Remote Monitoring of Implantable Cardioverter Defibrillator

The rate of implantable cardioverter defibrillator (ICD) implantation has gone up as primary and secondary prevention trials have relatively consistently shown significant improvement in mortality and morbidity. Most patients with ICDs are followed routinely at intervals ranging from 3 to 6 months. Many patients require additional non-scheduled visits to investigate symptoms that may or may not relate to their cardiac disease or device. Appropriate and inappropriate therapies of implantable cardioverter defibrillators have a major impact on morbidity and quality of life in ICD recipients. Remote monitoring systems can substitute for routine follow-up visits and/ or deliver continuous diagnostic and device status information. Remote monitoring of ICDs can decrease the need for many patient visits and, thereby, probably reduce expense

Sīrat Banī Hilāl : introduction and notes to an Arab oral epic tradition

This poetic tradition which Egypt’s preeminent literary scholar, Ṭaha Hussein, recalls at the outset of his autobiography is one familiar through much of the Arab world—the sīra of the Banī Hilāl Bedouin tribe which chronicles the tribe’s massive migration from their homeland on the Arabian peninsula, their sojourn in Egypt, their conquest of North Africa, and their final defeat one hundred years later. The migration, the conquest, and the defeat are historical events which took place between the tenth and twelfth centuries A.D. From this skein of actual events Arabic oral tradition has woven a rich and complex narrative centered on a cluster of heroic characters. Time and again Bedouin warriors and heroines are pitted against the kings and princes of towns and cities. The individual destinies of the main actors are constantly in a fragile balance with the fate of the tribe itself. Finally, with the conquest of North Africa, the Banī Hilāl nomads themselves become rulers of cities, a situation which leads to the internal fragmentation of the tribe and their eventual demise. Stories of the Banī Hilāl tribe have been recorded from oral tradition since the fourteenth century in regions located across the breadth of the Arab world: from Morocco on the shores of the Atlantic to Oman on the edges of the Indian Ocean, and as far south into Africa as Nigeria, Chad, and the Sudan. It is quite probably the single most widespread and best documented narrative of Arabic oral literature. We know far more about the historical development, the geographical distribution, and the living oral tradition of Sīrat Banī Hilāl than, for example, the 1001 Nights, which owes its fame almost entirely to the enormous amount of attention it received in eighteenth- and nineteenth-century Europe.1 Though Sīrat Banī Hilāl is little known in the urban centers of the Arab world, in rural areas it has been recorded in prose, in poetry, and in song. The most famous versions are those sung by epic poets in Egypt who perform for nights at a time their versifi ed narrative while accompanying themselves on the rabāb (spike-fi ddle), the ṭār (large frame-drum) or western violin (held vertically on the knee). The folk sīra tradition is one familiar to most scholars of Arabic literature, but it has for the most part escaped the notice of epic scholars, folklorists, and anthropologists in the West. This is certainly due primarily to the dearth of translations into European languages and in particular into English. Over the past two decades, however, Sīrat Banī Hilāl has sparked new academic interest and even a few translations. This article, then, is intended as an introduction for non-Arabists to the tradition of, and recent scholarship on, Sīrat Banī Hilāl

The Sirat Bani Hilal digital archive

The primary purpose of the Sirat Bani Hilal Digital Archive (http://www.siratbanihilal.ucsb.edu) is to preserve and make accessible online, to both scholars and the general public, materials related to the Arabic oral epic tradition of Sirat Bani Hilal (the epic of the Bani Hilal Bedouin tribe). The archive was created with the assistance of a yearlong "Digital Innovation" grant from the American Council of Learned Societies (2008-09) and is now a permanent collection in the holdings of the Davidson Research Library at the University of California, Santa Barbara. The core of the archive is a body of audio recordings, photographs, and field notes from research conducted by Dwight F. Reynolds (Professor, Arabic Language and Literature, UCSB) in Egypt in 1982-83, 1986-87, 1988, 1993, and 1995.1Not

A New Paradigm of Cardiovascular Risk Factor Modification

Atherosclerotic cardiovascular diseases (CVDs) are the leading cause of death and disability in the United States. While multiple studies have demonstrated that modification of atherosclerotic cardiovascular risk factors (CVRFs) significantly reduces morbidity and mortality rates, clinical control of CVDs and CVRFs remains poor. By 2010, the American Heart Association seeks to reduce coronary heart disease, stroke, and risk by 25%. To meet this goal, clinical practitioners must establish new treatment paradigms for CVDs and CVRFs. This paper discusses one such treatment model – a comprehensive atherosclerosis program run by physician extenders (under physician supervision), which incorporates evidence-based CVD and CVRF interventions to achieve treatment goals

Effect of piping arrangements on the steam engine indicator diagram

Thesis (BS)--University of Illinois, 1897M

Automatic optimization of cardiac resynchronization therapy using SonR-rationale and design of the clinical trial of the SonRtip lead and automatic AV-VV optimization algorithm in the paradym RF SonR CRT-D (RESPOND CRT) trial.

Although cardiac resynchronization therapy (CRT) is effective in most patients with heart failure (HF) and ventricular dyssynchrony, a significant minority of patients (approximately 30%) are non-responders. Optimal atrioventricular and interventricular delays often change over time and reprogramming these intervals might increase CRT effectiveness. The SonR algorithm automatically optimizes atrioventricular and interventricular intervals each week using an accelerometer to measure change in the SonR signal, which was shown previously to correlate with hemodynamic improvement (left ventricular [LV] dP/dtmax). The RESPOND CRT trial will evaluate the effectiveness and safety of the SonR optimization system in patients with HF New York Heart Association class III or ambulatory IV eligible for a CRT-D device. Enrolled patients will be randomized in a 2:1 ratio to either SonR CRT optimization or to a control arm employing echocardiographic optimization. All patients will be followed for at least 24 months in a double-blinded fashion. The primary effectiveness end point will be evaluated for non-inferiority, with a nested test of superiority, based on the proportion of responders (defined as alive, free from HF-related events, with improvements in New York Heart Association class or improvement in Kansas City Cardiomyopathy Questionnaire quality of life score) at 12 months. The required sample size is 876 patients. The two primary safety end points are acute and chronic SonR lead-related complication rates, respectively. Secondary end points include proportion of patients free from death or HF hospitalization, proportion of patients worsened, and lead electrical performance, assessed at 12 months. The RESPOND CRT trial will also examine associated reverse remodeling at 1 year

Incremental Reduction in Risk of Death Associated with Use of Guideline-Recommended Therapies in Patients with Heart Failure: A Nested Case-Control Analysis of IMPROVE HF

Background: Several therapies are guideline-recommended to reduce mortality in patients with heart failure (HF) and reduced left ventricular ejection fraction, but the incremental clinical effectiveness of these therapies has not been well studied. We aimed to evaluate the individual and incremental benefits of guideline-recommended HF therapies associated with 24-month survival. Methods and results: We performed a nested case-control study of HF patients enrolled in IMPROVE HF. Cases were patients who died within 24 months and controls were patients who survived to 24 months, propensity-matched 1:2 for multiple prognostic variables. Logistic regression was performed, and the attributable mortality risk from incomplete application of each evidence-based therapy among eligible patients was calculated. A total of 1376 cases and 2752 matched controls were identified. β-Blocker and cardiac resynchronization therapy were associated with the greatest 24-month survival benefit (adjusted odds ratio for death 0.42, 95% confidence interval (CI), 0.34–0.52; and 0.44, 95% CI, 0.29–0.67, respectively). Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, implantable cardioverter-defibrillators, anticoagulation for atrial fibrillation, and HF education were also associated with benefit, whereas aldosterone antagonist use was not. Incremental benefits were observed with each successive therapy, plateauing once any 4 to 5 therapies were provided (adjusted odds ratio 0.31, 95% CI, 0.23–0.42 for 5 or more versus 0/1, P<0.0001). Conclusions: Individual, with a single exception, and incremental use of guideline-recommended therapies was associated with survival benefit, with a potential plateau at 4 to 5 therapies. These data provide further rationale to implement guideline-recommended HF therapies in the absence of contraindications to patients with HF and reduced left ventricular ejection fraction