Right Ventricular Pacing and Sensing Function in High Posterior Septal and Apical Lead Placement in Cardiac Resynchronization Therapy

AbstractBackgroundThe conventional right ventricular (RV) lead position in cardiac resynchronization therapy pacemakers (CRT-P) is the RV apex (RV-A). Little is known about electrophysiological stability and associated complications of pacing leads in RV high posterior septal (RV-HS) position in CRT-P.MethodsTwo hundred and thirty-five consecutive CRT-P patients were included from 1999-2010. Pacing thresholds at 0.5ms and 2.5V, sensing electrograms and lead impedances were measured at implant and repeated 1,3,6,12,18 and 24months after CRT-P. Electrophysiological measurements of leads located in RV-A and RV-HS were analyzed retrospectively. Bipolar RV leads were used, including high impedance leads, passive fixation and active fixation.ResultsRV pacing leads were implanted in RV-A (n=79) and RV-HS (n=156). Average RV pacing thresholds from CRT implant procedure to 24-month follow-up at 0.5ms were 0.77±0.69V in RV-A and 0.71±0.35V in RV-HS (P=0.31), and at 2.5V were 0.06±0.08ms in RV-A and 0.07±0.05ms in RV-HS (P=0.12). Average RV electrogram amplitudes from baseline to 24months after CRT were 15.3±6.9mV in RV-A and 12.1±6.0mV in RV-HS (P=0.55). Average RV impedances during follow-up were 850±286Ω in RV-A and 618±147Ω in RV-HS (P=0.57). Similar RV lead revisions between RV-A and RV-HS were observed after 2-year follow-up (P=0.55).ConclusionsThe RV-HS lead position demonstrated stable and acceptable long-term pacing and sensing function, with rates of complications comparable to conventional RV-A lead position in CRT. The RV-HS lead position is feasible in CRT-P

EPIC 219217635: A Doubly Eclipsing Quadruple System Containing an Evolved Binary

We have discovered a doubly eclipsing, bound, quadruple star system in the field of K2 Campaign 7. EPIC 219217635 is a stellar image with $Kp = 12.7$ that contains an eclipsing binary (`EB') with $P_A = 3.59470$ d and a second EB with $P_B = 0.61825$ d. We have obtained followup radial-velocity (`RV') spectroscopy observations, adaptive optics imaging, as well as ground-based photometric observations. From our analysis of all the observations, we derive good estimates for a number of the system parameters. We conclude that (1) both binaries are bound in a quadruple star system; (2) a linear trend to the RV curve of binary A is found over a 2-year interval, corresponding to an acceleration, $\dot \gamma = 0.0024 \pm 0.0007$ cm s$^{-2}$; (3) small irregular variations are seen in the eclipse-timing variations (`ETVs') detected over the same interval; (4) the orbital separation of the quadruple system is probably in the range of 8-25 AU; and (5) the orbital planes of the two binaries must be inclined with respect to each other by at least 25$^\circ$. In addition, we find that binary B is evolved, and the cooler and currently less massive star has transferred much of its envelope to the currently more massive star. We have also demonstrated that the system is sufficiently bright that the eclipses can be followed using small ground-based telescopes, and that this system may be profitably studied over the next decade when the outer orbit of the quadruple is expected to manifest itself in the ETV and/or RV curves.Comment: Accepted for publication in MNRA

EPIC 220204960: A Quadruple Star System Containing Two Strongly Interacting Eclipsing Binaries

We present a strongly interacting quadruple system associated with the K2 target EPIC 220204960. The K2 target itself is a Kp = 12.7 magnitude star at Teff ~ 6100 K which we designate as "B-N" (blue northerly image). The host of the quadruple system, however, is a Kp = 17 magnitude star with a composite M-star spectrum, which we designate as "R-S" (red southerly image). With a 3.2" separation and similar radial velocities and photometric distances, 'B-N' is likely physically associated with 'R-S', making this a quintuple system, but that is incidental to our main claim of a strongly interacting quadruple system in 'R-S'. The two binaries in 'R-S' have orbital periods of 13.27 d and 14.41 d, respectively, and each has an inclination angle of >89 degrees. From our analysis of radial velocity measurements, and of the photometric lightcurve, we conclude that all four stars are very similar with masses close to 0.4 Msun. Both of the binaries exhibit significant ETVs where those of the primary and secondary eclipses 'diverge' by 0.05 days over the course of the 80-day observations. Via a systematic set of numerical simulations of quadruple systems consisting of two interacting binaries, we conclude that the outer orbital period is very likely to be between 300 and 500 days. If sufficient time is devoted to RV studies of this faint target, the outer orbit should be measurable within a year.Comment: 20 pages, 18 figures, 7 tables; accepted for publication in MNRA

Empowering Students in Leading their Education and Practice: The Design Workbook

© 2019 The Authors. iJADE © 2019 NSEAD/John Wiley & Sons Ltd How does education prepare future designers for current and future requirements of the field? An attempt to respond to this question is presented through the Design Workbook: a curricular project that has been proposed and developed over the course of three phases. In Phase One, the objectives, structure and format were defined: an online interface containing activities organised under five chapters that aim at building students’ creative confidence and sensitivity to surrounding contexts, and prepare them to lead their career path. In Phase Two, the website was developed to its first usable version, and content applied into live classes. Phase Three was marked with content refinement for the activities, navigation and feature redesign in the interface, and new ways of conducting the course. The article summarises learning points from the first two phases, and provides new findings and analyses from the final phase. It also includes a sample of the activities content, student works and feedback as well as the interface development stages. The methodology utilised throughout consisted of active research, as well as learning outcomes assessment using direct and indirect measures. Assessment results and classroom observations confirmed that students benefit greatly from visualising ideas, hands on activities, design thinking workshops, as well as from collaborative experiences, to avoid facing designer\u27s block and to practise empowerment of self and others. Finally, challenges, opportunities and future implications are discussed, alongside implementation possibilities: The Design Workbook can run as a sole course, spread across the curriculum, and expand into the community

Short-term western diet aggravates non-alcoholic fatty liver disease (NAFLD) with portal hypertension in TGR(mREN2)27 rats

Non-alcoholic fatty liver disease (NAFLD) is gaining in importance and is linked to obesity. Especially, the development of fibrosis and portal hypertension in NAFLD patients requires treatment. Transgenic TGR(mREN2)27 rats overexpressing mouse renin spontaneously develop NAFLD with portal hypertension but without obesity. This study investigated the additional role of obesity in this model on the development of portal hypertension and fibrosis. Obesity was induced in twelve-week old TGR(mREN2)27 rats after receiving Western diet (WD) for two or four weeks. Liver fibrosis was assessed using standard techniques. Hepatic expression of transforming growth factor-β1 (TGF-β1), collagen type Iα1, α-smooth muscle actin, and the macrophage markers Emr1, as well as the chemoattractant Ccl2, interleukin-1β (IL1β) and tumor necrosis factor-α (TNFα) were analyzed. Assessment of portal and systemic hemodynamics was performed using the colored microsphere technique. As expected, WD induced obesity and liver fibrosis as confirmed by Sirius Red and Oil Red O staining. The expression of the monocyte-macrophage markers, Emr1, Ccl2, IL1β and TNFα were increased during feeding of WD, indicating infiltration of macrophages into the liver, even though this increase was statistically not significant for the EGF module-containing mucin-like receptor (Emr1) mRNA expression levels. Of note, portal pressure increased with the duration of WD compared to animals that received a normal chow. Besides obesity, WD feeding increased systemic vascular resistance reflecting systemic endothelial and splanchnic vascular dysfunction. We conclude that transgenic TGR(mREN2)27 rats are a suitable model to investigate NAFLD development with liver fibrosis and portal hypertension. Tendency towards elevated expression of Emr1 is associated with macrophage activity point to a significant role of macrophages in NAFLD pathogenesis, probably due to a shift of the renin-angiotensin system towards a higher activation of the classical pathway. The hepatic injury induced by WD in TGR(mREN2)27 rats is suitable to evaluate different stages of fibrosis and portal hypertension in NAFLD with obesity

CD24 Expression is an Independent Prognostic Marker in Cholangiocarcinoma

CD24 has been described as an adverse prognostic marker in several malignancies. This study evaluates CD24 expression in cholangiocarcinoma and correlates the findings with clinicopathologic data and patient survival. Between 1996 and 2002, 22 consecutive patients with cholangiocarcinoma were treated at our institution. Demographic data, SEER stage, pathologic data, treatment, expression of CD24, mitogen-activated protein kinase (MAPK), phosphorylated MAPK, and survival were analyzed. The majority of the tumors demonstrated CD24 (81.8%) and p-MAPK (87%) expression. A negative association was noted between the expression of CD24 and p-MAPK. Median survival for patients with low expression of CD24 was 36 months and high expression was 8 months. Median survival for patients who received chemotherapy with low CD24 expression was 163 months, and for seven patients with high CD24 expression, it was 17 months (p = 0.04). With the addition of radiation therapy, median survival for patients with low expression of CD24 was 52 months and high expression was 17 months (p = 0.08). On multivariate analysis, the use of chemotherapy (p = 0.0014, hazard ratio 0.069) and the CD24 overexpression (p = 0.02, hazard ratio 7.528) were predictive of survival. CD24 is commonly expressed in cholangiocarcinoma, and overexpression is predictive of poor survival and possibly of lack of response to chemotherapy and radiation therapy. These findings may improve selection of patients for the appropriate treatment modality and the development of CD24-targeted therapy

Influenza pandemic: perception of risk and individual precautions in a general population. Cross sectional study

BACKGROUND: An influenza pandemic may have considerable impact on health and societal functioning. The aim of this study was to explore people's reflections on the consequences of a pandemic. METHODS: Cross-sectional web-based survey of 1,168 Norwegians aged 16–82 years. The main outcome measures were answers to questions about a potential pandemic ("serious influenza epidemic"): statements about personal precautions including stockpiling Tamiflu(®), the perceived number of fatalities, the perceived effects of Tamiflu(®), the sources of information about influenza and trust in public information. RESULTS: While 80% of the respondents stated that they would be "careful about personal hygiene", only a few would stay away from work (2%), or move to an isolated place (4%). While 27% of respondents were uncertain about the number of fatalities during an influenza pandemic, 48% thought it would be lower than the estimate of Norwegian health authorities (0.05%–1%) and only 3% higher. At least half of the respondents thought that Tamiflu(® )might reduce the mortality risk, but less than 1% had personally purchased the drug. The great majority had received their information from the mass media, and only 9% directly from health authorities. Still the majority (65%) trusted information from the authorities, and only 9% reported overt distrust. CONCLUSION: In Norway, considerable proportions of people seem to consider the mortality risk during a pandemic less than health authorities do. Most people seem to be prepared to take some, but not especially disruptive, precautions

Effect of the molecular structure of the polymer and nucleation on the optical properties of polypropylene homo- and copolymers.

Two soluble nucleating agents were used to modify the optical properties of nine PP homo- and random copolymers. The ethylene content of the polymers changed between 0 and 5.3 wt%. Chain regularity was characterized by the stepwise isothermal segregation technique (SIST), while optical properties by the measurement of the haze of injection molded samples. Crystallization and melting characteristics were determined by differential scanning calorimetry (DSC). The analysis of the results proved that lamella thickness and change in crystallinity influence haze only slightly. A model was introduced which describes quantitatively the dependence of nucleation efficiency and haze on the concentration of the nucleating agent. The model assumes that the same factors influence the peak temperature of crystallization and optical properties. The analysis of the results proved that the assumption is valid under the same crystallization conditions. The parameters of the model depend on the molecular architecture of the polymer. Chain regularity determines supermolecular structure and thus the dependence of optical properties on nucleation