Human atrial fibrillation substrate: towards a specific fibrotic atrial cardiomyopathy

The atrial structure/substrate of patients with atrial fibrillation (AF) and clinically similar characteristics can present very differently, and also the ‘phenotype' (i.e. paroxysmal, persistent, and long standing persistent) of the arrhythmia cannot comprehensively explain these differences. It was unclear why some patients stay in paroxysmal AF for decades, whereas other patients with the same characteristics progress to persistent AF within a few months. In this review, evidence is described that AF patients without apparent structural heart disease have a chronic fibrotic bi-atrial substrate. There is also evidence from intraoperatively obtained specimen analysis, post-mortem autopsy findings, electroanatomic mapping studies, and delayed enhancement-MRI investigations that a higher mean value of fibrosis is detected in patients with persistent vs. paroxysmal AF but that the variability in the extend of fibrosis is always very high with part of paroxysmal AF patients having massive fibrosis and part of persistent AF patients showing mild fibrosis. In addition, patients undergoing ablation very early after the first AF episodes show already significant fibrosis. These data do not support a causal relationship that AF (significantly) produces fibrosis in the sense of ‘AF begets AF' instead of being a consequence of the fibrotic process. In patients with mitral stenosis, evidence for reverse atrial remodelling after commissurotomy was reported, however, in patients with ‘lone' AF, the atrial substrate progressed after successful AF elimination indicating towards the independent/progressive disease process of an underlying structural atrial disease called fibrotic atrial cardiomyopathy. Other ‘conventional wisdoms' also need to be re-considered including the aetiological role of age and arterial hypertension for human structural atrial remodellin

A learning paradigm informed by knowledge of the learning self : a compendium of applied research on the Let Me Learn [Book review]

This research compendium was compiled to celebrate the 20th anniversary of the Let Me Learn Process®, Advanced Learning System and the US and Malta researchers who over the past two decades have conducted the researching and implementation of the Let Me Learn Process in the US, Australia, Malta and seven other EU member nations. The text was released during the International Learning Summit: Unlocking Learning Potential held in Sliema, Malta, July, 2015. It is edited by Dr. Colin Calleja, flag bearer for Let Me Learn- Malta and Europe, and Professor Christine Johnston, originator and lead researcher of Let Me Learn-USA.peer-reviewe

Apprendimento trasformativo: l’esperienza trasformativa del leader

A transformative leader is a person who inspires others to follow his or hervisionary position. Such a leader causes change in individuals and socialsystems. What follows is a narrative of a school leader whose inspirationand commitment brought about systemic change in the school he leads.Un leader trasformativo è una persona che ispira gli altri a seguire la propriaposizione visionaria. Tale leader provoca cambiamenti negli individui e neisistemi sociali. Quello che segue è il racconto di un leader di scuola, l’ispirazionee l’impegno del quale ha portato cambiamenti sistemici nella scuolache conduce

West Virginia Story: Achievement Gains from a Statewide Comprehensive Instructional Technology Program

This report describes West Virginia\u27s Basic Skills/Computer Education (BS/CE) program and connects its features to gains in student test scores that are practically and statistically significant. The program consists of three components: (1) software that focuses on the state\u27s basic skills goals in reading, language arts, and mathematics; (2) enough computers in the schools so that all students will be able to have easy and regular access to the basic skills software; and (3) professional development for teachers in the use of the software and the use of computers in general. Data were collected from all fifth graders (n=950) in 18 elementary schools selected to represent the range of variables that might influence technology use and student achievement. Survey data were also collected from 290 teachers. Results were analyzed using a model that includes access to software and computers, attitudes toward technology, and teacher training and involvement. The relationship of BS/CE to student achievement, as measured by the Stanford-9 achievement test, is examined. Findings suggest that the BS/CE program had a powerfully positive effect, especially in those schools that used it most intensively. Ten figures and tables illustrate findings. (AEF

HYDROLOGIC DRIVERS OF SOIL ORGANIC CARBON STORAGE AND STABILITY IN FRESHWATER MINERAL WETLANDS

Mineral wetlands comprise most of historic wetland loss, yet few studies focus on mineral wetland soil organic carbon (SOC). We explore SOC across continuous hydrologic gradients within and among seasonally flooded mineral wetlands. First, we quantify SOC stabilization (e.g., organo-mineral associations and aggregates) across a wetland–upland gradient. Second, we examine relationships between hydrologic regime and SOC stocks among wetlands. From wetland–upland, saturation was highly variable in the transition zone. Organo-mineral associations peaked in the transition zone while large macroaggregate SOC declined from wetland–upland. Across wetlands, indicators of drying (e.g., minimum water level and summertime recession rate) were more related to SOC than inundation duration. From wetland basin–upland, SOC stocks were significantly related to both mean water level and relative elevation. We highlight relationships between SOC and the dynamic hydrology of wetlands, emphasizing the need for research on how changing hydrologic regime may influence mineral wetland SOC

Stimmen im Neuen Hörspiel

Bei der Arbeit handelt es sich um eine detaillierte Analyse dreier Hörwerke aus dem Jahr 1969, die prägend für das "Neue Hörspiel" waren: One Two Two von Ferdinand Kriwet, Häuser von Jürgen Becker in der Realisation von Raoul Wolfgang Schnell und Alea von Paul Pörtner. Die intensive auditive Auseinandersetzung benennt und überprüft Montage-, Schnitt und Kompositionsverfahren experimenteller Hörspiele und Hörstücke. Es zeigt sich, dass jeder der drei Autoren dass Hören selbst thematisiert und bemüht ist, Hörkonventionen zu überschreiten. Die Analysen versuchen Handreichungen zu geben, sich dieser Herausforderung zu stellen

О применении кусочно-непрерывных функций к заданию функций принадлежности нечетких чисел (L-R)-типа

Предложен способ задания функций принадлежности нечетких чисел в виде кусочно-непрерывных функций, составленных из полиномов второго порядка. Приведены условия, определяющие формы представленных функций

Agate Fossil Beds National Monument, Paleontological Resources Management Plan (Public Version)

Executive Summary Since Agate Springs Ranch was founded by James H. Cook in 1887, exquisite examples of transitional Miocene mammalian fauna have been found along this stretch of the Niobrara River valley. Collectively these paleontological discoveries, along with the existing archeological and historical Native American collection, were the basis for establishing Agate Fossil Beds National Monument (AGFO) as a unit of the National Park System (NPS). The fossil remains from the Harrison and Anderson Ranch formations span a short, but important, time period within the Miocene Epoch. AGFO has provided science with an intimate look into North American mammalian evolution of the time that is matched nowhere else, with body fossils and trace fossils (burrows) of many mammals in excellent condition. Investigation of the paleontological resources at AGFO has been very limited since its establishment, but the opportunities for research and discovery are still substantial. Public and academic interest in the Monument’s paleontological resources are considerable. Although there are existing legal authorities, policies and guidelines regarding the management of paleontological resources, at both the departmental and agency levels, more specific guidance would be helpful for the management of AGFO’s non-renewable fossils. This document has been prepared to provide more specific guidance and recommendations for paleontological resources management at AGFO. The Introduction outlines the significance of AGFO’s paleontological resources and defines the purpose, need, and objectives for the Agate Fossil Beds National Monument Paleontological Resources Management Plan (PRMP). This plan also identifies the legal authorities, requirements, and mandates underpinning AGFO’s mission as a unit of the NPS, with special attention to authorities that address managing and preserving paleontological resources. Background Geology and Paleontology provides a basic park geologic description, discusses the scope of AGFO’s paleontological resources, and summarizes past paleontological work performed at the Monument. This information includes historical information from periods both before and after authorization of the Monument as a unit of the NPS. This section also presents the paleontological significance of AGFO and its specimens, such as how AGFO’s taxa are cornerstones of North American geochronology and biostratigraphy. Paleontological Resources Management begins by listing in greater detail the strategic objectives related to paleontological resources within the NPS and at AGFO. This section then proceeds to discuss the specific considerations related to paleontological resource inventories and monitoring along with management requirements (from policy and guidelines) specific to AGFO. This section discusses what a paleontology inventory is and why, when and how to conduct one; fundamentals of paleontological resource monitoring; the various types of threats to paleontological resources and how to mitigate them; and resource condition assessment and site monitoring protocols. It also addresses how to handle paleontological resources discovered or recovered during other park activities. Paleontological Research Management presents NPS and AGFO research goals, how to evaluate the scientific significance of research, and how to weigh the significance of research against other park mandates, operations, and goals. The section also includes a description of the permitting process, recommended park-specific permit conditions, and rules for overseeing collection and excavation. Museum Collections and Curation documents AGFO’s current paleontological collections, collections management and curation policies, AGFO’s photographic archives, collections from AGFO in external repositories, type specimens from AGFO, and Monument compliance with museum security policies. Interpretation discusses goals and current implementation for how AGFO interprets its paleontological resources for the public. This includes: the primary themes for interpretation; the exhibits, tools and programs used by AGFO to interpret fossil resources; the target audiences for the interpretive programs; teaching good stewardship of paleontological resources; and a discussion of public accessibility to AGFO, its interpretive materials, and the paleontological resources. Relation of Paleontological Resources to Other Park Programs provides an overview of how each park division may interact with paleontological resources and have their duties cross over with paleontological resource management related actions. It also discusses the potential impacts of paleontological resource management on other types of AGFO resources (archeological, biological, historical, and physical). Paleontological Resource Data Management discusses various paleontological resource records, datasets, and other archives. AGFO’s paleontological archives and library, as well as their current status, are discussed along with an overview of the type of contents stored within them. The NPS Paleontology Program Archives and Library, and how to exchange data and records between them and the AGFO archives, are also described. This section also reviews geospatial data available to AGFO and issues of sensitivity and confidentially related to paleontological resource data and information. Finally, the Summary, Conclusions, and Recommendations summarizes the work done on the AGFO PRMP, discusses ongoing and planned projects which assist in implementing the instructions and goals set out in this PRMP, and makes a variety of recommendations for future paleontological resource management at AGFO

Quarterly vs. yearly clinical follow-up of remotely monitored recipients of prophylactic implantable cardioverter-defibrillators: results of the REFORM trial

Aims The rapidly increasing number of patients with implantable cardioverter-defibrillators (ICD) places a large burden on follow-up providers. This study investigated the possibility of longer in-office follow-up intervals in primary prevention ICD patients under remote monitoring with automatic daily data transmissions from the implant memory. Methods and results Conducted in 155 ICD recipients with MADIT II indications, the study compared the burden of scheduled and unscheduled ICD follow-up visits, quality of life (SF-36), and clinical outcomes in patients randomized to either 3- or 12-month follow-up intervals in the period between 3 and 27 months after implantation. Remote monitoring (Biotronik Home Monitoring) was used equally in all patients. In contrast to previous clinical studies, no calendar-based remote data checks were performed between scheduled in-office visits. Compared with the 3-month follow-up interval, the 12-month interval resulted in a minor increase in the number of unscheduled follow-ups (0.64 vs. 0.27 per patient-year; P = 0.03) and in a major reduction in the total number of in-office ICD follow-ups (1.60 vs. 3.85 per patient-year; P < 0.001). No significant difference was found in mortality, hospitalization rate, or hospitalization length during the 2-year observation period, but more patients were lost to follow-up in the 12-month group (10 vs. 3; P = 0.04). The SF-36 scores favoured the 12-month intervals in the domains ‘social functioning' and ‘mental health'. Conclusion In prophylactic ICD recipients under automatic daily remote monitoring, the extension of the 3-month in-office follow-up interval to 12 months appeared to safely reduce the ICD follow-up burden during 27 months after implantation. ClinicalTrials.gov Identifier NCT00401466 (http://www.clinicaltrials.gov/ct2/show/NCT00401466