Age‐Specific Differences in Women with Implantable Cardioverter Defibrillators: An International Multi Center Study

Background: Common psychological adjustment difficulties have been identified for groups of implantable cardioverter defibrillator patients, such as those who are young (<50 years old), have been shocked, and are female. Specific aspects and concerns, such as fears of death or shock and body image concerns, that increase the chance of distress, have not been examined in different aged female implantable cardioverter defibrillator (ICD) recipients. The aim of the study was to investigate these areas of adjustment across three age groups of women from multiple centers. Methods: Eighty‐eight female ICD patients were recruited at three medical centers: Shands Hospital at the University of Florida, Brigham and Women's Hospital in Boston, and Royal North Shore Hospital in Sydney, Australia. Women completed individual psychological assessment batteries, measuring the constructs of shock anxiety, death anxiety, and body image concerns. Medical record review was conducted for all patients regarding cardiac illnesses and ICD‐specific data. Results: Multivariate and univariate analyses of variance revealed that younger women reported significantly higher rates of shock and death anxiety (Pillai's F = 3.053, P = 0.018, η²_p= 0.067) and significantly greater body image concerns (Pillai's F = 4.198, P = 0.018, η²_p= 0.090) than middle‐ and older‐aged women. Conclusions: Women under the age of 50 appear to be at greater risk for the development of psychosocial distress associated with shock anxiety, death anxiety, and body image. Clinical‐based strategies and interventions targeting these types of adjustment difficulties in younger women may allow for improved psychosocial and quality of life outcomes.     

Short forms of the AUDIT in a Web‐based study of young drinkers

Introduction. The Alcohol Use Disorders Identification Test (AUDIT) is under‐studied among young drinkers, as are the contributions of individual items to total AUDIT scores, and online performance of the existing briefer versions of this instrument. Design and Methods. This study examined individual items of the AUDIT, and various combinations, including the existing briefer versions, in relation to total AUDIT scores in a Web‐based study of young drinkers. A total of 167 young people aged 16–24 years old who had consumed any alcohol within the previous 7 days were recruited by both offline and online methods. Results. Considered individually, items 3, 4, 5 and 8 were predictive of the majority of the variance in total AUDIT scores in this Web‐based study. Existing briefer versions of the AUDIT do not better predict total scores than possible alternative combinations of items, for which acceptable levels of sensitivity and specificity for screening have been demonstrated. Conclusions. Short forms of the AUDIT, particularly those based only on consumption questions, require further validation study in online applications with young people.[McCambridge J, Thomas BA. Short forms of the AUDIT in a Web‐based study of young drinkers. Drug Alcohol Rev 2009;28:18–24]     

Relationship between European Mitochondrial Haplogroups and Chronic Renal Allograft Rejection in Patients with Kidney Transplant

Mitochondrial DNA variants may contribute to differences in mitochondrial function, leading to an altered immune system. The aim of this study was to analyze the relationship between mtDNA haplogroups and the development of chronic allograft dysfunction in patients with kidney transplant. A retrospective observational study was carried out on 261 patients who received kidney transplant (114 had stable transplant and 147 patients developed chronic allograft dysfunction). DNA samples were genotyped for 14 mtDNA polymorphisms by using Sequenom''s MassARRAY platform (San Diego, CA, USA). Only European white patients within the N macro-cluster were included. Patients with haplogroups V (odds ratio (OR)=0.32; p=0.037) and J (OR=0.36; p=0.038) showed lower odds for developing CRAD than patients with haplogroup H. After adjusting for the most significant variables, haplogroups V and J tended to statistical significance (p=0.091 and p=0.067 respectively). This is a preliminary study in which mtDNA haplogroups seem to be implicated in susceptibility or protection for developing chronic allograft dysfunction.     

Transmural Mapping of Myocardial Refractoriness and Endocardial Dispersion of Repolarization in an Ovine Model of Chronic Myocardial Infarction

Background: Myocardial refractoriness and repolarization is an important electrophysiological property that, when altered, increases the risk of arrhythmogenesis. These electrophysiological changes associated with chronic myocardial infarction (MI) have not been studied in detail. We assessed the influence of left ventricular (LV) scarring on local refractoriness, repolarization, and electrogram characteristics. Methods: MI was induced in five sheep by percutaneous left anterior descending artery occlusion for 3 hours. Mapping was performed at 19 ± 6 weeks post‐MI. A total of 20 quadripolar transmural needles were deployed at thoracotomy in the LV within and surrounding scar. Bipolar pacing was performed from each needle to assess the effective refractory period (ERP) of the subendocardium and subepicardium. The activation (AT) and repolarization (RT) times, and modified activation recovery interval (ARI_m) were determined from endocardial unipolar electrograms recorded in sinus rhythm simultaneously from all needles. Scarring was quantified histologically and compared with electrophysiological characteristics. Results: Increased scarring corresponded with increased ERP (P < 0.01), decreased subendocardial electrogram amplitude (P < 0.001), and slope (P < 0.001). ERP did not differ between endocardium and epicardium (P > 0.05). The ARI_m and RT were prolonged during early myocardial activation (P < 0.001). After adjusting for AT, the RT and ARI_m were prolonged in areas of scarring (P < 0.001). After adjusting for electrogram amplitude, the ARI_m was prolonged in dense scar (P < 0.05). Conclusions: We confirmed histologically that scarring contributes to prolongation of repolarization, increased refractoriness, and reductions in conduction and voltage post‐MI. Prolongation of repolarization may be further augmented when local activation is earliest or electrogram voltage is decreased within scar.     

Helping Agents' Attitudes Towards Alcohol-related Problems: situations vacant? A test and elaboration of a model

An elaboration of Cartwright's (1980) model explaining agents' negative attitudes to responding to alcohol-related problems (ARPs) is presented. Rather than Role Support, Experience, Education and Self-esteem per se being seen as the main variables with effect on therapeutic attitude, it is argued that the effects of these factors are best viewed as contingent upon situational influences operating within agents' occupational contexts. An attempt was made to isolate some of these influences by comparing the work situations of 24 Community Psychiatric Nurses (CPNs) and 24 Social Workers. Correlational data suggested that an index of Situational Constraint, although it was not independent of Role Support and Experience, could reliably predict levels of attitudes towards ARPs. It was found that CPNs expressed significantly more positive therapeutic attitudes towards drinkers than either ‘long-term’ generic, or medical, Social Workers, but were also working under less Situational Constraint. It is concluded that social workers do not attain such deep levels of involvement in ARPs as CPNs owing to their more constraining work environments. They are, therefore, less open to ARP educational events and are less likely to develop role support contacts. Recommendations for future role support provision and training programmes are briefly outlined.     

Standardization of a technique for analysing the frequency of parasite-specific cytotoxic T lymphocyte precursors in cattle immunized with Theileria parva

Summary A limiting dilution microculture system was optimized to quantify the frequency of Theileria parva-specific cytotoxic T lymphocyte precursors (CTLp) in peripheral blood mononuclear cells (PBMC) from immune cattle. Optimal results were obtained with responder cell input levels ranging from 2 × 10⁴/well to 6.25 × 10²/well, along with 1–5 × 10³/well stimulator cells in standard supplemented RPMI 1640 medium containing 2.5–5% T cell growth factors. Thirty-six microtitre wells were established at each responder input level. Cultures were incubated for 7 days at 38°C, at the end of which time individual wells were screened for cytotoxic activity in a 4-h ¹¹¹indium oxine-release assay. Analysis of the cytotoxicity data, by a computer-programmed maximum likelihood estimation method indicated that they conformed to the Poisson model of single-hit kinetics. Estimates of frequencies ranged from 1:3600 to 1:5275 CTLp in PBMC of eight cattle between 1 and 24 months after immunization with T. parva. By contrast, no CTLp were detected in six naïve animals analysed to a responder cell input of 10⁵/well. Split-well analysis of individual microwells showed that the CTL clones generated under limiting dilution conditions displayed exquisite specificity for parasitized cells, were genetically restricted and in some animals were parasite strain-specific.