Improving Shared Decision Making in Vascular Surgery: A Stepped Wedge Cluster Randomised Trial.

OBJECTIVE: Different treatment options are available and feasible for various vascular surgical disorders. Hence, vascular surgery seems an area par excellence for shared decision making (SDM), in which clinicians incorporate the patient's preferences into the final treatment decision. However, current SDM levels in vascular surgical outpatient clinics are below expectations. To improve this, different decision support tools (DSTs) have been developed: online patient decision aids, consultation cards, and decision cards. METHODS: This stepped wedge cluster randomised trial was conducted in 13 Dutch hospitals. Besides the developed DSTs, training on how to apply SDM during the clinician patient encounter was used in this study. Data were obtained via questionnaires and audio recordings. The primary outcome was the OPTION-5 score, an objective tool to assess the level of SDM, expressed as a percentage of exemplary performance. Main secondary outcomes were patients' disease specific knowledge, consultation duration, and treatment choice. Factors influencing OPTION-5 scores were studied using linear regression analysis. RESULTS: Included in the study were 342 patients with an abdominal aortic aneurysm (AAA; n = 87), intermittent claudication (IC; n = 143), or varicose veins (VV; n = 112). Audiotapes of 395 consultations were analysed. Overall the mean OPTION-5 score significantly improved from 28.7% to 37.8% (mean difference 9.1%, 95% CI 6.5% - 11.8%) after implementation of the DSTs. Also, patient knowledge increased significantly (median increase: 13%, effect size: 0.13, p = .025). The number of patients choosing non-surgical treatment choices increased, with 21.4% to 28.8% for patients with AAA and doubled (16.0% to 32.0%) among patients with IC. For surgeons, the SDM training and for patients the decision aid significantly and independently increased OPTION-5 scores (p < .001 and p = .047, respectively). CONCLUSION: Introducing DSTs improves the level of shared decision making in vascular surgery, improves patient knowledge, and shifts their preference towards more non-surgical treatments. The SDM training for clinicians and the decision aid for patients appeared the most effective means of improving SDM. TRIAL REGISTRATION: NTR6487.

Sedentary behaviour and bone health in older adults: a systematic review.

Older adults spend more than 8 h/day in sedentary behaviours. Detrimental effects of sedentary behaviour (SB) on health are established, yet little is known about SB and bone health (bone mineral density; BMD) in older adults. The purpose of this review is to examine associations of SB with BMD in older adults. Five electronic databases were searched: Web of Science (Core Collection); PubMed; EMBASE; Sports Medicine and Education and PsycInfo. Inclusion criteria were healthy older adults mean age ≥ 65 years; measured SB and measured BMD using dual-energy X-ray absorptiometry. Quality was assessed using National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. After excluding duplicates 17813 papers were assessed; 17757 were excluded on title/abstract, 49 at full text, resulting in two prospective and five cross-sectional observational studies reviewed. Four were rated 'good' and three were rated 'fair' using the quality assessment criteria. Findings varied across the studies and differed by gender. In women, four studies reported significant positive associations of SB with BMD at different sites, and two found significant negative associations. Five studies which examined both men and women, men reported negative or no associations of SB with femoral neck, pelvic, whole body, spine or leg BMD. Whilst these findings suggest differences between men and women in the associations of SB with BMD, they may be due to the varying anatomical sections examined for BMD, the different methods used to measure SB, the varied quality of the studies included and the limited number of published findings.

Small All-Range Lidar for Asteroid and Comet Core Missions.

We report the development of a new type of space lidar specifically designed for missions to small planetary bodies for both topographic mapping and support of sample collection or landing. The instrument is designed to have a wide dynamic range with several operation modes for different mission phases. The laser transmitter consists of a fiber laser that is intensity modulated with a return-to-zero pseudo-noise (RZPN) code. The receiver detects the coded pulse-train by correlating the detected signal with the RZPN kernel. Unlike regular pseudo noise (PN) lidars, the RZPN kernel is set to zero outside laser firing windows, which removes most of the background noise over the receiver integration time. This technique enables the use of low peak-power but high pulse-rate lasers, such as fiber lasers, for long-distance ranging without aliasing. The laser power and the internal gain of the detector can both be adjusted to give a wide measurement dynamic range. The laser modulation code pattern can also be reconfigured in orbit to optimize measurements to different measurement environments. The receiver uses a multi-pixel linear mode photon-counting HgCdTe avalanche photodiode (APD) array with near quantum limited sensitivity at near to mid infrared wavelengths where many fiber lasers and diode lasers operate. The instrument is modular and versatile and can be built mostly with components developed by the optical communication industry.

[Professionalization of Legal Dental Experts in Germany: Results of Studies on Structured Focus Groups]. / Ergebnisse strukturierter Fokusgruppenarbeit zur Professionalisierung des zahnärztlichen Gutachterwesens in Deutschland.

BACKGROUND: Legal expert opinions are a crucial instrument of professional self-control in medicine. To give impulses for further development, focus groups were initiated to reflect upon the perspective of legal dental experts. METHODS: 5 focus group discussions on the topic "Professionalization of legal dental experts" were conducted. A total of 32 experienced legal dental experts participated in the discussions. The results were evaluated by qualitative content analysis. RESULTS: A catalogue of 68 ideas was generated for improvement and divided into 15 categories. Among these were periodic quality circles, interprofessional exchange, supervision of novices and periodic feedback for legal dental experts and dentists. CONCLUSION: Self-reflection can be included as an instrument for quality improvement of legal dental expert opinions.

Seasonal dynamics of the standard test species Lemna sp. in outdoor microcosms.

Lemna L. sp. is a free-floating aquatic macrophyte that plays a key role as a standard test species in aquatic risk assessment for herbicides and other contaminants. Population modeling can be used to extrapolate from laboratory to field conditions. However, there are insufficient data on longer-term seasonal dynamics of this species to evaluate such models. Therefore, several long-term growth experiments were conducted in outdoor microcosms (surface area 0.174 m2). Monitoring parameters included biomass, frond numbers, water parameters, and weather data. Three different datasets were generated: frond numbers and biomass from weekly to monthly destructively sampled microcosms; a year-round dataset of frond numbers from five continuously monitored microcosms; and seasonal growth rates without the effect of density dependence over 1-2 weeks in freshly inoculated microcosms. Lemna sp. reached a maximum of approximately 500 000 fronds m-2 and 190 g dry weight m-2. During the first winter, the microcosms were covered by ice for approximately four weeks, and Lemna sp. populations collapsed. The second winter was warmer, without any ice cover, and Lemna sp. populations maintained high abundance throughout the winter. Dry weight per frond was not constant throughout the year but was highest in autumn and winter. Growth rates without density dependence under outdoor environmental conditions reached 0.29 day-1 for frond number, 0.43 day-1 for fresh weight, and 0.39 day-1 for dry weight. In linear regressions, these growth rates were best explained by water temperature. For the populations continuously monitored throughout a year, the nitrogen-to-phosphorus ratio best explained the growth rate of frond numbers. This study yielded a relevant dataset for testing and refining Lemna population models used in chemical risk assessment as well as for managing ecosystems and combating the effects of eutrophication. Integr Environ Assess Manag 2024;00:1-14. © 2024 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

[How dentists experience legal disputes with their patients - a qualitative approach]. / Wie erleben Zahnärzte eine gerichtliche Auseinandersetzung mit Patienten? Eine qualitative Untersuchung.

BACKGROUND: A well-established doctor-patient relationship is essential for dental care. Once ­there is a legal dispute between the dentist and the patient this doctor-patient relationship has failed. Here we show for the first time how dentists experience these lawsuits. We characterise the dentist's perspectives and investigate their influence on the doctor-patient relationship. METHODS: The experience of dentists who were involved in a legal dispute due to a failed dental treatment is pictured in a pilot study on the basis of narrative and problem-oriented interviews. The narrative part of the interview was analysed with the technique of narration analysis. The problem-oriented part of the interview was evaluated content-analytically. From these data a model describing the failure of a doctor-patient relationship was developed. RESULTS: Communicated burdens and stress were: expenditure of time, duration of the proceedings, financial burdens, limited support and the feeling of being treated unfairly. Consequences taken from the legal dispute were a more detailed documentation and an improvement in patient information. The conflict in the doctor-patient relationship is transformed to a different platform when the legal profession is involved. This contradictory constellation leads to a break in the doctor-patient relationship. Advice for other affected colleagues is: remain calm, aim at an out of court settlement, seek advice from other colleagues and request legal advice, be proactive, avoid court litigation and in the end draw conclusions from the dispute. There is a need for a higher quality of legal dental experts. A contact platform provided by the dental profession is required for interactive collegial communication. CONCLUSION: Lawsuits in cases of a conflict between the doctor and the patient are very stressful and need an active coping management but also are a chance for the development of the individual dentist and the profession.

Midterm outcome of balloon-expandable polytetrafluoroethylene-covered stents in the treatment of iliac artery chronic occlusive disease.

PURPOSE: To evaluate the 4-year results of polytetrafluoroethylene (PTFE)-covered stents in the treatment of iliac artery occlusive disease. METHODS: Between January 2003 and September 2010, PTFE-covered stents were implanted in 115 iliac arteries of 87 patients (73 men; mean age 60 ± 11 years) in a single center. The lesions were classified as TASC II A (n=40), B (n=41), C (n=7), and D (n=27). There were 69 primary endograft placements, while 46 procedures were performed after previous bare metal stent placement (reintervention group). Follow-up consisted of clinical investigation, ankle-brachial index (ABI) measurement, and duplex ultrasound scanning. In this retrospective analysis, outcomes were reported on a per-limb basis. RESULTS: The median Rutherford classification decreased from category 3 at baseline to 0 after the procedure (p<0.001) and the ABI increased from 0.66 ± 0.24 to 0.89 ± 0.21 (p<0.001). The primary limb patency was significantly higher in the primary treatment group (p=0.03): 88.7% at 1 year, 86.4% at 2 years, and 71.5% at 4 years compared to the reintervention group (77.9%, 72.1%, and 53.0%, respectively). Univariate analysis revealed prior stent placement as the only factor associated with loss of primary patency. The freedom from target lesion revascularization (TLR) in the primary treatment group was 95.2% at 1 year, 89.6% at 2 years, and 74.4% at 4 years, which did not differ significantly from rates in the reintervention group (88.0%, 82.3%, and 63.8%, respectively). CONCLUSION: The use of PTFE-covered stents for occlusive disease in the iliac arteries is related to satisfactory limb patency rates and high freedom from TLR. Previous stent placement was related to a lower primary patency rate. Additional studies are indicated to establish subgroups that may specifically benefit from covered stents.

Ecological impacts of time-variable exposure regimes to the fungicide azoxystrobin on freshwater communities in outdoor microcosms.

This paper evaluates the effects of different time-varying exposure patterns of the strobilurin fungicide azoxystrobin on freshwater microsocosm communities. These exposure patterns included two treatments with a similar peak but different time-weighted average (TWA) concentrations, and two treatments with similar TWA but different peak concentrations. The experiment was carried out in outdoor microcosms under four different exposure regimes; (1) a continuous application treatment of 10 µg/L (CAT(10)) for 42 days (2), a continuous application treatment of 33 µg/L (CAT(33)) for 42 days (3), a single application treatment of 33 µg/L (SAT(33)) and (4) a four application treatment of 16 µg/L (FAT(16)), with a time interval of 10 days. Mean measured 42-d TWA concentrations in the different treatments were 9.4 µg/L (CAT(10)), 32.8 µg/L (CAT(33)), 14.9 µg/L (SAT(33)) and 14.7 µg/L (FAT(16)). Multivariate analyses demonstrated significant changes in zooplankton community structure in all but the CAT(10) treated microcosms relative to that of controls. The largest adverse effects were reported for zooplankton taxa belonging to Copepoda and Cladocera. By the end of the experimental period (day 42 after treatment), community effects were of similar magnitude for the pulsed treatment regimes, although the magnitude of the initial effect was larger in the SAT(33) treatment. This indicates that for long-term effects the TWA is more important for most zooplankton species in the test system than the peak concentration. Azoxystrobin only slightly affected some species of the macroinvertebrate, phytoplankton and macrophyte assemblages. The overall no observed ecologically adverse effect concentrations (NOEAEC) in this study was 10 µg/L.

[Attitudes of dental legal expert witnesses on their present status in Germany and approaches to the development of the profession]. / Ist-Zustand und Ansätze zur Professionalisierung des zahnärztlichen Gutachterwesens in Deutschland aus der Selbstsicht der Gutachter.

BACKGROUND: Dental litigation has a key role for the autonomy of the dental profession. We conducted a study among legal dental expert witnesses in order to reflect the present situation and reveal the potential for professional development. METHODS: A questionnaire was distributed among 161 participants of the Karlsruhe training for legal dental experts between 2004 and 2009. They were asked to describe and to reflect on the present situation of dental litigation in Germany. RESULTS: 83 questionnaires were returned (51.6%). The main reason to become a legal dental expert was to "support the profession". 68 participants (85.0%) think that civil action resulting from dental treatment will become more frequent. The quality of dental expert opinions is considered to be in need of improvement. Strategies to optimise dental expert opinions and to deal with the potential growing number of claims are developed. CONCLUSION: Basic and advanced training for dental expert witnesses assures the quality of dental expert opinions and also provides a chance for the further development of the dental profession.

Seasonal dynamics of the macrophyte test species Myriophyllum spicatum over two years in experimental ditches for population modeling application in risk assessment.

Myriophyllum spicatum is a sediment-rooted, aquatic macrophyte growing submerged, with a wide geographical distribution and high ecological relevance in freshwater ecosystems. It is used in testing and risk assessment for pesticides in water and sediment. Population models enable effects measured under laboratory conditions to be extrapolated to effects expected in the field with time-variable environmental factors including exposure. These models are a promising tool in higher-tier risk assessments. However, there is a lack of data on the seasonal dynamics of M. spicatum, which is needed to test model predictions of typical population dynamics in the field. To generate such data, a two-year study was set up in outdoor experimental systems from May 2017 to May 2019. The growth of M. spicatum was monitored in 0.2025 m2 plant baskets installed in an experimental ditch. Parameters monitored included biomass (fresh weight [FW] and dry weight [DW]), shoot length, seasonal short-term growth rates of shoots, relevant environmental parameters, and weather data. The results showed a clear seasonal pattern of biomass and shoot length and their variability. M. spicatum reached a maximum total shoot length (TSL) of 279 m m-2 and a maximum standing crop above-ground DW of 262 g m-2 . Periodical growth rates reached up to 0.072, 0.095, and 0.085 day-1 for total length, FW, and DW, respectively. Multivariate regression revealed that pH (as a surrogate for the availability of carbon species) and water temperature could explain a significant proportion of the variability in M. spicatum growth rates (p < 0.05). This study has provided an ecologically relevant data set on seasonal population dynamics representative of shallow freshwater ecosystems, which can be used to test and refine population models for use in chemical risk assessment and ecosystem management. Integr Environ Assess Manag 2022;18:1375-1386. © 2021 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Surgical Treatment of Diabetic Foot Ulcers Complicated by Osteomyelitis with Gentamicin-Loaded Calcium Sulphate-Hydroxyapatite Biocomposite.

Diabetic foot ulcers, complicated by osteomyelitis, can be treated by surgical resection, dead space filling with gentamicin-loaded calcium sulphate-hydroxyapatite (CaS-HA) biocomposite, and closure of soft tissues and skin. To assess the feasibility of this treatment regimen, we conducted a multicenter retrospective cohort study of patients after failed conventional treatments. From 13 hospitals we included 64 patients with forefoot (n = 41 (64%)), midfoot (n = 14 (22%)), or hindfoot (n = 9 (14%)) ulcers complicated by osteomyelitis. Median follow-up was 43 (interquartile range, 20-61) weeks. We observed wound healing in 54 patients (84%) and treatment success (wound healing without ulcer recurrence) in 42 patients (66%). Treatment failures (no wound healing or ulcer recurrence) led to minor amputations in four patients (6%) and major amputations in seven patients (11%). Factors associated with treatment failures in univariable Cox regression analysis were gentamicin-resistant osteomyelitis (hazard ratio (HR), 3.847; 95%-confidence interval (CI), 1.065-13.899), hindfoot ulcers (HR, 3.624; 95%-CI, 1.187-11.060) and surgical procedures with gentamicin-loaded CaS-HA biocomposite that involved minor amputations (HR, 3.965; 95%-CI, 1.608-9.777). In this study of patients with diabetic foot ulcers, complicated by osteomyelitis, surgical treatment with gentamicin-loaded CaS-HA biocomposite was feasible and successful in 66% of patients. A prospective trial of this treatment regimen, based on a uniform treatment protocol, is required.

Subsets of transgenic T cells that recognize CD1 induce or prevent murine lupus: role of cytokines.

T cells with T cell receptor (TCR) transgenes that recognized CD1 on syngeneic B cells stimulated B cells to secrete immunoglobulins in vitro. The CD4+, CD8+, or CD4-CD8- T cells from the spleen of the TCR transgenic BALB/c donors induced lupus with anti-double stranded DNA antibodies, proteinuria, and immune complex glomerulonephritis in irradiated BALB/c nude mice reconstituted with nude bone marrow. Injection of purified CD4-CD8- T cells from the marrow of transgenic donors prevented the induction of lupus by the transgenic T cells. Transgenic T cells that induced lupus secreted large amounts of interferon (IFN)-gamma and little interleukin (IL)-4, and those that prevented lupus secreted large amounts of IL-4 and little IFN-gamma or IL-10.

Neuroimaging and Neuropsychological Outcomes Following Clinician-Delivered Cognitive Training for Six Patients With Mild Brain Injury: A Multiple Case Study.

Nearly half of all mild brain injury sufferers experience long-term cognitive impairment, so an important goal in rehabilitation is to address their multiple cognitive deficits to help them return to prior levels of functioning. Cognitive training, or the use of repeated mental exercises to enhance cognition, is one remediation method for brain injury. The primary purpose of this hypothesis-generating pilot study was to explore the statistical and clinical significance of cognitive changes and transfer of training to real-life functioning following 60 h of Brain Booster, a clinician-delivered cognitive training program, for six patients with mild traumatic brain injury (TBI) or non-traumatic acquired brain injury (ABI). The secondary purpose was to explore changes in functional connectivity and neural correlates of cognitive test gains following the training. We used a multiple case study design to document significant changes in cognitive test scores, overall IQ score, and symptom ratings; and we used magnetic resonance imaging (MRI) to explore trends in functional network connectivity and neural correlates of cognitive change. All cognitive test scores showed improvement with statistically significant changes on five of the seven measures (long-term memory, processing speed, reasoning, auditory processing, and overall IQ score). The mean change in IQ score was 20 points, from a mean of 108 to a mean of 128. Five themes emerged from the qualitative data analysis including improvements in cognition, mood, social identity, performance, and Instrumental Activities of Daily Living (IADLs). With MRI, we documented significant region-to-region changes in connectivity following cognitive training including those involving the cerebellum and cerebellar networks. We also found significant correlations between changes in IQ score and change in white matter integrity of bilateral corticospinal tracts (CST) and the left uncinate fasciculus. This study adds to the growing body of literature examining the effects of cognitive training for mild TBI and ABI, and to the collection of research on the benefits of cognitive training in general. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02918994.

KIF1A variants are a frequent cause of autosomal dominant hereditary spastic paraplegia.

Variants in the KIF1A gene can cause autosomal recessive spastic paraplegia 30, autosomal recessive hereditary sensory neuropathy, or autosomal (de novo) dominant mental retardation type 9. More recently, variants in KIF1A have also been described in a few cases with autosomal dominant spastic paraplegia. Here, we describe 20 KIF1A variants in 24 patients from a clinical exome sequencing cohort of 347 individuals with a mostly 'pure' spastic paraplegia. In these patients, spastic paraplegia was slowly progressive and mostly pure, but with a highly variable disease onset (0-57 years). Segregation analyses showed a de novo occurrence in seven cases, and a dominant inheritance pattern in 11 families. The motor domain of KIF1A is a hotspot for disease causing variants in autosomal dominant spastic paraplegia, similar to mental retardation type 9 and recessive spastic paraplegia type 30. However, unlike these allelic disorders, dominant spastic paraplegia was also caused by loss-of-function variants outside this domain in six families. Finally, three missense variants were outside the motor domain and need further characterization. In conclusion, KIF1A variants are a frequent cause of autosomal dominant spastic paraplegia in our cohort (6-7%). The identification of KIF1A loss-of-function variants suggests haploinsufficiency as a possible mechanism in autosomal dominant spastic paraplegia.

Parallel and serial processes in motion detection.

Apparent motion was used to explore humans' ability to perceive the direction of motion in the visual field. A marked qualitative difference in this ability was found between short- and long-range motion. For short-range motion, the detection of the direction of motion is characterized by parallel operation over a wide visual field (that is, detection performance is independent of the number of objects in an array). When the positional displacement is large relative to an object's size, the direction of motion is detected in a serial manner. The process of detection is limited in this case by the ability to detect other events, such as appearance and disappearance of an object, and the ability to compute their spatio-temporal relations. The results are consistent with a previously suggested division of the motion detection system into short- and long-range processes. The direction of short-range motion can be perceived in parallel (preattentively), whereas long-range motion is attentive and requires more complicated computations. It seems that the detection of long-range motion is a conjunction task, combining the detection of disappearance and appearance.

Mariner 9 ultraviolet spectrometer experiment: seasonal variation of ozone on Mars.

Ozone is observed to be present in the polar regions of Mars and to have a seasonal variation. In the summer, the amount present in the polar atmosphere is less than 3 micrometer-atmospheres. In the fall, ozone increases in amount and is found in association with the formation of the polar hood. In winter, the maximum amount of ozone is present, 57 micrometer-atmospheres over the polar hood and 16 over the polar cap. In spring, the amount over the polar cap decreases monotonically until by the beginning of summer the ozone disappears. Ozone is not observed in the equatorial region during any season.

A combination of cetirizine and pseudoephedrine has therapeutic benefits when compared to single drug treatment in allergic rhinitis.

UNLABELLED: Antihistamines and nasal decongestants are well-established therapeutics in allergic rhinitis. However, no data are available which directly compare the effect size of the single substances with their combination in a single study including placebo (PLA) treatment. OBJECTIVE: The aim of this study was to evaluate the effect of a combination of cetirizine (CET) and pseudoephedrine (PSE) and to compare it to treatment with CET or PSE alone and to PLA during grass pollen allergen challenge in an environmental challenge chamber (ECC). MATERIAL AND METHODS: In a randomized, double-blind, placebo-controlled, four-way crossover study the effect of a combination of 10 mg CET with 120 mg PSE (CET + PSE) versus CET or PSE alone or PLA on symptoms, nasal flow, and nasal secretions was investigated in 49 patients with intermittent allergic rhinitis. Subjects underwent four 6-h pollen exposures in an ECC with administration of the drugs after 2 h. RESULTS: The induction of nasal symptoms, nasal secretion and nasal obstruction (measured as nasal flow) during the first 2 h of pollen exposure was highly reproducible at the 4 consecutive exposures. The symptom of nasal obstruction was significantly reduced after treatment with CET + PSE compared to the treatment with CET or PSE alone or PLA (p < 0.0001). Furthermore, the combination treatment significantly reduced the total nasal symptom score (TNSS) and visual analogue scale score (VAS) compared to the single treatments or PLA. Nasal flow was significantly increased after treatment with CET + PSE and PSE and nasal secretions were significantly reduced by CET + PSE and CET without significant additional improvement of the combination therapy. CONCLUSION: The combination treatment with CET and PSE is more effective than treatment with single substances in subjects with allergic rhinitis.

Impact of a benzoyl urea insecticide on aquatic macroinvertebrates in ditch mesocosms with and without non-sprayed sections.

The long-term response, including recovery, of aquatic macroinvertebrates to short-term insecticide exposure may be affected by the presence of uncontaminated refuges in the stressed ecosystem. Experimental ditches were used to study the influence of non-sprayed ditch sections regarding the ecotoxicological effects on and the recovery of macroinvertebrates following treatment with the insecticide lufenuron. The treatment regimes differed in the proportion of the ditch (0, 33, 67, and 100% of surface area) that was sprayed to reach a lufenuron concentration of 3 microg/L in the water column of the sprayed ditch section. The magnitude and duration of effects on macroinvertebrates, and on arthropods in particular, were higher when a larger proportion of the ditch was treated. Initially, more pronounced responses were observed for bivoltine and multivoltine insects and macrocrustaceans than for univoltine and semivoltine arthropods. Most macroinvertebrate arthropods showed delayed responses, with maximum treatment-related effects observed two to six weeks after lufenuron application. This latency of effects can be explained by the mode of action of lufenuron, involving inhibition of chitin synthesis, which affects arthropod molting and metamorphosis. The observed effects were short-lived only in those ditches where 33% of the surface area was sprayed. In the ditches where 67 and 100% of the surface area was sprayed, some insects and macrocrustaceans showed long-term effects. In the 100% sprayed ditches in particular, the treatment-related reduction in arthropods resulted in indirect effects, such as an increase in snails, and later in an increase in the ephemeropteran Cloeon dipterum, probably because of an increase in periphyton, and release from competition and predation. Effects that are most likely indirect also were observed for Oligochaeta, Hirudinea, and the flatworm Mesostoma sp.

Morphology discrimination in implantable cardioverter-defibrillators: consistency of template match percentage during atrial tachyarrhythmias at different heart rates.

BACKGROUND: Morphology discrimination (MD) in implantable cardioverter-defibrillators (ICDs) is based on the comparison of the ventricular electrogram during tachycardia with a stored reference template obtained during baseline rhythm. However, the effect of heart rate on the template match percentage during supraventricular tachyarrhythmias (SVT) is not known. The purpose of this study was to evaluate the performance of the template match percentage during SVT at different heart rates. METHODS AND RESULTS: Stored electrograms of 868 tachyarrhythmias from 88 patients with a dual-chamber ICD (St Jude Medical, USA) were analysed by the investigators. The effect of heart rate on template match percentage was estimated by regression analysis. For performance measures, data were corrected for multiple episodes in a patient by using the generalized estimating equation method. The mean template match percentage was 86.6 +/- 22.2% (median 100%) for SVT episodes. No significant differences in template match percentage between fast [ventricular cycle length (CL) 300-350 ms] and slow (ventricular CL >400 ms) SVTs were observed (85.4 +/- 27.0 vs. 87.1 +/- 19.7%). Using nominal settings, MD alone provided sensitivity and specificity of 70.2% and 89.4% overall, respectively. Morphology discrimination in conjunction with rate branch analysis, sudden onset, and stability yielded sensitivity and specificity of 98.5% and 91.2%, respectively. CONCLUSION: Morphology discrimination has a consistently high template match percentage during SVTs, which is independent of ventricular CL. The consistent high match percentage results in high specificity for arrhythmia discrimination.

Sensitivity of submersed freshwater macrophytes and endpoints in laboratory toxicity tests.

The toxicological sensitivity and variability of a range of macrophyte endpoints were statistically tested with data from chronic, non-axenic, macrophyte toxicity tests. Five submersed freshwater macrophytes, four pesticides/biocides and 13 endpoints were included in the statistical analyses. Root endpoints, reflecting root growth, were most sensitive in the toxicity tests, while endpoints relating to biomass, growth and shoot length were less sensitive. The endpoints with the lowest coefficients of variation were not necessarily the endpoints, which were toxicologically most sensitive. Differences in sensitivity were in the range of 10-1000 for different macrophyte-specific endpoints. No macrophyte species was consistently the most sensitive. Criteria to select endpoints in macrophyte toxicity tests should include toxicological sensitivity, variance and ecological relevance. Hence, macrophyte toxicity tests should comprise an array of endpoints, including very sensitive endpoints like those relating to root growth.