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Background Cardiac syncope occurs when the heart fails to maintain cardiac output to match cerebral need and can occur due to either mechanical/structural defect of the heart or secondary to an arrhythmia. It has a raised 1-year mortality with some figures estimating this as high as 30%. Implantable loop recorders (ILR) are a useful diagnostic tool in patients presenting with syncope or pre-syncope to ascertain a cardiac cause. A higher number of patients are presenting with advancing age and undergoing ILR implantation. Subsequently, they end up requiring a cardiac implantable electronic device (CIED) implantation, adding to additional costs, exposure to procedural complications and frequent hospitalisations. Purpose To investigate the number of patients undergoing CIED implantation following implantation of ILRs for syncope and identify predictors of CIED implantation in patients presenting with syncope. Methods A retrospective analysis of 736 patients who underwent ILR implantation at our teaching hospital trust between November 2012 to October 2020. Data on demographics, clinical characteristics, pathology results, ECGs, holter findings and CIED implanted was collected using the local electronic patient record system. The data was analysed using SPSS software. Univariable and multivariable regression analysis and ROC curve analysis was carried out to determine prediction model for CIED implantation. Results The mean age of patients who underwent an ILR implantation was 65±19 years. 22% of patients required CIED implantation, 68% of patients did not require a cardiac device and were safely discharged and 10% of patients died during follow up. Age (p Conclusions Old age, presence of coronary artery disease, impaired left ventricular function and presence of hypertension are inter-linked and in our study were found to be key predictors of poor prognosis and thus requiring CIED implantation. We propose a scoring system based on age >75, male sex, presence of ischaemic heart disease, heart failure and hypertension as key markers of conduction abnormalities requiring CIED implantation (see fi−ure 1). Funding Acknowledgement Type of funding sources: None.

Background The incidence of bailout stenting post-drug coated balloon use (DCB) in the literature has been more than 10%; ranging up-to 21% in Bello trial and this variation could be due to the different criteria used to consider bailout stenting and may also reflect aggressive pre-dilatation. Our eyes are trained to expect stent like result and anything less is considered sub-optimal and this could be one of the reasons for high incidence of bailout stenting. The current recommendation is to use drug eluting stent (DES) for bailout stenting and hence raising in the possibility of drug toxicity or maybe even synergistic effect from combination of Paclitaxel (DCB) and limus (DES). Aim We have evaluated the incidence and outcomes of patients needing bailout stenting in our centre. Methods and results We evaluated all patients who were treated with DCB between January 2016-August 2017. Bailout stenting per lesion were identified and studied for endpoints which included cardiac death, target vessel MI, stent thrombosis, target lesion revascularization and target vessel revascularisation. Between the study period; 468 lesions (in 364 patients) were treated with paclitaxel DCB (Sequent Please, B Braun, Germany). Bailout stenting was required in 23 lesions (4.9%) and of which 12 (52%) was for flow limiting dissections (type C or more) and the remaining 11 was for recoil of more than 50%. Majority of the lesions were de novo (18; 78%). All bailout stenting was performed with third generation limus eluting stents. During a median follow-up of 18.14 months; range; 7–33 months, there was no cardiac death and target vessel MI occurred in 1 patient (4.3%), TLR and TVR were in 3 lesions (13%). MACE rate (combination of cardiac death, target vessel MI and TVR) was 13%. There were no cases of stent thrombosis as per the ARC definition. Conclusion One of the highlighting features of our study is very low-rates of bailout stenting. This may be due to our criteria of not stenting mild dissections (unless they are flow limiting) and also to accepting recoil of up-to 50% post-DCB use. The outcome in bailout stenting group is acceptable especially with hard endpoints (cardiac death, target vessel MI and stent thrombosis) although TLR and TVR rates were higher indicating synergistic effect of paclitaxel and limus may not offer additional benefits.

When there is more than one possible intervention, clinicians have to decide which intervention to offer first. This paper hypothesises that where there is more than one intervention for which the evidence indicates there is similar effectiveness that selecting the intervention with the lowest credibility first may lead to optimal long-term results.

Item does not contain fulltext BACKGROUND: The effect of intensified platelet inhibition for patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization has not been delineated. METHODS: In this double-blind, randomized trial, in a primary analysis involving 7243 patients under the age of 75 years receiving aspirin, we evaluated up to 30 months of treatment with prasugrel (10 mg daily) versus clopidogrel (75 mg daily). In a secondary analysis involving 2083 patients 75 years of age or older, we evaluated 5 mg of prasugrel versus 75 mg of clopidogrel. RESULTS: At a median follow-up of 17 months, the primary end point of death from cardiovascular causes, myocardial infarction, or stroke among patients under the age of 75 years occurred in 13.9% of the prasugrel group and 16.0% of the clopidogrel group (hazard ratio in the prasugrel group, 0.91; 95% confidence interval [CI], 0.79 to 1.05; P=0.21). Similar results were observed in the overall population. The prespecified analysis of multiple recurrent ischemic events (all components of the primary end point) suggested a lower risk for prasugrel among patients under the age of 75 years (hazard ratio, 0.85; 95% CI, 0.72 to 1.00; P=0.04). Rates of severe and intracranial bleeding were similar in the two groups in all age groups. There was no significant between-group difference in the frequency of nonhemorrhagic serious adverse events, except for a higher frequency of heart failure in the clopidogrel group. CONCLUSIONS: Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

Background: Stroke occurs in about 20% of patients with IE. In previous studies we showed that cardiac surgery (CS) during acute episode of IE decreases intrahospital mortality in patients complicated with stroke. Outcome related to the timing of surgery was not evaluated. The aim was to assess the influence of the timing of cardiac surgery (CS) on patients’ outcome in patients with IE complicated with stroke. Methods and results: From January 1, 2000 and August 31 2005, 2760 cases of definite IE were included by 61 centers in 28 countries. Each center utilized a standard case report form. Stroke was characterized as ischemic or hemorrhagic using neuroimaging results. Early surgery was defined as CS performed within two weeks from stroke, and late surgery if performed more than two weeks from the date of stroke. This study included only patients with known date of stroke and date of cardiac surgery. The primary outcome was intrahospital mortality. There were 34 patients with hemorrhagic stroke and performed CS and 100 patients with ischemic stroke and performed CS. In the group of patients with hemorrhagic stroke and late CS 3 of 22 patients died vs four of 12 patients in early CS group (p=0.175). In the group of patients with ischemic stroke and late performed CS 4 of 45 patients died vs 13 of 54 in early CS group (p=0.046). Overall, late CS was associated with improved outcome. Intrahospital mortality in late CS was significantly lower than in early CS group (10.4% vs 25.7 ; p=0.038). Chances for survival were almost three times higher if surgery was performed more than two weeks from stroke (OR 2.97, 95%CI 1.05– 8.67). Conclusions: Cardiac surgery during acute episode of IE significantly improves survival in patients complicated with stroke. Late cardiac surgery (more than two weeks after stroke) is associated with better outcome.

Detailed measurements of herbage accumulation were made on a ‘Grasslands Nui’ perennial ryegrass (Lolium perenne)-dominant, ‘Grasslands Huia’ white clover (Trifolium repens) pasture under 4 late spring grazing intensities, based on residual leaf area index (LAI), and 2 grazing frequencies based on light interception. Lax grazing during late spring (residual LAI 0.9–3.0) resulted in rank stalky herbage, whereas hard grazing (residual LAI 0.1–0.9) resulted in more leafy herbage and higher ryegrass tiller density. For the 46 weeks of the experiment, 16.5 and 14.61 DM/ha accumulated with hard and lax spring grazing respectively. During autumn, delaying grazing until 2 weeks after 95% light interception markedly increased green herbage accumulation compared with grazing at 95% light interception, without significantly reducing ryegrass tiller density or white clover content. It is concluded that in spring, in contrast to other seasons, management of ryegrass-dominant pasture to control reproductive de...

This survey was carried out to obtain information on seed establishment practices of dairy and sheep farmers of the central districts of New Zealand, from South Auckland to Canterbury. Sheep and dairy farmers in different regions did not differ significantly in their pasture establishment practices. Many sowed pasture seed every year, and old pastures were renovated rather than new land developed. Most either broadcast or drilled their seeds; a small proportion of farmers used both methods. An increase in drilling is anticipated. Farmers used, or intend using, simple pasture mixtures containing 2–4 grass species. Single pasture species have been, and will be used either for renovating old pastures, establishing special purpose leys, or for seed production. Ryegrass was the most popular grass species and ‘Grasslands Nui’ the most widely used cultivar. Farmers generally sowed their pastures in autumn, irrespective of region. They relied on their experience to select pasture species, and the seeds w...

Nitrogen at 0, 84, 168, 336, and 672 kg/ha was applied as liquid urea to a commercial maize cultivar (PX610) over three different growth stages. Plants were grown at a population of 96 900/ha and received continual trickle irrigation. Response was measured in terms of dry matter and nitrogen yields of the whole plant, leaf laminae, stem, cob, grain, husk, and roots. Overall yields of grain (11 000–14000 kg/ha) and total plant dry matter (24 000–29 000 kg/ha) at physiological maturity were high, but dry weight responses to different levels of nitrogen and times of application were not significant. Nitrogen content of the whole plant increased significantly with increasing nitrogen application rate. Dry matter and nitrogen concentration in the plant components changed in relation to changes in source-sink patterns as reproductive development began. Plants receiving 0 and 84 kg fertiliser N/ha showed classical nitrogen deficiency symptoms from late vegetative growth to maturity, but were the most ef...

Reproductive development, tillering, and herbage production were studied in mixed pastures containing ‘Grasslands Nui’ perennial ryegrass (Lolium perenne L.) and ‘Grasslands Huia’ white clover (Trifolium repens L.), which were rotationally grazed by sheep. The effects of interruption of ryegrass reproductive development during early culm elongation (TI) or 30% inflorescence emergence (T2), by either hard grazings (H; residual leaf area index (LAI) 0–0.7) or lax grazings (L; residual LAI 0.8–2.2) were compared. These grazing intensity treatments were continued until mid summer; and in late summer and autumn all pastures received the same grazing management. Culm elongation in an initial group of reproductive tillers, 2400/m2, started in October, and 30% inflorescence emergence occurred in mid November. During November and December a further 1000/m2 secondary reproductive tillers appeared. Few new reproductive tillers appeared after December. Vegetative ryegrass tiller density declined markedly dur...

The effect of sheep grazing on ryegrass aerial tiller development in mixed perennial ryegrass — white clover swards was studied in two experiments. Aerial tiller numbers were increased by lax grazing and reduced by hard grazing. Later interruption of reproductive development encouraged aerial tiller development. Aerial tillers made a minor contribution to herbage production and ryegrass tiller populations. It was concluded that aerial tillering contributed little to ryegrass persistence in mixed swards under the grazing systems used in this experiment, but that under different grazing or climatic conditions they could be more important.

An irrigated ‘Grasslands Nui’ perennial ryegrass (Lolium perenne L.) sward was mown during reproductive growth and subsequent vegetative summer growth using 6 cutting treatments. The treatments included combinations of stages of interruption of reproductive development and regrowth intervals. Tagged ryegrass tillers were used to measure tillering, tiller longevity, and tiller weight at different ages. Periods of rapid tillering in spring before culm elongation started, and after interruption of reproductive growth were observed. Interruption of reproductive development at inflorescence emergence increased tillering in the second period compared with other treatments. Later interruption of reproductive development reduced the number of pre-flowering tillers surviving into summer. Longevity of tillers tagged at the start of the experiment was greatest with early interruption of reproductive growth followed by infrequent cutting. Youngest tillers were smallest, and new tillers took 60–100 days after...

This paper considers the sequence of seed development by measurement and observation of ehanges in seed moisture content, weight, colour, endosperm consistency, germination capacity and yield in perennial ryegrass Grasslands Ruanui, timothy Grasslands Kahu and a New Zealand strain of prairie grass (Bromus unioloides). Seed moisture content was high (60–70%) after anthesis and declined at different rates, depending on the species and the weather. Maximum seed dry weight (maturity) was reached approximately 30 days after peak anthesis in all species and was influenced by N application and grazing. Colour changes in the seedhead and endosperm solidification proved unsatisfactory as measures of maturity. Endosperm solidification was reached 4, 11 and 12 days before maximum seed dry weight in ryegrass, timothy and prairie grass, respectively. Seeds removed from the plant as little as 7, 10 and 4 days after anthesis in ryegrass, timothy, and prairie grass, respectively, germinated, provided that dormancy was broken; but they did not retain viability after 3 months storage. Maximum viability of ryegrass, timothy and prairie grass seed tested immediately after harvest occurred 30, 38 and 16 days after anthesis, compared with 17, 35 and 12 days, respeetively, when germination testing was delayed for 3 months. In ryegrass, grazing caused a significant increase in seed yield in the second year while N application alone did not significantly increase yield. In timothy, grazing and to a lesser extent N, were both detrimental to seed yield in the second year. Highest yields were obtained in treatments not receiving either grazing or N. In prairie grass, grazing depressed and N application increased yields in both years. In all species similar or increased yield could be obtained by mowing the crop at, or slightly prior to, seed maturity and allowing seed development and ripening to continue on the cut straw for up to 10 days. Using this technique higher seed yields were obtained in ryegrass and timothy than when seed was direct-harvested. In prairie grass similar yields were obtained whether the erop was direct-harvested or threshed following drying in the swath for 10 days. The use of ‘drying curves’ for the prediction of correct cutting time of seed crops is suggested for ryegrass, timothy and prairie grass.

Measurements were made of the influence of season and stocking rate on herbage mass, composition, and organic matter digestibility (OMD) and on the composition and OMD of the diet selected by grazing hoggets. A stocking rate of 36 hoggets per ha reduced the amount of stem and dead matter and increased the OMD of herbage on offer compared to 24 hoggets per ha. Herbage OMD declined from 60.7% to 54.7% over summer and increased from 56.7% to 72.1% in autumn. Herbage composition changes during 3-day grazing periods showed reductions of OMD, green leaf, ryegrass, and weeds, and increases in the proportion of dead matter. Diet samples from oesophageal fistulated sheep showed the selection of green leaf and the rejection of dead matter. Dead matter content of the diet was positively correlated with percentage composition of dead matter in the sward, and negatively correlated with the amount and percentage green leaf on offer. Diet OMD was positively correlated with percentage green leaf on offer and per...

The pattern of nitrogen distribution in field grown Lupinus albus, L. luteus, Pisum sativum, and Vicia faba which were sown in August or October, was measured. Although rates of N accumulation were similar, the start and duration of the rapid N accumulation phase differed between species. L. albus had the longest accumulation phase, which contributed to its superior seed protein yield. The data suggest that, in the field, timing of the initiation of the ‘self destruction‘ cycle in grain legumes is an important determinant of seed protein yield and can be initiated by the effects of water stress. The exception to this was P. sativum in which, at the early sowing, self shading may have been an important factor. It was concluded that early sowing was important to ensure maximum N accumulation and seed protein yield. Relatively small extension to the growth period by irrigation or reliable summer rain should achieve significant increases in seed protein yield.

It was found that in terms of the relationship between capacitance and yield of pasture as measured by a modified electronic probe and by cutting, respectively, that: differences existed between the types of pastures studied; dry-matter estimation was inferior to either the fresh-material or the ‘total–water’ yield estimation; the degree of curvilinearity of the fresh-material regression was not constant; the presence of dew on the plants resulted in a small increase hi capacitance reading. The possible significance of these results is discussed.

1. In a grazing trial with sheep, cocksfoot, ryegrass and tall fescue were grown with and without white clover, under ‘short’ and ‘long’ management systems, and also white clover.2. Live weights were recorded every 2-3 weeks, and wool production was estimated by clipping midside patches every month.3. Sheep on grass plus clover plots were significantly superior to sheep on grass plots in terms of live-weight gain, final live weight and clean-wool production.4. Sheep on ‘long’ pastures were significantly heavier than sheep on ‘short’ pastures for a month in the early part of the trial. Thereafter, differences in live weight were not significant.

1. In a grazing experiment with sheep, cocksfoot, rye-grass and tall fescue were grown with and without white clover, under ‘short’ and ‘long’ management systems.2. One sheep on each plot was fitted with an oesophageal fistula, from which herbage samples were collected at fortnightly intervals. The botanical composition of samples from the mixed swards was estimated by an optical point quadrat method. Samples were analysed for crude protein and cellulose, and digestibility was estimated in vitro.3. Treatment difference within the mixed swards were not significant in terms of botanical composition. The mean proportions selected were 73% grass, 9% clover and 18% dead matter. The proportion of clover selected did not differ significantly between sample collections.

A study was made to determine the effects of grazing to a height of 1 in. when the swards reached heights of 3 and 9 in. on the dry matter production, LAI, tillering and rate of leaf production of new and old tillers in the spring–summer and autumn–winter seasons of 3 pasture species growing in association with white and red clovers. In both seasons the herbage yield under 9–1 management was higher than that under 3–1 and was significantly greater in the spring-summer season. Differences in DM production between cocksfoot, tall fescue and Ariki ryegrass failed to reach significance. Light utilization under the 2 management systems was considered to be inefficient. In the autumn-winter period there was a linear relationship between the LAI and DM production in all treatments. The rate of leaf production per tiller was significantly higher in cocksfoot than in ryegrass and tall fescue in both seasons. New tillers had a significantly higher rate of leaf production than old tillers in the spring-summer period, but not in autumn-winter. The numbers of grass tillers and rooted nodes of clover were significantly higher under 3–1 than under 9–1 and were influenced by season.

1. The rate of clean wool production, carcass apparisal and reticulo-ruminal development of grazing sheep were used to evaluate differences in pasture quality. Perennial ryegrass, cocksfoot and tall fescue pastures were assessed as pure stands and also white clover.

1. An experiment was conducted in which lambs grazed on pastures of cocksfoot, ryegrass and tall fescue grown with and without white clover, as well as on pastures of pure white clover.

A study was made of the effects of gangmowing, grazing, and combinations of the two on the productivity, botanical composition, nitrogen status, and animal consumption of a pasture, and on the earthworm population under the pasture. Gangmowing increased pasture production, particularly in the summer, by encouraging greater clover growth. The nitrogen contents of both grass and clover were also increased. Grazing plus gangmowing resulted in greater pasture consumption than from grazing alone. Numbers and weights of earthworms under the gangmown pastures were much higher than under the pasture only grazed.

The eifect of 1 ft-diameter (0.30 m) dung patches on the yield and botanical composition of a dairy pasture was followed in two randomized-block experiments. Experimental plots consisted of 3 concentric rings round each dung patch of diameter 2 ft (0.61 m), called R2; 3 ft (0.91 m), called R3; and 4 ft (1.22 m), called R4. They were sequentially harvested. In the first experiment described there was a significant increase in the total yield of grass species, predominantly ryegrasses, around each dung patch. This increase was first evident in R2 but spread progressively outward and was still detectable in R4. Plant material, particularly clover components, decayed rapidly beneath the dung patches. Leaving a dung patch on the pasture for 15 days kiUed 75% of the grass tillers and the rooted nodes of clover stolons; thus causing a significant reduction in pasture regrowth from the patch area when the dung patch was removed. The second experiment included three defoliation treatments, viz. 1. Cut regularly to 1 in. (2.54 cm) in all three rings; 2. Cut to 21/2 in. (6.35 cm) in R2 and 1 in. (2.54 cm) in R3 and R4; 3. Control undefoliated. In all three treatments there was a significant increase throughout the experiment in total yield of grasses around the dung patchy. The increase was confined to R2, but was still evident after 14 weeks. The greatest cumulative yield during tbe period of the experiment came from around the dung patches receiving the most intensively defoliated treatment.

The botanical and chemical composition of herbage collected from sheep fitted with oesophageal fistulae was compared with the composition of herbage offered and rejected in pen feeding trials. The sampling variance of macerated botanical samples compared favourably with expected values from a binomial distribution. High correlations were obtained between actual and calculated values for soluble carbohydrates, crude protein and cellulose in fistula samples.

The results of experiments undertaken in England and New Zealand are reported. Under highly productive pasture a significant correlation was found between pasture production and earthworm numbers and weights. This relationship was not evident until the pastures were more than 3 years old. On pastures of similar total dry-matter production there was a significant correlation between yield of clover and numbers and weights of earthworms. The return of dung by the grazing animal increased earthworm numbers and weights, and the application of nitrogenous fertilizer had a similar but less marked effect. The earthworm population was not demonstrably related to the macro-organic-maller content of the pastures. The grazing of grass-clover pastures was not essential for an increase in earthworm populations to occur. Allolohophora species (mainly A. caliginosa) were dominant under pure grass swards, whereas Lumhricus species (mainly L. rubellus) were dominant under grass/clover swards.

An instrument for estimating pasture yield electronically was constructed. It was a modification of that described by Campbell et al (1). A transistorized crystal oscillator was incorporated to provide a highly stable frequency standard for use in the field. This provided a zero reference point for both the measuring head oscillator and the reading oscillator before and during use. The instrument is fully described and details are given of its field adjustment and operation.