Surgical procedure for the cure of atrioventricular junctional (“AV node”) reentrant tachycardia: Anatomic and electrophysiologic effects of dissection of the anterior atrionodal connections in a canine model

AbstractObjectives. This study was undertaken to examine the electrophysiologic and anatomic efects of a surgical procedure that cures the anterior (common) type of atrioventricular (AV) junciional reentrant tachycardia.Background. The procedure was designed to interrupt the reentrant circuit at the point of earliest atrial activation during AV junctional reentrant tachycardia, the anterior atrionodal connections.Methods. Atrioventricular node function and the sequence of electrical excitation of Koch's triangle were examined in 18 dogs. Excitation of Koch's triangle was mapped using a 60-channel mapping system. Surgical dissection was performed in 10 dogs and a sham procedure in 8. After 28 to 35 days, AV node function and the atrial excitation pattern were reassessed. The AV junction was examined using light microscopy.Results. Some degree of AV node damage was visible in all dogs in the dissection group, but it was minor in 40% of cases. The anterior part of the AV node was disconnected from the anterior atrionodal connections in all cases. Anterograde AV node function was mildly impaired. The median AH interval was increased (62 vs. 76 ms [interquartile ranges 48 to 72 and 64 to 104, respectively], P = 0.05), and the AV Wenckebach cycle length was increased (210 vs. 245 ms [interquartile ranges 200 to 230 and 210 to 260, respectively], p = 0.02). The degree of impairment of conduction was directly proportional to the length of dissection (p < 0.05) but not to the degree of damage to the AV node. Ventriculoatrial (VA) conduction was destroyed in 50% of dogs undergoing dissection but in none of those with a sham operation (p < 0.04). The AV node remained responsive to autonomic blocking drugs, and atrial mapping during ventricular pacing revealed that the site of exit from the AV node had been altered.Conclusions. The atrionodal connections closest to the His bundle are the preferred route of conduction through the AV node during normal AV or VA conduction. Destruction of these connections modifies AV node conduction. The surgical procedure selectively interrupts these connections, and this interruption is likely to be the mechanism of cure

Cross-sectional survey of sexual health professionals’ experiences and perceptions of the 2022 mpox outbreak in the UK

Objective: To understand the experiences and perceptions of sexual health professionals responding to the May 2022 mpox outbreak in the UK. Design: Cross-sectional, anonymous, online survey collecting quantitative and qualitative data. Convenience sample recruited via an international network of sexual health and HIV clinicians responding to mpox and promoted through clinical associations and social media. Survey domains included: clinical workload; preparedness, support, and training; safety at work; vaccination; and well-being. Qualitative descriptive analysis of open-text responses was conducted to support interpretation of the quantitative data. Participants: Participants who were employed as sexual health professionals in the UK and had direct clinical experience of mpox were included in the analysis. The survey was completed between 11 August and 31 October 2022 by 139 respondents, the majority of whom were doctors (72.7%), cis-female (70.5%) and White (78.4%). Results: 70.3% reported that they were required to respond to mpox in addition to their existing clinical responsibilities, with 46.8% working longer hours as a result. In the open-text data, respondents highlighted that workload pressures were exacerbated by a lack of additional funding for mpox, pre-existing pressures on sexual health services, and unrealistic expectations around capacity. 67.6% of respondents reported experiencing negative emotional impact due to their mpox work, with stress (59.0%), fatigue (43.2%) and anxiety (36.0%) being the most common symptoms. 35.8% stated that they were less likely to remain in their profession because of their experiences during the mpox outbreak. In the open-text data, these feelings were ascribed to post-COVID exhaustion, understaffing and frustration among some participants at the handling of the mpox response. Conclusions: These findings indicate that sexual health services require increased funding and resources, along with evidence-based well-being interventions, to support sexual health professionals’ outbreak preparedness and recovery

A within-person theoretical perspective in sales research: outlining recommendations for adoption and consideration of boundary conditions

In the sales literature it is standard practice for researchers to collect cross-sectional data from multiple salespeople, and to compare those salespeople on the data obtained. This between-person approach is suitable for research aiming to draw conclusions between salespeople. However, many salesperson processes are dynamic and vary within salespeople over time, requiring datasets with repeated-measures. This article highlights the need to adopt a within-person theoretical perspective in sales research. Critically, the article shows how our present understanding of boundary conditions may change depending on whether a between-person or within-person level of analysis is adopted. Using examples from the sales literature, we show how the practical implications from between-persons research designs do not necessarily generalize to the within-person level. Further, we explain the methodological and analytical considerations that researchers must account for when undertaking within-person research. Furthermore, the article provides decision criteria that help to identify when within-person analysis should be conducted, outlining analysis tools that are capable of correctly estimating within-person effects without bias. Examples of how within-person research can enhance theory within future sales research, and how within-person research may influence management implications are also discussed. Finally, potential remedies to within-person research barriers are given

The Context of Sexual Risk Behaviour Among Men Who Have Sex with Men Seeking PrEP, and the Impact of PrEP on Sexual Behaviour

There are still important gaps in our understanding of how people will incorporate PrEP into their existing HIV prevention strategies. In this paper, we explore how PrEP use impacted existing sexual risk behaviours and risk reduction strategies using qualitative data from the PROUD study. From February 2014 to January 2016, we conducted 41 in-depth interviews with gay, bisexual and other men who have sex with men (GBMSM) enrolled in the PROUD PrEP study at sexual health clinics in England. The interviews were conducted in English and were audio-recorded. The recordings were transcribed, coded and analysed using framework analysis. In the interviews, we explored participants' sexual behaviour before joining the study and among those using or who had used PrEP, changes to sexual behaviour after starting PrEP. Participants described the risk behaviour and management strategies before using PrEP, which included irregular condom use, sero-sorting, and strategic positioning. Participants described their sexual risk taking before initiating PrEP in the context of the sexualised use of drugs, geographical spaces linked with higher risk sexual norms, and digitised sexual networking, as well as problematic psychological factors that exacerbated risk taking. The findings highlight that in the main, individuals who were already having frequent condomless sex, added PrEP to the existing range of risk management strategies, influencing the boundaries of the 'rules' for some but not all. While approximately half the participants reduced other risk reduction strategies after starting PrEP, the other half did not alter their behaviours. PrEP provided an additional HIV prevention option to a cohort of GBMSM at high risk of HIV due to inconsistent use of other prevention options. In summary, PrEP provides a critical and necessary additional HIV prevention option that individuals can add to existing strategies in order to enhance protection, at least from HIV. As a daily pill, PrEP offers protection in the context of the sex cultures associated with sexualised drug use, digitised sexual applications and shifting social norms around sexual fulfilment and risk taking. PrEP can offer short or longer-term options for individuals as their sexual desires change over their life course offering protection from HIV during periods of heightened risk. PrEP should not be perceived or positioned in opposition to the existing HIV prevention toolkit, but rather as additive and as a tool that can and is having a substantial impact on HIV

GALFIT-ing AGN Host Galaxies in COSMOS: HST versus Subaru

The COSMOS field has been extensively observed by most major telescopes, including Chandra, HST, and Subaru. HST imaging boasts very high spatial resolution and is used extensively in morphological studies of distant galaxies. Subaru provides lower spatial resolution imaging than HST but a substantially wider field of view with greater sensitivity. Both telescopes provide near-infrared imaging of COSMOS. Successful morphological fitting of Subaru data would allow us to measure morphologies of over 10 ^4 known active galactic nucleus (AGN) hosts, accessible through Subaru wide-field surveys, currently not covered by HST. The morphological parameters indicate the types of galaxies that host AGNs. For 4016 AGNs between 0.03 < z < 6.5, we study the morphology of their galaxy hosts using GALFIT, fitting components representing the AGN and host galaxy simultaneously using the i -band imaging from both HST and Subaru. Comparing the fits for the differing telescope spatial resolutions and image signal-to-noise ratios, we identify parameter regimes for which there is strong disagreement between distributions of fitted parameters for HST and Subaru. In particular, the Sérsic index values strongly disagree between the two sets of data, including sources at lower redshifts. In contrast, the measured magnitude and radius parameters show reasonable agreement. Additionally, large variations in the Sérsic index have little effect on the ${\chi }_{\nu }^{2}$ of each fit, whereas variations in other parameters have a more significant effect. These results indicate that the Sérsic index distributions of high-redshift galaxies that host AGNs imaged at ground-based spatial resolution are not reliable indicators of galaxy type and should be interpreted with caution

Electrophysiologic and histologic effects of dissection of the connections between the atrium and posterior part of the atrioventricular node

AbstractObjectives. This study was designed to examine the effects of destroying the posterior approaches to the atrioventricular (AV) node.Background. Surgical and catheter ablation procedures have been developed for the cure of AV junctional reentrant tachycardia. Some of these destroy the posterior approaches to the AV node.Methods. Atrioventricular node function and electrical excitation of Koch's triangle and the proximal coronary sinus were examined in 18 dogs. Dissection of the posterior atrionodal connections was performed in 10 dogs and a sham procedure in 8. After 28 to 35 days, repeat electrophysiologic and mapping studies were performed to assess changes in AV node function and the routes of AV and ventriculoatrial (VA) conduction. The AV junction was then examined with light microscopy.Results. The compact AV node was undamaged in eight cases (80%). In two cases minor fibrosis occurred at the posterior limit of the compact node. The right-sided posterior atrionodal connections lying between the coronary sinus orifice and the tricuspid annulus were replaced by scar tissue in all cases, but the left-sided posterior connections and the anterior connections remained intact. Atrioventricular and VA conduction intervals and refractory periods were not altered. Atrioventricular junctional echoes were present in 10 dogs before and in 7 dogs after dissection (p = 0.06). Posterior (slow pathway) retrograde exits from the AV node were present in seven dogs before and in seven dogs after dissection. However, retrograde atrial excitation was altered in four of these seven dogs, so that the site of exit from the AV node was more leftward than it had been preoperatively. The node remained responsive to autonomic blocking drugs postoperatively. Double atrial electrograms similar to slow pathway potentials were found in all dogs.Conclusions. This procedure ablates the posterior atrionodal connections but rarely damages the compact AV node. Atrioventricular node function is not impaired and the node is not denervated. The mechanism of cure of AV junctional reentrant tachycardia is probably damage to the perinodal atrium. This suggests that part of the slow AV node pathway may lie outside the compact AV node. Dual AV node exits and double atrial electrograms are present in the normal canine heart

P65 Sexual behaviour in the time period between being tested for chlamydia and receiving test result and treatment

Background/introduction There is a lack of data on the sexual behaviour of patients between being tested for chlamydia, receiving the test result, and being treated. This time-period may be important in the transmission of chlamydia, as infection could continue to be spread to sexual partners whilst awaiting the test result and treatment. Aim(s)/objectives To investigate the sexual behaviours of patients between the time of being tested for chlamydia and receiving test result and treatment in order to investigate the benefits that a point-of-care test (POCT) might bring to clinical practice. Methods We conducted a cross-sectional clinical audit of GUM clinic attendees. Clinic staff conducted a notes review of patients returning for chlamydia treatment following a positive chlamydia test result, and of age- and sex-matched chlamydia negatives. The data also served as an audit for the GUM clinics, following BASHH guidelines. Results Five of nine GUM clinics approached participated, in July–December 2014. Data from 775 patients were included in analyses, 365 of whom were chlamydia-positive. Males with 2–4 partners, and those who reported never using a condom, were more likely to be chlamydia positive. For 21/143 (14.7%) positive patients who provided data, last new sexual contact was in the period between test and treatment. Data were missing on condom use (22%) and recent new partners (81%). Discussion/conclusion Patients continue to form new sexual partnerships whilst awaiting chlamydia test results, allowing for the possibility of infecting new sexual partners. POCTs which remove the test to treatment delay could prevent this onward transmission