Reducing nitrate loss in tile drainage water with cover crops and water-table management systems.

Nitrate lost from agricultural soils is an economic cost to producers, an environmental concern when it enters rivers and lakes, and a health risk when it enters wells and aquifers used for drinking water. Planting a winter wheat cover crop (CC) and/or use of controlled tile drainage-subirrigation (CDS) may reduce losses of nitrate (NO) relative to no cover crop (NCC) and/or traditional unrestricted tile drainage (UTD). A 6-yr (1999-2005) corn-soybean study was conducted to determine the effectiveness of CC+CDS, CC+UTD, NCC+CDS, and NCC+UTD treatments for reducing NO loss. Flow volume and NO concentration in surface runoff and tile drainage were measured continuously, and CC reduced the 5-yr flow-weighted mean (FWM) NO concentration in tile drainage water by 21 to 38% and cumulative NO loss by 14 to 16% relative to NCC. Controlled tile drainage-subirrigation reduced FWM NO concentration by 15 to 33% and cumulative NO loss by 38 to 39% relative to UTD. When CC and CDS were combined, 5-yr cumulative FWM NO concentrations and loss in tile drainage were decreased by 47% (from 9.45 to 4.99 mg N L and from 102 to 53.6 kg N ha) relative to NCC+UTD. The reductions in runoff and concomitant increases in tile drainage under CC occurred primarily because of increases in near-surface soil hydraulic conductivity. Cover crops increased corn grain yields by 4 to 7% in 2004 increased 3-yr average soybean yields by 8 to 15%, whereas CDS did not affect corn or soybean yields over the 6 yr. The combined use of a cover crop and water-table management system was highly effective for reducing NO loss from cool, humid agricultural soils.

Measuring QT dispersion: man versus machine.

OBJECTIVE: To compare manual and computer automated techniques for measuring QT dispersion. DESIGN: Assessment of the ability of manual and automatic measurements of QT dispersion to discriminate between a normal group and two cardiac groups. SUBJECTS: 12 simultaneous electrocardiogram leads were recorded from 25 healthy volunteers, 25 subjects after myocardial infarction, and 25 with cardiac arrhythmias. MAIN OUTCOME MEASURES: For each subject, QT dispersion was measured as the difference between the maximum and minimum QT from all 12 leads and separately for only those leads with T amplitudes of > 100 microV and for those > 250 microV. RESULTS: Manual QT dispersion (T > 100 microV) was greater (P < 0.02) in the arrhythmia patients (mean (SD), 45 (21) ms), but not the infarction patients (54 (36) ms), than in the normal subjects (39 (13) ms). There were no significant differences when all T waves were included. QT dispersion was significantly reduced by an average of 30% when T waves < 100 microV were excluded, and by 51% when those < 250 microV were excluded. Automatic techniques gave different measurements for dispersion in comparison with manual measurements. Three of the four automatic techniques detected significant differences between normal and both patient groups when no leads were excluded (P < 0.01) as well as when T waves < 100 microV were excluded (with increased significance, P < 0.002). CONCLUSIONS: Measurements of QT dispersion from small T waves increases measurement variability and reduces the potential for detecting clinical differences. Automatic measurement of QT dispersion gives different results from manual measurement, but can satisfactorily discriminate between normal and abnormal groups with good quality electrocardiograms.

Accuracy of four automatic QT measurement techniques in cardiac patients and healthy subjects.

OBJECTIVE: To assess differences in the accuracy of automatic QT measurement in three subject groups, and to determine the influence of T wave amplitude on these measurements. SUBJECTS: Standard simultaneous 12 lead electrocardiograms were acquired from 25 patients post myocardial infarction, 25 with arrhythmias, and 25 controls. DESIGN: Because there is not yet a standard automatic method for QT analysis, four different techniques were used. Manual QT measurements were used as the reference. QT was measured in two complexes by each technique in each lead, subject, and group. MAIN OUTCOME MEASURE: The differences between reference and automatic QT measurements from the three subject groups were compared independently for the four techniques. The T wave amplitudes for each of the groups were also compared. RESULTS: Variability of the automatic QT measurements, relative to the manual reference, in the cardiac patients was 2.1 times that in the controls (P < 0.005). Mean T wave amplitude was lower (by a factor of two) for the cardiac patients compared with the controls (P < 0.01). No simple relation between T wave amplitude and the difference between automatic and manual QT measurements was found, although the difference was 2.2 times greater for absolute T wave amplitudes of less than 0.25 mV (P < 0.001). CONCLUSIONS: Automatic QT measurement techniques are less accurate in cardiac patients than in controls. Measurements from T waves with amplitudes less than 0.25 mV are less reliable.

Comparison of automatic QT measurement techniques in the normal 12 lead electrocardiogram.

OBJECTIVE: To undertake a quantitative assessment of different automatic QT measurement techniques and investigate the influence of electrocardiogram filtering and algorithm parameters. DESIGN: Four methods for identifying the end of the T wave were compared: (1) threshold crossing of the T wave (TH); (2) threshold crossing of the differential of the T wave (DTH); (3) intercept of an isoelectric level and the maximum T wave slope (SI); and (4) intercept of an isoelectric level and the line passing through the peak and the point of maximum slope of the T wave (PSI). Automatic QT measurements were made by all techniques following different electrocardiogram filtering and, when appropriate, with four different isoelectric levels and with three different threshold levels. SUBJECTS: 12 simultaneous standard electrocardiogram leads, containing at least two electrocardiogram complexes, were recorded from 25 healthy volunteers relaxing in a semirecumbent position. MAIN OUTCOME MEASURE: Mean and standard deviation of differences between reference and automatic QT measurements were compared for the four techniques. RESULTS: The mean automatic QT measurements varied by up to 62 ms, which was greater than has been found between manual measurements by experienced clinicians. Technique TH was particularly poor. The other techniques produced consistent results for most electrocardiogram filter, isoelectric level, and threshold level setting; but technique SI underestimated QT relative to the other techniques. CONCLUSION: Different QT measurement techniques produced results which were influenced, to varying degrees, by filtering and technique variables. This is relevant for the inter-comparison of studies using different techniques. Technique TH, a common approach, is not recommended.

Variation in the identification of Q wave initiation and its contribution to QT measurement.

Cardiac repolarization abnormalities can be assessed from measurements of the QT duration taken from paper electrocardiogram recordings. Errors associated with determining the end of the T wave are known, but those associated with the start of the Q wave have so far been neglected. This paper quantifies the variation in manual identification of the start of the Q wave, and assesses its contribution to errors in the manual measurement of QT. A randomized study of errors in the timing of Q wave initiation from electrocardiograms plotted on paper was conducted. Four electrocardiogram leads were recorded in eight subjects relaxing in a semi-recumbent position. Manual measurements were made of the time of Q wave initiation in 512 electrocardiograms, presented with different superimposed noise, recording speed and recording gain. The greatest mean difference between four cardiologists amounted to 6.7 ms. A recording gain of 5 mm mV-1, in comparison with 10 mm mV-1, resulted in a difference in Q wave timing of 3.2 ms (P < 0.05). A further increase in gain, or the addition of noise up to 20 microV made no significant difference to Q wave measurements. Provided ECGs of at least 10 mm mV-1 are used, the effect of variation in Q determination on QT measurement is likely to be small.

Simplified body-surface electrocardiographic maps with depolarization magnitude and direction.

A new technique is presented for extracting the magnitude and direction of ventricular depolarization at the body surface from surface electrocardiographic (ECG) map data. Bipolar electrocardiograms were obtained from 36 sites on the chest surface in five normal subjects. The direction and magnitude of depolarization as seen from the chest surface were calculated for 18 body-surface areas centred between electrode positions V1 and V6. Each area was bounded by three electrodes with an electrode spacing of 5 cm. A major depolarization component could be calculated for all triangular areas, with 48% of areas having a smaller second component. The area with the greatest magnitude in each subject had a depolarization vector pointing downwards and to the left, with an average angle to the horizontal of 55 degrees. This was consistent with an average angle of 51 degrees obtained from the subjects' 12-lead electrocardiograms. There was more variability in vector angle between adjacent areas on the right-hand side. At the V5/V6 areas, close to the cardiac apex, the vector component had an upwards orientation in all subjects, opposing the overall downward component of ventricular depolarization. The technique was able to determine local depolarization directions which were in agreement with the normal cardiac vector derived from standard electrocardiography. Reversal of the vector direction close to the cardiac apex and the collision of depolarization components from different directions could be detected. This simple form of body-surface mapping can reduce the essential features of depolarization to a single map, and provide information not directly available from a 12-lead electrocardiogram.

Errors in manual measurement of QT intervals.

OBJECTIVE: To quantify the errors associated with manual measurement of QT intervals and to determine the source of the errors. DESIGN: A randomised study of QT measurement by four cardiologists of electrocardiograms plotted on paper in presentations with different noise levels, paper speeds, amplifier gains, and with and without a second QRST complex to indicate the RR interval. SUBJECTS: Four electrocardiograph leads (I, aVR, V1, V5) recorded in eight healthy people relaxing in a semirecumbent position. MAIN OUTCOME MEASURES: Manual measurement of QT interval in 512 electrocardiograms (eight subjects x four leads x eight presentations x two repeats) by each of four cardiologists. RESULTS: QT intervals measured were significantly longer with greater amplifier gain: by 8 ms for a doubling of gain (p < 0.005), equivalent to a doubling of T wave height. QT intervals measured were significantly longer at slower paper speeds: by 11 ms when paper speed was reduced from 100 to 50 mm/s (p < 0.001) and by 16 ms when speed was further reduced from 50 to 25 mm/s (p < 0.001). Neither the presence of noise nor the presence of a second QRST complex altered the mean QT measurements. There were consistent differences in the measurements between cardiologists, amounting to a maximum mean difference of 20 ms. CONCLUSIONS: Manual measurement of QT interval is significantly affected by the paper speed used to plot the electrocardiogram and by electrocardiogram gain, and hence also T wave amplitude. Manual QT measurement also differed consistently with different cardiologists.

Review of seven cardiac electrophysiology stimulators.

Seven cardiac electrophysiology stimulators from four manufacturers (Biotronik, Bloom, Digitimer and Medtronic) in common current use are reviewed. The stimulators differ in the features provided and the design adopted to achieve these features. The number of output channels ranges from one to four, the number of extra-stimuli available ranges from two to six, and these can be delivered as a variety of sequences. Some of the stimulators (Digitimer and Bloom) are modular while others (Biotronik and Medtronic 532 series) are of an integrated design comprising a single physical unit. The design of the Medtronic EP-2 has both integrated and modular characteristics. The features of the stimulators associated with input, output, control and the user interface are specifically reviewed. The features are also compared against the published recommendations of the American Heart Association. In addition, a summary of stimulator user comments from a number of electrophysiology centres is presented. All of the stimulators fulfil, or are close to fulfilling, basic electrophysiological requirements, but some provide more complex facilities such as would be required by specialist centres.