Force‐sensing catheters during pediatric radiofrequency ablation: The FEDERATION Study

Background Based on data from studies of atrial fibrillation ablations, optimal parameters for the TactiCath (TC; St. Jude Medical, Inc) force‐sensing ablation catheter are a contact force of 20 g and a force‐time integral of 400 g·s for the creation of transmural lesions. We aimed to evaluate TC in pediatric and congenital heart disease patients undergoing ablation. Methods and Results Comprehensive chart and case reviews were performed from June 2015 to March 2016. Of the 102 patients undergoing electrophysiology study plus ablation, 58 (57%) underwent ablation initially with a force‐sensing catheter. Patients had an average age of 14 (2.4–23) years and weight of 58 (18–195) kg with 15 patients having abnormal cardiac anatomy. Electrophysiology diagnoses for the + TC group included 30 accessory pathway–mediated tachycardia, 24 atrioventricular nodal reentrant tachycardia, and 7 other. Baseline generator settings included a power of 20 W, temperature of 40°, and 6 cc/min flow during lesion creation with 11 patients (19%) having alterations to parameters. Seventeen patients (30%) converted to an alternate ablation source. A total of 516 lesions were performed using the TC with a median contact force of 6 g, force‐time integral of 149 g·s, and lesion size index of 3.3. Median‐term follow‐up demonstrated 5 (10%) recurrences with no acute or median‐term complications. Conclusions TactiCath can be effectively employed in the treatment of pediatric patients with congenital heart disease with lower forces than previously described in the atrial fibrillation literature. Patients with atrioventricular nodal reentrant tachycardia or atrioventricular reciprocating tachycardia may not require transmural lesions and the TC may provide surrogate markers for success during slow pathway ablation. </jats:sec

Percutaneous pulmonary valve implantation alters electrophysiologic substrate

BACKGROUND: Percutaneous pulmonary valve implantation (PPVI) is first‐line therapy for some congenital heart disease patients with right ventricular outflow tract dysfunction. The hemodynamics improvements after PPVI are well documented, but little is known about its effects on the electrophysiologic substrate. The objective of this study is to assess the short‐ and medium‐term electrophysiologic substrate changes and elucidate postprocedure arrhythmias. METHODS AND RESULTS: A retrospective chart review of patients undergoing PPVI from May 2010 to April 2015 was performed. A total of 106 patients underwent PPVI; most commonly these patients had tetralogy of Fallot (n=59, 55%) and pulmonary insufficiency (n=60, 57%). The median follow‐up time was 28 months (7‐63 months). Pre‐PPVI, 25 patients (24%) had documented arrhythmias: nonsustained ventricular tachycardia (NSVT) (n=9, 8%), frequent premature ventricular contractions (PVCs) (n=6, 6%), and atrial fibrillation/flutter (AF/AFL) (n=10, 9%). Post‐PPVI, arrhythmias resolved in 4 patients who had NSVT (44%) and 5 patients who had PVCs (83%). New arrhythmias were seen in 16 patients (15%): 7 NSVT, 8 PVCs, and 1 AF/AFL. There was resolution at medium‐term follow‐up in 6 (86%) patients with new‐onset NSVT and 7 (88%) patients with new‐onset PVCs. There was no difference in QRS duration pre‐PPVI, post‐PPVI, and at medium‐term follow‐up (P=0.6). The median corrected QT lengthened immediately post‐PPVI but shortened significantly at midterm follow‐up (P<0.01). CONCLUSIONS: PPVI reduced the prevalence of NSVT. The majority of postimplant arrhythmias resolve by 6 months of follow‐up

Thyroid hormones correlate with resting metabolic rate, not daily energy expenditure, in two charadriiform seabirds

K. Woo, M. Le Vaillant, T. van Nus, and especially A. Wesphal, J. Schultner and I. Dorresteijn, assisted with field work, often under unpleasant conditions. K. Wauthier was instrumental in wrestling the gamma counter into submission. P. Redman and C. Hambly conducted the isotopic analyses. K. Scott and K. Campbell provided the FoxBox. K.H.E. benefited from a Natural Sciences and Engineering Research Council (NSERC) Vanier Scholarship, Association of Canadian Universities for Northern Studies Garfield Weston Northern Studies Award and the Arctic Institute of North America Jennifer Robinson Scholarship. Research support came from Bird Studies Canada/Society of Canadian Ornithologists James Baillie Award, Animal Behavior Society Research Grant, American Ornithologists’ Union Research Grant, Frank Chapman Research Grant, the Waterbird Society Nisbet Grant and NSERC Discovery Grants to J.F.H. and W.G.A. Any use of trade names is for descriptive purposes only and does not imply endorsement by the US Government.Peer reviewedPublisher PD

Charge injection instability in perfect insulators

We show that in a macroscopic perfect insulator, charge injection at a field-enhancing defect is associated with an instability of the insulating state or with bistability of the insulating and the charged state. The effect of a nonlinear carrier mobility is emphasized. The formation of the charged state is governed by two different processes with clearly separated time scales. First, due to a fast growth of a charge-injection mode, a localized charge cloud forms near the injecting defect (or contact). Charge injection stops when the field enhancement is screened below criticality. Secondly, the charge slowly redistributes in the bulk. The linear instability mechanism and the final charged steady state are discussed for a simple model and for cylindrical and spherical geometries. The theory explains an experimentally observed increase of the critical electric field with decreasing size of the injecting contact. Numerical results are presented for dc and ac biased insulators.Comment: Revtex, 7pages, 4 ps figure

The omnivorous Tyrolean Iceman: colon contents (meat, cereals, pollen, moss and whipworm) and stable isotope analyses

The contents of the colon of the Tyrolean Iceman who lived Ga. 5300 years ago include muscle fibres, cereal remains, a diversity of pollen, and most notably that of the hop hornbeam (Ostrya carpinifolia) retaining cellular contents, as well as a moss leaf (Neckera complanata) and eggs of the parasitic whipworm (Trichuris trichiura). Based almost solely on stable isotope analyses and ignoring the work on the colon contents, two recently published papers on the Iceman's diet draw ill- founded conclusions about vegetarianism and even veganism. Neither the pollen nor the moss is likely to have been deliberately consumed as food by the Iceman. All the available evidence concerning the Iceman's broad-based diet is reviewed and the significance of the colon contents for matters other than assessment of food intake is outlined

Serum Neurofilament Light, Glial Fibrillary Acidic Protein and Tau Are Possible Serum Biomarkers for Activity of Brain Metastases and Gliomas

BACKGROUND: Primary central nervous system (CNS) tumors and brain metastases (BMs) are major causes of morbidity and mortality, accompanied by low survival rates. Efforts to early discovery of CNS malignancies are critical. However, to date, there are no biomarkers approved for detection of cancer activity in the brain. Blood levels of neurofilament light (NfL) and tau, as well as glial fibrillary acidic protein (GFAp), show promise as biomarkers for brain injury in previous studies. Therefore, we performed a cross-sectional study to investigate correlations of those biomarkers with CNS activity of gliomas and BMs. METHODS: Serum samples of 36 participants of a single centered institution were tested for NfL, GFAp and tau with Simoa immunoassay, and correlated with clinical and radiological data. RESULTS: fL and GFAp levels were significantly associated with the state of intracranial disease (analysis of variance (ANOVA), P_{sNfL} = 0.03; ANOVA, P_{GFAp} = 0.03). Although statistically significant (P = 0.04), differences in concentrations were not clinically meaningful for tau levels. Serum NfL (sNfL) and GFAp concentrations were higher in the group of patients with CNS tumors with disease in progression versus CNS with stable disease (P = 0.03 and P = 0.01, respectively). In addition, sNfL were higher in patients with metastatic solid tumors with known BMs than in those with metastatic tumors with no BM (P = 0.0004). CONCLUSION: sNfL and GFAp both apparently vary closely with presence and activity of gliomas and BMs. Further studies in larger populations are needed to expand these findings

Structural, item, and test generalizability of the psychopathology checklist - revised to offenders with intellectual disabilities

The Psychopathy Checklist–Revised (PCL-R) is the most widely used measure of psychopathy in forensic clinical practice, but the generalizability of the measure to offenders with intellectual disabilities (ID) has not been clearly established. This study examined the structural equivalence and scalar equivalence of the PCL-R in a sample of 185 male offenders with ID in forensic mental health settings, as compared with a sample of 1,212 male prisoners without ID. Three models of the PCL-R’s factor structure were evaluated with confirmatory factor analysis. The 3-factor hierarchical model of psychopathy was found to be a good fit to the ID PCL-R data, whereas neither the 4-factor model nor the traditional 2-factor model fitted. There were no cross-group differences in the factor structure, providing evidence of structural equivalence. However, item response theory analyses indicated metric differences in the ratings of psychopathy symptoms between the ID group and the comparison prisoner group. This finding has potential implications for the interpretation of PCL-R scores obtained with people with ID in forensic psychiatric settings

The impact of climate change on incomes and convergence in Africa

© 2019 Elsevier Ltd Climate change is projected to detrimentally affect African countries’ economic development, while income inequalities across economies is among the highest on the planet. However, it is projected that income levels would converge on the continent. Hitherto there is limited evidence on how climate change could affect projected income convergence, accelerating, slowing down, or even reversing this process. Here, we analyze convergence considering climate-change damages, by employing an economic model embedding the three dimensions of risks at the country-level: exposure, vulnerability and hazards. The results show (1) with historical mean climate-induced losses between 10 and 15 percent of GDP per capita growth, the majority of African economies are poorly adapted to their current climatic conditions, (2) Western and Eastern African countries are projected to be the most affected countries on the continent and (3) As a consequence of these heightened impacts on a number of countries, inequalities between countries are projected to widen in the high warming scenario compared to inequalities in the low and without warming scenarios. To mitigate the impacts of economic development and inequalities across countries, we stress (1) the importance of mitigation ambition and Africa's leadership in keeping global mean temperature increase below 1.5 °C, (2) the need to address the current adaptation deficit as soon as possible, (3) the necessity to integrate quantitatively climate risks in economic and development planning and finally (4) we advocate for the generalization of a special treatment for the most vulnerable countries to access climate-related finance. The analysis raises issues on the ability of African countries to reach their SDGs targets and the potential increasing risk of instability, migration across African countries, of decreased trade and economic cooperation opportunities as a consequence of climate change – exacerbating its negative consequences

The impact of climate change on incomes and convergence in Africa

© 2019 Elsevier Ltd Climate change is projected to detrimentally affect African countries’ economic development, while income inequalities across economies is among the highest on the planet. However, it is projected that income levels would converge on the continent. Hitherto there is limited evidence on how climate change could affect projected income convergence, accelerating, slowing down, or even reversing this process. Here, we analyze convergence considering climate-change damages, by employing an economic model embedding the three dimensions of risks at the country-level: exposure, vulnerability and hazards. The results show (1) with historical mean climate-induced losses between 10 and 15 percent of GDP per capita growth, the majority of African economies are poorly adapted to their current climatic conditions, (2) Western and Eastern African countries are projected to be the most affected countries on the continent and (3) As a consequence of these heightened impacts on a number of countries, inequalities between countries are projected to widen in the high warming scenario compared to inequalities in the low and without warming scenarios. To mitigate the impacts of economic development and inequalities across countries, we stress (1) the importance of mitigation ambition and Africa's leadership in keeping global mean temperature increase below 1.5 °C, (2) the need to address the current adaptation deficit as soon as possible, (3) the necessity to integrate quantitatively climate risks in economic and development planning and finally (4) we advocate for the generalization of a special treatment for the most vulnerable countries to access climate-related finance. The analysis raises issues on the ability of African countries to reach their SDGs targets and the potential increasing risk of instability, migration across African countries, of decreased trade and economic cooperation opportunities as a consequence of climate change – exacerbating its negative consequences