Short- and long-term experience in pulmonary vein segmental ostial ablation for paroxysmal atrial fibrillation*

Introduction: Segmental ostial pulmonary vein isolation (PVI) is considered a potentially curative therapeutic approach in the treatment of paroxysmal atrial fibrillation (PAF). There is only limited data available on the long-term effect of this procedure. Methods: Patients (Pts) underwent a regular clinical follow up visit at 3, 6 and 24 months after PVI. Clinical success was classified as complete (i.e. no arrhythmia recurrences, no antiarrhythmic drug), partial (i.e. no/only few recurrences, on drug) or as a failure (no benefit). The clinical responder rate (CRR) was determined by combining complete and partial success. Results: 117 patients (96 male, 21 female), aged 51±11 years (range 25 to 73) underwent a total of 166 procedures (1.4/patient) in 2-4 pulmonary veins (PV). 115 patients (98%) had AF, 2 patients presented with regular PV atrial tachycardia. ,109/115 patients. exhibited PAF as the primary arrhythmia (versus persistent AF). A total of 113 patients with PVI in the years 2001 to 2003 were evaluated for their CRR after 6 (3) months. A single intervention was carried out in 63 patients (55.8%), two interventions were performed in 45 patients (39.8%) and three interventions in 5 patients (4.4%). The clinical response demonstrated a complete success of 52% (59 patients), a partial success of 26% (29 patients) and a failure rate of 22% (25 patients), leading to a CRR of 78% (88 patients). Ostial PVI in all 4 PVs exhibited a tendency towards higher curative success rates (54% versus 44% in patients with 3 PVs ablated for the 6 month follow up). Long-term clinical outcome was evaluated in 39 patients with an ablation attempt at 3 PVs only (excluding the right inferior PV in our early experience) and a mean clinical follow up of 21±6 months. At this point in time the success rate was 41% (complete, 16 patients) and 21% (partial, 8 patients), respectively, adding up to a CRR of 62% (24 patients). In total, 20 patients (17.1%) had either a single or 2 (3 patients, 2.6%) complications independent of the number of procedures performed with PV stenosis as the leading cause (7.7%). Conclusion: The CRR of patients with medical refractory PAF in our patient cohort is 78% at the 6 month follow up. PV stenosis is the main cause for procedure-related complications. Ablation of all 4 PV exhibits a tendency towards higher complete success rates despite equal CRR. Calculation of the clinical response after a mid- to long-term follow of 21±6 months in those patients with an ostial PVI in only 3 pulmonary veins (sparing the right inferior PV) shows a further reduction to 62%, exclusively caused by a drop in patients with a former partial success. To evaluate the long-term clinical benefit of segmental ostial PVI in comparison with other ablation techniques, more extended follow up periods are mandatory, including a larger study cohort and a detailed description of procedural parameters

Response Elaboration Training: Application to Procedural Discourse and Personal Recounts

Response Elaboration Training (RET; Kearns, 1985) is a verbal production treatment for aphasia that was designed to facilitate increased content and length of utterances. RET was developed on the premise that treatment should encourage the creative use of language rather than restrict the speaker’s productions to predetermined, convergent responses. RET entails elicitation of verbal productions of the speaker’s choice in response to action pictures. Then, clinician modeling and forward-chaining are employed to assist the speaker in expanding upon his/her original production. Kearns and colleagues conducted a systematic series of investigations to examine the effects of RET (Gaddie, Kearns, & Yedor, 1991; Kearns, 1985; Kearns, 1986; Kearns & Scher, 1989; Kearns & Yedor, 1991). Wambaugh and colleagues (2000; 2001) modified RET to allow application with persons with apraxia of speech and Conley and Coelho (2003) combined RET with Semantic Feature Analysis (Boyle & Coelho, 1995). Across the relatively numerous RET investigations, 17 persons with aphasia have demonstrated positive effects of treatment (12 with Broca’s aphasia, 3 with anomic aphasia, and 2 with conduction aphasia). Aphasia severity among participants has ranged from relatively mild to severe. Although strong response generalization effects of treatment have been demonstrated for RET (i.e., improved responding with similar, untrained pictures), stimulus generalization has received relatively limited study. Kearns and Scher (1989) found mixed results with respect to elicited discourse for three speakers. Wambaugh and Martinez (2000) reported modest changes in personal recounts for two of three speakers as a result of picture level RET training. When they modified RET to apply it without pictures in a personal recount condition, slight additional gains were evidenced. We speculated that application of RET without pictures, but in a more structured condition than personal recounts, may stimulate generalized responding. Consequently, this investigation was designed to explore the effects of RET applied to procedural discourse as well as to personal recounts

International Courts and Tribunals

This article reviews and summarizes significant developments in 2004 concerning international courts and tribunals, particularly events relating to tbe International Court of Justice, tbe United Nations Compensation Commission, the Iran-U.S. Claims Tribunal, and tbe Claims Resolution Tribunal. Significant developments relating to the International Criminal Court, the International Criminal Tribunals for the former Yugoslavia and for Rwanda, proposed additional ad hoc international criminal tribunals, the International Tribunal for the Law of tbe Sea, and tbe World Trade Organization dispute settlement system and other trade dispute settlement systems are detailed in other articles in this issue

The Mechanical and Social Feasibility of Using Biogas to Fuel an Essential Oil Distillation Unit in the Rural Commune of Ankarimbelo, Madagascar

The rural commune of Ankarimbelo is located on the edge of the Ikongo Rainforest Corridor in southeastern Madagascar. The commune’s remote location, an increasing population, and the prohibition of farming in the rainforest corridor have contributed to extreme poverty. In an attempt to mitigate these effects, the Malagasy NGO Ny Tanintsika has implemented an essential oils distillation plant as an alternative livelihood project. While the project may provide needed income to local populations, thereby diverting destructive agriculture practices such as tavy, or slash-and-burn agriculture, the distillation of essential oils still requires that firewood be burned. Over the course of one year, between 700,000 and 111,000 kilograms of wood could be consumed. While Ny Tanintsika is investing in a sustainable Eucalyptus plantation in the commune, establishing a biogas plant as an alternative fuel source could benefit the local environment and population. This study evaluated the mechanical and social feasibility of using biogas at the essential oils plant. In particular, it determined the proportion of the energy demand that biogas produced from local biomass sources could meet. The results indicate that in the extreme case in which the still’s energy demand is maximized and biogas production is minimized, biogas could meet 4% of total energy demand. However, in less extreme cases, in which biogas production is larger or still energy use is less, biogas may be able to meet most or all of the energy demand. Moreover, the local population supported the creation of a biodigester

Comparison of Three-Dimensional Speckle Tracking Echocardiography and Two-Dimensional Echocardiography for Evaluation of Left Atrial Size and Function in Healthy Volunteers (Results from the MAGYAR-Healthy Study)

This thesis explores the possibilities of constructing an indoor positioning system based on Bluetooth Smart technology. Two non-trainable trilateration approaches and two trainable fingerprinting were implemented and evaluated at Mobiento's offices in Stockholm, Sweden. A trilateration approach is based on finding a sought location based on known distances towards know locations, at least three locations and distances are needed. A fingerprinting approach is based on creating a radio map, which describes transmission signals within the room, towards different transmitters. A set amount of coordinates are assigned a fingerprint. These are then used as reference points for a sought location. For each major approach, trilateration and fingerprinting, a weighted approach is conducted. These approaches are evaluated in a disturbance free environment in term of accuracy, implementation and setup. In terms of accuracy, the non-weighted fingerprinting approach performs slightly better than the weighted fingerprinting approaches. Both of these are more accurate than the trilateration approaches. When it comes to implementation and setup, the trilateration algorithms impose less cost. These allow for better scalability when the indoor environment becomes larger.

A Look at the Effectiveness of High School Chemistry Curriculum in Preparing Students for ACT

In the ever-changing world, students are challenged with cultivating the skills and knowledge needed to handle the pace and level of understanding required to excel in their future. The foundation for a student\u27s future begins in their formative years, but high school is a prime environment for nurturing the applied, critical thinking, and problem-solving skills needed to move forward into independent, adult life. Mississippi schools are ranked by an accountability score, which is used to determine fund allocation and the development of improvement plans. This score is compiled by looking at various state-tested courses, College and Career Readiness Standards (MS CCRS) scores (including the ACT), and graduation rates. Chemistry is not an accountability subject, but students who take chemistry also take the ACT in the same year. In this case, the ACT serves as a tool for accountability and a tool for predicting college readiness and success (ACT.org, 2016). Given that the skills needed to succeed in chemistry are also needed to succeed on the ACT, it seems prudent to find ways to help students understand the chemistry content while simultaneously strengthening the skills to do well on the ACT Science sub-test. To address this, a two-tiered study was conducted over five years to determine if integrating an Inquiry-Based (IBL) method, specifically Process Oriented Guided Inquiry Learning (POGIL), would benefit student chemistry success and increase scores on the ACT. The first two years looked at the effects of POGIL integration by comparing 3 assessment scores (Pre-test, Post-test, and ACT science sub-test). Years 3-5 sought to establish a difference between teaching methods by comparing the effects of POGIL integration versus non-POGIL integration The POGIL and non-POGIL classes were taught by two different teachers, and the scores were compared through the 3 same assessments (Pre-test, Post-test, and ACT Science sub-test). The research significantly impacts student ACT Science scores over a five-year period. The two-tiered study indicated that students were better prepared to be successful on the ACT science test. The change came through using critical thinking in the chemistry classroom in controlled environments and helping students build capacity with those skills

The Effect of Changes in Local Labour Market Conditions on Disability Benefit Take-Up : Evidence From Norway

This master’s thesis examines the impact of changes in local labour market conditions on disability benefit take-up, particularly focusing on the 2014 oil price decline. Using municipality-level data for Norway from 2009-2021, the study employs a Two-Stage Least Squares methodology with instrumental variables to explore the relationship between changes in employment and disability benefits. A Difference-in-Difference and Event Study approach is applied to analyse the effects of the oil price decline in 2014 on disability benefits. This event significantly affected employment in Norwegian municipalities with a high dependence on the oil industry. By differentiating municipalities based on their level of oil workers, I investigate if the municipalities most dependent on the oil industry experienced a higher increase in benefit take-up compared to other municipalities postevent. The Two-Stage Least Squares results reveal a significant inverse relationship between employment levels and disability benefit take-up with an elasticity of -1.454. The findings from the Difference-in-Difference and Event Study indicate that the decline in oil prices in 2014 led to a more pronounced increase in benefit recipients in municipalities with higher levels of oil workers, with a delayed effect that remained for several years after the event. The results indicate that economic shocks to local economies can increase disability benefits take-up. This suggests that for some individuals, disability benefits may function as a substitute for employment during economic downturns.nhhma

Assessing Islamic State’s commitment to attacking the West

How much of a terrorist threat does the Islamic State (IS) pose to Western countries? This article looks at what IS has said and done with regard to attacks in the West. We examine IS statements and take stock of IS-related attack plots in Western Europe, North America, and Australia from January 2011 through June 2015 using a new dataset of jihadi plots and a new typology of links between organizations and attackers. IS appears to have had a decentralized attack strategy based on encouraging sympathiser attacks while not mounting centrally directed operations of their own. There have also been more plots involving only IS sympathisers than plots involving returned foreign fighters. However, the organization’s formidable resources and verbal hints at future attacks give reason for vigilance

Corporate Governance and Audit Qualifications: Empirical Study from Saudi Arabia and Oman

Since last decade corporate governance has been the focus of many studies worldwide. This stems from the belief that the better governance of the firms lead to more healthy corporations. Prior studies investigated many issues that could be affected by corporate governance of the firms such as performance, earnings management, transparency and disclosure. The current study will contribute to the growing literature in this field of study and mainly focusing on the impact of corporate governance on audit qualifications in Gulf countries, specifically, Oman and Saudi Arabia. The notion behind corporate governance could be extended also to study its impact on the role of auditor. The audit report is considered as a signal to the users of financial information disseminated in that report. Therefore, some argue that occurrence of audit qualifications is directly related to audit quality. In such a way the incentives that may motivate the auditor to express his opinion in a qualified manner could vary. However, it is contended that good corporate governance would lead to enhance the auditor role and mitigate the pressure on him by management and thus he will be more likely to issue a qualified opinion whenever certain circumstances exist. As many studies investigated the issue in different counties, this study will examine the impact of corporate governance mechanisms namely, independence, CEO duality, Board size, board meeting, audit committee independence and meeting on audit qualifications following the enactment the code of corporate governance in 2003 in Oman and in 2006 for Saudi listed firms. This result of study shows that corporate governance mechanisms have no impact on audit qualifications accept for the board size which shows that audit qualifications and board size are associated negatively. The results of study revealed that corporate governance in Gulf countries is a matter of illusion and the efforts should be directed towards enhancing the corporate governance in order to grasp the benefits behind the enactment of corporate governance worldwide

Context Specificity in Causal Signaling Networks Revealed by Phosphoprotein Profiling.

Signaling networks downstream of receptor tyrosine kinases are among the most extensively studied biological networks, but new approaches are needed to elucidate causal relationships between network components and understand how such relationships are influenced by biological context and disease. Here, we investigate the context specificity of signaling networks within a causal conceptual framework using reverse-phase protein array time-course assays and network analysis approaches. We focus on a well-defined set of signaling proteins profiled under inhibition with five kinase inhibitors in 32 contexts: four breast cancer cell lines (MCF7, UACC812, BT20, and BT549) under eight stimulus conditions. The data, spanning multiple pathways and comprising ∼70,000 phosphoprotein and ∼260,000 protein measurements, provide a wealth of testable, context-specific hypotheses, several of which we experimentally validate. Furthermore, the data provide a unique resource for computational methods development, permitting empirical assessment of causal network learning in a complex, mammalian setting.This work was supported by the National Institutes of Health National Cancer Institute (grant U54 CA112970 to J.W.G., G.B.M., S.M., and P.T.S.). S.M.H. and S.M. were supported by the UK Medical Research Council (unit program numbers MC_UP_1302/1 and MC_UP_1302/3). S.M. was a recipient of a Royal Society Wolfson Research Merit Award. The MD Anderson Cancer Center RPPA Core Facility is funded by the National Institutes of Health National Cancer Institute (Cancer Center Core Grant CA16672)