULTS: Major osteoporotic fractures incidence was 773 and 2,078 per 100,000 men and women aged 50 and older. Corresponding remaining lifetime probabilities at age 50 were 20.2% and 51.3%. Hospitalisation for clinical spine, distal radius, and proximal humerus fractures reached 25%, 30% and 50%, respectively. Absolute 10-year probability of osteoporotic fracture increased with advancing age and decreasing BMD and was higher in women than in men. CONCLUSION: This study validates the elements required to populate a Swiss-specific FRAX model, a country at highest risk for osteoporotic fractures.

A comparison of frontal radiographs obtained from cone beam CT scans and conventional frontal radiographs of human skulls

This study evaluated whether measurements on conventional frontal radiographs are comparable with measurements on cone beam computed tomography (CBCT)-constructed frontal cephalometric radiographs taken from dry human skulls. CBCT scans and conventional frontal cephalometric radiographs were made of 40 dry skulls. With I-Cat Vision((R)) software, a cephalometric radiograph was constructed from the CBCT scan. Standard cephalometric software was used to identify landmarks and calculate ratios and angles. The same operator identified 10 landmarks on both types of cephalometric radiographs on all Images 5 times with a time-interval of 1 week. Intra-observer reliability was acceptable for all measurements. The reproducibility of the measurements on the frontal radiographs obtained from the CBCT scans was higher than those on conventional frontal radiographs. There is a statistically significant and clinically relevant difference between measurements on conventional and constructed frontal radiographs. There is a clinically relevant difference between angular measurements performed on conventional frontal cephalometric radiographs, compared with measurements on frontal cephalometric radiographs constructed from CBCT scans, owing to different positioning of patients in both devices. Positioning of the patient in the CBCT device appears to be an important factor in cases where a 2D projection of the 3D scan is made.

Tracing glacier wastage in the Northern Tien Shan (Kyrgyzstan/Central Asia) over the last 40 years

The status and dynamics of glaciers are crucial for agriculture in semiarid parts of Central Asia, since river flow is characterized by major runoff in spring and summer, supplied by glacier- and snowmelt. Ideally, this coincides with the critical period of water demand for irrigation. The present study shows a clear trend in glacier retreat between 1963 and 2000 in the Sokoluk watershed, a catchment of the Northern Tien Shan mountain range in Kyrgyzstan. The overall area loss of 28% observed for the period 1963–2000, and a clear acceleration of wastage since the 1980s, correlate with the results of previous studies in other regions of the Tien Shan as well as the Alps. In particular, glaciers smaller than 0.5 km2 have exhibited this phenomenon most starkly. While they registered a medium decrease of only 9.1% for 1963–1986, they lost 41.5% of their surface area between 1986 and 2000. Furthermore, a general increase in the minimum glacier elevation of 78 m has been observed over the last three decades. This corresponds to about one-third of the entire retreat of the minimum glacier elevation in the Northern Tien Shan since the Little Ice Age maximum.