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1.
Eur J Heart Fail ; 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31389111

RESUMO

OBJECTIVES: We investigated the natural history of patients after a first episode of acute heart failure (FEAHF) requiring emergency department (ED) consultation, focusing on: the frequency of ED visits and hospitalisations, departments admitting patients during the first and subsequent hospitalisations, and factors associated with difficult disease control. METHODS AND RESULTS: We included consecutive patients diagnosed with FEAHF (either with or without previous heart failure diagnosis) in four EDs during 5 months in three different time periods (2009, 2011, 2014). Diagnosis was adjudicated by local principal investigators. The clinical characteristics of the index event were prospectively recorded, and all post-discharge ED visits and hospitalisations [related/unrelated to acute heart failure (AHF)], as well as departments involved in subsequent hospitalisations were retrospectively ascertained. 'Uncontrolled disease' during the first year after FEAHF was considered if patients were attended at ED (≥ 3 times) or hospitalised (≥ 2 times) for AHF or died. Overall, 505 patients with FEAHF were included and followed for a mean of 2.4 years. In-hospital mortality was 7.5%. Among 467 patients discharged alive, 288 died [median survival 3.9 years, 95% confidence interval (CI) 3.5-4.4], 421 (90%) revisited the ED (2342 ED visits; 42.4% requiring hospitalisation, 34.0% AHF-related) and 357 (77%) were hospitalised (1054 hospitalisations; 94.1% through ED, 51.4% AHF-related). AHF-related hospitalisations were mainly in internal medicine (28.0%), short-stay unit (26.3%), cardiology (20.8%), and geriatrics (14.1%). Only 47.4% of AHF-related hospitalisations were in the same department as the FEAHF, and internal medicine involvement significantly increased with subsequent hospitalisations (P = 0.01). Uncontrolled disease was observed in 31% of patients, which was independently related to age > 80 years [odds ratio (OR) 1.80, 95% CI 1.17-2.77], systolic blood pressure < 110 mmHg at ED arrival (OR 2.61, 95% CI 1.26-5.38) and anaemia (OR 2.39, 95% CI 1.51-3.78). CONCLUSION: In the present aged cohort of AHF patients from Barcelona, Spain, the natural history after FEAHF showed different patterns of hospital department involvement. Advanced age, low systolic blood pressure and anaemia were factors related to uncontrolled disease during the year after debut.

2.
Int J Cardiol ; 2018 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-30274750

RESUMO

BACKGROUND: The value of the 12-lead ECG in the diagnosis of non-ST-elevation myocardial infarction (NSTEMI) is limited due to insufficient sensitivity and specificity of standard ECG criteria. The QRS-T angle reflects depolarization-repolarization heterogeneity and might assist in detecting patients with a NSTEMI (diagnosis) as well as predicting patients with an increased mortality risk (prognosis). METHODS: We prospectively enrolled 2705 consecutive patients with symptoms suggestive of NSTEMI. The QRS-T angle was automatically derived from the standard 10 s 12-lead ECG recorded at presentation to the ED. Patients were followed up for all-cause mortality for 2 years. RESULTS: NSTEMI was the final diagnosis in 15% (n = 412) of patients. QRS-T angles were significantly greater in patients with NSTEMI compared to those without (p < 0.001). The use of the QRS-T angle in addition to standard ECG criteria indicative of ischemia improved the diagnostic accuracy for NSTEMI as quantified by the area under the ROC curve from 0.68 to 0.72 (p < 0.001). An algorithm for the combined use of standard ECG criteria and the QRS-T angle improved the sensitivity of the ECG for NSTEMI from 45% to 78% and the specificity from 86% to 91% (p < 0.001 for both comparisons). The 2-year survival rates were 98%, 97% and 87% according to QRS-T angle tertiles (p < 0.001). CONCLUSION: In patients with suspected NSTEMI, the QRS-T angle derived from the standard 12-lead ECG provides incremental diagnostic accuracy on top of standard ECG criteria indicative of ischemia, and independently predicts all-cause mortality during 2 years of follow-up.

3.
Appl Cogn Psychol ; 32(4): 518-522, 2018 Jul-Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30046221

RESUMO

The aim of this study was to examine how people mentally represent and depict true and false statements about claimed future actions-so-called true and false intentions. On the basis of construal level theory, which proposes that subjectively unlikely events are more abstractly represented than likely ones, we hypothesized that false intentions should be represented at a more abstract level than true intentions. Fifty-six hand drawings, produced by participants to describe mental images accompanying either true or false intentions, were rated on level of abstractness by a second set of participants (N = 117) blind to the veracity of the intentions. As predicted, drawings of false intentions were rated as more abstract than drawings of true intentions. This result advances the use of drawing-based deception detection techniques to the field of true and false intentions and highlights the potential for abstractness as a novel cue to deceit.

4.
Cardiol J ; 25(5): 601-610, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29611166

RESUMO

BACKGROUND: While prolongation of QRS duration and QTc interval during acute myocardial infarction (AMI) has been reported in animals, limited data is available for these readily available electrocardiography (ECG) markers in humans. METHODS: Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected AMI in a prospective diagnostic multicentre study were prospectively assessed. Digital 12-lead ECGs were recorded at presentation. QRS duration and QTc interval were automatically calculated in a blinded fashion. Final diagnosis was adjudicated by two independent cardiologists. The prognostic endpoint was all-cause mortality during 24 months of follow-up. RESULTS: Among 4042 patients, AMI was the final diagnosis in 19% of patients. Median QRS duration and median QTc interval were significantly greater in patients with AMI compared to those with other final diagnoses (98 ms [IQR 88-108] vs. 94 ms [IQR 86-102] and 436 ms [IQR 414-462] vs. 425 ms [IQR 407-445], p < 0.001 for both comparisons). The diagnostic value of both ECG signatures however was only modest (AUC 0.56 and 0.60). Cumulative mortality rates after 2 years were 15.9% vs. 5.6% in patients with a QRS > 120 ms compared to a QRS duration ≤ 120 ms (p < 0.001), and 11.4% vs. 4.3% in patients with a QTc > 440 ms compared to a QRS duration ≤ 440 ms (p < 0.001). After adjustment for age and important ECG and clinical parameters, the QTc interval but not QRS duration remained an independent predictor of mortality. CONCLUSIONS: Prolongation of QRS duration > 120 ms and QTc interval > 440 ms predict mortality in patients with suspected AMI, but do not add diagnostic value.

5.
Front Psychol ; 8: 2037, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29209261

RESUMO

The aim was to examine how people mentally represent alleged future actions-their true and false intentions. In two experiments, participants were asked to either tell the truth (i.e., express true intentions) or lie (i.e., express false intentions) about performing future tasks. Drawing on Construal Level Theory, which proposes that psychologically distant events are more abstractly construed than proximal ones, it was predicted that liars would have more abstract mental representations of the future tasks than truth tellers, due to differences in hypotheticality (i.e., the likelihood of the future tasks occurring). Construal level was measured by a video segmentation task (Experiment 1, N = 125) and preference for abstract or concrete descriptions of tasks (Experiment 2, N = 59). Veracity had no effect on construal level. Speaking against our initial predictions, the data indicate that true and false intentions are construed at similar levels of abstraction. The results are discussed in the light of Construal Level Theory and the emerging psycho-legal research on true and false intentions.

6.
J Exp Biol ; 216(Pt 9): 1630-7, 2013 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-23348947

RESUMO

Chill tolerance of insects is defined as the ability to tolerate low temperature under circumstances not involving freezing of intracellular or extracellular fluids. For many insects chill tolerance is crucial for their ability to persist in cold environments and mounting evidence indicates that chill tolerance is associated with the ability to maintain ion and water homeostasis, thereby ensuring muscular function and preventing chill injury at low temperature. The present study describes the relationship between muscle and haemolymph ion homeostasis and time to regain posture following cold shock (CS, 2 h at -4°C) in the chill-susceptible locust Locusta migratoria. This relationship was examined in animals with and without a prior rapid cold-hardening treatment (RCH, 2 h at 0°C) to investigate the physiological underpinnings of RCH. CS elicited a doubling of haemolymph [K(+)] and this disturbance was greater in locusts pre-exposed to RCH. Recovery of ion homeostasis was, however, markedly faster in RCH-treated animals, which correlated well with whole-organism performance as hardened individuals regained posture faster than non-hardened individuals following CS. The present study indicates that loss and recovery of muscular function are associated with the resting membrane potential of excitable membranes as attested by the changes in the equilibrium potential for K(+) (EK) following CS. Both hardened and non-hardened animals regained movement once K(+) homeostasis had recovered to a fixed level (EK≈-41 mV). RCH is therefore not associated with altered sensitivity to ion disturbance but instead is correlated to a faster recovery of haemolymph [K(+)].


Assuntos
Adaptação Fisiológica , Migração Animal/fisiologia , Temperatura Baixa , Homeostase/fisiologia , Locusta migratoria/fisiologia , Estresse Fisiológico , Animais , Resposta ao Choque Frio/fisiologia , Hemolinfa/metabolismo , Íons , Potenciais da Membrana/fisiologia , Reprodução/fisiologia , Comportamento Sexual Animal , Análise de Sobrevida , Fatores de Tempo
7.
Behav Processes ; 86(1): 7-20, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20696218

RESUMO

Studies of dogs report that individuals reliably respond to the goal-directed communicative actions (e.g., pointing) of human experimenters. All of these studies use some version of a multi-trial approach, thereby allowing for the possibility of rapid learning within an experimental session. The experiments reported here ask whether dogs can respond correctly to a communicative action based on only a single presentation, thereby eliminating the possibility of learning within the experimental context. We tested 173 dogs. For each dog reaching our test criteria, we used a single presentation of six different goal-directed actions within a session, asking whether they correctly follow to a target goal (container with concealed food) a (1) distal hand point, (2) step toward one container, (3) hand point to one container followed by step toward the other, (4) step toward one container and point to the other, (5) distal foot point with the experimenter's hands free, and (6) distal foot point with the experimenter's hands occupied. Given only a single presentation, dogs selected the correct container when the experimenter hand pointed, foot pointed with hands occupied, or stepped closer to the target container, but failed on the other actions, despite using the same method. The fact that dogs correctly followed foot pointing with hands occupied, but not hands free, suggests that they are sensitive to environmental constraints, and use this information to infer rational, goal-directed action. We discuss these results in light of the role of experience in recognizing communicative gestures, as well as the significance of coding criteria for studies of canine competence.


Assuntos
Comunicação , Algoritmos , Animais , Comportamento Animal , Peso Corporal/fisiologia , Compreensão , Sinais (Psicologia) , Cães , Meio Ambiente , Metas , Mãos/fisiologia , Humanos , Comportamento Imitativo , Individualidade , Aprendizagem/fisiologia , Motivação , Movimento , Olfato/fisiologia , Especificidade da Espécie , Gravação de Videoteipe
8.
J Exp Biol ; 212(Pt 6): 859-66, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19252003

RESUMO

Ectothermic animals inhabiting the subarctic and temperate regions have evolved strategies to deal with periods of continuous frost during winter. The earthworm Dendrobaena octaedra is freeze tolerant and accumulates large concentrations of glucose upon freezing. The present study investigates the roles of glucose accumulation for long-term freeze tolerance in worms kept frozen at -2 degrees C for 47 days. During this period, worms were sampled periodically for determination of survival and for measurements of glucose, glycogen, lactate, alanine and succinate. In addition we performed calorimetric measurements to assess metabolic rate of frozen and unfrozen worms. Long-term freezing was associated with a gradual depletion of glucose and worms that succumbed during this period were always characterised by low glucose and glycogen levels. The anaerobic waste products lactate and alanine increased slightly whereas succinate levels remained constant. However, it is argued that other waste products (particularly propionate) could be the primary end product of a continued anaerobic metabolism. Calorimetric measures of the metabolic rate of frozen worms were in accord with values calculated from the reduction in glucose assuming that most ( approximately 90%) glucose was metabolised anaerobically. Both estimates of metabolic rate demonstrated a 10-fold metabolic depression associated with freezing. Thus, in addition to the suspected role of glucose as cryoprotectant, the present study demonstrates that glucose accumulation is vital to ensure substrate for long-term anaerobic metabolism in frozen worms. On the basis of the estimated metabolite levels, we calculate that the combined effect of metabolic depression and large glucose stores enables a projected 3 months survival of freezing at -2 degrees C of the ;average' D. octaedra. Such conditions are very likely to occur in the northern distribution ranges of this stress-tolerant earthworm.


Assuntos
Crioprotetores/metabolismo , Congelamento , Glucose/metabolismo , Oligoquetos/fisiologia , Adaptação Fisiológica/fisiologia , Animais , Fatores de Tempo
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