The Magic of Large Numbers versus Clinical Experience

Introduction: Long-term ECG monitoring is often necessary in patients (pts) with unexplained syncope and suspected or known atrial fibrillation (AF). The recently released Medtronic LinQ loop recorder (ILR) accrues ECG data daily; “alert” conditions are wirelessly transmitted to providers. To date, the frequency and characteristics of these alerts are unknown. Hypothesis: We hypothesized that alerts would occur infrequently, thus allowing for remote management of large numbers of pts. Methods: Consecutive pts implanted with the LinQ were assessed. All alerts were collected and analyzed. Alerts ideally reflect a change within the past 24 hours of monitoring. However, some alerts (once triggered) perpetuate daily until cleared by a patient initiating a manual transmission. Results: Our first 100 LinQ pts (mean age 67.5 years; 51% male) implanted within the first 3 months of market release were assessed. The indications for monitoring included suspected AF (cryptogenic stroke, n=10; history of atrial flutter, n=1), known AF (n=61), and unexplained syncope (n=25). During follow-up, an alert occurred in 63 pts; a similar frequency of alerts occurred in AF and syncope pts (Figure). Once present, 29 (46%) alerts perpetuated daily and required manual transmission to clear. Conclusion: We report the initial clinical experience with the LinQ ILR. We found that alerts occurred frequently, irrespective of indication for monitoring. Once present, alerts were frequently perpetuated due to a major design limitation. A more robust system is needed to triage the data being accrued to prevent unnecessary data deluge.

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The great Bacterial Contamination of the Milk of Cities. Can it be lessened by the Action of Health Authorities?

Journal of Hygiene ◽

10.1017/s0022172400000334 ◽

1901 ◽

Vol 1 (3) ◽

pp. 391-406 ◽

Cited By ~ 6

Author(s):

Wm. Hallock Park

Keyword(s):

Clinical Experience ◽

Bacterial Contamination ◽

Bacteriological Examination ◽

Original Condition ◽

Gastric Digestion ◽

Maternal Milk ◽

Health Authorities ◽

Large Numbers ◽

Dead Bodies ◽

Hot Weather

It will be accepted that milk containing large numbers of bacteria, as well as the products of their growth, is less suitable for food than unpolluted milk. A bacteriological examination of the milk in great cities generally will show that much of it in hot weather, and some of it at all seasons of the year, abounds in bacteria. Clinical experience also teaches that much of the milk in hot weather is unsuitable for food, especially for infants; because in them, owing to the rapidity with which the milk passes through the stomach, gastric digestion is almost no safeguard against the entrance of disturbing microorganisms into the intestines. Even pasteurization of milk charged with bacteria and their products does not restore it to its original condition, for the dead bodies of the bacteria and their toxins still remain. The changes in milk which are most deleterious being now known to be due to bacteria, it is theoretically conceded by all, that commercial cow's milk, the substitute for maternal milk, should be as nearly free as practicable from bacteria.

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An Exploration of Homesickness among Student Nurses

Australian & New Zealand Journal of Psychiatry ◽

10.3109/00048678109159411 ◽

1981 ◽

Vol 15 (1) ◽

pp. 57-62 ◽

Cited By ~ 8

Author(s):

D. Porritt ◽

D. Taylor

Keyword(s):

Young Adults ◽

Clinical Experience ◽

Student Nurses ◽

Residential Relocation ◽

Therapeutic Implications ◽

Adjustment Difficulties ◽

Self Reliance ◽

Intensive Interview ◽

Large Numbers ◽

Attachment Behaviour

Clinical experience of the author and literature reports suggest that homesickness can be an important factor in adjustment difficulties among student nurses. Following previous studies of residential relocation, homesickness is conceptualised as a grief reaction. It is suggested that attempts to maintain attachment to home and family will also be involved. A scale of ‘homesickness symptoms’ based on this conceptualisation was developed and administered to 185 student nurses, 85 after 4 months of training and 100 after 10 months. Results supported the view that homesickness is a state involving both grief behaviour and attachment behaviour. Recency of separation increased the likelihood of reporting many symptoms. The numbers reporting large numbers of symptoms declined after the first 6 weeks but remained steady at 40–50% thereafter. Students with easier access to their homes were not less likely to report many symptoms initially, but were more likely to report fewer symptoms after the first 6 weeks. Some findings of a more intensive interview study of studnets, some of whom appeared never to have been homesick, some to have recovered, and some to have continued being homesick, are described. Finally, the therapeutic implications of the results are discussed and the potential of further research for elucidation of attachment behaviour in young adults and of maturation to self-reliance is suggested.

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Cytoplasmic Granules in Lymphocytes from Rats Dosed with SK&F 14336-D

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100066838 ◽

1971 ◽

Vol 29 ◽

pp. 556-557

Author(s):

T. G. Merrill ◽

B. J. Payne ◽

A. J. Tousimis

Keyword(s):

Lipid Storage ◽

Pokeweed Mitogen ◽

Electron Microscopic ◽

Cytoplasmic Granules ◽

Storage Diseases ◽

Tay Sachs Disease ◽

Large Numbers ◽

Microscopic Studies ◽

Neurovisceral Lipidosis

Rats given SK&F 14336-D (9-[3-Dimethylamino propyl]-2-chloroacridane), a tranquilizing drug, developed an increased number of vacuolated lymphocytes as observed by light microscopy. Vacuoles in peripheral blood of rats and humans apparently are rare and are not usually reported in differential counts. Transforming agents such as phytohemagglutinin and pokeweed mitogen induce similar vacuoles in in vitro cultures of lymphocytes. These vacuoles have also been reported in some of the lipid-storage diseases of humans such as amaurotic familial idiocy, familial neurovisceral lipidosis, lipomucopolysaccharidosis and sphingomyelinosis. Electron microscopic studies of Tay-Sachs' disease and of chloroquine treated swine have demonstrated large numbers of “membranous cytoplasmic granules” in the cytoplasm of neurons, in addition to lymphocytes. The present study was undertaken with the purpose of characterizing the membranous inclusions and developing an experimental animal model which may be used for the study of lipid storage diseases.

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Prolonged Fixation Studies For Spaceflight

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100072101 ◽

1973 ◽

Vol 31 ◽

pp. 332-333

Author(s):

Robert Corbett ◽

Delbert E. Philpott ◽

Sam Black

Keyword(s):

High Pressure ◽

Living Systems ◽

Prolonged Storage ◽

Time Intervals ◽

Early Signs ◽

Large Numbers

Observation of subtle or early signs of change in spaceflight induced alterations on living systems require precise methods of sampling. In-flight analysis would be preferable but constraints of time, equipment, personnel and cost dictate the necessity for prolonged storage before retrieval. Because of this, various tissues have been stored in fixatives and combinations of fixatives and observed at various time intervals. High pressure and the effect of buffer alone have also been tried.Of the various tissues embedded, muscle, cartilage and liver, liver has been the most extensively studied because it contains large numbers of organelles common to all tissues (Fig. 1).

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Analysis of the Anterior Secretory Cells of Onchidohs Muricata (Nudibranchia)

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100099490 ◽

1981 ◽

Vol 39 ◽

pp. 614-615

Author(s):

Roy Skidmore

Keyword(s):

Endoplasmic Reticulum ◽

Secretory Granules ◽

Golgi Body ◽

The Body ◽

Secretory Cells ◽

Secretory Vesicles ◽

High Magnification ◽

Large Numbers ◽

Membrane Bound ◽

Sole Of The Foot

The long-necked secretory cells in Onchidoris muricata are distributed in the anterior sole of the foot. These cells are interspersed among ciliated columnar and conical cells as well as short-necked secretory gland cells. The long-necked cells contribute a significant amount of mucoid materials to the slime on which the nudibranch travels. The body of these cells is found in the subepidermal tissues. A long process extends across the basal lamina and in between cells of the epidermis to the surface of the foot. The secretory granules travel along the process and their contents are expelled by exocytosis at the foot surface.The contents of the cell body include the nucleus, some endoplasmic reticulum, and an extensive Golgi body with large numbers of secretory vesicles (Fig. 1). The secretory vesicles are membrane bound and contain a fibrillar matrix. At high magnification the similarity of the contents in the Golgi saccules and the secretory vesicles becomes apparent (Fig. 2).

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Selective Sampling and Orientation of Non-Homogeneous Tissues

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100100238 ◽

1968 ◽

Vol 26 ◽

pp. 98-99

Author(s):

C. C. Clawson ◽

L. W. Anderson ◽

R. A. Good

Keyword(s):

Electron Microscopy ◽

Electron Microscope ◽

Light Microscopy ◽

Random Sampling ◽

New Method ◽

Microscope Examination ◽

Small Areas ◽

Selective Sampling ◽

Large Numbers ◽

Specific Orientation

Investigations which require electron microscope examination of a few specific areas of non-homogeneous tissues make random sampling of small blocks an inefficient and unrewarding procedure. Therefore, several investigators have devised methods which allow obtaining sample blocks for electron microscopy from region of tissue previously identified by light microscopy of present here techniques which make possible: 1) sampling tissue for electron microscopy from selected areas previously identified by light microscopy of relatively large pieces of tissue; 2) dehydration and embedding large numbers of individually identified blocks while keeping each one separate; 3) a new method of maintaining specific orientation of blocks during embedding; 4) special light microscopic staining or fluorescent procedures and electron microscopy on immediately adjacent small areas of tissue.

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Microanalysis of precipitates in a ferritic steel

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100110234 ◽

1978 ◽

Vol 36 (1) ◽

pp. 618-619

Author(s):

J.M. Titchmarsh

Keyword(s):

Ferritic Steel ◽

Particle Identification ◽

Energy Dispersive ◽

Objective Lens ◽

Ferritic Steels ◽

Replica Technique ◽

X Ray ◽

Large Numbers ◽

Scanning Transmission ◽

Made In

The advances in recent years in the microanalytical capabilities of conventional TEM's fitted with probe forming lenses allow much more detailed investigations to be made of the microstructures of complex alloys, such as ferritic steels, than have been possible previously. In particular, the identification of individual precipitate particles with dimensions of a few tens of nanometers in alloys containing high densities of several chemically and crystallographically different precipitate types is feasible. The aim of the investigation described in this paper was to establish a method which allowed individual particle identification to be made in a few seconds so that large numbers of particles could be examined in a few hours.A Philips EM400 microscope, fitted with the scanning transmission (STEM) objective lens pole-pieces and an EDAX energy dispersive X-ray analyser, was used at 120 kV with a thermal W hairpin filament. The precipitates examined were extracted using a standard C replica technique from specimens of a 2¼Cr-lMo ferritic steel in a quenched and tempered condition.

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An SEM study of raphide crystal initials in the leaves of vitis (grape)

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100141299 ◽

1995 ◽

Vol 53 ◽

pp. 984-985

Author(s):

H. J. Arnott ◽

M. A. Webb ◽

L. E. Lopez

Keyword(s):

Calcium Oxalate ◽

Water Soluble ◽

Calcium Oxalate Crystals ◽

Calcium Oxalate Crystal ◽

Oxalate Crystals ◽

Large Numbers ◽

Sem Study ◽

The Matrix ◽

Crystal Cells ◽

Crystal Idioblast

Many papers have been published on the structure of calcium oxalate crystals in plants, however, few deal with the early development of crystals. Large numbers of idioblastic calcium oxalate crystal cells are found in the leaves of Vitis mustangensis, V. labrusca and V. vulpina. A crystal idioblast, or raphide cell, will produce 150-300 needle-like calcium oxalate crystals within a central vacuole. Each raphide crystal is autonomous, having been produced in a separate membrane-defined crystal chamber; the idioblast''s crystal complement is collectively embedded in a water soluble glycoprotein matrix which fills the vacuole. The crystals are twins, each having a pointed and a bidentate end (Fig 1); when mature they are about 0.5-1.2 μn in diameter and 30-70 μm in length. Crystal bundles, i.e., crystals and their matrix, can be isolated from leaves using 100% ETOH. If the bundles are treated with H2O the matrix surrounding the crystals rapidly disperses.

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Localization of Intracisternal a Particle Antigens in Neoplastic Cells and Preimplantation Mouse Embryos

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s1431927600003044 ◽

1980 ◽

Vol 38 ◽

pp. 696-697

Author(s):

Thomas T.F. Huang ◽

Patricia G. Calarco

Keyword(s):

Endoplasmic Reticulum ◽

Normal Development ◽

Mouse Embryos ◽

Neoplastic Cells ◽

Large Numbers ◽

Preimplantation Mouse Embryos ◽

Preimplantation Mouse ◽

Intracisternal A Particle ◽

Normal Feature

The stage specific appearance of a retravirus, termed the Intracisternal A particle (IAP) is a normal feature of early preimplantation development. To date, all feral and laboratory strains of Mus musculus and even Asian species such as Mus cervicolor and Mus pahari express the particles during the 2-8 cell stages. IAP form by budding into the endoplasmic reticulum and appear singly or as groups of donut-shaped particles within the cisternae (fig. 1). IAP are also produced in large numbers in several neoplastic cells such as certain plasmacytomas and rhabdomyosarcomas. The role of IAP, either in normal development or in neoplastic behavior, is unknown.

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