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PubMed1994

Idiopathic ventricular fibrillation in out-of-hospital cardiac arrest survivors.

This study examined diagnostic and therapeutic roles of electrophysiological testing and long-term clinical outcome after out-of-hospital cardiac arrest due to idiopathic ventricular fibrillation. This is defined as ventricular fibrillation occurring in the absence of detectable underlying heart disease or metabolic or electrolyte disturbance. Out-of-hospital cardiac arrest resulting from idiopathic ventricular fibrillation is uncommon. Records of all patients who underwent electrophysiological testing between June 1979 and June 1992 were reviewed. Patients with out-of-hospital cardiac arrest due to idiopathic ventricular fibrillation were identified. Follow-up information was obtained by telephone interview in June 1992. Of 194 patients who underwent electrophysiological study after out-of-hospital cardiac arrest not associated with acute myocardial infarction, only six (4 male and 2 female) had idiopathic ventricular fibrillation. It was induced in only two patients by programmed ventricular stimulation. No sustained ventricular arrhythmias were induced in the remaining four patients. Four patients received implantable cardioverter defibrillators, one was treated with a beta-adrenergic blocker, and one received no treatment. All patients were alive at a mean follow-up of 50 months. Two of the four patients without inducible sustained ventricular arrhythmias had events during follow-up. Of the two patients with inducible ventricular fibrillation, one experienced a cardiac arrest and documented ventricular fibrillation at 41 months after the index event and the other had had no recurrence at 15-month follow-up. All four patients with implantable cardioverter defibrillators were alive at last follow-up, and two had device discharges.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1993

Idiopathic ventricular tachycardia and fibrillation.

Important data have recently been added to our understanding of sustained ventricular tachyarrhythmias occurring in the absence of demonstrable heart disease. Idiopathic ventricular tachycardia (VT) is usually of monomorphic configuration and can be classified according to its site of origin as either right monomorphic (70% of all idiopathic VTs) or left monomorphic VT. Several physiopathological types of monomorphic VT can be presently individualized, according to their mode of presentation, their relationship to adrenergic stress, or their response to various drugs. The long-term prognosis is usually good. Idiopathic polymorphic VT is a much rarer type of arrhythmia with a less favorable prognosis. Idiopathic ventricular fibrillation may represent an underestimated cause of sudden cardiac death in ostensibly healty patients. A high incidence of inducibility of sustained polymorphic VT with programmed ventricular stimulation has been found by our group, but not by others. Long-term prognosis on Class IA antiarrhythmic medications that are highly effective at electrophysiologic study appears excellent.

Electrophysiology↗

PubMed1998

Redesigning a school health workforce for a new health care environment: training school nurses as nurse practitioners.

Diminishing financial resources for school health dictate the most efficient possible deployment of the school health workforce. School nurses trained as nurse practitioners could help resolve the common problems of ready access to and appropriate use of primary care, early detection of potentially costly medical problems, and efficient use of school health staff. To determine how best to use existing resources to meet the increasingly varied and complex health care needs of children and adolescents, a pilot project was conducted in Denver from 1994 to 1996. With physician back-up and health aide support, school nurses were trained as nurse practitioners to provide in-school diagnostic and treatment services. Based on their evaluation study of this pilot project, the authors suggest ways to solve problems in role transition, including well-balanced training; clear role definition and assignment of responsibilities; appropriate back-up and mentoring support; and issues of sustaining long-term programs.

Adolescent↗

PubMed1998

Dengue and dengue hemorrhagic fever.

Dengue fever, a very old disease, has reemerged in the past 20 years with an expanded geographic distribution of both the viruses and the mosquito vectors, increased epidemic activity, the development of hyperendemicity (the cocirculation of multiple serotypes), and the emergence of dengue hemorrhagic fever in new geographic regions. In 1998 this mosquito-borne disease is the most important tropical infectious disease after malaria, with an estimated 100 million cases of dengue fever, 500,000 cases of dengue hemorrhagic fever, and 25,000 deaths annually. The reasons for this resurgence and emergence of dengue hemorrhagic fever in the waning years of the 20th century are complex and not fully understood, but demographic, societal, and public health infrastructure changes in the past 30 years have contributed greatly. This paper reviews the changing epidemiology of dengue and dengue hemorrhagic fever by geographic region, the natural history and transmission cycles, clinical diagnosis of both dengue fever and dengue hemorrhagic fever, serologic and virologic laboratory diagnoses, pathogenesis, surveillance, prevention, and control. A major challenge for public health officials in all tropical areas of the world is to develop and implement sustainable prevention and control programs that will reverse the trend of emergent dengue hemorrhagic fever.

Dengue↗

PubMed1995

MyoD-induced expression of p21 inhibits cyclin-dependent kinase activity upon myocyte terminal differentiation.

The terminal differentiation of C2C12 skeletal muscle cells involves the activation of unique sets of genes and an irreversible withdrawal from the cell cycle. This process is associated with a decrease in cdk2 activity in cell extracts. The decrease in cdk2 activity correlates with diminished levels of cdk2 and cyclin A and with a marked induction of the p21 cyclin-dependent kinase (cdk) inhibitor. The upregulation of p21 occurred at the levels of mRNA and protein, and p21 formed a complex with the cyclin kinases in myotubes. Further, the immunodepletion of p21 from myotube extracts neutralized the heat-stable cdk2 inhibitory activity that was induced upon myogenic differentiation. The levels of p21 mRNA, protein, and activity remained constant in myotubes when they were reexposed to mitogen-rich growth medium, indicating that permanent changes in the cell's genetic program contribute to its sustained expression following terminal differentiation. Indeed, 10T1/2 fibroblasts transformed with the myogenic factor MyoD, but not the parental multipotent cells, upregulated p21 transcript levels when induced to differentiate by serum withdrawal, demonstrating that the upregulation is an integral feature of myogenic commitment and differentiation. The functional consequences of this upregulation were indicated by ectopically expressing p21 in myoblasts; this was sufficient for cell cycle arrest in mitogen-rich growth medium. The induction and sustained expression of p21 appears to be a contributory mechanism by which myocytes irreversibly exit the cell cycle upon terminal differentiation.

Base Sequence↗

PubMed2002

Interaction between smooth anticipation and saccades during ocular orientation in darkness.

A saccade triggered during sustained smooth pursuit is programmed using retinal information about the relative position and velocity of the target with respect to the eye. Thus the smooth pursuit and saccadic systems are coordinated by using common retinal inputs. Yet, in the absence of retinal information about the relative motion of the eye with respect to the target, the question arises whether the smooth and saccadic systems are still able to be coordinated possibly by using extraretinal information to account for the saccadic and smooth eye movements. To address this question, we flashed a target during smooth anticipatory eye movements in darkness, and the subjects were asked to orient their visual axis to the remembered location of the flash. We observed multiple orientation saccades (typically 2-3) toward the memorized location of the flash. The first orienting saccade was programmed using only the position error at the moment of the flash, and the smooth eye movement was ignored. However, subsequent saccades executed in darkness compensated gradually for the smooth eye displacement (mean compensation congruent with 70%). This behavior revealed a 400-ms delay in the time course of orientation for the compensation of the ongoing smooth eye displacement. We conclude that extraretinal information about the smooth motor command is available to the saccadic system in the absence of visual input. There is a 400-ms delay for smooth movement integration, saccade programming and execution.

Darkness↗

PubMed1987

Effects of flecainide acetate on ventricular tachyarrhythmia and fibrillation in dogs with recent myocardial infarction.

The antiarrhythmic and antifibrillatory actions of the class IC antiarrhythmic agent flecainide acetate were examined in urethane-anesthetized dogs with recent myocardial infarction. The intravenous administration of flecainide in a loading dose of 1.0 mg/kg (n = 7) or 2.0 mg/kg (n = 6), followed by a maintenance infusion of 1.0 mg/kg/h to achieve plasma drug concentrations considered clinically therapeutic, failed to significantly elevate the electrical threshold current required to provoke ventricular fibrillation at infarct zone, border zone and non-infarct zone stimulation sites in postinfarction dogs. In 8 dogs which responded to baseline programmed stimulation with inducible sustained ventricular tachycardia, flecainide administered as 1.0 or 2.0 mg/kg loading doses followed by a 1.0 mg/kg/h maintenance infusion failed to prevent ventricular tachycardia initiation in any animal tested, although the post-treatment ventricular tachycardia cycle lengths were prolonged compared to baseline values (pre: 178 +/- 11 ms vs post: 202 +/- 17 ms, p less than 0.05). Flecainide administration apparently facilitated the induction of newly sustained ventricular tachycardia in 3 previously noninducible postinfarction dogs. The development of acute posterolateral ischemia at a site remote from previous anterior myocardial infarction resulted in the development of ventricular fibrillation in 4 of 11 (36%) saline-treated postinfarction dogs vs a cumulative 10 of 12 (83%) flecainide-treated, baseline noninducible postinfarction dogs (p less than 0.05 vs saline-treated). The incidence of sudden ischemic ventricular fibrillation was 7 of 7 (100%) among flecainide-treated baseline inducible postinfarction dogs. These data suggest that flecainide acetate may have only limited efficacy in preventing ventricular tachycardia or ventricular fibrillation soon after myocardial infarction.

Animals↗

PubMed2003

Determinants of sudden cardiac death in individuals with the electrocardiographic pattern of Brugada syndrome and no previous cardiac arrest.

BACKGROUND: Patients with Brugada syndrome who were resuscitated from an episode of ventricular fibrillation are at high risk for recurrent sudden death. There is general agreement about the therapeutic strategy for these patients. Conversely, the prognosis and approach in patients with a diagnostic ECG but without a previous history of sudden cardiac death is controversial. We analyzed a large cohort of patients with Brugada syndrome without previous cardiac arrest to understand the determinants of prognosis. METHODS AND RESULTS: A total of 547 patients with an ECG diagnostic of Brugada syndrome and no previous cardiac arrest were studied. The mean age was 41+/-15 years, and 408 were male. The diagnostic ECG was present spontaneously in 391 patients. In the remaining 156 individuals, the abnormal ECG was noted only after the administration of an antiarrhythmic drug. One hundred twenty-four patients had suffered from at least 1 episode of syncope. During programmed ventricular stimulation, a sustained ventricular arrhythmia was induced in 163 of 408 patients. During a mean follow-up of 24+/-32 months, 45 patients (8%) suffered sudden death or documented ventricular fibrillation. Multivariate analysis identified the inducibility of a sustained ventricular arrhythmia (P<0.0001) and a history of syncope (P<0.01) as predictors of events. Logistic regression analysis showed that a patient with a spontaneously abnormal ECG, a previous history of syncope, and inducible sustained ventricular arrhythmias had a probability of 27.2% of suffering an event during follow-up. CONCLUSIONS: Individuals with Brugada syndrome and no previous cardiac arrest have a high risk of sudden death. Inducibility of ventricular arrhythmias and a previous history of syncope are markers of a poor prognosis.

Adolescent↗

PubMed1986

Adenosine-sensitive ventricular tachycardia: evidence suggesting cyclic AMP-mediated triggered activity.

Catecholamine-induced triggered activity is thought to be caused by intracellular calcium overload mediated by elevation of intracellular cyclic AMP (cAMP). Although shown to occur in isolated preparations, evidence supporting its clinical existence has been lacking. Electrophysiologic studies were performed in four patients with structurally normal hearts who had exertionally related sustained ventricular tachycardia (VT). Programmed stimulation reproducibly initiated and terminated VT in all patients. Induction of tachycardia was also facilitated by infusion of isoproterenol. Adenosine, an endogenous nucleoside, whose only known electrophysiologic effect on ventricular myocardium and Purkinje fibers is antagonism of catecholamine-induced stimulation of intracellular cAMP production, reproducibly terminated all episodes of VT. The tachycardia was also terminated by intravenous verapamil and by the Valsalva maneuver and/or carotid sinus massage. Beta-Adrenergic receptor blockade with propranolol either terminated or prevented induction of VT during programmed stimulation or catecholamine challenge. Adenosine was also administered during VT to 14 patients whose arrhythmias fulfilled standard criteria for reentry, two of whom also had exercise-induced VT. Adenosine, at a dose (112.5 to 225 micrograms/kg iv) sufficient to cause either sinus slowing/arrest or ventriculoatrial block during ventricular pacing, failed to slow or terminate any episode of VT in these patients. Verapamil and autonomic modulation were also ineffective in this group of patients. Adenosine, verapamil, vagal maneuvers (acetylcholine), and beta-adrenergic receptor blockade are all known to decrease the slow-inward calcium current either directly by modulating calcium channels or indirectly by inhibiting production of cellular cAMP. Therefore the observation in this study that interventions that lower intracellular cAMP either terminate or prevent induction of VT in patients with structurally normal hearts and exercise-induced VT suggests that the mechanism of tachycardia may be cAMP-mediated triggered activity.

Adenosine↗

PubMed1992

Supplementation of breastfed infants: does continuing education for nurses make a difference?

Supplementation of breastfed newborns in the first few days of life is a common practice that interferes with the establishment of lactation and is related to early cessation of breastfeeding. Quality assurance audit results at a large maternity hospital led to the development of a continuing education program to increase nurses' knowledge of breastfeeding and thereby reduce supplementation. An integrated quality assurance and research methodology was selected to analyze the impact of the education and yield results that would be more generalizable and interest a wider audience. Findings revealed no change in supplementation behavior occurred following a four-week education program. Only 33 percent of newborns in the study were unsupplemented during their hospital stay. Formula was the most often used supplement. Continuing education alone was not effective in changing behavior. As shown in the literature, post-course reinforcement of behavior needs to be built into the cost of the program to implement and sustain desired changes.

Adult↗

PubMed1963

Experimental self-punishment and superstitious escape behavior.

Rats were trained to escape from shock by pressing a bar. Bar holding was subsequently punished with very brief shocks. This treatment failed to depress bar-holding behavior. In some cases, although the escape shocks were delivered very infrequently, bar holding was maintained and resulted in the delivery of several thousand punishments per session. These and other effects of the punishment treatment were investigated. Finally, some of the possibilities of superstitious escape responding were explored by presenting inescapable shocks to rats that had been trained to escape shock by lever pressing. Although responding during these shocks had no programmed consequences, responding was sustained.

Animals↗

PubMed2001

Effects of programmed growth rate and days fed on performance and carcass characteristics of feedlot steers.

Two experiments were conducted to investigate a feeding regimen in which a programmed amount of feed was offered daily to control growth rate of steers. In Exp. 1, steers (n = 107, 309 +/- 3 kg) were used to determine effects of offering ad libitum access to feed (AL) vs a programmed intake feeding regimen (PI) and the number of days steers were fed (168 vs 203) on performance and carcass characteristics. Steers in the programmed intake feeding regimen were fed to achieve a predicted gain of 1.13 kg/d for the first 78 kg of gain, 1.36 kg/d for the next 124 kg of gain, and were given ad libitum access to feed for the final 54 or 103 kg of gain before slaughter (for steers fed for 168 d or 203 d, respectively). Feed efficiency was greater (P < 0.02) for steers in the PI than for those in the AL feeding regimen (0.193 vs 0.183 kg gain/kg feed, respectively). From d 169 to 203, steers in the PI feeding regimen had greater (P < 0.06) ADG (1.60 vs 1.38 kg/d) and similar (P = 0.38) feed efficiency than steers in the AL regimen. In Exp. 2, steers (n = 96; 308 +/- 3 kg BW) were offered feed ad libitum throughout the experiment (AL) or were programmed to gain at a high (PI-H) or low (PI-L) growth rate. For the first 78 kg of gain, intake was restricted to achieve predicted gains of 1.13 kg/d (PI-L) or 1.25 kg/d (PI-H). For the next 124 kg of gain, intake was restricted to achieve predicted gains of 1.36 kg/d (PI-L) or 1.47 kg/d (PI-H). Feed was offered ad libitum for the final 58 kg of gain. Overall ADG was similar (P > 0.37) among feeding regimens despite lower DMI for the steers in the PI-L and PI-H feeding regimens than for those in the AL regimen. Feeding regimen did not affect (P < 0.22) carcass characteristics. Programmed intake feeding regimens sustained growth rate and feed efficiency for an extended period of time without detrimental effects on carcass characteristics.

Animal Feed↗

PubMedDate not supplied

Aftercare in therapeutic communities.

Relapse is the rule across all treatment approaches. However, evidence shows that treatment gains can be maintained and the recovery process sustained with continued aftercare programming beyond that of primary treatment. This paper discusses aftercare in the context of therapeutic community (TC) treatment. The initial section briefly reviews general considerations and distinctions concerning relapse and aftercare; the remainder outlines the TC approach to aftercare.

Aftercare↗

PubMed2001

Mission possible: community health.

VHA Health Foundation and the AHA's Health Research and Educational Trust surveyed 15 national community health award winners to learn how they have sustained their community health programs in a challenging economic environment.

Community Health Planning↗

PubMed2001

Developing a model based decision support tool for the identification of sustainable treatment options for domestic wastewater.

To enable decision makers to select sustainable wastewater treatment systems, insight into the sustainability of a wide variety of systems should be provided in a transparent way leaving room for adaptation and interpretation according to the local situation. To provide this insight a structured methodology comparing wastewater treatment systems with respect to sustainability is defined. Similar to life cycle assessment (LCA) three phases can be distinguished: (1) goal and scope definition, (2) inventory analysis, and (3) optimisation and results. In the goal and scope definition we set the system boundaries to include most of the water cycle and part of the food cycle. Furthermore, we defined a multi-disciplinary set of sustainability indicators including technical, economic, environmental, and socio-cultural aspects. In the inventory analysis these sustainability indicators are quantified using simple static models of wastewater unit operations. Selection of unit operations results in a model of a complete wastewater treatment system. In the optimisation phase the decision maker can weigh the different sustainability indicators and select sustainable options through integer programming.

Decision Support Techniques↗

PubMed2001

Managing the Brisbane River and Moreton Bay: an integrated research/management program to reduce impacts on an Australian estuary.

The Brisbane River and Moreton Bay Study, an interdisciplinary study of Moreton Bay and its major tributaries, was initiated to address water quality issues which link sewage and diffuse loading with environmental degradation. Runoff and deposition of fine-grained sediments into Moreton Bay, followed by resuspension, have been linked with increased turbidity and significant loss of seagrass habitat. Sewage-derived nutrient enrichment, particularly nitrogen (N), has been linked to algal blooms by sewage plume maps. Blooms of a marine cyanobacterium, Lyngbya majuscula, in Moreton Bay have resulted in significant impacts on human health (e.g., contact dermatitis) and ecological health (e.g., seagrass loss), and the availability of dissolved iron from acid sulfate soil runoff has been hypothesised. The impacts of catchment activities resulting in runoff of sediments, nutrients and dissolved iron on the health of the Moreton Bay waterways are addressed. The Study, established by 6 local councils in association with two state departments in 1994, forms a regional component of a national and state program to achieve ecologically sustainable use of the waterways by protecting and enhancing their health, while maintaining economic and social development. The Study framework illustrates a unique integrated approach to water quality management whereby scientific research, community participation and the strategy development were done in parallel with each other. This collaborative effort resulted in a water quality management strategy which focuses on the integration of socioeconomic and ecological values of the waterways. This work has led to significant cost savings in infrastructure by providing a clear focus on initiatives towards achieving healthy waterways. The Study's Stage 2 initiatives form the basis for this paper.

Australia↗

PubMed2000

Practice development credentialing in the United Kingdom - a unique framework for providing excellence, accountability and quality in nursing and healthcare.

This paper will describe the purpose, process and value of an international Practice Development Program by which clinical units can choose to be credentialed. It will describe how the fourteen criteria that a Unit is credentialed against takes them along a journey of practice, personal and professional development that equips them to not only positively respond to, but to proactively influence, the challenges and changes that healthcare is facing globally. It explains how The Program focuses on credentialing sustainable practice development that then contributes to the development of both the capability and capacity of healthcare services. As a result, it crosses professional and organisational boundaries and constraints and concentrates on their shared purpose, delivering excellent patient care.

Credentialing↗

PubMed2001

Women living long, living well: community driven women's health priorities.

The Office on Women's Health of the Department of Health and Human Services led an effort to seek feedback on women's health issues. The response showed that women in communities nationwide focused less on individual organ-specific health issues than on broader strategies they thought were critical to improving and sustaining women's health programs. This article summarizes the result of those discussions as expressed in the "Women Living Long, Living Well" framework.

Community-Institutional Relations↗