Pharmacological cardioversion for atrial fibrillation and flutter*

Atrial fibrillation is the commonest cardiac dysrhythmia. It is associated with significant morbidity and mortality. There are two approaches to the management of atrial fibrillation: controlling the ventricular rate or converting to sinus rhythm in the expectation that this would abolish its adverse effects. The objective of this review was to assess the effects of pharmacological cardioversion of atrial fibrillation in adults on the annual risk of stroke, peripheral embolism, and mortality. We made a thorough search for existing evidence in the following databases: the Cochrane Controlled Trials Register (Issue 3, 2002), MEDLINE (2000 to 2002), EMBASE (1998 to 2002), CINAHL (1982 to 2002), Web of Science (1981 to 2002). We also handsearched the following journals: Circulation (1997 to 2002), Heart (1997 to 2002), European Heart Journal (1997-2002), Journal of the American College of Cardiology (1997-2002) and selected abstracts published on the web site of the North American Society of Pacing and Electrophysiology (2001, 2002). We selected trials based on the following criteria: randomised controlled trials or controlled clinical trials of pharmacological cardioversion versus rate control in adults (>18 years) with acute, paroxysmal or sustained atrial fibrillation or atrial flutter, of any duration and of any aetiology. We identified two completed studies AFFIRM (n=4060) and PIAF (n=252). We found no difference in mortality between rhythm control and rate control - relative risk 1.14 (95% confidence interval 1.00 to 1.31). Both studies show significantly higher rates of hospitalisation and adverse events in the rhythm control group and no difference in quality of life between the two treatment groups. In AFFIRM there was a similar incidence of ischaemic stroke, bleeding and systemic embolism in the two groups. Certain malignant dysrhythmias were significantly more likely to occur in the rhythm control group. There were similar scores of cognitive assessment in both groups. In PIAF, cardioverted patients enjoyed an improved exercise tolerance but there was no overall benefit in terms of symptom control or quality of life. There is no evidence that pharmacological cardioversion of atrial fibrillation to sinus rhythm is superior to rate control. Rhythm control is associated with more adverse effects and increased hospitalisation. It does not reduce the risk of stroke. These conclusions cannot be generalised to all people with atrial fibrillation as most of the patients included in these studies were relatively older (>60 years) with significant cardiovascular risk factors

The international geomagnetic reference field 1965.0 in dipole coordinates

Computer program for transforming spherical harmonic coefficients to geomagnetic dipole coordinate

Quantitative magnetospheric models derived from spacecraft magnetometer data

Quantitative models of the external magnetospheric field were derived by making least-squares fits to magnetic field measurements from four IMP satellites. The data were fit to a power series expansion in the solar magnetic coordinates and the solar wind-dipole tilt angle, and thus the models contain the effects of seasonal north-south asymmetries. The expansions are divergence-free, but unlike the usual scalar potential expansions, the models contain a nonzero curl representing currents distributed within the magnetosphere. Characteristics of four models are presented, representing different degrees of magnetic disturbance as determined by the range of Kp values. The latitude at the earth separating open polar cap field lines from field lines closing on the dayside is about 5 deg lower than that determined by previous theoretically-derived models. At times of high Kp, additional high latitude field lines are drawn back into the tail

Accuracy of remotely sensed data: Sampling and analysis procedures

A review and update of the discrete multivariate analysis techniques used for accuracy assessment is given. A listing of the computer program written to implement these techniques is given. New work on evaluating accuracy assessment using Monte Carlo simulation with different sampling schemes is given. The results of matrices from the mapping effort of the San Juan National Forest is given. A method for estimating the sample size requirements for implementing the accuracy assessment procedures is given. A proposed method for determining the reliability of change detection between two maps of the same area produced at different times is given

Improving CMB non-Gaussianity estimators using tracers of local structure

Local non-Gaussianity causes correlations between large scale perturbation modes and the small scale power. The large-scale CMB signal has contributions from the integrated Sachs Wolfe (ISW) effect, which does not correlate with the small scale power. If this ISW contribution can be removed, the sensitivity to local non-Gaussianity is improved. Gravitational lensing and galaxy counts can be used to trace the ISW contribution; in particular we show that the CMB lensing potential is highly correlated with the ISW signal. We construct a nearly-optimal estimator for the local non-Gaussianity parameter \fnl and investigate to what extent we can use this to decrease the variance on {\fnl}. We show that the variance can be decreased by up to $20\%$ at Planck sensitivity using galaxy counts. CMB lensing is a good bias-independent ISW tracer for future more sensitive observations, though the fractional decrease in variance is small if good polarization data is also available.Comment: 8 pages, 3 figures. Comments welcom

Mapping the invisible hand: a body model of a phantom limb

After amputation, individuals often have vivid experiences of their absent limb (i.e., a phantom limb). Therefore, one’s conscious image of one’s body cannot depend on peripheral input only (Ramachandran & Hirstein, 1998). However, the origin of phantom sensations is hotly debated. Reports of vivid phantoms in the case of congenital absence of the limb show that memory of former body state is not necessary (Brugger et al., 2000). According to one view, phantoms may reflect innate organization of sensorimotor cortices (Melzack, 1990). Alternatively, phantoms could reflect generalization from viewing other people’s bodies (Brugger et al., 2000), a sensorimotor example of the classic theory that understanding oneself follows from understanding the “generalized other” (Mead, 1934, p. 154). Because phantom limbs cannot be stimulated, sensory testing cannot directly compare visual and somatosensory influences on representations of phantom limbs. Consequently, empirical investigation of phantoms is limited

Nationwide forestry applications program. Analysis of forest classification accuracy

The development of LANDSAT classification accuracy assessment techniques, and of a computerized system for assessing wildlife habitat from land cover maps are considered. A literature review on accuracy assessment techniques and an explanation for the techniques development under both projects are included along with listings of the computer programs. The presentations and discussions at the National Working Conference on LANDSAT Classification Accuracy are summarized. Two symposium papers which were published on the results of this project are appended

Locality and topology in the molecular Aharonov-Bohm effect

It is shown that the molecular Aharonov-Bohm effect is neither nonlocal nor topological in the sense of the standard magnetic Aharonov-Bohm effect. It is further argued that there is a close relationship between the molecular Aharonov-Bohm effect and the Aharonov-Casher effect for an electrically neutral spin$-{1/2}$ particle encircling a line of charge.Comment: 3 pages, no figure

Jupiter's radiation belts: Can Pioneer 10 survive?

Model calculations of Jupiter's electron and proton radiation belts indicate that the Galilean satellites can reduce particle fluxes in certain regions of the inner magnetosphere by as much as six orders of magnitude. Average fluxes should be reduced by a factor of 100 or more along the Pioneer 10 trajectory through the heart of Jupiter's radiation belts in early December. This may be enough to prevent serious radiation damage to the spacecraft