Isolated very low QRS voltage predicts response to tilt-table testing in patients with neurally mediated syncope.

BACKGROUND: A number of patients with neurally mediated syncope (NMS) have isolated QRS complexes of very low voltage (≤0.3 mV) in the frontal plane leads on the 12-lead electrocardiogram (ECG). HYPOTHESIS: The aim of this study was to assess the importance of QRS voltage in predicting response to tilt-table testing (TTT) in patients with suspected NMS. METHODS: We included 216 patients (age: 49 ± 20 years, 103 men) with suspected NMS who had either a positive or negative response to TTT (n = 91 TTT+, and n = 125 TTT-). The QRS voltage was measured in mV on 12-lead ECGs performed within 3 days of the TTT. The lowest QRS voltage (QRSmin), as well as the voltage in each of the 12 leads was also determined. RESULTS: Very low voltage (QRSmin  ≤ 0.3 mV) in the frontal leads was significantly more prevalent in the TTT+ group than in the TTT- group (74 vs 22%, respectively; P  < .001). Patients in the TTT+ group had significantly lower QRSmin when compared to patients in the TTT- group. QRSmin predicted a positive tilt-table test in a multivariate model that also included patient gender, height, history of presyncope, QRS duration, and left ventricular end-diastolic diameter indexed to height. ROC analysis showed that QRSmin of ≥0.3 mV discriminated between TTT+ and TTT- patients with a sensitivity of 78% and specificity of 68%. CONCLUSION: Isolated very low QRS voltage in the frontal leads predicts a positive response to TTT in patients with suspected NMS.

Home labour induction with retrievable prostaglandin pessary and continuous telemetric trans-abdominal fetal ECG monitoring.

OBJECTIVE: To evaluate the feasibility of continuous telemetric trans-abdominal fetal electrocardiogram (a-fECG) in women undergoing labour induction at home. STUDY DESIGN: Low risk women with singleton term pregnancy undergoing labour induction with retrievable, slow-release dinoprostone pessaries (n = 70) were allowed home for up to 24 hours, while a-fECG and uterine activity were monitored in hospital via wireless technology. Semi-structured diaries were analysed using a combined descriptive and interpretive approach. RESULTS: 62/70 women (89%) had successful home monitoring; 8 women (11%) were recalled because of signal loss. Home monitoring lasted between 2-22 hours (median 10 hours). Good quality signal was achieved most of the time (86%, SD 10%). 3 women were recalled back to hospital for suspicious a-fECG. In 2 cases suspicious a-fECG persisted, requiring Caesarean section after recall to hospital. 48/51 women who returned the diary coped well (94%); 46/51 were satisfied with home monitoring (90%). CONCLUSIONS: Continuous telemetric trans-abdominal fetal ECG monitoring of ambulatory women undergoing labour induction is feasible and acceptable to women.

A typology of prevention activities: Applications to community coalitions.

Use of community coalitions as a strategy for the primary prevention of tobacco, alcohol, and other drug abuse is justified in part on the prospect that these coalitions will mount comprehensive, multi-level, multi-target intervention packages. To judge the success of such coalitions, reliable and valid means for assessing the content and pattern of their overall prevention efforts are required. This article proposes a typology of prevention activities, discusses the logic on which it is based, and provides examples of useful applications in examining community coalition prevention plans. Evidence for reliability and validity is provided through assessments of inter-rater agreement, and the relation of measures of "scope of prevention activities" to independent ratings of comprehensiveness. The typology can be used in research validating the logic model on which prevention coalitions are based, and it is also demonstrably useful for improving the local planning process.

Empowerment praxis in community coalitions.

Community coalitions address a wide variety of community problems, espousing a community development processes that promotes individual and collective self-determination. They offer a promising venue for the study of empowerment of individuals and organizations. This study utilizes data from members of 35 community coalitions organized for the prevention of alcohol and other drug problems to address the following questions: What individual characteristics are related to the psychological empowerment of coalition members? What organizational characteristics are related to the collective empowering of members? What organization characteristics are related to a coalition being organizationally empowered to succeed in achieving its objectives? At the individual level, psychological empowerment was most strongly related to individuals' participation levels, sense of community, and perceptions of a positive organizational climate. At the group level, the strongest predictors of collective empowering (our operationalization of the empowering organization) were net benefits of participation, commitment, and positive organization climate. Psychological empowerment and positive organizational climate were the two predictors of organizational effectivenes (the empowered organization). Implications and limitations of these findings are discussed.

Nurturing grassroots initiatives for health and housing.

This article has discussed the need to support grassroots community development. Grassroots community development requires the development and maintenance of voluntary community organizations (e.g., block, neighborhood, and tenant associations). These organizations have proved effective in the social, physical, and economic development of a community. The challenge facing policy makers and strategists is to develop a system that supports a multitude of community initiatives. This article has discussed such an "enabling system" and structure, functions, and services required as part of this system. The challenge we face is to increase the problem-solving capacity of disenfranchised communities. One of the biggest barriers we face in this mission is the competition and lack of coordination among professional service organizations.

[Surgical treatment of ectopic lentis (a report of 113 cases) (author's transl)]. / Le traitement chirurgical de l'ectopie du cristallin. A propos de 113 cas.

The analysis of the results of surgical treatment of ectopia lentis by different technics used since twenty years on 113 cases demonstrates that: --In spite of satisfactory results obtained by discission alone of the lens when surgical possibilities were limited, this method must now be given up.--Intra-capsular extraction is still valuable when the lens is luxated in the anterior chamber or cataracted.--Extra-capsular extraction remains nowadays the best technic:--by classical discission aspiration associated to an anterior vitrectomy in case of rupture of the hyaloid, when the lens is moderately subluxated;--by means of the vitreotome through the pars plana when the lens is totally luxated.