Diagnostic value of the electrocardiogram in the assessment of prior myocardial infarction.

BACKGROUND: The best available imaging technique for the detection of prior myocardial infarction (MI) is cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE). Although the electrocardiogram (ECG) still plays a major role in the diagnosis of prior MI, the diagnostic value of the ECG remains uncertain. This study evaluates the diagnostic value of the ECG in the assessment of prior MI. METHODS: In this retrospective study, data from electronic patient files were collected of 1033 patients who had undergone CMR with LGE between January 2014 and December 2017. After the exclusion of 59 patients, the data of 974 patients were analysed. Twelve-lead ECGs were blinded and evaluated for signs of prior MI by two cardiologists separately. Disagreement in interpretation was resolved by the judgement of a third cardiologist. Outcomes of CMR with LGE were used as the gold standard. RESULTS: The sensitivity of the ECG in the detection of MI was 38.0% with a 95% confidence interval (CI) of 31.6-44.8%. The specificity was 86.9% (95% CI 84.4-89.1%). The positive and negative predictive value were 43.6% (95% CI 36.4-50.9%) and 84.0% (95% CI 81.4-86.5%) respectively. In 170 ECGs (17.5%), the two cardiologists disagreed on the presence or absence of MI. Inter-rater variability was moderate (κ 0.51, 95% CI 0.45-0.58, p < 0.001). CONCLUSION: The ECG has a low diagnostic value in the detection of prior MI. However, if the ECG shows no signs of prior MI, the absence of MI is likely. This study confirms that a history of MI should not be based solely on an ECG.

Mycobacterium tuberculosis lineages in Hawaii demonstrate distinctive demographic and migration characteristics.

OBJECTIVES: The American state of Hawaii presents a tuberculosis (TB) burden more consistent with that of the Philippines and the Pacific Islands than that with the United States (US) or Europe. This study seeks to determine if the genetic families of Mycobacterium tuberculosis (Mtb) that are prevalent in Hawaii display differences in host demographics that may be of use for TB control in Hawaii and the Pacific. STUDY DESIGN: This retrospective study was conducted by analyzing data from the Hawaii State Department of Health to investigate the demographics associated with the Beijing (global lineage 2) and Manila (lineage 1) families of Mtb in Hawaii. METHODS: Deidentified records of all culture-positive TB cases reported by the Hawaii State Department of Health Tuberculosis Control Program from 2004 to 2016 were analyzed to identify lineage-specific demographic differences and trends. Patients' countries of origin, age, sex, and time in the US before TB diagnosis were included in this analysis. RESULTS: Manila family isolates were found to predominantly enter Hawaii through Filipino immigrants, whereas Beijing family isolates originated from a diverse set of countries. Both families exhibited significant differences in age and sex demographics. In addition, Manila family cases presented from patients with significantly longer average time of residence in the US than non-Manila cases, whereas Beijing family cases presented from patients with significantly shorter time of residence in the US than non-Beijing cases. CONCLUSIONS: Both the Beijing and Manila families of Mtb demonstrated demographic differences in Hawaii that may prove important for improving TB control and surveillance policy in Hawaii and throughout the Pacific. Areas with heavy Filipino immigration may benefit from directing more resources toward screening and education efforts for middle-aged men and those who have resided in the country longer, whereas other areas of the Pacific should consider a younger and more sex-balanced allocation. Specific to the US and Hawaii, effective screening of youths emigrating from the Compact of Free Association states remains vital.

Dynamic signatures of the transition from stacking disordered to hexagonal ice: Dielectric and nuclear magnetic resonance studies.

Using various temperature-cycling protocols, the dynamics of ice I were studied via dielectric spectroscopy and nuclear magnetic resonance relaxometry on protonated and deuterated samples obtained by heating high-density amorphous ices as well as crystalline ice XII. Previous structural studies of ice I established that at temperatures of about 230 K, the stacking disorder of the cubic/hexagonal oxygen lattice vanishes. The present dielectric and nuclear magnetic resonance investigations of spectral changes disclose that the memory of the existence of a precursor phase is preserved in the hydrogen matrix up to 270 K. This finding of hydrogen mobility lower than that of the undoped hexagonal ice near the melting point highlights the importance of dynamical investigations of the transitions between various ice phases and sheds new light on the dynamics in ice I in general.

Influence of working conditions and salary on agency work for intermediate and intensive care units : Part 2: Partial results of a nationwide survey.

BACKGROUND: Agency work in nursing is used as a form of labor to counter vacant staff positions in hospitals. Both hospital owners and nurses view this critically for different reasons. AIM: The aim of this study was to assess what personal net income nurses in German intensive care units and intermediate care units consider "fair and sufficient" for their work (addressed in Part 1 of the survey) and what influence-aside from the salary-the working conditions have on the willingness to change to temporary work or back to a permanent position. METHODS: From September to October 2020, an anonymous online survey was conducted among nurses of intermediate care units, intensive care units, and special care units in German-speaking countries. Descriptive statistics were used for the analysis. RESULT: Of 1203 participants, 86% (n = 1036) could be evaluated. None of the job satisfaction factors queried received four or five stars (maximum five stars) from those participating in the survey. The most unsatisfied group proved to be regularly employed nurses with an additional part-time job. Key job satisfaction factors differed markedly between the groups, with regular employees favoring consistency and stability. Agency workers prefer gaining experience in a broader range of tasks. Unreliable duty rosters and poor nurse to patient ratios were common points of criticism. CONCLUSION: For job satisfaction, making nurses feel appreciated and respected is essential. This includes a guaranteed nurse to patient ratio and reliable duty rosters that also include tasks outside direct patient care. In order for nurses to leave agency work, it is necessary to take into account the differences in interests in terms of the focus of activity.

[Influence of working conditions and salary on temporary agency work for intermediate care and intensive care units : Partial results of a nationwide survey]. / Einfluss der Arbeitsbedingungen und des Gehalts auf die Leiharbeit für Intermediate-Care- und Intensivstationen : Teilergebnisse einer bundesweiten Umfrage.

BACKGROUND: Agency nursing is used as a form of labour to counter vacant staff positions in hospitals. Stakeholders and nurses might view this critically for different reasons. AIM: The aim of this study was to evaluate what individual net income nurses in German intensive care units and intermediate care units consider "fair and acceptable" for their work. Furthermore, what influence does salary have on the willingness to change to agency nursing or back to a permanent position. METHODS: From September-October 2020, an anonymous online survey was performed among nurses of intermediate care units, intensive care units and special care units in German-speaking countries. The results were evaluated using descriptive statistics. RESULT: Of 1203 participants, 1036 (86%) of those working in Germany could be evaluated. The question about the individual net income was answered by 1032 (99%) participants. The majority of respondents (n = 522) stated that they had an individual net income of 2000-2999 €/month. The higher the level of the net income, the lower the willingness to switch to agency work. The participants in permanent employment only perceive a net income of 3200 €/month (median 3200 €; interquartile range [IQR] 2800-3800 €) as acceptable and fair for their work. In all, 142 agency nurses stated that an individual net income of 3200 €/month (median 3200 €; IQR 3000-3950 €) would be sufficient to move from agency nursing back into permanent employment. CONCLUSION: The intensive care nurses in this survey consider a salary of 3200 €/month as acceptable and fair for their work. The salary level can be a parameter for the decision to go into agency work, but also to move back to permanent employment. Regardless of the salary, better working conditions were indicated as an essential element in terms of job satisfaction for all respondent groups.

Author Correction: Dynamics enhanced by HCl doping triggers 60% Pauling entropy release at the ice XII-XIV transition.

This corrects the article DOI: 10.1038/ncomms8349.

[Scientific development of critical care : Position paper]. / Wissenschaftliche Weiterentwicklung in der Intensivpflege : Positionspapier.

Demographic changes in Germany means that nursing and medical care is becoming increasingly complex. This is especially true for intensive care. Despite the closure of hospitals in Germany, the number of beds in intensive care units rose between 2002 from 23,113 to 26,162 in 2010. At the same time the number of patients treated in intensive care units increased by 148,989 to 2,049,888. The increasing complexity requires specific education for nurses in intensive care based on a model of advanced nursing practice (ANP). Nursing experts who fulfill an advanced practise nursing are competent to make decisions autonomously and accountably within complex care situations. This includes decisions such as artificial ventilation, weaning, nutrition management and the management of delirium, wounds and pain. Nursing experts are responsible for specific clearly defined areas of care and initiate nurse-led services and practice. Scientific and research based evidence are transferred directly into health care practice and can be implemented directly. The DGF demands a scientific and with it academic development of critical care as advanced nursing practice based on a master level qualification. This also includes the request for expansion of competencies and roles and the assignment of decision making authority within complex health care situations and an orientation on the Competencies for European Critical Care Nurses of the European Federation of Critical Care Nursing Associations (EfCCNa).

Atypical Cowpox Virus Infection in a Series of Cats.

Within 4 weeks, five cats with skin lesions affecting the hindlimbs and mainly consisting of oedema, hyperaemia and plaque-like alterations were presented to the same veterinary clinic. The cats were suffering from lameness, trauma, renal insufficiency or complicated tail amputation. Although the lesions seemed unusual for a poxvirus infection, microscopical examination of biopsy samples or specimens taken during necropsy examination revealed ballooning degeneration of keratinocytes with eosinophilic, cytoplasmic inclusion bodies indicative of an orthopoxvirus infection. Cowpox virus infection was verified using immunohistochemistry and virus isolation. Molecular analysis revealed identical haemagglutinin gene sequences in four cases and spatiotemporal circumstances in some cases pointed to hospital-acquired transmission. Unusual manifestations of feline cowpox may have an unexpected risk for human infection.

Interactions between soluble sugars and POPC (1-palmitoyl-2-oleoylphosphatidylcholine) during dehydration: vitrification of sugars alters the phase behavior of the phospholipid.

The phase behavior of 1-palmitoyl-2-oleoylphosphatidylcholine (POPC) was characterized as a function of hydration in the presence of combinations of sugars representative of sugars found in seed embryos having differing degrees of desiccation tolerance. The tendency of the sugar mixes to vitrify was also monitored as a function of hydration. Using differential scanning calorimetry, it was found that all sugars diminished the increase in the gel-to-fluid phase transition temperature (Tm) of POPC that occurred upon dehydration of the pure lipid. These results are analyzed in terms of the osmotic and volumetric properties of sugars. Also, it was found that in those samples for which the glass transition temperature (Tg) was greater than the Tm of POPC, Tm was lowered by approx. 20 C degrees from the value for the fully hydrated lipid. X-ray diffraction data confirmed that acyl chain freezing was deferred to a lower temperature during cooling of vitrified samples. The significance of these results is discussed in terms of the ability of many organisms to tolerate desiccation.

Clinical response to coronary artery reoperations.

Repeat coronary artery bypass operations were performed on 112 patients at a university hospital between 1971 and 1981. When compared with patients who did poorly after a first operation but did not have repeat surgery, patients undergoing repeat surgery tended to be younger, to have a higher smoking rate and to have fewer prior myocardial infarctions, fewer diseased vessels and fewer lesions in distal vessels. At least 1 graft was occluded in 83% of patients undergoing reoperation, and a mean of 1.7 grafts were placed at reoperation. The operative mortality rate was 4%, with a follow-up mortality rate of 6% at a mean of 3.8 years. After reoperation, patients initially showed improvement to a mean specific activity scale class of 1.6, compared with 2.4 before the first operation and 2.7 before the second operation. The principal correlate of a better long-term symptomatic response compared with that in the period before the first operation was a lower serum cholesterol level, whereas the principal correlate of a better symptomatic response compared with that in the period just before the reoperation was the left ventricular ejection fraction. As recurrent symptoms after a first coronary artery operation become more prevalent, consideration of the selection factors and prognostic correlates of reoperation will become increasingly important.

Dynamics enhanced by HCl doping triggers full Pauling entropy release at the ice XII-XIV transition.

The pressure-temperature phase diagram of ice displays a perplexing variety of structurally distinct phases. In the century-long history of scientific research on ice, the proton-ordered ice phases numbered XIII through XV were discovered only recently. Despite considerable effort, none of the transitions leading from the low-temperature ordered ices VIII, IX, XI, XIII, XIV and XV to their high-temperature disordered counterparts were experimentally found to display the full Pauling entropy. Here we report calorimetric measurements on suitably high-pressure-treated, hydrogen chloride-doped ice XIV that demonstrate just this at the transition to ice XII. Dielectric spectroscopy on undoped and on variously doped ice XII crystals reveals that addition of hydrogen chloride, the agent triggering complete proton order in ice XIV, enhances the precursor dynamics strongest. These discoveries provide new insights into the puzzling observation that different dopants trigger the formation of different proton-ordered ice phases.

Quantitative analysis of planar technetium-99m-sestamibi myocardial perfusion images using modified background subtraction.

Standard interpolative background subtraction, as used for thallium-201 (201Tl), may create artifacts when applied to planar technetium-99m-Sestamibi (99mTc-Sestamibi) images, apparently because of the oversubtraction of relatively high extra-cardiac activity. A modified background subtraction algorithm was developed and compared to standard background subtraction in 16 patients who had both exercise-delayed 201Tl and exercise-rest 99mTc-Sestamibi imaging. Furthermore, a new normal data base was generated. Normal 99mTc-Sestamibi distribution was slightly different compared to 201Tl. Using standard background subtraction, mean defect reversibility was significantly underestimated by 99mTc-Sestamibi compared to 201Tl (2.8 +/- 4.9 versus -1.8 +/- 8.4, p less than 0.05). Using the modified background subtraction, mean defect reversibility on 201Tl and 99mTc-Sestamibi images was comparable (2.8 +/- 4.9 versus 1.7 +/- 5.2, p = NS). We conclude, that for quantification of 99mTc-Sestamibi images a new normal data base, as well as a modification of the interpolative background subtraction method should be employed to obtain quantitative results comparable to those with 201Tl.

Visual stimulation increases technetium-99m-HMPAO distribution in human visual cortex.

The ability of changes in the distribution of technetium-99m-hexamethylpropylene amine oxime (99mTc-HMPAO) to reflect physiologic changes in regional cerebral blood flow (rCBF) was evaluated using photic stimulation, a procedure known to increase rCBF in the striate cortex. Seven healthy subjects were injected with 740 MBq 99mTc-HMPAO on two separate days. On one day, the injection was performed following closure of the eyes and patching for 5 min. On the other day, subjects were exposed to a stroboscopic light to produce photic simulation. Images of distribution of 99mTc-HMPAO were obtained using a Strichman 810X single-photon emission computed tomogram (SPECT) brain scanner. Comparison of images obtained during light occluded versus stimulation conditions revealed a significant increase in distribution of radiopharmaceutical in visual cortex relative to whole brain (peak increase corrected for radiopharmaceutical backdiffusion 36.7% +/- 6.6%). HMPAO appears to provide a useful method for detecting relative rCBF increases with SPECT.

HDR brachytherapy applied to cervical carcinoma with moderate lateral expansion: modified principles of treatment.

BACKGROUND AND PURPOSE: In order to meet the deficiencies of endocavitary applications, a combined technique was introduced with the aim of achieving better target coverage for improvement of loco-regional tumour control. In high dose rate (HDR) endocavitary applications with tandem and ovoids, enlargement of the distance between the ovoids, shifting of dwell times and also optimization often fail to achieve sufficient expansion of the cervical parametrial area encompassed by the reference isodose. MATERIALS AND METHODS: The Deventer method, whereby HDR endocavitary and HDR interstitial brachytherapy are applied in the same session, was applied for tumours with a lateral expansion of 25 mm or more from the axis of the cervical canal. For the addition of HDR interstitial brachytherapy, each ovoid was provided with a channel which allowed insertion of an afterloading needle into the cervix up to a fixed depth. The dose specifications and dosimetry in neighbouring organs are presented in detail. RESULTS: Seventy-six combined applications were given to 41 patients. The follow-up averaged at 23 months, with a maximum of 59 months. No severe early or persistent late complications were observed. In stage IIB tumours, the most important evaluation of the merits of this technique, the disease-free 3-year survival determined with the Kaplan-Meier method was 75% (n=20). CONCLUSIONS: The Deventer method of HDR endocavitary and HDR interstitial brachytherapy applied in the same session is a feasible method for enlargement of the reference isodose envelope in the cervical parametrial area. The 3-year disease-free survival in stage IIB patients and the low complication rates in all stages together, justify its continuation.

Conservative management of uremic pericardial effusions.

Although there has been a recent trend toward early operative treatment of uremic pericardial effusions unresponsive to intensified dialysis, this approach may be unnecessarily aggressive. Review of 787 patients in our chronic dialysis program since 1969 has shown 54 patients (6.9 percent) to have developed 56 episodes of large pericardial effusion. All were managed by increasing the frequency of dialysis. If the effusion failed to diminish or if life-threatening signs of tamponade developed, pericardiocentesis was performed. In 63 percent (35/56) the effusion resolved with increased dialysis. In 37 percent (21/56), pericardiocentesis was performed, with 57 percent (12/21) requiring only one aspiration. During a mean follow-up of 34 months (2 to 100 months) only 5.5 percent (3/54) have undergone operation: one partial pericardiectomy incidental to pulmonary decortication and two pericardiectomies for late (3 months and 5 months, respectively) constriction. There were five complications of pericardiocentesis: one pneumothorax, one pneumoperitoneum, one costochondritis, and two myocardial punctures without sequelae. The one death related to pericardial effusion in this series occurred in a home-dialysis patient who arrived in the emergency room moribund. Our experience suggests that the great majority of uremic pericardial effusions can be effectively controlled with simple needle aspiration by experienced personnel and that pericardial resection is usually not necessary.

Vertical versus planar induction in amphibian early development.

In the Urodeles, the archenteron roof invaginates as a single continuous sheet of cells, vertically inducing the neural anlage in the overlying ectoderm during invagination. The induction comprises first the activation process, leading, to forebrain differentiation tendencies, and then the superimposed transformation process, which changes presumptive forebrain development into that of hindbrain and spinal cord acting with a caudally increasing intensity. The activating action, being maximal anteriorly, decreases caudally to nearly zero. In the double-layered Xenopus embryo, the internal mesodermal marginal zone shows much more independent and earlier regional segregation and involution than the external marginal zone in the Urodeles; its prechordal mesoderm already initiating vertical neural induction in overlying ectoderm at stages 10 to 10+ before any visible archenteron invagination. In Xenopus incomplete exogastrulae the prechordal mesoderm involutes normally prior to evagination of the endoderm and mesodem. Artificially produced Xenopus total exogastrulae, made at stage 9 before mesoderm involution, behave just like axolotl total exogastrulae, showing no neural differentiation. The notion of planar neural induction in Xenopus can only be applied in exogastrulae and Keller explants for the transforming action, which is maximal in the caudal archenteron roof. In normal Xenopus development, the formation of the entire nervous system is essentially due to vertical induction by the successively involuting prechordal and notochordal mesoderm. The different behavior of Xenopus embryos in comparison with Urodele embryos can essentially be explained by the double-layered character of the animal moiety of the Xenopus embryo.

Electroconvulsive therapy in adolescents: experience, knowledge, and attitudes of recipients.

OBJECTIVE: To ascertain the experience, knowledge, and attitudes regarding electroconvulsive therapy (ECT) of persons who received the treatment in adolescence. METHOD: A 53-item survey was administered by telephone to persons who received ECT before the age of 19 years in the Australian state of New South Wales between 1990 and 1998. RESULTS: Twenty-six patients were interviewed. Experiences and opinions about ECT were generally positive. Fifty percent stated ECT had been helpful. Approximately three quarters believed their illness was worse than either ECT or pharmacotherapy. Frequencies of recalled side effects with ECT and medication were similar. Some patients perceived deficiencies in the consent process. A slight majority had attempted to conceal the history of ECT treatment. The vast majority considered ECT a legitimate treatment and, if medically indicated, would have ECT again and would recommend it to others. CONCLUSIONS: The findings are consistent with and complement evidence showing ECT to be an effective and safe treatment for seriously ill adolescents. The mostly favorable experiences and attitudes reported by interviewees will be reassuring to adolescent patients, their families, and treating health professionals when ECT is being considered.

Gastric Acid Secretion in Patients with Duodenal Ulcer.

Augmented histamine tests were performed in 349 patients with duodenal ulcers verified by operation, of whom 268 were men between 16 and 84 years of age, and 81 were women between 12 and 78 years; all were citizens of Copenhagen. In the men the mean peak acid output was 44 mEq H+ per hour, ranging from 16.8 to 111.4 mEq. The mean acid output in women was 32.3 mEq H+ per hour, ranging from 13.7 to 74.4 mEq. In men with duodenal ulcer a statistically significant correlation between age and peak acid output is clearly demonstrable, the acid output decreasing by 5 mEq H+ per hour for each ten years' increase of age. In women, the acid output falls about two mEq H+ per hour per decade, although the statistical significance of this finding is not certain.

Normal auditory brain stem evoked responses in infants of diabetic mothers.

Auditory brain stem responses potentials were recorded from 71 newborns within the first 2 weeks after birth; conceptional age ranged from 37 to 41 weeks. Thirty-nine newborns were infants of diabetic mothers (IDMs) (17 White A, 22 White B-D) and 32 healthy term newborns served as control group. IDMs with additional high risk for cochlear or brain stem integrity were excluded. Birthweight for gestational age was significantly higher for IDMs. No differences in auditory brain stem responses wave latencies or amplitudes were observed between healthy infants of the control group and IDMs.