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The History, Electrocardiogram (ECG), Age, Risk Factors, and Troponin (HEART) score is a decision aid designed to risk stratify emergency department (ED) patients with acute chest pain. It has been validated for ED use, but it has yet to be evaluated in a prehospital setting.
A prehospital modified HEART score can predict major adverse cardiac events (MACE) among undifferentiated chest pain patients transported to the ED.
A retrospective cohort study of patients with chest pain transported by two county-based Emergency Medical Service (EMS) agencies to a tertiary care center was conducted. Adults without ST-elevation myocardial infarction (STEMI) were included. Inter-facility transfers and those without a prehospital 12-lead ECG or an ED troponin measurement were excluded. Modified HEART scores were calculated by study investigators using a standardized data collection tool for each patient. All MACE (death, myocardial infarction [MI], or coronary revascularization) were determined by record review at 30 days. The sensitivity and negative predictive values (NPVs) for MACE at 30 days were calculated.
Over the study period, 794 patients met inclusion criteria. A MACE at 30 days was present in 10.7% (85/794) of patients with 12 deaths (1.5%), 66 MIs (8.3%), and 12 coronary revascularizations without MI (1.5%). The modified HEART score identified 33.2% (264/794) of patients as low risk. Among low-risk patients, 1.9% (5/264) had MACE (two MIs and three revascularizations without MI). The sensitivity and NPV for 30-day MACE was 94.1% (95% CI, 86.8-98.1) and 98.1% (95% CI, 95.6-99.4), respectively.
Prehospital modified HEART scores have a high NPV for MACE at 30 days. A study in which prehospital providers prospectively apply this decision aid is warranted.
With the rise of ultranationalist organizations throughout Europe, the issue of attitudes and orientations held toward designated "out-groups" has become a critical concern of anxious observers. In Russia the strength registered by Vladimir Zhirinovskii's ultranationalist Liberal Democratic Party during the parliamentary elections of 1993 has been interpreted as a sign of intolerance among the Russian populace. In fact, the success of candidates associated with the Liberal Democratic Party was not only based upon appeals to strengthen the Russian nation against perceived enemies, but also upon promises of a return to price stability and upon Zhirinovskii's anti-establishment, populist program. Nonetheless, Zhirinovskii's success in the 1991 presidential elections (he attracted 7.8% of the electorate) does serve to reaffirm the importance of tracking how attitudes toward groups that have often been targeted as scapegoats in times of social or economic upheaval have evolved in the late Soviet and immediate post-Soviet period. Two major questions concern us here: first, how pervasive among Russians and Ukrainians are perceptions of significant "social distance" between themselves and designated out-groups, most notably the Jewish population; and second, to what extent do these perceptions of distance form part of a cohesive ideology of ultranationalism? Understanding the basis of sentiments toward Jewish populations is particularly important for interpreting the workings of the complex mosaic of the post-Soviet political culture.
Brym and Degtyarev argue that in the "volatile" post-Soviet context, the potential for anti-Semitism is high. On the basis of responses drawn from 988 interviews conducted in Moscow in 1992 they conclude that the number of anti-Semites in Moscow is much higher than in the United States or Canada, and they also conclude that anti-Semitic orientations are part of a broader authoritarian, xenophobic and illiberal set of attitudes.
Approximately half of the variation in wellbeing measures overlaps with variation in personality traits. Studies of non-human primate pedigrees and human twins suggest that this is due to common genetic influences. We tested whether personality polygenic scores for the NEO Five-Factor Inventory (NEO-FFI) domains and for item response theory (IRT) derived extraversion and neuroticism scores predict variance in wellbeing measures. Polygenic scores were based on published genome-wide association (GWA) results in over 17,000 individuals for the NEO-FFI and in over 63,000 for the IRT extraversion and neuroticism traits. The NEO-FFI polygenic scores were used to predict life satisfaction in 7 cohorts, positive affect in 12 cohorts, and general wellbeing in 1 cohort (maximal N = 46,508). Meta-analysis of these results showed no significant association between NEO-FFI personality polygenic scores and the wellbeing measures. IRT extraversion and neuroticism polygenic scores were used to predict life satisfaction and positive affect in almost 37,000 individuals from UK Biobank. Significant positive associations (effect sizes <0.05%) were observed between the extraversion polygenic score and wellbeing measures, and a negative association was observed between the polygenic neuroticism score and life satisfaction. Furthermore, using GWA data, genetic correlations of -0.49 and -0.55 were estimated between neuroticism with life satisfaction and positive affect, respectively. The moderate genetic correlation between neuroticism and wellbeing is in line with twin research showing that genetic influences on wellbeing are also shared with other independent personality domains.
Are national legal cultures in Europe converging or diverging as a result of the pressures of European legal integration? Åse B. Grødeland and William L. Miller address this question by exploring the attitudes and perceptions of the general public and law professionals in five European countries: England, Norway, Bulgaria, Poland and the Ukraine. Presenting new findings, they challenge the established view that ordinary citizens and people working professionally with the law have different legal cultures. Their research in fact reveals that the attitudes of citizens in Eastern and Western Europe towards 'law-in-principle' are remarkably similar, whereas perceptions of 'law-in-practice' differ by country and often correlate with GDP per capita and country ranking in rule of law indices. Grødeland and Miller's innovative methodological approach will appeal to both experts and non-experts with an interest in legal culture, European integration, or European elite and public opinion.