Graham Hepworth

Prospective Characterization of Catheter–Tissue Contact Force at Different Anatomic Sites During Antral Pulmonary Vein Isolation

Background— Catheter–tissue contact is critical for effective lesion creation. We characterized the contact force (CF) at different anatomic sites during antral pulmonary vein (PV) isolation for atrial fibrillation. Methods and Results— Two experienced operators performed PV isolation in 22 patients facilitated by a novel CF-sensing ablation catheter in a blinded fashion. Average CF and force-time integral data from 1602 lesions were analyzed. The left and right PV antra were divided into the following: carina, superior, inferior, anterior, and posterior quadrants for analysis. There was significant variability in CF within and between different PV quadrants (P<0.05). Lowest CF of all left PV sites was at the carina and anterior quadrant, whereas highest CF was at the superior and inferior quadrants (P<0.05). Lowest CF of all right PV sites was at the carina, whereas highest CF was at the anterior and inferior quadrants (P<0.05). When comparing similar PV quadrants on the left versus right (eg, left carina versus right carina), CF was always higher in the right PVs (P<0.05), except at the superior quadrant where CF was similar in the left and right PVs (P=0.19). There was no specific pattern of anatomic distribution of excess CF (P=0.39). Conclusions— Monitoring of catheter–tissue CF during PV isolation demonstrates significant variability in CF within and between different PV antral sites. Sites of lowest CF were the carina and anterior left PVs and the carina of the right PVs. This information may be important for improving ablation efficacy and clinical outcomes during PV isolation.

Exact Confidence Intervals for Proportions Estimated by Group Testing

In plant disease assessment, estimation of the proportion of infected units in a population can be greatly facilitated by group testing. Further gains may be possible by the sequential testing of groups of different sizes. The construction of exact confidence intervals is considered here for problems involving unequal sized groups. The recommended method uses an ordering of outcomes based on their associated maximum likelihood estimates. The method is compared with the technique proposed by Sterne (1954, Biometrika 41, 275-278) in which outcomes are ordered according to their probability. An assessment of the prevalence of viruses in carnation populations is used to illustrate the method. made by such pooling or group testing. A series of tests in which all groups test positive is of very limited value, but the presence of at least one negative group often provides enough information to make the pooling of units worthwhile. This study arose from an assessment of carnation populations in nursery glasshouses in Victoria, Australia. The purpose of the investigation was to estimate the prevalence of several viruses in carnations grown by a range of growers. Following the collection of a sample of leaves from a glasshouse (a leaf being assumed to accurately indicate a plants infection status), it was possible to reliably test large groups of leaves for the presence of a virus using enzyme-linked immunosorbent assay (ELISA). The cost of sampling a leaf was small compared to that of performing an ELISA, and so group testing was seen as a likely way of improving precision within the available resources. Group testing first appeared in the statistics literature in the context of identifying individual infected units in a population. Dorfman (1943) proposed the pooling of blood samples in testing for the syphilis antigen, followed by the retesting of individuals in any group found to be infected. This has spawned a considerable body of literature on group testing procedures for efficient identification. The other major area which has emerged is that in which estimation of the prevalence of a disease is much more important than the identification of infected units. This was the case in the assessment of the Victorian carnation industry, and it is estimation with which this paper is concerned. Most of the work in this area has been applied to the problem of estimating the proportion of vectors transmitting a plant or animal virus (Gibbs and Gower, 1960; Thompson, 1962; Walter, Hildreth, and Beaty, 1980; Romanow, Moyer, and Kennedy, 1986; Swallow, 1987). In those studies the vectors

Socio-demographic and clinical characteristics of re-presentation to an Australian inner-city emergency department: implications for service delivery

BackgroundPeople who have complex health care needs frequently access emergency departments for treatment of acute illness and injury. In particular, evidence suggests that those who are homeless, or suffer mental illness, or have a history of substance misuse, are often repeat users of emergency departments. The aim of this study was to describe the socio-demographic and clinical characteristics of emergency department re-presentations. Re-presentation was defined as a return visit to the same emergency department within 28 days of discharge from hospital.MethodsA retrospective cohort study was conducted of emergency department presentations occurring over a 24-month period to an Australian inner-city hospital. Characteristics were examined for their influence on the binary outcome of re-presentation within 28 days of discharge using logistic regression with the variable patient fitted as a random effect.ResultsFrom 64,147 presentations to the emergency department the re-presentation rate was 18.0% (n = 11,559) of visits and 14.4% (5,894/40,942) of all patients. Median time to re-presentation was 6 days, with more than half occurring within one week of discharge (60.8%; n = 6,873), and more than three-quarters within two weeks (80.9%; n = 9,151). The odds of re-presentation increased three-fold for people who were homeless compared to those living in stable accommodation (adjusted OR 3.09; 95% CI, 2.83 to 3.36). Similarly, the odds of re-presentation were significantly higher for patients receiving a government pension compared to those who did not (adjusted OR 1.73; 95% CI, 1.63 to 1.84), patients who left part-way through treatment compared to those who completed treatment and were discharged home (adjusted OR 1.64; 95% CI, 1.36 to 1.99), and those discharged to a residential-care facility compared to those who were discharged home (adjusted OR 1.46: 95% CI, 1.03 to 2.06).ConclusionEmergency department re-presentation rates cluster around one week after discharge and rapidly decrease thereafter. Housing status and being a recipient of a government pension are the most significant risk factors. Early identification and appropriate referrals for those patients who are at risk of emergency department re-presentation will assist in the development of targeted strategies to improve health service delivery to this vulnerable group.

Effect of heating and aging of poultry litter on the persistence of enteric bacteria

Food-borne illnesses have rarely been associated with the reuse of poultry litter as an organic fertilizer and soil amendment in agriculture. Yet farming practices in many countries have come under increased scrutiny because of heightened consumer awareness of food safety and environmental issues. This study was conducted to determine whether simple on-farm management practices could improve the microbiological safety of poultry litter. First, the effects of heat and moisture on the survival of Escherichia coli and Salmonella enterica serovar Typhimurium in poultry litter were investigated under laboratory conditions. Second, the persistence and regrowth of enteric bacteria were examined in poultry litter that had been aged for up to 12 wk in either a turned or static (unturned) windrow. Escherichia coli and Salmonella counts in poultry litter were reduced by >99% in 1 h at 55 or 65°C under laboratory conditions. At 35°C, both persisted longer under moist (65% wt/wt, wet basis) than dry (30% wt/wt) conditions. Poultry litter aged for 3 wk in a turned windrow, and up to 6 wk in a static windrow, supported increased E. coli densities when incubated in the laboratory at 37°C for 21 d. Peak temperatures >65°C were observed in both windrows within the first 3 wk of aging; after this point, the turned windrow was more consistently exposed to temperatures >45°C than the static windrow. By 12 wk, however, E. coli counts were very similar (3 to 3.6 log(10)) in the outside edge of both windrows. This study highlights the need for a better understanding of the interrelationship between spontaneous heating in organic waste streams, organic matter stabilization, and pathogen reduction.

Confidence Intervals for Proportions Estimated by Group Testing With Groups of Unequal Size

Group testing, in which units are pooled together and tested as a group for the presence of an attribute, has been used in many fields of study, including blood testing, plant disease assessment, fisheries, and vector transmission of viruses. When groups are of unequal size, complications arise in the derivation of confidence intervals for the proportion of units in the population with the attribute. We evaluate several asymptotic interval estimation methods for problems in which groups are of different size. Each method is examined for its theoretical properties, and adapted or developed for group testing. In an initial assessment using a study of virus prevalence in carnations, four methods are found to be satisfactory, and are considered further—two based on the distribution of the MLE, one on the score statistic, and one on the likelihood ratio. The performance of each method is then tested empirically on five realistic group testing procedures, with the evaluation focusing on the coverage probability provided by the confidence intervals. A method based on the score statistic with a correction for skewness is recommended, followed by a method in which the logit function is applied to the MLE.

Ten-year trends in the use of catheter ablation for treatment of atrial fibrillation vs. the use of coronary intervention for the treatment of ischaemic heart disease in Australia.

AIMS Percutaneous coronary intervention (PCI) and catheter ablation are well-accepted therapeutic interventions for treatment of coronary artery disease and atrial fibrillation (AF), respectively. We sought to examine temporal trends in the provision of these services over the past decade in Australia. METHODS AND RESULTS A retrospective review of the numbers of PCIs and AF ablations from 2000/01 to 2009/10 was performed on data from three sources: the Australian Institute of Health, Welfare and Aging (AIHW), Medicare Australia database (MA), and local records at a high volume tertiary referral centre (RMH) for AF ablation. Linear regression models were fitted comparing trends in population-adjusted procedural numbers over the 10-year period. There was a 5% per year population-adjusted increment in PCIs over 10 years from both the AIHW and MA sources, respectively (P < 0.001). This was similar to the growth rate of all cardiovascular procedures (AIHW: 5.1 vs. 3.8%/year, P = 0.27). Atrial fibrillation ablations showed a 30.9, 23.2, and 39.8% per year population-adjusted increment over 10 years from the AIHW, MA, and RMH sources respectively (P < 0.001 for all). Growth of AF ablations was significantly higher than PCIs (P < 0.001 for AIHW and MA sources) and all cardiovascular procedures (AIHW: 30.9 vs. 3.8%/year, P < 0.001). CONCLUSION The provision of catheter-based AF ablation services in Australia has increased exponentially over the past decade. Its annual growth rate exceeded that of PCIs and all cardiovascular procedures. Given the increasing epidemic of AF, these data have critical implications for public health policy assessing the adequacy of infrastructure, training, and funding for AF ablation services.

Effect of treatment with progesterone and oestradiol when starting treatment with an intravaginal progesterone releasing insert on ovarian follicular development and hormonal concentrations in Holstein cows.

Ovarian follicular development and concentrations of gonadotrophin and steroid hormones were studied in non-lactating Holstein cows following administration of progesterone (P(4)) or oestradiol benzoate (ODB) at the start of treatment with an intravaginal progesterone releasing insert (IVP(4)) in a 2 by 2 factorial experiment. Cows were treated at random stages of the oestrous cycle with an IVP(4) device (Day 0) and either no other treatment (n=8), 200 mg of P(4) IM (n=9), 2.0 mg of ODB IM (n=8) or both P(4) and ODB (n=9). Seven days later devices were removed and PGF(2alpha) was administered. Twenty-four hours later 1.0mg of ODB was administered IM. Oestrus was detected in 97.1% and ovulation in 64.7% (effect of treatment, P=0.41) of cows within 96 h of removing inserts. In the cows that ovulated, day of emergence of the ovulatory follicle was delayed (P<0.01) and more precise (P<0.05) in cows treated with ODB compared to the cows treated with P(4). Interval from wave emergence to ovulation and the diameter of the ovulatory follicle was less (P<0.05) in cows treated with ODB compared to cows treated with P(4). Combined treatment with P(4) and ODB at the time of starting treatment with an IVP(4) device did not significantly change the pattern of ovarian follicular development compared to treatment with ODB alone. Concentrations of LH and FSH in plasma were less in cows treated with ODB between Days 0 and 4 (P<0.05) while treatment with P(4) increased concentrations of FSH in plasma between Days 0 and 4 (P<0.05). When anovulatory cows were compared to ovulatory cows, diameters of follicles (P<0.001) and growth rate of follicles (P<0.01) were less in anovulatory cows between Days 7 and 9, while concentrations of FSH in plasma were greater (P<0.01), concentrations of LH similar (P>0.90) and concentrations of oestradiol were less (P=0.01) in the anovulatory cows between Days 4 and 10. Our findings support a hypothesis that ovarian follicular development following administration of P(4) or ODB at the start of treatment with an IVP(4) device differs. Anovulatory oestrus may have been associated with reduced maturity and/or later emergence of ovarian follicles.

Accounting for Cluster Sampling in Constructing Enumerative Sequential Sampling Plans

Abstract Green’s sequential sampling plan is widely used in applied entomology. Green’s equation can be used to construct sampling stop charts, and a crop can then be surveyed using a simple random sampling (SRS) approach. In practice, however, crops are rarely surveyed according to SRS. Rather, some type of hierarchical design is usually used, such as cluster sampling, where sampling units form distinct groups. This article explains how to make adjustments to sampling plans that intend to use cluster sampling, a commonly used hierarchical design, rather than SRS. The methodologies are illustrated using diamondback moth, Plutella xylostella (L.), a pest of Brassica crops, as an example.

Ovarian follicular development in Holstein cows following synchronisation of oestrus with oestradiol benzoate and an intravaginal progesterone releasing insert for 5-9 days and duration of the oestrous cycle and concentrations of progesterone following ovulation

The aim of this study was to determine if the duration of treatment with an intravaginal progesterone releasing insert (IVP(4)) after treatment with oestradiol benzoate (ODB) at the time of insertion and 24 h after removal would affect selected variables including: size of ovarian follicles at the time of removal of inserts, diameter of ovulatory follicles, plasma concentrations of progesterone following ovulation, and duration of the following oestrous cycle. Characteristics of oestrus at a synchronised and spontaneous oestrus were also monitored. Non-lactating Holstein cows were synchronised with an IVP(4) for 5 (n = 10), 7 (n = 10), 8 (n = 9) or 9 (n = 9) days together with injections of ODB at device insertion (2 mg) and 24 h after removal (1 mg). Ultrasonography showed no significant effect of treatment on the day of emergence of preovulatory follicles relative to the day of removal of inserts (overall mean = -4.22 +/- 0.58; P = 0.15) for cows that ovulated within 120 h insert removal (n = 36). Treatment with ODB and an IVP(4) for 5 days reduced the diameter of preovulatory follicles at the time of removal of inserts and for the following 2 days compared to cows treated for 7-9 days (mean difference 2.56 +/- 1.15 mm; P = 0.033) but did not reduce the diameter of the ovulatory follicle (P = 0.21). Day of emergence relative to removal of inserts was associated with the diameter of the ovulatory follicle (R2 = 0.69; P < 0.001). Concentrations of progesterone and the diameter of the corpus luteum following ovulation were not affected by treatment (P > 0.20), but were affected by the diameter of the ovulatory follicle (P < 0.01). Diameter of the ovulatory follicle did not affect interoestrous and interovulatory intervals (P > 0.40). We conclude that treatment with an IVP(4) for 5 compared to 7-9 days with ODB administered at device insertion, and 24 h after removal reduced the diameter of preovulatory follicles at the time of removal of the insert but did not reduce the diameter of the ovulatory follicle or concentrations of progesterone in plasma. Emergence of preovulatory follicles closer to the time of removal of inserts reduced the diameter of the ovulatory follicle when oestrus was induced with ODB. Ovulation of smaller follicles reduced concentrations of progesterone in plasma following ovulation but did not affect oestrous cycle duration.

The incidence of chrysanthemum stunt viroid, chrysanthemum B carlavirus, tomato aspermy cucumovirus and tomato spotted wilt tospovirus in Australian chrysanthemum crops

A sequential batch testing procedure was used in conjunction with ELISA or cDNA probes to estimate the incidence of chrysanthemum stunt viroid (CSVd), chrysanthemum carlavirus B (CVB), tomato aspermy cucumovirus (TAV) and tomato spotted wilt tospovirus (TSWV) in chrysanthemum (Dendranthema grandiflora) crops in Australia. A total of 2480 samples of potted, field-grown and greenhouse-grown chrysanthemums was tested from six Australian States. All four of these pathogens were detected. CVB (39.2%) and TAV (6.7%) were the most prevalent, CSVd (0.7%) was detected only in greenhouse chrysanthemums from Queensland, and TSWV (1.4%) was detected only in field-grown chrysanthemums from Western Australia.