An Approach to Catheter Ablation of Cavotricuspid Isthmus Dependent Atrial Flutter

Much of our understanding of the mechanisms of macro re-entrant atrial tachycardia comes from study of cavotricuspid isthmus (CTI) dependent atrial flutter. In the majority of cases, the diagnosis can be made from simple analysis of the surface ECG. Endocardial mapping during tachycardia allows confirmation of the macro re-entrant circuit within the right atrium while, at the same time, permitting curative catheter ablation targeting the critical isthmus of tissue located between the tricuspid annulus and the inferior vena cava. The procedure is short, safe and by demonstration of an electrophysiological endpoint - bidirectional conduction block across the CTI - is associated with an excellent outcome following ablation. It is now fair to say that catheter ablation should be considered as a first line therapy for patients with documented CTI-dependent atrial flutter

Object Relations in the Museum: A Psychosocial Perspective

This article theorises museum engagement from a psychosocial perspective. With the aid of selected concepts from object relations theory, it explains how the museum visitor can establish a personal relation to museum objects, making use of them as an ‘aesthetic third’ to symbolise experience. Since such objects are at the same time cultural resources, interacting with them helps the individual to feel part of a shared culture. The article elaborates an example drawn from a research project that aimed to make museum collections available to people with physical and mental health problems. It draws on the work of the British psychoanalysts Donald Winnicott and Wilfred Bion to explain the salience of the concepts of object use, potential space, containment and reverie within a museum context. It also refers to the work of the contemporary psychoanalyst Christopher Bollas on how objects can become evocative for individuals both by virtue of their intrinsic qualities and by the way they are used to express personal idiom

Atrial Fibrillation and In-Hospital Mortality in Covid-19 patients

BACKGROUND: There are conflicting data on whether new-onset atrial fibrillation (AF) is independently associated with poor outcomes in COVID-19 patients. This study represents the largest dataset curated by manual chart review comparing clinical outcomes between patients with sinus rhythm, pre-existing AF, and new-onset AF. OBJECTIVE: The primary aim of this study was to assess patient outcomes in COVID-19 patients with sinus rhythm, pre-existing AF, and new-onset AF. The secondary aim was to evaluate predictors of new-onset AF in patients with COVID-19 infection. METHODS: This was a single-center retrospective study of patients with a confirmed diagnosis of COVID-19 admitted between March and September 2020. Patient demographic data, medical history, and clinical outcome data were manually collected. Adjusted comparisons were performed following propensity score matching between those with pre-existing or new-onset AF and those without AF. RESULTS: The study population comprised of 1241 patients. A total of 94 (7.6%) patients had pre-existing AF and 42 (3.4%) patients developed new-onset AF. New-onset AF was associated with increased in-hospital mortality before (odds ratio [OR] 3.58, 95% confidence interval [CI] 1.78-7.06, P < .005) and after (OR 2.80, 95% CI 1.01-7.77, P < .005) propensity score matching compared with the no-AF group. However, pre-existing AF was not independently associated with in-hospital mortality compared with patients with no AF (postmatching OR: 1.13, 95% CI 0.57-2.21, P = .732). CONCLUSION: New-onset AF, but not pre-existing AF, was independently associated with elevated mortality in patients hospitalised with COVID-19. This observation highlights the need for careful monitoring of COVID-19 patients with new-onset AF. Further research is needed to explain the mechanistic relationship between new-onset AF and clinical outcomes in COVID-19 patients

Mapping the disease-specific LupusQoL to the SF-6D

Purpose To derive a mapping algorithm to predict SF-6D utility scores from the non-preference-based LupusQoL and test the performance of the developed algorithm on a separate independent validation data set. Method LupusQoL and SF-6D data were collected from 320 patients with systemic lupus erythematosus (SLE) attending routine rheumatology outpatient appointments at seven centres in the UK. Ordinary least squares (OLS) regression was used to estimate models of increasing complexity in order to predict individuals’ SF-6D utility scores from their responses to the LupusQoL questionnaire. Model performance was judged on predictive ability through the size and pattern of prediction errors generated. The performance of the selected model was externally validated on an independent data set containing 113 female SLE patients who had again completed both the LupusQoL and SF-36 questionnaires. Results Four of the eight LupusQoL domains (physical health, pain, emotional health, and fatigue) were selected as dependent variables in the final model. Overall model fit was good, with R2 0.7219, MAE 0.0557, and RMSE 0.0706 when applied to the estimation data set, and R2 0.7431, MAE 0.0528, and RMSE 0.0663 when applied to the validation sample. Conclusion This study provides a method by which health state utility values can be estimated from patient responses to the non-preference-based LupusQoL, generalisable beyond the data set upon which it was estimated. Despite concerns over the use of OLS to develop mapping algorithms, we find this method to be suitable in this case due to the normality of the SF-6D data

Neuroprotection in a Novel Mouse Model of Multiple Sclerosis

The authors acknowledge the support of the Barts and the London Charity, the Multiple Sclerosis Society of Great Britain and Northern Ireland, the National Multiple Sclerosis Society, USA, notably the National Centre for the Replacement, Refinement & Reduction of Animals in Research, and the Wellcome Trust (grant no. 092539 to ZA). The siRNA was provided by Quark Pharmaceuticals. The funders and Quark Pharmaceuticals had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

The One with the Feminist Critique: Revisiting Millennial Postfeminism with Friends

In the aftermath of its initial broadcast run, iconic millennial sitcom Friends (NBC, 1994–2004) generated some quality scholarship interrogating its politics of gender. But as a site of analysis, it remains a curious, almost structuring absence from the central canon of the first wave of feminist criticism of postfeminist culture. This absence is curious not only considering the place of Friends at the forefront of millennial popular culture but also in light of its long-term syndication in countries across the world since that time. And it is structuring in the sense that Friends was the stage on which many of the familiar tropes of postfeminism interrogated across the body of work on it appear in retrospect to have been tried and tested. This article aims to contribute toward redressing this absence through interrogation and contextualization of the series’ negotiation of a range of structuring tropes of postfeminist media discourse, and it argues for Friends as an unacknowledged ur-text of millennial postfeminism

Ethics for an uninhabited planet

Some authors argue that we have a moral obligation to leave Mars the way it is, even if it does not harbour any life. This claim is usually based on an assumption that Mars has intrinsic value. The problem with this concept is that different authors use it differently. In this chapter, I investigate different ways in which an uninhabited Mars is said to have intrinsic value. First, I investigate whether the planet can have moral standing. I find that this is not a plausible assumption. I then investigate different combinations of objective value and end value. I find that there is no way we can know whether an uninhabited Mars has objective end value and even if it does, this does not seem to imply any moral obligations on us. I then investigate whether an uninhabited Mars can have subjective end value. I conclude that this is very plausible. I also investigate whether an uninhabited Mars can have objective instrumental value in relation to some other, non-Mars related end value. I find also this very plausible. It is also highly plausible, however, that spreading (human or other) life to a presently uninhabited Mars can also have subjective end value, as well as objective instrumental value. I mention shortly two ways of prioritising between these values: (1) The utilitarian method of counting the number of sentient beings who entertain each value and determining the strength of the values to them. (2) Finding a compromise that allows colonisation on parts of the planet while leaving other parts untouched. These methods should be seen as examples, not as an exhaustive list. Also, I do not take a definitive stand in favour of any of the two approaches, though it seems at least prima facie that the second approach may have a better chance of actually leading to a constructive result