AimsTo investigate the combination of heart rate turbulence (HRT) and deceleration capacity (DC) as risk predictors in post-infarction patients with left ventricular ejection fraction (LVEF) > 30%.Methods and resultsWe enrolled 2343 consecutive survivors of acute myocardial infarction (MI) (<76 years) in sinus rhythm. HRT and DC were obtained from 24 h Holter recordings. Patients with both abnormal HRT (slope ≤ 2.5 ms/RR and onset ≥ 0%) and abnormal DC (≤4.5 ms) were considered suffering from severe autonomic failure (SAF) and prospectively classified as high risk. Primary and secondary endpoints were all-cause, cardiac, and sudden cardiac mortality within the first 5 years of follow-up. During follow-up, 181 patients died; 39 deaths occurred in 120 patients with LVEF ≤ 30%, and 142 in 2223 patients with LVEF>30% (cumulative 5-year mortality rates of 37.9% and 7.8%, respectively). Among patients with LVEF > 30%, SAF identified another high-risk group of 117 patients with 37 deaths (cumulative 5-year mortality rates of 38.6% and 6.1%, respectively). Merging both high-risk groups (i.e. LVEF ≤ 30% and/or SAF) doubled the sensitivity of mortality prediction compared with LVEF ≤ 30% alone (21.1% vs. 42.1%, P < 0.001) while preserving 5-year mortality rate (38.2%).ConclusionIn post-MI patients with LVEF>30%, SAF identifies a high-risk group equivalent in size and mortality risk to patients with LVEF ≤ 30%.

Twenty-three out of 517 patients had a complicated clinical course as defined by meeting the endpoint definition. Twenty-one out of 23 complicated courses had a positive IRS (defined as greater or equal 6 points), as compared to 255/494 patients with an uncomplicated clinical course (p < .001, Fisher's exact test). One patient (with a positive IRS) died. The negative predictive value of the IRS was 0.99 (95% CI: 0.97-1), the sensitivity was 0.91 and the specificity 0.48. In conclusion, the IRS is significantly linked to outcome. While a negative IRS virtually excludes the need for ICU care, a positive IRS has a positive predictive value too low to be used for risk stratification. The IRS could also be applied to unselected admissions of poisoned patients.

The paper examines from a historical and theoretical point of view the interrelation between the sociological theory of inclusion and exclusion and the classical sociology of the stranger. Inclusion/exclusion is a new theoretical perspective which mirrors the increasing prominence of communication in modern social systems and the pluralization of reference systems in which any psychic system in modern society is involved. Sociological theorizing on inclusion/exclusion thinks about how social systems include persons via addresses and the formation of expectations or exclude them by not creating addresses and expectations referring to them. In contradistinction to this general analytics of inclusion/exclusion, the sociology of the stranger theorizes a special case. It belongs to those corpora of sociological theorizing closely coupled with a historical semantics which we find in nearly every society we know anything about. There are at least three important social structural premises of the sociology of the stranger: participation in social systems is thought as membership; social systems are characterized by social closure; and, finally, persons as members are compact social objects, unifying diverse participations from a core identity attributed to persons. As all these three characteristics are no longer valid in modern society, the paper postulates that the sociology of the stranger and the analytics of inclusion/exclusion are successive historical models for the participation of psychic systems in society. From this results the concluding discussion of structural changes in concepts of identity. Identities in modern society are characterized by atomization; they are decoupled from authenticity; they are multiple identities, all of which imply part-time engagements. The network metaphor is interpreted as an apt description of these transformations. All these changes in identity concepts are related to a societal structure in which the participation of persons is particularized by multiple inclusions.

74% of respondents were male. 41% were under the age of 30 and a further 38% between 30 and 39 years old. Cathinones were used on more than 10 days in the preceding year by 62% of study subjects. The nasal and intravenous routes of administration were most often used. About 80% of respondents reported binge use. There were frequent co-administrations of opioids and opiates. The most common complication was prolonged confusion (47%). 16% had been involuntarily confined. One third had thoughts of violence and 16% acted on these thoughts either against themselves or others. About 44% reported high-risk sexual activity under the influence of cathinones. About 31% had driven or ridden a bike while intoxicated. About 6% had problems with law-enforcement for selling cathinones and 16% for crimes committed under the influence of cathinones. In conclusion, cathinone users are typically young males in their twenties and thirties. Most are experienced drug users, particularly of alcohol and opiates/opioids. The impact on society is tremendous as evidenced by high rates of self-reported violence, high-risk sexual activity, crimes, and traffic violations.