Wide QRS complex tachycardia due to typical atrial flutter with accessory pathway conduction

A 62-year-old male patient was admitted with regular wide QRS complex tachycardia. After ajmaline administration, the heart rate slowed down disclosing atrial flutter with variable QRS morphologies. Electrocardiography after conversion to sinus rhythm showed narrow QRS complexes. Decremental atrial stimulation during electrophysiological study caused progressive pre-excitation. Spontaneously, typical atrial flutter occurred with pre-excited QRS complexes. Both accessory pathway and atrial flutter were ablated in the same session.

Community Partners in Care: 6- and 12-month Outcomes of Community Engagement versus Technical Assistance to Implement Depression Collaborative Care among Depressed Older Adults

Objective

Community Partners in Care, a community-partnered, cluster-randomized trial with depressed clients from 95 Los Angeles health and community programs, examined the added value of a community coalition approach (Community Engagement and Planning [CEP]) versus individual program technical assistance (Resources for Services [RS]) to implement depression collaborative care in underserved communities. This exploratory subanalysis examines 6- and 12-month outcomes among CPIC participants aged >50 years.

Design

Community-partnered, cluster-randomized trial conducted between April 2010 and March 2012.

Setting

Hollywood-Metropolitan (HM) and South Los Angeles (SLA) Service Planning Areas (SPAs), Los Angeles, California.

Participants

394 participants aged >50 years with depressive symptoms (8-item Patient Health Questionnaire score ≥ 10).

Intervention

A community-partnered multi-sector coalition approach (Community Engagement and Planning [CEP]) vs individual program technical assistance (Resources for Services [RS]) to implement depression collaborative care.

Main Outcome Measures

Depressive symptoms (PHQ-8 score), mental health-related quality of life (MHRQL), community-prioritized outcomes including mental wellness, homelessness risk and physical activity, and services utilization.

Results

At 6 months, CEP was more effective than RS at improving MHRQL and mental wellness among participants aged >50 years; no differences were found in the effects of CEP vs RS on other outcomes. No significant outcome differences between CEP and RS were found at 12 months.

Conclusions

A multisector community coalition approach may offer additional benefits over individual program technical assistance to improve outcomes among depressed adults aged >50 years living in underserved communities.

A Community-Partnered, Participatory, Cluster-Randomized Study of Depression Care Quality Improvement: Three-Year Outcomes

OBJECTIVE

Community Partners in Care, a community-partnered, cluster-randomized trial with depressed clients from 93 Los Angeles health and community programs, examined the added value of a community coalition approach (Community Engagement and Planning [CEP]) versus individual program technical assistance (Resources for Services [RS]) for implementing depression quality improvement in underserved communities. CEP was more effective than RS in improving mental health-related quality of life, reducing behavioral health hospitalizations, and shifting services toward community-based programs at six months. At 12 months, continued evidence of improvement was found. This study examined three-year outcomes.

METHODS

Among 1,004 participants with depression who were eligible for three-year follow-up, 600 participants from 89 programs completed surveys. Multiple regression analyses estimated intervention effects on poor mental health-related quality of life and depression, physical health-related quality of life, behavioral health hospital nights, and use of services.

RESULTS

At three years, no differences were found in the effects of CEP versus RS on depression or mental health-related quality of life, but CEP had modest effects in improving physical health-related quality of life and reducing behavioral health hospital nights, and CEP participants had more social- and community-sector depression visits and greater use of mood stabilizers. Sensitivity analyses with longitudinal modeling reproduced these findings but found no significant differences between groups in change from baseline to three years.

CONCLUSIONS

At three years, CEP and RS did not have differential effects on primary mental health outcomes, but CEP participants had modest improvements in physical health and fewer behavioral health hospital nights.

Comparative Effectiveness of Two Models of Depression Services Quality Improvement in Health and Community Sectors

OBJECTIVE

The effectiveness of community coalition building and program technical assistance was compared in implementation of collaborative care for depression among health care and community sector clients.

METHODS

In under-resourced communities, within 93 programs randomly assigned to coalition building (Community Engagement and Planning) or program technical assistance (Resources for Services) models, 1,018 clients completed surveys at baseline and at six, 12, or 36 months. Regression analysis was used to estimate intervention effects and intervention-by-sector interaction effects on depression, mental health-related quality of life, and community-prioritized outcomes and on services use.

RESULTS

For outcomes, there were few significant intervention-by-sector interactions, and stratified findings suggested benefits of coalition building in both sectors. For services use, at 36 months, increases were found for coalition building in primary care visits, self-help visits, and appropriate treatment for community clients and in community-based services use for health care clients.

CONCLUSIONS

Relative to program technical assistance, community coalition building benefited clients across sectors and shifted long-term utilization across sectors.

Time-domain control of ultrahigh-frequency nanomechanical systems

Nanoelectromechanical systems could have applications in fields as diverse as ultrasensitive mass detection and mechanical computation, and can also be used to explore fundamental phenomena such as quantized heat conductance and quantum-limited displacement. Most nanomechanical studies to date have been performed in the frequency domain. However, applications in computation and information storage will require transient excitation and high-speed time-domain operation of nanomechanical systems. Here we show a time-resolved optical approach to the transduction of ultrahigh-frequency nanoelectromechanical systems, and demonstrate that coherent control of nanomechanical oscillation is possible through appropriate pulse programming. A series of cantilevers with resonant frequencies ranging from less than 10 MHz to over 1 GHz are characterized using the same pulse parameters.