Atrial Tachycardias Arising from Ablation of Atrial Fibrillation: A Proarrhythmic Bump or an Antiarrhythmic Turn?

The occurrence of atrial tachycardias (AT) is a direct function of the volume of atrial tissue ablated in the patients with atrial fibrillation (AF). Thus, the incidence of AT is highest in persistent AF patients undergoing stepwise ablation using the strategic combination of pulmonary vein isolation, electrogram based ablation and left atrial linear ablation. Using deductive mapping strategy, AT can be divided into three clinical categories viz. the macroreentry, the focal and the newly described localized reentry all of which are amenable to catheter ablation with success rate of 95%. Perimitral, roof dependent and cavotricuspid isthmus dependent AT involve large reentrant circuits which can be successfully ablated at the left mitral isthmus, left atrial roof and tricuspid isthmus respectively. Complete bidirectional block across the sites of linear ablation is a necessary endpoint. Focal and localized reentrant AT commonly originate from but are not limited to the septum, posteroinferior left atrium, venous ostia, base of the left atrial appendage and left mitral isthmus and they respond quickly to focal ablation. AT not only represents ablation-induced proarrhythmia but also forms a bridge between AF and sinus rhythm in longstanding AF patients treated successfully with catheter ablation

In vitro and in vivo characterisation of Listeria monocytogenes outbreak isolates

Listeriosis is an important food-borne disease responsible for high rates of morbidity and mortality. L. monocytogenes has been the cause of several foodborne outbreaks and its ability to adapt and survive in a wide range of environmental conditions makes eradication difficult. Many L. monocytogenes strains are avirulent but have the ability to increase their virulence if exposed to environmental stresses. The aim of this study was to explain the observed increase in virulence of outbreak L. monocytogenes isolates by using phenotypic assays and whole genome sequencing. Four L. monocytogenes isolates from sweetcorn and one isolate from a raw milk (control) were sequenced and characterised using a range of phenotypic assays. The four L. monocytogenes sweetcorn isolates displayed a significant increase for in vitro adhesion and invasion of epithelial cells compared to the control isolate. They also showed a higher level of colonisation of the liver and spleen in vivo. In addition, the four L. monocytogenes isolates displayed an increased ability to form biofilms, resist heat stress and resist a combination of antimicrobials. Investigation of the genomes of the four L. monocytogenes sweet corn isolates identified Single Nucleotide Polymorphisms (SNPs) in genes, which may have a role in the observed phenotypes characteristic of these strains, particularly in response to survival properties within the environment or in terms of virulence. We highlight the importance of combining whole genomic sequencing with phenotypic characterisation as a key element in the investigation of outbreaks of foodborne pathogens

Improving ultrasound video classification: an evaluation of novel deep learning methods in echocardiography

Echocardiography is the commonest medical ultrasound examination, but automated interpretation is challenging and hinges on correct recognition of the ‘view’ (imaging plane and orientation). Current state-of-the-art methods for identifying the view computationally involve 2-dimensional convolutional neural networks (CNNs), but these merely classify individual frames of a video in isolation, and ignore information describing the movement of structures throughout the cardiac cycle. Here we explore the efficacy of novel CNN architectures, including time-distributed networks and two-stream networks, which are inspired by advances in human action recognition. We demonstrate that these new architectures more than halve the error rate of traditional CNNs from 8.1% to 3.9%. These advances in accuracy may be due to these networks’ ability to track the movement of specific structures such as heart valves throughout the cardiac cycle. Finally, we show the accuracies of these new state-of-the-art networks are approaching expert agreement (3.6% discordance), with a similar pattern of discordance between views

Impact of industrial production system parameters on chicken microbiomes: mechanisms to improve performance and reduce Campylobacter

Publication history: Accepted - 17 August 2020; Published online - 9 September 2020Background The factors affecting host-pathogen ecology in terms of the microbiome remain poorly studied. Chickens are a key source of protein with gut health heavily dependent on the complex microbiome which has key roles in nutrient assimilation and vitamin and amino acid biosynthesis. The chicken gut microbiome may be influenced by extrinsic production system parameters such as Placement Birds/m2 (stocking density), feed type and additives. Such parameters, in addition to on-farm biosecurity may influence performance and also pathogenic bacterial numbers such as Campylobacter. In this study, three different production systems ‘Normal’ (N), ‘Higher Welfare’ (HW) and ‘Omega-3 Higher Welfare’ (O) were investigated in an industrial farm environment at day 7 and day 30 with a range of extrinsic parameters correlating performance with microbial dynamics and Campylobacter presence. Results Our data identified production system N as significantly dissimilar from production systems HW and O when comparing the prevalence of genera. An increase in Placement Birds/m2 density led to a decrease in environmental pressure influencing the microbial community structure. Prevalence of genera, such as Eisenbergiella within HW and O, and likewise Alistipes within N were representative. These genera have roles directly relating to energy metabolism, amino acid, nucleotide and short chain fatty acid (SCFA) utilisation. Thus, an association exists between consistent and differentiating parameters of the production systems that affect feed utilisation, leading to competitive exclusion of genera based on competition for nutrients and other factors. Campylobacter was identified within specific production system and presence was linked with the increased diversity and increased environmental pressure on microbial community structure. Addition of Omega-3 though did alter prevalence of specific genera, in our analysis did not differentiate itself from HW production system. However, Omega-3 was linked with a positive impact on weight gain. Conclusions Overall, our results show that microbial communities in different industrial production systems are deterministic in elucidating the underlying biological confounders, and these recommendations are transferable to farm practices and diet manipulation leading to improved performance and better intervention strategies against Campylobacter within the food chain.OG and NC acknowledge research funding from Moy Park. UZI is funded by NERC Independent Research Fellowship (NE/L011956/1)

Distribution and characteristics of overdeepenings beneath the Greenland and Antarctic ice sheets: Implications for overdeepening origin and evolution

Glacier bed overdeepenings are ubiquitous in glacier systems and likely exert significant influence on ice dynamics, subglacial hydrology, and ice stability. Understanding of overdeepening formation and evolution has been hampered by an absence of quantitative empirical studies of their location and morphology, with process insights having been drawn largely from theoretical or numerical studies. To address this shortcoming, we first map the distribution of potential overdeepenings beneath the Antarctic and Greenland ice sheets using a GIS-based algorithm that identifies closed-contours in the bed topography and then describe and analyse the characteristics and metrics of a subset of overdeepenings that pass further quality control criteria. Overdeepenings are found to be widespread, but are particularly associated with areas of topographically laterally constrained ice flow, notably near the ice sheet margins where outlet systems follow deeply incised troughs. Overdeepenings also occur in regions of topographically unconstrained ice flow (for example, beneath the Siple Coast ice streams and on the Greenland continental shelf). Metrics indicate that overdeepening growth is generally allometric and that topographic confinement of ice flow in general enhances overdeepening depth. However, overdeepening depth is skewed towards shallow values – typically 200 to 300 m – indicating that the rate of deepening slows with overdeepening age. This is reflected in a decline in adverse slope steepness with increasing overdeepening planform size. Finally, overdeepening long-profiles are found to support headward quarrying as the primary factor in overdeepening development. These observations support proposed negative feedbacks related to hydrology and sediment transport that stabilise overdeepening growth through sedimentation on the adverse slope but permit continued overdeepening planform enlargement by processes of headward erosion

Non-Standard Errors

In statistics, samples are drawn from a population in a data-generating process (DGP). Standard errors measure the uncertainty in estimates of population parameters. In science, evidence is generated to test hypotheses in an evidence-generating process (EGP). We claim that EGP variation across researchers adds uncertainty: Non-standard errors (NSEs). We study NSEs by letting 164 teams test the same hypotheses on the same data. NSEs turn out to be sizable, but smaller for better reproducible or higher rated research. Adding peer-review stages reduces NSEs. We further find that this type of uncertainty is underestimated by participants

ERS/EACTS statement on the management of malignant pleural effusions

Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomized clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature. Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE. The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.Management options for malignant pleural effusions have advanced over the past decade, with high-quality randomized trial evidence informing practice in many areas. However, uncertainties remain and further research is required http://ow.ly/rNt730jOxOS

Comprehensive Monitoring of Tailings Dams : Navigating the Limitations and Blind Spots of Interferometric Synthetic Aperture Radar (InSAR) Technology

Interferometric Synthetic Aperture Radar (InSAR) is a remote sensing technology used to identify deformations of the earth over large areas. The use of this technology has become widespread in recent years to obtain information about structural performance and to help identify large-scale movements of tailings dams and other mine structures. Dam owners and consultants have started to specify Trigger Action Response Plan (TARP) thresholds based on deformations detected by InSAR. However, more recent scrutiny of InSAR technology has exposed some “blind spots” or limitations of the technology. These limitations must be understood by all who rely on InSAR technology as part of their performance monitoring programs. In addition, TARP thresholds may not be relevant to InSAR monitoring technology in the same way that they are applied to more conventional geotechnical instrumentation (e.g., piezometers, slope inclinometers). The slope aspect is a critical aspect of InSAR interpretation. InSAR deformation data is typically provided for both the vertical and east-west displacement directions. Measuring east-west deformations on a slope with a north or south facing slope aspect results in a low sensitivity to deformations. However, InSAR pixels are still used to represent movements on these slopes and can provide users with a misrepresentation of potential deformation on these slopes. Caution should be applied when setting TARP thresholds, as the TARP thresholds will depend on the interaction between the slope angle and the imaging direction. It is important that InSAR analysis is supported by ground-based deformation monitoring systems, including visual inspection and instrumentation readings. InSAR data can be used as an indicator of structural performance but should never be relied upon in isolation of other data sources. The data processing algorithms may need to be adjusted and validated multiple times before a good match is made with ground-based monitoring systems. An iterative, site-specific approach to InSAR data analysis must be utilized to assess the accuracy and value of InSAR data as part of a comprehensive monitoring program designed to effectively facilitate informed risk management decisions.AlumniNon UBCUnreviewedOthe