Recurring patterns of atrial fibrillation in surface ECG predict restoration of sinus rhythm by catheter ablation

Background Non-invasive tools to help identify patients likely to benefit from catheter ablation (CA) of atrial fibrillation (AF) would facilitate personalised treatment planning. Aim To investigate atrial waveform organisation through recurrence plot indices (RPI) and their ability to predict CA outcome. Methods One minute 12-lead ECG was recorded before CA from 62 patients with AF (32 paroxysmal AF; 45 men; age 57±10 years). Organisation of atrial waveforms from i) TQ intervals in V1 and ii) QRST suppressed continuous AF waveforms (CAFW), were quantified using RPI: percentage recurrence (PR), percentage determinism (PD), entropy of recurrence (ER). Ability to predict acute (terminating vs. non-terminating AF), 3-month and 6-month postoperative outcome (AF vs. AF free) were assessed. Results RPI either by TQ or CAFW analysis did not change significantly with acute outcome. Patients arrhythmia-free at 6-month follow-up had higher organisation in TQ intervals by PD (

Time resolved spectroscopy of dust and gas from extrasolar planetesimals orbiting WD 1145+017

Multiple long and variable transits caused by dust from possibly disintegrating asteroids were detected in light curves of WD 1145+017. We present time-resolved spectroscopic observations of this target with QUCAM CCDs mounted in the Intermediate dispersion Spectrograph and Imaging System at the 4.2-m William Herschel Telescope in two different spectral arms: the blue arm covering 3800-4025 {\AA} and the red arm covering 7000-7430 {\AA}. When comparing individual transits in both arms, our observations show with 20 {\sigma} significance an evident colour difference between the in- and out-of-transit data of the order of 0.05-0.1 mag, where transits are deeper in the red arm. We also show with > 6 {\sigma} significance that spectral lines in the blue arm are shallower during transits than out-of-transit. For the circumstellar lines it also appears that during transits the reduction in absorption is larger on the red side of the spectral profiles. Our results confirm previous findings showing the u'-band excess and a decrease in line absorption during transits. Both can be explained by an opaque body blocking a fraction of the gas disc causing the absorption, implying that the absorbing gas is between the white dwarf and the transiting objects. Our results also demonstrate the capability of EMCCDs to perform high-quality time resolved spectroscopy of relatively faint targets.Comment: 9 pages, 5 figures. Accepted to MNRA

Principal component analysis of atrial fibrillation: Inclusion of posterior ECG leads does not improve correlation with left atrial activity

Background Lead V? is routinely analysed due to its large amplitude AF waveform. V? correlates strongly with right atrial activity but only moderately with left atrial activity. Posterior lead V? correlates strongest with left atrial activity. Aims (1) To establish whether surface dominant AF frequency (DAF) calculated using principal component analysis (PCA) of a modified 12-lead ECG (including posterior leads) has a stronger correlation with left atrial activity compared to the standard ECG. (2) To assess the contribution of individual ECG leads to the AF principal component in both ECG configurations. Methods Patients were assigned to modified or standard ECG groups. In the modified ECG, posterior leads V? and V? replaced V? and V?. AF waveform was extracted from one-minute surface ECG recordings using PCA. Surface DAF was correlated with intracardiac DAF from the high right atrium (HRA), coronary sinus (CS) and pulmonary veins (PVs). Results 96 patients were studied. Surface DAF from the modified ECG did not have a stronger correlation with left atrial activity compared to the standard ECG. Both ECG configurations correlated strongly with HRA, CS and right PVs but only moderately with left PVs. V? contributed most to the AF principal component in both ECG configurations

Effect of catheter ablation on quality of life in patients with atrial fibrillation and its correlation with arrhythmia outcome

Objective To assess the effect of catheter ablation on atrial fibrillation (AF) symptoms and quality of life (QoL). Methods Patients with AF scheduled for ablation were recruited. Pulmonary vein isolation (PVI) was performed and complex fractionated atrial electrogram (CFAE)±linear ablation undertaken in patients in AF despite PVI. QoL and AF symptoms were assessed using SF-36 V2 and Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaires before and 3 months after ablation. Change in QoL scores after ablation was correlated with clinical parameters and the extent of ablation. Magnitude of QoL change was compared between AFEQT and SF-36 physical component summary (PCS) and mental component summary (MCS) scores and correlated with arrhythmia outcome. Results 80 patients were studied. Summative and individual health scores for both AFEQT (51.5±22.0 vs 81.3±18.2; p<0.01) and SF-36 (PCS 43.3±10.5 vs 47.9±11.3; p<0.01 and MCS 45.0±11.5 vs 51.5±9.4; p<0.01) improved significantly in patients who maintained sinus rhythm after ablation, but not in those with recurrent AF. Improvement in AFEQT (25.4±19) was significantly greater than change in PCS (6.8±6.4; p<0.01) and MCS (8.5±7.9; p<0.01) scores and correlated more closely with arrhythmia outcome (AFEQT r=0.55; PCS r=0.26; MCS r=0.30). Conclusions Patients who maintained sinus rhythm after ablation had a significant improvement in AF symptoms and QoL; however, no improvement was observed in patients with recurrent AF. QoL change after ablation did not correlate with baseline clinical parameters or ablation strategy. AF specific QoL scales are more responsive to change and correlate better with ablation outcome

Endometrial injury in women undergoing assisted reproductive techniques

ACKNOWLEDGEMENTS We would like to express our appreciation to Dra Abha Maheshwari for her important authorial contribution to the previous version of this review. We also acknowledge the important help provided by the Cochrane Menstrual Disorders and Subfertility Group team, specially by Marian Showell, Trials Search Co-ordinator; by Helen Nagels, Managing Editor; and by Prof. Cindy Farquhar, Co-ordinating Editor. Finally, we would like to express our gratitude to the following investigators, who provided essential information for the preparation of this review: TK Aleyamma, Erin F Wolff, Lukasz Polanski, Nava Dekel, Neeta Singh, Suleyman Guven and Tracy YeungPeer reviewedPublisher PD

Developing the use of diagrammatic representations in primary mathematics through professional development

Background: The research on diagrammatic representations highlights their importance for the teaching and learning of mathematics. However, the empirical evidence to support their use in the classroom is mixed and somewhat lacking. Purpose: The aim of this study was to develop the use of diagrammatic representations of mathematical concepts in primary classrooms, through introducing primary teachers to the research literature in this area, and researching the subsequent impact on children and teachers. A professional development programme was designed, involving three one-day training sessions for mathematics co-ordinators. They were asked to implement the ideas from the training back in their schools. Sample: Mathematics co-ordinators from eight primary schools attended the professional development programme. The study focussed on Year 3 pupils (aged seven–eight) and Year 5 pupils (aged nine–10). Design and methods: In this paper, we report the qualitative findings from the larger project looking at the overall impact of the professional development programme. The paper focuses on semi-structured interviews carried out with the mathematics co-ordinators attending the professional development sessions, and the Year 3 and Year 5 class teachers who subsequently worked with the co-ordinators on their use of diagrammatic representations in their teaching of mathematics. Lesson observations involving the class teachers were also carried out in order to explore further the possible impact of the project on classroom practice. Results: The qualitative results identified the impact of the project on mathematics co-ordinators and class teachers’ knowledge and practice. However, the nature of this impact was complex, with a variety of facilitating and hindering factors identified for the transfer of the professional development ideas on the use of diagrammatic representations. In addition, different levels of sophistication of class teachers’ use of diagrammatic representations were identified. Conclusions: Implications for the development of professional development programmes to facilitate the transfer of research into practice were identified. Recommendations for the use of diagrammatic representations are also put forward

Sequence stratigraphy, chemostratigraphy and facies analysis of Cambrian Series 2 – Series 3 boundary strata in northwestern Scotland

Globally, the Series 2 – Series 3 boundary of the Cambrian System coincides with a major carbon isotope excursion, sea-level changes and trilobite extinctions. Here we examine the sedimentology, sequence stratigraphy and carbon isotope record of this interval in the Cambrian strata (Durness Group) of NW Scotland. Carbonate carbon isotope data from the lower part of the Durness Group (Ghrudaidh Formation) show that the shallow-marine, Laurentian margin carbonates record two linked sea-level and carbon isotopic events. Whilst the carbon isotope excursions are not as pronounced as those expressed elsewhere, correlation with global records (Sauk I – Sauk II boundary and Olenellus biostratigraphic constraint) identifies them as representing the local expression of the ROECE and DICE. The upper part of the ROECE is recorded in the basal Ghrudaidh Formation whilst the DICE is seen around 30m above the base of this unit. Both carbon isotope excursions co-occur with surfaces interpreted to record regressive–transgressive events that produced amalgamated sequence boundaries and ravinement/flooding surfaces overlain by conglomerates of reworked intraclasts. The ROECE has been linked with redlichiid and olenellid trilobite extinctions, but in NW Scotland, Olenellus is found after the negative peak of the carbon isotope excursion but before sequence boundary formation

Estimating the furrow infiltration characteristic from a single advance point

Management and control of surface irrigation, in particular furrow irrigation, is limited by spatio-temporal soil infiltration variability as well as the high cost and time associated with collecting intensive field data for estimation of the infiltration characteristics. Recent work has proposed scaling the commonly used infiltration function by using a model infiltration curve and a single advance point for every other furrow in an irrigation event. Scaling factors were calculated for a series of furrows at two sites and at four points down the length of the field (0.25 L, 0.5 L, 0.75 L and L). Differences in the value of the scaling factor with distance were found to be a function of the shape of the advance curves. It is concluded that use of points early in the advance results in a substantial loss of accuracy and should be avoided. The scaling factor was also strongly correlated with the furrow-wetted perimeter suggesting that the scaling is an appropriate way of both predicting and accommodating the effect of the hydraulic variability

The Energy-Momentum Tensor in Fulling-Rindler Vacuum

The energy density in Fulling-Rindler vacuum, which is known to be negative "everywhere" is shown to be positive and singular on the horizons in such a fashion as to guarantee the positivity of the total energy. The mechanism of compensation is displayed in detail.Comment: 9 pages, ULB-TH-15/9

Trajectories of Disease Accumulation Using Electronic Health Records

Multimorbidity is a major problem for patients and health services. However, we still do not know much about the common trajectories of disease accumulation that patients follow. We apply a data-driven method to an electronic health record dataset (CPRD) to analyse and condense the main trajectories to multimorbidity into simple networks. This analysis has never been done specifically for multimorbidity trajectories and using primary care based electronic health records. We start the analysis by evaluating temporal correlations between diseases to determine which pairs of disease appear significantly in sequence. Then, we use patient trajectories together with the temporal correlations to build networks of disease accumulation. These networks are able to represent the main pathways that patients follow to acquire multiple chronic conditions. The first network that we find contains the common diseases that multimorbid patients suffer from and shows how diseases like diabetes, COPD, cancer and osteoporosis are crucial in the disease trajectories. The results we present can help better characterize multimorbid patients and highlight common combinations helping to focus treatment to prevent or delay multimorbidity progression