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Atrial fibrillation (AF) is a common arrhythmia in adults associated with thromboembolic complications. External electrical cardioversion (DCCV) is a safe procedure used to convert AF to normal sinus rhythm. We sought to study factors that affect utilization of DCCV in hospitalized patients with AF. The study sample was drawn from the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project in the United States. Patients with a primary discharge diagnosis of AF that received DCCV during hospitalization in the years 2000–2010 were included. An estimated 2,810,530 patients with a primary diagnosis of AF were hospitalized between 2001 and 2010, of which 1,19,840 (4.26%) received DCCV. The likelihood of receiving DCCV was higher in patients who were males, whites, privately insured, and aged < 40 years and those with fewer comorbid conditions. Higher CHADS2 score was found to have an inverse association with DCCV use. In-hospital stroke, in-hospital mortality, length of stay, and cost for hospitalization were significantly lower for patients undergoing DCCV during AF related hospitalization. Further research is required to study the contribution of other disease and patient related factors affecting the use of this procedure as well as postprocedure outcomes.

The Biomass Burning and Lightning Experiment phase C (BIBLE-C) aircraft mission was carried out near Darwin, Australia (12°S, 131°E) in December 2000. This was the first aircraft experiment designed to estimate lightning NO production rates in the tropics, where production is considered to be most intense. During the two flights (flights 10 and 13 made on December 9 and 11-12, respectively) enhancements of NOx (NO + NO2) up to 1000 and 1600 parts per trillion by volume (pptv, 10-s data) were observed at altitudes between 11.5 and 14 km. The Geostationary Meteorological Satellite (GMS) cloud (brightness temperature) data and ground-based lightning measurements by the Global Positioning and Tracking System (GPATS) indicate that there were intensive lightning events over the coast of the Gulf of Carpentaria, which took place upstream from our measurement area 10 to 14 h prior to the measurements. For these two flights, air in which NOx exceeded 100 pptv extended over 620 × 140 and 400 × 170 km2 (wind direction x perpendicular direction), respectively, suggesting a significant impact of lightning NO production on NOx levels in the tropics. We estimate the amount of NOx observed between 11.5 and 14 km produced by the thunderstorms to be 3.3 and 1.8 × 1025 NO molecules for flights 10 and 13, respectively. By using the GPATS lightning flash count data, column NO production rates are estimated to be 1.9-4.4 and 21-49 × 1025 NO molecules per single flash for these two flight data sets. In these estimations, it is assumed that the column NO production between 0 and 16 km is greater than the observed values between 11.5 and 14 km by a factor of 3.2, which is derived using results reported by Pickering et al. (1998). There are however large uncertainties in the GPATS lightning data in this study and care must be made when the production rates are referred. Uncertainties in these estimates are discussed. The impact on the ozone production rate is also described. Copyright 2007 by the American Geophysical Union.

The Biomass Burning and Lightning Experiment phase A (BIBLE-A) aircraft observation campaign was conducted from 24 September to 10 October 1998, during a La Niña period. During this campaign, distributions of ozone and its precursors (NO, CO, and nonmethane hydrocarbons (NMHCs)) were observed over the tropical Pacific Ocean, Indonesia, and northern Australia. Mixing ratios of ozone and its precursors were very low at altitudes between 0 and 13.5 km over the tropical Pacific Ocean. The mixing ratios of ozone precursors above 8 km over Indonesia were often significantly higher than those over the tropical Pacific Ocean, even though the prevailing easterlies carried the air from the tropical Pacific Ocean to over Indonesia within several days. For example, median NO and CO mixing ratios in the upper troposphere were 12 parts per trillion (pptv) and 72 parts per billion (ppbv) over the tropical Pacific Ocean and were 83 pptv and 85 ppbv over western Indonesia, respectively. Meteorological analyses and high ethene (C2H4) mixing ratios indicate that the increase of the ozone precursors was caused by active convection over Indonesia through upward transport of polluted air, mixing, and lightning all within the few days prior to observation. Sources of ozone precursors are discussed by comparing correlations of some NMHCs and CH3Cl concentrations with CO between the lower and upper troposphere. Biomass burning in Indonesia was nearly inactive during BIBLE-A and was not a dominant source of the ozone precursors, but urban pollution and lightning contributed importantly to their increases. The increase in ozone precursors raised net ozone production rates over western Indonesia in the upper troposphere, as shown by a photochemical model calculation. However, the ozone mixing ratio (∼20 ppbv) did not increase significantly over Indonesia because photochemical production of ozone did not have sufficient time since the augmentation of ozone precursors. Backward trajectories show that many air masses sampled over the ocean south of Indonesia and over northern Australia passed over western Indonesia 4-9 days prior to being measured. In these air masses the mixing ratios of ozone precursors, except for short-lived species, were similar to those over western Indonesia. In contrast, the ozone mixing ratio was higher by about 10 ppbv than that over Indonesia, indicating that photochemical production of ozone occurred during transport from Indonesia. The average rate of ozone increase (1.8 ppbv/d during this transport is similar to the net ozone formation rate calculated by the photochemical model. This study shows that active convection over Indonesia carried polluted air upward from the surface and had a discernable influence on the distribution of ozone in the upper troposphere over the Indian Ocean, northern Australia, and the south subtropical Pacific Ocean, combined with NO production by lightning.

BACKGROUND/OBJECTIVES: There have been few studies on the association of fruit and vegetable (FV) intake with cardiovascular disease (CVD) risk in Asian populations where both dietary habits and disease structure are different from western countries. No study in Asia has found its significant association with stroke. We examined associations of FV intake with mortality risk from total CVD, stroke and coronary heart diseases (CHDs) in a representative Japanese sample. METHODS: A total of 9112 participants aged from 24-year follow-up data in the NIPPON DATA80, of which baseline data were obtained in the National Nutrition Survey Japan in 1980, were studied. Dietary data were obtained from 3-day weighing dietary records. Participants were divided into sex-specific quartiles of energy adjusted intake of FV. Multivariate-adjusted hazard ratios (HRs) were calculated between strata of the total of FV intake, fruit intake and vegetable intake. The adjustment included age, sex, smoking, drinking habit and energy adjusted intakes of sodium and some other food groups. RESULTS: Participants with higher FV intake were older, ate more fish, milk and dairy products and soybeans and legumes and ate less meat. Multivariate-adjusted HR (95% confidence interval;P; P for trend) for the highest versus the lowest quartile of the total of FV intake was 0.74 (0.61-0.91;0.004;0.003) for total CVD, 0.80 (0.59-1.09;0.105;0.036) for stroke and 0.57 (0.37-0.87;0.010;0.109) for CHD. CONCLUSIONS: The results showed that higher total intake of FVs was significantly associated with reduced risk of CVD mortality in Japan. European Journal of Clinical Nutrition (2015) 69, 482-488; doi: 10.1038/ejcn.2014.276; published online 14 January 2015, INTRODUCTION Cardiovascular diseases (CVDs) are among the leading causes of death in most developed countries. (1-3) An increasing number of cohort studies, many of them from western countries, have reported [...]

Oral leukoplakia is a widely known white oral mucosal lesion which is encountered by dental practitioners specially by oral and maxillofacial surgeons in daily practice. The objective of this article is to update the reader on the concept of treatment algorithm for the management of leukoplakia. Articles were searched through PubMed, Google Scholar and the Cochrane Library (2017 to 2021), confining search to English language with the key words e.g., leukoplakia, white patch, precancerous lesion, premalignant lesion and oral potentially malignant disorders. After initial collection of abstracts of 78 articles, finally 24 papers have been selected for writing up the paper updating on clinico-pathologic characters, diagnosis, evaluation, risk of malignant transformation, management and prognosis of oral leukoplakia. Oral leukoplakia is a common oral potentially malignant disorder. Early diagnosis and screening for oral cancer can potentially subside the mortality and morbidity of disease. Incisional biopsy is mandatory for diagnosis, treatment planning and for checking the prognosis of the lesion. There are no universal modalities on the most appropriate treatment, and despite the treatment disease can recur and undergo malignant transformation in patients. For high-risk lesions, complete excision is recommended and clinician should closely follow up these patients for life. For low-risk lesions and successfully treated cases, routine check-up is recommended by dental practitioners. Health education, counselling the individual, and behavioral therapies are most essential methods of prevention at a primary level by every health care provider. [ABSTRACT FROM AUTHOR]

Fear is expressed as an unpleasant emotion caused by threat of danger, pain and harm. Anxiety is an emotional state of a person such as doubt, mental-conflict, and disappointment. Phobia is persistent, unrealistic and intense fear of a specific stimulus, leading to absolute avoidance of the perceived danger. Corah's Dental Anxiety Scale (CDAS), Modified Dental Anxiety Scale (MDAS), and Dental Fear Survey (DFS) are the tools to assess fear and anxiety. Dental fear and anxiety can be managed by change in dental set up and office environment, improving communication skill of practitioner and trust building among patients. Other approaches like behaviour-management techniques e.g., technique of relaxation, attention distraction, hypnotherapy, positive reinforcement, systematic desensitization and pharmacological management e.g., general anaesthesia and conscious sedation are also used to prevent and treat dental fear and anxiety in dental practice. [ABSTRACT FROM AUTHOR]