Fear and the startle reflex: Blink modulation and autonomic response patterns in animal and mutilation fearful subjects

The present study was designed to examine the pattern of startle reflex modulation and autonomic responses for individuals high in animal or blood-injury fear when viewing pictures of their feared objects. Sixteen individuals in each fear group and 16 low-fear control individuals viewed 32 color slides depicting fear-relevant, unpleasant but fear-unrelated, neutral, and pleasant scenes. Free viewing times were assessed in a second phase of the procedure as an index of avoidance behavior. Exposure to pictures of feared objects resulted in a consistent startle reflex potentiation and behavioral avoidance in both fear groups. This activation of the basic aversive system was independent of the autonomic pattern of the fear responses, which differed for the high-fear groups. These results suggest that the probe startle response indexes the organism's basic motivational disposition and add new information to the assessment of fear.     

Acute Efficacy and Chronic Follow-Up of Patients with Non-Thoracotomy Third Generation Implantahle Defibrillators

Non-thoracotomy implantation of implantable cardioverter defibrillators (ICDs) has simplified the process of device inserfion, promising to decrease associated procedural coniplications while providing sudden death protection at least equal to epicardial systems. This study presents the acute and chronic results of 110 patients who underwent attempted non-thoracotomy ICD impiuntation wiih the Medtronic Transvene lead system and PCD model 7217 or 7219. Of the 110 patients attempted, 100 (91%) had the system successfully implanted without the need for an epicar-dial patch. One patient died 1 week postoperatively of septic shock related to the implantation (0.9% perioperative mortality). During folloiv-up of 16 ± 11 months, 45% of the patients had an event detected as ventricular tachycardia; 26% of these detections were felt clinically to be due to supraventricular rhythms. Of the remainder, 87% were successfully treated with the first VT therapy, and 98% were terminated by the final therapy; 66% of the patients had at least one episode of ventricular fibrillation, of which 5% were felt to be inappropriate detections; 65% of the appropriate episodes were successfully treated with the first VF therapy, and all were converted by the final therapy. Total mortality at 6, 12, and 24 months was 3%, 11%, and 19% respectively. Only one patient had sudden cardiac death, occurring at 13 months postimplant. Overall, the non-thoracotomy lead system for this ICD displayed infrequent implant complications and proved to be reliable ai terminating arrhythmias and maintaining a low rate of sudden cardiac death in this high risk popuiation.     

Clinical Results of Far‐Field R‐Wave Reduction with a Short Tip‐Ring Electrode

Background: Far‐field R‐wave (FFRW) sensing of the atrial lead of AAI or DDD pacemakers causes incorrect mode switches and remains a problem in patients with atrial arrhythmias in whom low voltage sensing is essential. We studied a pacing electrode with a short tip‐ring distance (1.1 mm). We compared our findings with recordings from a conventional electrode with a larger tip‐ring distance (10 mm). Methods: Thirty‐six consecutive patients with an indication for DDD pacing were implanted with the short tip‐ring electrode. Another 23 patients received the conventional electrode. FFRW and P‐wave amplitudes during pacing and intrinsic ventricular depolarization were measured at implantation. Measurements were repeated before hospital discharge and at follow‐up between 10 and 14 days after implantation. Results: P‐wave amplitude was slightly smaller in the short tip‐ring group (2.71 ± 1.04 vs 3.17 ± 1.30 mV in the conventional group, respectively, P = NS). All P‐waves exceeded 1.2 mV. FFRW during pacing was 0.07 ± 0.05 in the short tip‐ring group and 0.54 ± 0.32 mV in the conventional group (P < 0.001). FFRW during intrinsic rhythm was 0.08 ± 0.04 and 0.55 ± 0.31 mV, respectively (P < 0.001). The ratio between P‐wave and FFRW was 48.6 ± 27.2 in the short tip‐ring group and 7.3 ± 4.4 in the conventional group (P < 0.001). FFRW and P‐wave amplitudes did not change at hospital discharge or during follow‐up. Conclusion: FFRW can be suppressed without compromising P‐wave sensing by using a pacing electrode with a short tip‐ring distance. Whether reduced FFRW amplitude results in clinical endpoints remains to be determined.     

2-(2‘-Pyridyl)-ethyl-ester (Pet ester) derivatives of polyfunctional amino acids

The 2-(2′-pyridyl)-ethyl-esters (Pet-esters) of bi- and tri-functional amino acids are introduced as a semipermanent protecting group in peptide synthesis.     

Cardiovascular responses during effortful active coping and acute experience of anger in women

This study addresses the question of whether effortful active coping and anger provocation add in their effects on cardiovascular responses. Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) responses of 64 female students were collected during an active versus nonactive coping task with and without provocation. After a baseline period, women did mental arithmetic (active coping) or read numbers aloud (nonactive coping). Half of each group was then additionally provoked. Ratings of the emotional states (Positive and Negative Affect Scale) indicate that provocation led to an increase in anger, but not in fear or negative or positive affect. Effortful active coping and provocation elevated cardiovascular activity. Although active coping enhanced all cardiovascular variables, provocation particularly affected HR and DBP. The effects of active coping and provocation on HR and DBP but not on SBP were additive and probably were produced by different physiological mechanisms.     

Trends in oral contraceptive use in a Southern German population: Results of the MONICA project Augsburg: surveys 1984/85 and 1989/90

In the surveys of the MONICA project Augsburg, conducted in1984/85 (S1) and 1989/90 (S2), data on oral contraceptive (OC)use were gathered in two independent representative population-basedsamples of women aged 25–44 years (medication historyover the previous seven days). OCs were categorized accordingto their oestrogen content (< 50mg, 50mg) and according totheir progestogen component. The prevalence of OC use was unchangedbetween the two points in time (23.4% in S1 and 23.7% in S2).OCs with low oestrogen content were used in 49.0% of the OCusers in S1 and in 76.6% in S2. The use of the progestogen componentchanged also: norethindrone (acetate), levonorgestrel, and lynestrenolwere used less, desogestrel more often in S2. Gestoden and norgestimatewere used by 15% of the OC users in S2. In conclusion, we cansay that there was no change in the prevalence of OC use inthe study population; however, a change in hormone content towardspreparations with lower hormone content was observed.     

The use of medical equipment by Australian registered nurses

Summary

• ? Registered nurses in Australia are the primary users of medical equipment in the direct care of patients. The cross-sectional survey reported in this paper explores how and what registered nurses working in a large hospital in a South Australian city initially learn about the medical equipment they use in direct patient care, as well as the consequences of equipment use for both patients and staff.
• ? Equipment use had positive and negative aspects both for registered nurses and patients, the central issue of which was quality patient care. Inherent in this issue was knowledgeable and proficient device use, which, it is argued, hinges on equipment education.
• ? The two most frequently identified methods of initial learning were reading the user/instruction manual and consulting the policy and procedure manual. At least 90% of respondents indicated they initially learned how to operate equipment and its purpose and function.
• ? Medical equipment use caused nearly half the nurses to feel stressed, but only 9.4% had used medical equipment that had harmed a patient.