Systematic review and network meta-analysis of atrial fibrillation percutaneous catheter ablation technologies using randomized controlled trials

AIMS: We sought out to make comparisons between all atrial fibrillation (AF) catheter ablation technologies using randomized controlled trial data. Our comparisons were freedom from AF, procedural duration, and fluoroscopy duration. METHODS: Searches were made of EMBASE, MEDLINE, and CENTRAL databases, and studies were selected which had cryoballoon, conventional radiofrequency (RF), multipolar RF catheters, and laser technology as an arm in the study and were identified as randomized controlled trials (RCTs). These studies were analyzed for direct comparisons using conventional meta-analysis and a combination of indirect and direct comparisons via a network meta-analysis (NMA). RESULTS: With respect to freedom from AF both direct comparisons and NMA did not demonstrate any significant difference. However in analysis of procedural and fluoroscopy duration (minutes) for the pulmonary vein ablation catheter (PVAC), both conventional analysis and NMA revealed significantly shorter procedure times, RF vs PVAC (conventional: 61.99 [38.03-85.94], P <.00001; NMA: 54.76 [36.64-72.88], P < .0001) and fluoroscopy times, RF vs PVAC (conventional: 12.96 [6.40-19.53], P = .0001; NMA: 8.89 [3.27-14.51], P < .01). The procedural duration was also shorter for the cryoballoon with NMA, RF vs CRYO (20.56 [3.47-37.65], P = .02). DISCUSSION: Our analysis demonstrated that while there was no difference in the efficacy of the individual catheter technologies, there are significant differences in the procedural duration for the PVAC and the cryoballoon. While they may seem an attractive solution for high-volume centers, further RCTs of next-generation technologies should be examined

Moment inversion problem for piecewise D-finite functions

We consider the problem of exact reconstruction of univariate functions with jump discontinuities at unknown positions from their moments. These functions are assumed to satisfy an a priori unknown linear homogeneous differential equation with polynomial coefficients on each continuity interval. Therefore, they may be specified by a finite amount of information. This reconstruction problem has practical importance in Signal Processing and other applications. It is somewhat of a ``folklore'' that the sequence of the moments of such ``piecewise D-finite''functions satisfies a linear recurrence relation of bounded order and degree. We derive this recurrence relation explicitly. It turns out that the coefficients of the differential operator which annihilates every piece of the function, as well as the locations of the discontinuities, appear in this recurrence in a precisely controlled manner. This leads to the formulation of a generic algorithm for reconstructing a piecewise D-finite function from its moments. We investigate the conditions for solvability of the resulting linear systems in the general case, as well as analyze a few particular examples. We provide results of numerical simulations for several types of signals, which test the sensitivity of the proposed algorithm to noise

Measurements of the LHC Corrector Magnets at Room and Cryogenic Temperatures

The superconducting twin aperture main dipole magnets of the LHC accelerator are equipped with pairs of sextupole and decapole correctors at their ends. Similarly, octupole correctors are aligned at t he end of the main quadrupole magnets. Dedicated stations have been built for tests of these correctors at room temperature as well as superfluid helium temperature. Measurements of the training behav iour and of the magnetic field quality are routinely performed. The search for the magnetic axis and the transfer of its position to fiducials are performed at room temperature. A description and the performances obtained with these two benches are also presented

Matrix Models for Supersymmetric Chern-Simons Theories with an ADE Classification

We consider N=3 supersymmetric Chern-Simons (CS) theories that contain product U(N) gauge groups and bifundamental matter fields. Using the matrix model of Kapustin, Willett and Yaakov, we examine the Euclidean partition function of these theories on an S^3 in the large N limit. We show that the only such CS theories for which the long range forces between the eigenvalues cancel have quivers which are in one-to-one correspondence with the simply laced affine Dynkin diagrams. As the A_n series was studied in detail before, in this paper we compute the partition function for the D_4 quiver. The D_4 example gives further evidence for a conjecture that the saddle point eigenvalue distribution is determined by the distribution of gauge invariant chiral operators. We also see that the partition function is invariant under a generalized Seiberg duality for CS theories.Comment: 20 pages, 3 figures; v2 refs added; v3 conventions in figure 3 altered, version to appear in JHE

Dallas with balls: televized sport, soap opera and male and female pleasures

Two of the most popular of television genres, soap opera and sports coverage have been very much differentiated along gender lines in terms of their audiences. Soap opera has been regarded very much as a 'gynocentric' genre with a large female viewing audience while the audiences for television sport have been predominantly male. Gender differentiation between the genres has had implications for the popular image of each. Soap opera has been perceived as inferior; as mere fantasy and escapism for women while television sports has been perceived as a legitimate, even edifying experience for men. In this article the authors challenge the view that soap opera and television sport are radically different and argue that they are, in fact, very similar in a number of significant ways. They suggest that both genres invoke similar structures of feeling and sensibility in their respective audiences and that television sport is a 'male soap opera'. They consider the ways in which the viewing context of each genre is related to domestic life and leisure, the ways in which the textual structure and conventions of each genre invoke emotional identification, and finally, the ways in which both genres re-affirm gender identities

Over-expansion capacity and stent design model: an update with contemporary DES platforms

© 2016 The AuthorsBackground Previously, we examined the difference in stent designs across different sizes for six widely used Drug Eluting Stents (DESs). Although stent post-dilatation to larger diameter is commonly done, typically in the setting of long tapering segment or left-main PCI, there is an increasing recognition that information with regard to the different stent model designs has a critical impact on overexpansion results. This study aims to provide an update on stent model designs for contemporary DES platforms as well as test overexpansion results under with oversized post-dilatation. Methods and results We studied 6 different contemporary commercially available DES platforms: Synergy, Xience Xpedition, Ultimaster, Orsiro, Resolute Onyx and Biomatrix Alpha. We investigated for each platform the difference in stent designs across different sizes and results obtained after post-expansion with larger balloon sizes. The stents were deployed at nominal diameter and subsequently over expanded using increasingly large post dilatation balloon sizes (4.0, 5.0 and 6.0 mm at 14ATM). Light microscopy was used to measure the changes in stent geometry and lumen diameter after over-expansion. For each respective DES platform, the MLD observed after overexpansion of the largest stent size available with a 6.0 mm balloon was 5.7 mm for Synergy, 5.6 mm for Xience, 5.2 mm for Orsiro, 5.8 mm for Ultimaster, 5.5 mm for 4 mm Onyx (5.9 mm for the 5 mm XL size) and 5.8 mm for BioMatrix Chroma. Conclusion This update presents valuable novel insights that may be helpful for careful selection of stent size for contemporary DES based on model designs. Such information is especially critical in left main bifurcation stenosis treatment where overexpansion to larger oversized diameter may be required to ensure full stent apposition

Multicultural mediations, developing world realities: Indians, Koreans and Manila’s entertainment media

In this article, I examine the mediation of multiculturalism in the developing world city of Manila, the Philippines. Drawing on both a thematic analysis of the Manila-centric Philippine entertainment media and six focus group discussions with the city’s local Filipinos, I reveal that this instance of mediation is entangled with the broader discourses of the Philippine postcolonial nationalist project. For one, the mediation of multiculturalism in Manila tends to symbolically marginalize the city’s Indians and Koreans and, in so doing, reinforces existing negative discourses about them. I contend that this is linked to the locals’ preoccupation with establishing a unifying cultural identity that tends to make them elide the issue of their own internal cultural diversity, as well as of the increasing diasporic population of the city. Second, the said mediation also tends to valorize the lighter-skinned Koreans over the darker-skinned Indians. I posit that this is related to how the locals’ discourse of cultural homogeneity has resulted in their continued reluctance to publicly discuss the persistence of their unspoken skin-tone-based racial hierarchy not only of themselves, but also of their cultural others

Narratives of ethnic identity among practitioners in community settings in the northeast of England

The increasing ethnic diversity of the UK has been mirrored by growing public awareness of multicultural issues, alongside developments in academic and government thinking. This paper explores the contested meanings around ethnic identity/ies in community settings, drawing on semi-structured interviews with staff from Children’s Centres and allied agencies conducted for a research project that examined the relationship between identity and the participation of parents/carers in services in northeast England. The research found that respondents were unclear about, especially, white ethnic identities, and commonly referred to other social categorizations, such as age, nationality, and circumstances such as mobility, when discussing service users. While in some cases this may have reflected legitimate attempts to resist overethnicizing non-ethnic phenomena, such constructions coexisted with assumptions about ethnic difference and how it might translate into service needs. These findings raise important considerations for policy and practice

Young people's uses of celebrity: Class, gender and 'improper' celebrity

This is an Author's Accepted Manuscript of an article published in Discourse: Studies in the Cultural Politics of Education, 34(1), 2013, copyright Taylor & Francis, available online at: http://www.tandfonline.com/10.1080/01596306.2012.698865.In this article, we explore the question of how celebrity operates in young people's everyday lives, thus contributing to the urgent need to address celebrity's social function. Drawing on data from three studies in England on young people's perspectives on their educational and work futures, we show how celebrity operates as a classed and gendered discursive device within young people's identity work. We illustrate how young people draw upon class and gender distinctions that circulate within celebrity discourses (proper/improper, deserving/undeserving, talented/talentless and respectable/tacky) as they construct their own identities in relation to notions of work, aspiration and achievement. We argue that these distinctions operate as part of neoliberal demands to produce oneself as a ‘subject of value’. However, some participants produced readings that show ambivalence and even resistance to these dominant discourses. Young people's responses to celebrity are shown to relate to their own class and gender position.The Arts and Humanities Research Council, the British Academy, the Economic and Social Research Council, and the UK Resource Centre for Women in Science Engineering and Technology

Evidence-based decision support for pediatric rheumatology reduces diagnostic errors.

BACKGROUND: The number of trained specialists world-wide is insufficient to serve all children with pediatric rheumatologic disorders, even in the countries with robust medical resources. We evaluated the potential of diagnostic decision support software (DDSS) to alleviate this shortage by assessing the ability of such software to improve the diagnostic accuracy of non-specialists. METHODS: Using vignettes of actual clinical cases, clinician testers generated a differential diagnosis before and after using diagnostic decision support software. The evaluation used the SimulConsult® DDSS tool, based on Bayesian pattern matching with temporal onset of each finding in each disease. The tool covered 5405 diseases (averaging 22 findings per disease). Rheumatology content in the database was developed using both primary references and textbooks. The frequency, timing, age of onset and age of disappearance of findings, as well as their incidence, treatability, and heritability were taken into account in order to guide diagnostic decision making. These capabilities allowed key information such as pertinent negatives and evolution over time to be used in the computations. Efficacy was measured by comparing whether the correct condition was included in the differential diagnosis generated by clinicians before using the software ( unaided ), versus after use of the DDSS ( aided ). RESULTS: The 26 clinicians demonstrated a significant reduction in diagnostic errors following introduction of the software, from 28% errors while unaided to 15% using decision support (p \u3c 0.0001). Improvement was greatest for emergency medicine physicians (p = 0.013) and clinicians in practice for less than 10 years (p = 0.012). This error reduction occurred despite the fact that testers employed an open book approach to generate their initial lists of potential diagnoses, spending an average of 8.6 min using printed and electronic sources of medical information before using the diagnostic software. CONCLUSIONS: These findings suggest that decision support can reduce diagnostic errors and improve use of relevant information by generalists. Such assistance could potentially help relieve the shortage of experts in pediatric rheumatology and similarly underserved specialties by improving generalists\u27 ability to evaluate and diagnose patients presenting with musculoskeletal complaints. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02205086