More than 85% of US adults had been infected with SARS-CoV-2 by the end of 2023. Continued serosurveillance of transmission and assessments of correlates of protection require robust detection of reinfections. We developed a serologic method for identifying reinfections in longitudinal blood donor data by assessing nucleocapsid (N) antibody boosting using a total immunoglobulin assay. Receiver operating characteristic curve analysis yielded an optimal ratio of >1.43 (sensitivity 87.1%, specificity 96.0%). When prioritizing specificity, a ratio of >2.33 was optimal (sensitivity 75.3%, specificity 99.3%). In donors with higher anti-N reactivity levels before reinfection, sensitivity was reduced. Sensitivity could be improved by expanding the dynamic range of the assay through dilutional testing, from 38.8% to 66.7% in the highest reactivity group (signal-to-cutoff ratio before reinfection >150). This study demonstrated that longitudinal testing for N antibodies can be used to identify reinfections and estimate total infection incidence in a blood donor cohort.

BACKGROUND:COVID-19 convalescent plasma (CCP) remains a treatment option for immunocompromised patients; however, the current FDA qualification threshold of ≥200 BAU/mL of spike antibody appears to be relatively low. We evaluated the levels of binding (bAb) and neutralizing antibodies (nAb) on serial samples from repeat blood donors who were vaccinated and/or infected to inform criteria for qualifying CCP from routinely collected plasma components. METHODS:Donors were categorized into four groups: (1) infected, then vaccinated, (2) vaccinated then infected during the delta, or (3) omicron waves, (4) vaccinated without infection. IgG Spike and total Nuclecapsid bAb were measured, along with S variants and nAb titers using reporter viral particle neutralization. RESULTS:Mean S IgG bAb peaks after infection alone were lower than after primary and booster vaccinations, and higher after delta and omicron infection in previously vaccinated donors. Half-lives for S IgG ranged from 34 to 66 days after first infection/vaccination events and up to 108 days after second events. The levels of S IgG bAb and nAb were similar across different variants, except for omicron, which were lower. Better correlations of nAb with bAb were observed at higher levels (hybrid immunity) than at the current FDA CCP qualifying threshold. DISCUSSION:Routine plasma donations from donors with hybrid immunity had high S bAb and potent neutralizing activity for 3-6 months after infection. In donations with high (>4000 BAU/mL) S IgG, >95% had high nAb titers (>500) against ancestral and variant S, regardless of COVID-19 symptoms. These findings provide the basis for test-based criteria for qualifying CCP from routine blood donations.

Background Exposure to antiretrovirals at or early after HIV acquisition can suppress viral replication and blunt antibody (Ab) responses; a reduced HIV detectability could impact diagnosis and blood donation screening. Methods We used three antigen (Ag)/Ab assays and one nucleic acid test (NAT) to analyze samples collected in pre-exposure prophylaxis (PrEP) trials (iPrEx; Partners PrEP) before infection detection by Ab-only rapid diagnostic tests (RDTs), and in early antiretroviral treatment (ART) initiation studies (RV254; SIPP). Results Reactivity using NAT and Ag/Ab assays in samples collected up to 8 weeks prior to the first reactive RDT from 251 PrEP trials participants varied between 49-61% for active PrEP users and between 27-37% for placebo users. Among RV254 participants, reactivity in Ag/Ab assays was <100% at all timepoints, and lower among those initiating ART earlier. Seroreversions occurred for 29% (16/55), and blood donation screening with NAT and Ag/Ab assays could have missed up to 36% (20/55) of RV254 participants. For SIPP participants, who started ART at later timepoints, Ag/Ab assays identified infections with no evidence of reactivity waning. Conclusion PrEP and early ART initiation can delay or reduce HIV detectability. Considerations for the implementation of NAT and Ag/Ab tests in PrEP/PEP programs relying on Ab-only RDTs should be balanced according to feasibility and public health impact. While blood transfusion services using Ab-only RDTs for HIV screening should adopt higher sensitivity tests, surveillance and further research are needed to determine the need for novel HIV testing algorithms for those already using NAT and Ag/Ab screening assays.

Large-scale coastal erosion in the Mekong Delta has been dramatically increasing in severity in recent decades. There are several effective hard engineering solutions that have been implemented in this delta to efficiently prevent coastal erosion and stimulate sedimentation while supporting the local ecosystem conservation. These measures include Pile-Rock Breakwaters (PRBW), Hollow Triangle Breakwaters (HTB) and Semicircular Breakwaters (SBW). However, research on the sediment transport, morphological changes and toe erosion for these offshore breakwaters is very limited and is currently in the initial stages of understanding the specific conditions of sediment characteristics and foundations. The objective of this study was to reproduce the morphological changes and toe erosion of three breakwaters due to wave-structure interactions. This was investigated using 2D physical models with 3000 irregular waves during 8 experimental hours (equal to 15,000*Tp). To extract the bed morphological changes and toe erosion both specialized laser measurements (SW50M laser ruler) and analysis of high-speed video recording by images digitalization were applied. The experimental results show that the shape and structural design of offshore breakwaters can have a significant influence on the bed morphology on both the seaside and the leeside. We found that generally the toe of the construction on the seaside was eroded due to the occurrence of reflected waves, and that the flow is narrowed while passing through the construction, increasing the flow velocity and causing toe erosion. Additionally, the accretion of sediment at the leeside of the breakwaters was found to be mainly driven by the transport of sediment through the construction. Comparing the breakwater designs the experimental results showed that the HTB has the maximum accretion rate behind the structure, as well as the fastest accretion rate behind the breakwater. The SBW has high wave energy dissipation efficiency, although the toe erosion rate is faster than the other classes of breakwaters. The PRBW shows the fastest toe erosion rate in front of the structure and causes accretion at the leeside of the construction but at a lower rate than the HTB. The findings from this study will help practical designers to reinforce the foot of construction during real breakwater designing and inform stability calculations. We recommendation is to apply these three classes of breakwaters, especially the HTB and SBW, for stimulating sedimentation for mangrove restoration in the mangrove mud-coast delta.

This study presents a laboratory scale implementation of breakwaters and their ability to mitigate extreme wave erosion on the coast of Mekong Delta. Three classes of breakwaters are tested in this study: Hollow Triangle breakwaters (HTBW), pile-Rock breakwaters (PRBW), and semi-circular breakwaters (SBW) using physical models in the laboratory. The investigation includes 210 experimental tests using a physical model under various incident waves and water levels. The experimental results show that the SBW has the lowest wave transmission coefficient (Kt). The HTBW has the highest Kt. The Kt of SBW, PRBW and HTBW in the submerged state (Rc/Hm0,i < 0) varies between 0.45 - 0.73; 0.55 - 0.73 and 0.64 - 0.82, respectively. The wave reflected coefficient of the PRBW is found larger than SBW and HTBW. The SBW demonstrates the largest wave energy dissipation capacity. The wave reflection coefficients (Kr) in the submerged state for SBW, PRBW and HTBW have a similar range of Kr with varying range i.e., 0.16 - 0.30, 0.16 - 0.27 and 0.16 - 0.28, respectively. Meanwhile, the Kr of the HTBW and the SBW in the emerged state (Rc/Hm0,i > 0) varies in a range, 0.17 - 0.35 and 0.19 - 0.33, respectively, while the Kr of the PRBW has a larger variation with a range of 0.22 - 0.48. From the field measurements, the Kt and wave spectrum is verified with the physical model results. The average wave dissipation capacity of the three breakwaters is obtained about 54-80% for PRBW, 75-81% for HTBW, and 51-90% for SBW, respectively. The observed Kt for the field scale breakwaters shows non-linearity rather than the physical models due to the large variability of incident wave conditions in the East and West Seas. HTBW and SBW are highly efficient in dissipating the longer period waves peak, while PRBW is highly efficient in dissipating the short period waves peak. The results indicate that three breakwaters particularly the PRBW have a great capacity to dissipate wave energy under the different sea states in the Mekong Delta.

Coastal protection measures and management play an important role in coping with coastal disasters and climate-induced sea-level rise. In this study, the success and failure of typical coastal protection works of the Vietnamese Mekong Delta (VMD) are reported and documented from field observations over a study period of 10–15 years. The coastal protection structures evaluated include revetments, geotubes, t-shaped bamboo fences, Pile-rock breakwaters, Busadco's breakwaters, Semi-Circular breakwaters, and Hollow triangle breakwaters. This paper briefly reviews the current situation of coastline erosion problem and accretion in the VMD and illustrates the severity of the current erosion rate that threatens the safety of coastal communities. The paper then evaluates the advantages and disadvantages of various coastal management approaches currently in practice in the VMD to classify different types of possible measures for coastal management with the aim to find holistic measures for planning which require low construction investment. Integrated coastal management and planning are outlined at a regional scale followed by the lessons learned from the previous coastal protection works, and finally the multiple lines of defense (MLD) solution is proposed, which is a green infrastructure inspired nature-based solution. The MLD solution can improve biodiversity, facilitate mangrove forest restoration, and ensure sustainable livelihoods for local communities. Integrated coastal planning and management solutions that are based on the MLD principle are expected to withstand coastal disasters under future climate change, and sea-level rise on the VMD.

Coastal erosion has been occuring at a rapid rate in recent years along the Vietnamese Mekong coastline with particularly significant impacts occurring in the Tan Thanh – Go Cong coastal area. This erosion issue poses an urgent need for rapid deployment of offshore breakwaters for coastal protection and to reduce the severity of incoming waves. This objective of this study is to apply a multi-scale numerical model (MIKE21-FM) to evaluate the impact of breakwaters on hydrodynamic behavior and morphological changes in the coastal zone. The results from the numerical model simulations showed that breakwater stuctures can effectively reduce the velocity and height of incoming waves by over 50%. The results also showed that the breakwater structures lead to increased sediment accumulation, even during the Northeast monsoon season, when strong waves and currents can occur. Our results indicated that construction of a sufficient number of breakwaters is crucial to increase the efficiency of the breakwaters as well as the protection coverage of the coastline. Finally, the results showed that the longer construction is, the wider coastal area it can protect to stimulate accretion.

In recent years coastal erosion in the Vietnamese Mekong Delta (VMD) is occurring at a rapid rate which is leading to considerable damage of infrastructure and the human-made environment. Various solutions have been proposed to protect the coastline in the VMD including Pile-Rock breakwaters (PRBWs). PRBWs have several advantages that make them particularly applicable to the coast of West Ca Mau and the Mekong Delta. The focus of this study is to test PRBW efficiency in the VMD by evaluating a physical experimental model followed by evaluation of observations in the field from the Ca Mau province. A series of experiments were undertaken to build an empirical formula of the wave transmission coefficient. The results show that the PRBW structure works effectively in the case of emergence when the wave transmission coefficient Kt is between 0.3 and 0.4 but in this case the wave reflection coefficient is quite large (i.e. Kr of 0.45–0.6). The experimentally obtained and measured transmission coefficient Kt show strong agreement. The analytical results show that a PRBW dissipates most of the energy for short periodic waves, however long periodic waves can still be transmitted through the PRBW. The PRBW shows significant advantages over other styles of breakwaters including an increased potential to reduce erosion, high stability, and a reduced deadweight of construction materials. These advantages mean that PRBWs have a great potential to aid restoration of mangrove forests that are sheltered behind the breakwater in the VMD region.

Influence diagnostics aim to identify a small number of influential data points that have a disproportionate impact on the model parameters and/or predictions. The key issues with current influence diagnostic techniques are that the regression-theory approaches do not provide hydrologically relevant influence metrics, while the case-deletion approaches are computationally expensive to calculate. The main objective of this study is to introduce a new two-stage hybrid framework that overcomes these challenges, by delivering hydrologically relevant influence metrics in a computationally efficient manner. Stage one uses computationally efficient regression-theory influence diagnostics to identify the most influential points based on Cook's distance. Stage two then uses case-deletion influence diagnostics to quantify the influence of points using hydrologically relevant metrics. To illustrate the application of the hybrid framework, we conducted three experiments on 11 hydro-climatologically diverse Australian catchments using the GR4J hydrological model. The first experiment investigated how many data points from stage one need to be retained in order to reliably identify those points that have the hightest influence on hydrologically relevant metrics. We found that a choice of 30-50 is suitable for hydrological applications similar to those explored in this study (30 points identified the most influential data 98% of the time and reduced the required recalibrations by 99% for a 10 year calibration period). The second experiment found little evidence of a change in the magnitude of influence with increasing calibration period length from 1, 2, 5 to 10 years. Even for 10 years the impact of influential points can still be high (>30% influence on maximum predicted flows). The third experiment compared the standard least squares (SLS) objective function with the weighted least squares (WLS) objective function on a 10 year calibration period. In two out of three flow metrics there was evidence that SLS, with the assumption of homoscedastic residual error, identified data points with higher influence (largest changes of 40%, 10%, and 44% for the maximum, mean, and low flows, respectively) than WLS, with the assumption of heteroscedastic residual errors (largest changes of 26%, 6%, and 6% for the maximum, mean, and low flows, respectively). The hybrid framework complements existing model diagnostic tools and can be applied to a wide range of hydrological modelling scenarios. (C) 2018 Published by Elsevier B.V.

Influence diagnostics are used to identify data points that have a disproportionate impact on model parameters, performance and/or predictions, providing valuable information for use in model calibration. Regression-theory influence diagnostics identify influential data by combining the leverage and the standardised residuals, and are computationally more efficient than case-deletion approaches. This study evaluates the performance of a range of regression-theory influence diagnostics on ten case studies with a variety of model structures and inference scenarios including: nonlinear model response, heteroscedastic residual errors, data uncertainty and Bayesian priors. A new technique is developed, generalised Cook's distance, that is able to accurately identify the same influential data as standard case deletion approaches (Spearman rank correlation: 0.93–1.00) at a fraction of the computational cost (<1%). This is because generalised Cook's distance uses a generalised leverage formulation which outperforms linear and nonlinear leverage formulations due to less restrictive assumptions. Generalised Cook's distance has the potential to enable influential data to be efficiently identified on a wide variety of hydrological and environmental modelling problems.

F the first reported cases of West Nile Virus (WNV) in North America in August of 1999 through 2013, more than 39,000 cases of West Nile virus (WNV) were reported in the United States (1). In 2003, identification of transfusiontransmitted WNV infections (2) led to screening of the blood supply for WNV by using nucleic acid amplification technology (NAT) assays in mini-pools (MP-NAT) (3). Despite the success of MP-NAT screening of samples from blood donors, WNV transmission from infected donors continued. During 2004, screening algorithms expanded, including triggered individual donation NAT (ID-NAT) (3). Approximately 25% of viremic blood donors can be detected by ID-NAT (4). Estimates of WNV infections in 2003 were derived from viremic blood donor rates detected by MP-NAT throughout the United States. West Nile neuroinvasive disease (WNND) reports were then used to approximate the number of infections relative to WNND cases (5). With the introduction of targeted ID-NAT, estimates of WNV infections from viremic blood donors must account for differential ID-NAT and MP-NAT screening during epidemic seasons. Nationwide, the largest WNV epidemic since 2003 occurred in 2012, and approximately one third of cases were reported from Texas. Approximately 48% of cases in Texas were in 4 counties: Collin, Dallas, Denton, and Tarrant, located in the northern area of the state. The aim of this study was to estimate the number of WNV infections in this area during the 2012 arboviral season using 2 models: blood donor NAT yield and WNND-based models (5,6).

BACKGROUND:The significance of detection of Trypanosoma cruzi DNA in blood of antibody-positive patients for risk of development of Chagas heart disease is not well established. The objective of this study was to compare detection of T. cruzi DNA with known clinical and laboratory markers of Chagas cardiomyopathy (CC) severity. METHODS:This is a case-control study nested within a retrospective cohort developed in Brazil to understand the natural history of Chagas disease. The study enrolled 499 T. cruzi seropositive blood donors (SP-BD) and 488 frequency matched seronegative control donors (SN-BD) who had donated between 1996 and 2002, and 101 patients with clinically diagnosed CC. In 2008-2010 all enrolled subjects underwent a health questionnaire, medical examination, electrocardiograms and echocardiograms and polymerase chain reaction (PCR) analyses. A blinded panel of three cardiologists adjudicated the outcome of CC. Trypanosoma cruzi kinetoplast minicircle sequences were amplified by real-time PCR using an assay with a sensitivity of one parasite per 20 mL of blood. All testing was performed on coded samples. RESULTS:Rates of PCR detection of T. cruzi DNA were significantly (P = 0.003) higher in CC patients and SP-BD diagnosed with CC (79/105 [75.2 %]) compared with SP-BD without CC (143/279 [51.3%]). The presence of parasitaemia was significantly associated with known markers of disease progression such as QRS and QT interval duration, lower left ventricular ejection fraction, higher left ventricular index mass, and elevated troponin and NTpro-BNP levels. CONCLUSION:Trypanosoma cruzi PCR positivity is associated with presence and severity of cardiomyopathy, suggesting a direct role of parasite persistence in disease pathogenesis.

Influential data are those that have a disproportionate impact on model performance, parameters and/or predictions. This paper evaluates two classes of diagnostics that identify influential data for hydrological model calibration: (1) numerical "case-deletion" diagnostics, which directly measure the influence of each data point on the calibrated model; and (2) analytical diagnostics based on Cook's distance, which combine information on the model residuals with a measure of the distance of each input point from the centre of the range of the input data (i.e., the leverage). Case-deletion methods rank influence by changes in the model parameters (measured through the Mahalanobis distance), performance (using objective function displacement) and predictions (e.g. mean and maximum streamflow). For the analytical methods, both linear and nonlinear estimates of leverage are used to calculate Cook's distance, which is used to rank influential data. We apply these diagnostics to three case studies and show that a single point could change mean/maximum streamflow predictions by 7%/9% for a rating curve model, and 13%/25%, for a hydrological model (GR4J) in an ephemeral catchment. In contrast, the influence was far less for GR4J in a humid catchment (0.2%/2.3%). Assuming the data are of high quality this indicates deficiencies in the ability of the GR4J model structure to reproduce the flow regime in the ephemeral catchment. The linear Cook's distance-based metric produced reasonably similar rankings to the case-deletion metrics at a fraction of the computational cost (300-1000 times faster), but with less flexibility to rank influence using specific aspects of model behaviour. The nonlinear distance produced rankings that were virtually the same as the case-deletion metrics for all case studies - this highlights the importance of its use for nonlinear hydrological models. Visual assessment was not a reliable method of influence analysis as there was no direct relationship between the most influential data and the highest observed streamflows. The findings establish the feasibility and importance of including influence detection diagnostics as a standard tool in hydrological model calibration. (C) 2015 Elsevier B.V. All rights reserved.

BACKGROUND:Seasonal distribution of blood donation hinders efforts to provide a safe and adequate blood supply leading to chronic and persistent shortages. This study examined whether holidays, geographical area and donation type (community versus replacement) has any impact on the fluctuation of donations.METHODS:The numbers of blood donations from 2007 through 2010 in three Brazilian Retrovirus Epidemiological Donor Study II (REDS-II) participating centers were analyzed according to the week of donation. The weeks were classified as holiday or non-holiday. To compare donations performed during holiday versus non-holiday weeks, tabulations and descriptive statistics for weekly donations by blood center were examined and time series analysis was conducted.RESULTS:The average weekly number of donations varied according to the blood center and type of week. The average number of donations decreased significantly during Carnival and Christmas and increased during the Brazilian National Donor Week. The fluctuation was more pronounced in Recife and Belo Horizonte when compared to São Paulo and higher among community donors.CONCLUSION:National bank holidays affect the blood supply by reducing available blood donations. Blood banks should take into account these oscillations in order to plan local campaigns, aiming at maintaining the blood supply at acceptable levels.

Background and Objectives Higher risk of HIV infection could be associated with test seeking, which is one motivation for donating blood. Cognitive social capital is defined as the social support, trust and co-operation that guide community behaviour. Structural social capital refers to an individuals participation in institutions and organizations. The association between social capital and test seeking was assessed. Materials and Methods A survey of over 7500 donors in three Brazilian blood centres was conducted. Test seeking was classified into four non-overlapping categories (non-test seeker, possible, presumed and self-disclosed test seekers) using one direct and two indirect questions. Social capital was summarized into cognitive and structural categorizations. Multivariable logistic regression analysis was performed. Results Compared with non-test seekers (62% of survey respondents), cognitive social capital was higher for each category of test seeking (OR = 1.1, 7.4, 7.1, P < 0.05 respectively). Male gender, lower education and lower income were also significantly associated with test seeking. Conclusion As test seekers appear to have strong social networks, blood banks may leverage this to convince them to seek testing at other locations.

HomeCirculationVol. 128, No. 9Letter by Rassi and Rassi Regarding Article, "Ten-Year Incidence of Chagas Cardiomyopathy Among Asymptomatic, Trypanosoma cruzi–Seropositive Former Blood Donors" Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Rassi and Rassi Regarding Article, "Ten-Year Incidence of Chagas Cardiomyopathy Among Asymptomatic, Trypanosoma cruzi–Seropositive Former Blood Donors" Anis RassiJr, MD, PhD and Anis Rassi, MD Anis RassiJrAnis RassiJr Division of Cardiology, Anis Rassi Hospital, Goiânia, GO, Brazil and Anis RassiAnis Rassi Division of Cardiology, Anis Rassi Hospital, Goiânia, GO, Brazil Originally published27 Aug 2013https://doi.org/10.1161/CIRCULATIONAHA.113.002384Circulation. 2013;128:e135To the Editor:We read with interest the article by Sabino et al,1 who show a difference in the rate of progression to cardiomyopathy of 1.85% per year among 499 initially asymptomatic Trypanosoma cruzi–seropositive blood donors compared with 488 T cruzi–seronegative individuals (control group). That is, in a 1-year period, of 100 patients with the indeterminate form of Chagas disease, ≈2 patients will develop some cardiac alteration that is exclusively attributable to T cruzi infection. However, the study has some limitations that should be considered in the interpretation of the results. First, because of its retrospective design, instead of having programmed repeated follow-up observations on each subject, cardiac evaluation was done only once (at a single point in time), 7 to 14 years after the index blood donation. So, the approximate or exact date at which progression to cardiomyopathy occurred was not known. Because T cruzi–infected individuals who develop cardiomyopathy usually do so within 20 years after being infected and because the mean exposure time to Chagas disease was already 18 years when the study started, we suspect that most Chagas disease progression occurred shortly after the patients entered the study, not 10 years later. In contrast, this may not have been the case for the seronegative patients, in whom a more constant progression rate to cardiomyopathy is expected to occur. Second, we disagree with the authors` definition that the presence of diastolic dysfunction on echocardiography associated with signs or symptoms of heart failure or arrhythmias in a middle-aged population 50 to 60 years of age, about half of them with comorbidities (including hypertension), is a definite marker of Chagas cardiomyopathy. It would be interesting to know whether the 5% rate of false-negative results on the ECG of patients with T cruzi infection (ECG was normal but there was progression to cardiomyopathy) corresponded to cases of diastolic dysfunction. Third, in our article quoted by the authors,2 we did not mention that frequent supraventricular premature beats are ECG abnormalities typical of Chagas cardiomyopathy with prognostic significance.Despite these limitations, we congratulate Sabino et al1 for their important research reinforcing the usefulness of the 12-lead ECG alone for initial screening of asymptomatic patients with Chagas disease, whereas echocardiography (and other tests) should be performed only in patients who present with abnormal ECG findings.3Anis Rassi Jr, MD, PhDAnis Rassi, MDDivision of CardiologyAnis Rassi HospitalGoiânia, GO, BrazilDisclosuresNone.References1. Sabino EC, Ribeiro AL, Salemi VM, Di Lorenzo Oliveira C, Antunes AP, Menezes MM, Ianni BM, Nastari L, Fernandes F, Patavino GM, Sachdev V, Capuani L, de Almeida-Neto C, Carrick DM, Wright D, Kavounis K, Goncalez TT, Carneiro-Proietti AB, Custer B, Busch MP, Murphy EL; National Heart, Lung, and Blood Institute Retrovirus Epidemiology Donor Study-II (REDS-II), International Component. Ten-year incidence of Chagas cardiomyopathy among asymptomatic, Trypanosoma cruzi–seropositive former blood donors.Circulation.2013; 127:1105–1115.LinkGoogle Scholar2. Rassi A, Rassi A, Rassi SG. Predictors of mortality in chronic Chagas disease: a systematic review of observational studies.Circulation. 2007; 115:1101–1108.LinkGoogle Scholar3. Rassi A, Rassi A, Marin-Neto JA. Chagas disease.Lancet. 2010; 375:1388–1402.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails August 27, 2013Vol 128, Issue 9 Advertisement Article InformationMetrics © 2013 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.113.002384PMID: 23979634 Originally publishedAugust 27, 2013 PDF download Advertisement SubjectsElectrocardiology (ECG)