Barriers and facilitators of physical activity in adolescents with intellectual disabilities: An analysis informed by the COM-B model

BACKGROUND: Adolescents with intellectual disabilities are insufficiently physically active. Where interventions have been developed and delivered, these have had limited effectiveness, and often lack a theoretical underpinning. AIM: Through application of the COM‐B model, our aim is to explore the factors influencing adolescent physical activity within schools. METHODS: A qualitative methodology, using focus groups with students who have mild/moderate intellectual disabilities, their parents'/carers' and teachers'. The COM‐B model provided the lens through which the data were collected and analysed. RESULTS: We identified of a range of individual, interpersonal, and environmental factors influencing physical activity, across all six COM‐B constructs, within the context of the ‘school‐system’. CONCLUSION: This is the first study to use the COM‐B model to explore school‐based physical activity behaviour, for adolescents with intellectual disabilities. Identification of such physical activity behavioural determinants can support the development of effective and sustainable interventions

Bridging the gap between computation and clinical biology: validation of cable theory in humans

Introduction: Computerized simulations of cardiac activity have significantly contributed to our understanding of cardiac electrophysiology, but techniques of simulations based on patient-acquired data remain in their infancy. We sought to integrate data acquired from human electrophysiological studies into patient-specific models, and validated this approach by testing whether electrophysiological responses to sequential premature stimuli could be predicted in a quantitatively accurate manner. Methods: Eleven patients with structurally normal hearts underwent electrophysiological studies. Semi-automated analysis was used to reconstruct activation and repolarization dynamics for each electrode. This S(2) extrastimuli data was used to inform individualized models of cardiac conduction, including a novel derivation of conduction velocity restitution. Activation dynamics of multiple premature extrastimuli were then predicted from this model and compared against measured patient data as well as data derived from the ten-Tusscher cell-ionic model. Results: Activation dynamics following a premature S(3) were significantly different from those after an S(2). Patient specific models demonstrated accurate prediction of the S(3) activation wave, (Pearson's R(2) = 0.90, median error 4%). Examination of the modeled conduction dynamics allowed inferences into the spatial dispersion of activation delay. Further validation was performed against data from the ten-Tusscher cell-ionic model, with our model accurately recapitulating predictions of repolarization times (R(2) = 0.99). Conclusions: Simulations based on clinically acquired data can be used to successfully predict complex activation patterns following sequential extrastimuli. Such modeling techniques may be useful as a method of incorporation of clinical data into predictive models

Measurement bias in activation-recovery intervals from unipolar electrograms

The activation-recovery interval (ARI) calculated from unipolar electrograms is regularly used as a convenient surrogate measure of local cardiac action potential durations (APD). This method enables important research bridging between computational studies and in vitro and in vivo human studies. The Wyatt method is well established as a theoretically sound method for calculating ARIs; however, some studies have observed that it is prone to a bias error in measurement when applied to positive T waves. This article demonstrates that recent theoretical and computational studies supporting the use of the Wyatt method are likely to have underestimated the extent of this bias in many practical experimental recording scenarios. This work addresses these situations and explains the measurement bias by adapting existing theoretical expressions of the electrogram to represent practical experimental recording configurations. A new analytic expression for the electrogram's local component is derived, which identifies the source of measurement bias for positive T waves. A computer implementation of the new analytic model confirms our hypothesis that the bias is systematically dependent on the electrode configuration. These results provide an aid to electrogram interpretation in general, and this work's outcomes are used to make recommendations on how to minimize measurement error

Assessment of a conduction-repolarisation metric to predict Arrhythmogenesis in right ventricular disorders

Background: The re-entry vulnerability index (RVI) is a recently proposed activation-repolarization metric designed to quantify tissue susceptibility to re-entry. This study aimed to test feasibility of an RVI-based algorithm to predict the earliest endocardial activation site of ventricular tachycardia (VT) during electrophysiological studies and occurrence of haemodynamically significant ventricular arrhythmias in follow-up. Methods: Patients with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) (n = 11), Brugada Syndrome (BrS) (n = 13) and focal RV outflow tract VT (n = 9) underwent programmed stimulation with unipolar electrograms recorded from a non-contact array in the RV. Results: Lowest values of RVI co-localised with VT earliest activation site in ARVC/BrS but not in focal VT. The distance between region of lowest RVI and site of VT earliest site (D min ) was lower in ARVC/BrS than in focal VT (6.8 ± 6.7 mm vs 26.9 ± 13.3 mm, p = 0.005). ARVC/BrS patients with inducible VT had lower Global-RVI (RVI G ) than those who were non-inducible (−54.9 ± 13.0 ms vs −35.9 ± 8.6 ms, p = 0.005) or those with focal VT (−30.6 ± 11.5 ms, p = 0.001). Patients were followed up for 112 ± 19 months. Those with clinical VT events had lower Global-RVI than both ARVC and BrS patients without VT (−54.5 ± 13.5 ms vs −36.2 ± 8.8 ms, p = 0.007) and focal VT patients (−30.6 ± 11.5 ms, p = 0.002). Conclusions: RVI reliably identifies the earliest RV endocardial activation site of VT in BrS and ARVC but not focal ventricular arrhythmias and predicts the incidence of haemodynamically significant arrhythmias. Therefore, RVI may be of value in predicting VT exit sites and hence targeting of re-entrant arrhythmias

Tesseract supersonic business transport

This year, the senior level Aerospace Design class at Case Western Reserve University developed a conceptual design of a supersonic business transport. Due to the growing trade between Asia and the United States, a transpacific range was chosen for the aircraft. A Mach number of 2.2 was chosen, too, because it provides reasonable block times and allows the use of a large range of materials without a need for active cooling. A payload of 2,500 lbs. was assumed corresponding to a complement of nine passengers and crew, plus some light cargo. With these general requirements set, the class was broken down into three groups. The aerodynamics of the aircraft were the responsibility of the first group. The second developed the propulsion system. The efforts of both the aerodynamics and propulsion groups were monitored and reviewed for weight considerations and structural feasibility by the third group. Integration of the design required considerable interaction between the groups in the final stages. The fuselage length of the final conceptual design was 107.0 ft, while the diameter of the fuselage was 7.6 ft. The delta wing design consisted of an aspect ratio of 1.9 with a wing span of 47.75 ft and mid-chord length of 61.0 ft. A SNECMA MCV 99 variable-cycle engine design was chosen for this aircraft

Campus Vol IV N 3

Hawk, Bob. Adventures of a Private Eye . Prose. 3. Gillies, Jean. The Fine Arts . Prose. 4. Hauser, Bill. After Hours Almanac . Prose. 5. Chase, Dick. Admirals of the Inland Lake . Prose. 6. Runkle, Pete. They Float Through the Air With the Greatest . Prose. 8. Barton, Rusty. Threads For the Female . Prose. 10. Crocker, Larry. Innocents Abroad . Prose. 11. Wilson, Bob. The Drums of Port Au Prince . Prose. 12. Johnston, Ed. Threads For the Male . Prose. 14. Kreuger, Ben. Column For Contributors . 15. Rounds, Dave. Untitled. Cartoon. 21. Taggart, Marilou. Nightmare . Poem. 22. Thompson, Rolan. Cover. Picture. 0. Cover, Frank and John Trimble. Campus Congratulates Emotion . Picture. 2. Rees, Tom. Our March Pin-Up Girl . Picture. 7. Rees, Tom. They Fly Through the Air With the Greatest . Picture. 8. McGlone, Joe and Tom Rees. Threads for Females . Picture. 10

Campus Vol IV N 2

Hodgson, Don. Big Red On The Radio . Prose. 2. Hauser, Bill. After Hours Almanac . Prose. 4. Ide, Don and Bob Porter. I Remember D-Day . Picture. 6. Hawk, Bob. The Shysters: Drama in The Counselor\u27s Office a la Hemingway . Prose. 7. McGlone, Joe and Tom Rees. Terpischore Takes Over . Picture. 8. Parker, Chris. Nuns Fret Not . Prose. 9. Johnston, Ed. Fashions For Men . Prose. 10. Barton, Rusty. Fashions For Women . Prose. 11. Matthews, Jack and Joe McGlone. Campus Congratulates . Picture. 12. Rossi, Bob. Doane * 9:55 . Picture. 14. Bedell, Barrie and John Hodges. Ballroom to Boudoir . 15. Anonymous. Calender Girls For \u2750 . Picture. 16. Wittich, Hugh. Prelude . Prose. 20. Chase, Dick. The Intramural Saga . Prose. 21. Kruger, Ben. Column For Contributors . Prose. 22. Taggart, Marilou. Leaves, Oh Man! . Poem. 22. Taggart, Marilou. Christmas Fugue . Poem. 22. Froth. Untitled. Prose. 24. Anonymous. Untitled. Cartoon. 24. Optekar, Pat. Polyphemis\u27 Wrath . Prose. 5

Expandable external support device to improve Saphenous Vein Graft Patency after CABG

Objectives: Low patency rates of saphenous vein grafts remain a major predicament in surgical revascularization. We examined a novel expandable external support device designed to mitigate causative factors for early and late graft failure. Methods: For this study, fourteen adult sheep underwent cardiac revascularization using two vein grafts for each; one to the LAD and the other to the obtuse marginal artery. One graft was supported with the device while the other served as a control. Target vessel was alternated between consecutive cases. The animals underwent immediate and late angiography and were then sacrificed for histopathologic evaluation. Results: Of the fourteen animals studied, three died peri-operatively (unrelated to device implanted), and ten survived the follow-up period. Among surviving animals, three grafts were thrombosed and one was occluded, all in the control group (p = 0.043). Quantitative angiographic evaluation revealed no difference between groups in immediate level of graft uniformity, with a coefficient-of-variance (CV%) of 7.39 in control versus 5.07 in the supported grafts, p = 0.082. At 12 weeks, there was a significant non-uniformity in the control grafts versus the supported grafts (CV = 22.12 versus 3.01, p < 0.002). In histopathologic evaluation, mean intimal area of the supported grafts was significantly lower than in the control grafts (11.2 mm^2 versus 23.1 mm^2 p < 0.02). Conclusions: The expandable SVG external support system was found to be efficacious in reducing SVG’s non-uniform dilatation and neointimal formation in an animal model early after CABG. This novel technology may have the potential to improve SVG patency rates after surgical myocardial revascularization

New-Onset Atrial Fibrillation After PCI or CABG for Left Main Disease: The EXCEL Trial

Background: There is limited information on the incidence and prognostic impact of new-onset atrial fibrillation (NOAF) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD). Objectives: This study sought to determine the incidence of NOAF following PCI and CABG for LMCAD and its effect on 3-year cardiovascular outcomes. Methods: In the EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, 1,905 patients with LMCAD and low or intermediate SYNTAX scores were randomized to PCI with everolimus-eluting stents versus CABG. Outcomes were analyzed according to the development of NOAF during the initial hospitalization following revascularization. Results: Among 1,812 patients without atrial fibrillation on presentation, NOAF developed at a mean of 2.7 ± 2.5 days after revascularization in 162 patients (8.9%), including 161 of 893 (18.0%) CABG-treated patients and 1 of 919 (0.1%) PCI-treated patients (p < 0.0001). Older age, greater body mass index, and reduced left ventricular ejection fraction were independent predictors of NOAF in patients undergoing CABG. Patients with versus without NOAF had a significantly longer duration of hospitalization, were more likely to be discharged on anticoagulant therapy, and had an increased 30-day rate of Thrombolysis In Myocardial Infarction major or minor bleeding (14.2% vs. 5.5%; p < 0.0001). By multivariable analysis, NOAF after CABG was an independent predictor of 3-year stroke (6.6% vs. 2.4%; adjusted hazard ratio [HR]: 4.19; 95% confidence interval [CI]: 1.74 to 10.11; p = 0.001), death (11.4% vs. 4.3%; adjusted HR: 3.02; 95% CI: 1.60 to 5.70; p = 0.0006), and the primary composite endpoint of death, MI, or stroke (22.6% vs. 12.8%; adjusted HR: 2.13; 95% CI: 1.39 to 3.25; p = 0.0004). Conclusions: In patients with LMCAD undergoing revascularization in the EXCEL trial, NOAF was common after CABG but extremely rare after PCI. The development of NOAF was strongly associated with subsequent death and stroke in CABG-treated patients. Further studies are warranted to determine whether prophylactic strategies to prevent or treat atrial fibrillation may improve prognosis in patients with LMCAD who are undergoing CABG. (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularizatio