P1738Pre-hospital delay in patients with suspected myocardial infarction: a prospective observational study in the Russian Federation

Background

Russia has one of the highest mortality rates from cardiovascular disease (CVD) in the world. For patients with acute myocardial infarction (AMI), longer pre-hospital delays are associated with increased complications and mortality.

Purpose

Identify risk factors for prolonged pre-hospital delay and its components (patient decision time delay and transport time delay) in the Russian Federation for AMI patients.

Methods

A total of 1128 hospitalised patients with suspected AMI were recruited in a prospective observational study with a representative sample of suspected AMI patients from 16 hospitals in 13 regions of Russia. Data were collected from both patient questionnaires and clinical records, 251 patients were excluded due to missing data and/or having MI while already hospitalised (n=6). Pre-hospital delays analysed include total pre-hospital delay ≥2hrs, patient decision time (≥1 hr) and transport time (≥1). Logistic regression models were used to identify patient (sociodemographic, socioeconomic, previous medical history), symptom and admission related predictors of prolonged delays.

Results

The median total pre-hospital delay was 4.83 hrs (IQR 2.64–10.82), decision time 1.25 hrs (IQR 0.38–4.5), and transport time 2.03 hrs (IQR 1.23–4.5). No age or sex differences were found across total, decision or transport delay. The odds of admission within 2 hours from symptom onset (total prehospital delay) significantly decreased with poorer wealth status, indirect route to hospital (first medical contact elsewhere) and symptom onset between 12–6am. Additionally, taking aspirin was associated with lower odds of arriving within 2hrs. Whilst symptom presentation and co-morbidity was not significantly associated with total delay, patients who correctly associated symptoms to a heart problem were more likely to reach the hospital within 2 hours (OR1.65, 95% CI 1.03–2.62). Odds of transport delay >1hr were significantly greater for patients travelling indirectly but also significantly lower for male patients. Odds of decision time >1 hr were significantly greater among patients that did not attribute their symptoms to a heart problem and patients with symptoms starting overnight (12–6am). Sociodemographic, socioeconomic and comorbid status were not significantly associated with decision time.

Conclusion

Pre-hospital delay in the Russian Federation is protracted, particularly when patients travel indirectly to their definitive health facility. Symptom characteristics (time of onset and attribution to heart) are important for all components of pre-hospital delay in the Russian Federation. There is initial evidence that male patients experience reduced transport times, but further analyses are required to understand why. Tractable areas for improvement exist; reducing patient decision time and increasing use of EMS.

Acknowledgement/Funding

Ministry of Health and Care Services, Norway, Norwegian Institute of Public Health, The University of Tromsø - Norway, the Wellcome Trust

Petawatt Laser Guiding and Electron Beam Acceleration to 8 GeV in a Laser-Heated Capillary Discharge Waveguide

Guiding of relativistically intense laser pulses with peak power of 0.85 PW over 15 diffraction lengths was demonstrated by increasing the focusing strength of a capillary discharge waveguide using laser inverse bremsstrahlung heating. This allowed for the production of electron beams with quasimonoenergetic peaks up to 7.8 GeV, double the energy that was previously demonstrated. Charge was 5 pC at 7.8 GeV and up to 62 pC in 6 GeV peaks, and typical beam divergence was 0.2 mrad.

[COMPREHENSIVE STUDY OF ANTI-FUNGAL EFFECT OF EVGENOL EMULSION IN POLYSORBAT-80 ON REFERENCE STRAIN OF CANDIDA ALBICANS ATCC 885-653]

The aim of this research was a comprehensive study of the polysorbate - 80 emulsified eugenol effect on the culture of Candida albicans ATCC 885-653 by determining of minimal mycostatic, mycocidal concentrations and indexes of fungi reproduction intensity in postmycostatic eugenol concentrations. Minimal mycostatic and mycocidal concentrations was determined by sequentialmakrodilution of eugenol emulsion in Sabouraud liquid medium with next transferringthe tubes' contents on the solid Sabouraud medium. The amount of colony forming units /ml of Candida albicans ATCC 885-653 was determined by the sector method. The high antifungal activity of the eugenol emulsion in polysorbate-80 for the Candida albicans ATCC 885-653 culture has been proven. However, postmicostatic concentrations of eugenol led to increasing the number of colony-forming units per 1ml 10 times compared with control, it can promoteincreasingthe colonization potential offungi in this range of concentrations.

Knowledge of HIV serostatus and risk behaviour among injecting drug users in Estonia

We used the findings from two, cross-sectional studies of HIV serostatus and risk behaviours to assess the effects of knowledge of HIV serostatus and risk behaviours (relating to sex and injection drug use) among injecting drug users (IDUs). Respondent-driven sampling was used simultaneously at two sites in Estonia (the capital Tallinn, and the second-largest city of Ida-Virumaa County, Kohtla-Jarve). The research tool was an interviewer-administered survey. Biological samples were collected for HIV testing. Participants were categorised into three groups based on HIV testing results and self-report on HIV serostatus: HIV-negative (n=133); HIV-positive unaware of their serostatus (n=75); and HIV-positive aware of their serostatus (n=168). In total, 65% of the participants tested positive for HIV. Of those 69% were aware of their positive serostatus. HIV-positive IDUs aware of their serostatus exhibited more risk behaviours than their HIV-positive counterparts unaware of their serostatus or HIV-negative IDUs. Effective prevention of HIV among IDUs should therefore, include programmes to reduce high-risk sexual and drug use behaviours at the public health scale and enhanced prevention efforts focusing on HIV-infected individuals.

Magnetic field energy dissipation due to particle trapping in a force-free configuration of collisionless pair plasmas

It is shown by using a two-dimensional, fully relativistic, electromagnetic particle-in-cell simulation code that a force-free magnetic configuration in collisionless, electron-positron (pair) plasmas becomes unstable against current-driven Buneman instability and subsequently there occurs a strong magnetic field energy dissipation associated with collisionless magnetic reconnection, which can be driven by particle trapping due to two-dimensional electric potentials remaining in the nonlinear stage of the initial current-driven Buneman instability. About 43% of the initial magnetic field energy dissipates and is transformed to plasma heating as well as high-energy particle production. The energy spectrum in the high-energy region is given by an exponential type with two temperatures. We also show the simulation results for the electron-ion plasma to compare the effect of the mass ratio of the electron and proton.