T wave alternans in idiopathic long QT syndrome

AbstractObjectives. The study evaluates the association between T wave alternans and the risk of cardiac events (syncope, aborted cardiac arrest or cardiac death) in a large population of patients with idiopathic long QT syndrome.Background. T wave alternans is an infrequently recorded electrocardiographic (ECG) finding in patients with delayed repolarization, and its clinical significance is not clear.Methods. A total of 4,656 ECG recordings in 2,442 patients enrolled in the International Long QT Syndrome Registry were reviewed for episodes of T wave alternans. To determine the risk associated with T wave alternans, independent of corrected QT interval (QTc) duration, patients with T wave alternans were matched for QTc value (every 0.025 s1/2) to patients with long QT syndrome without T wave alternans.Results. T wave alternans was identified in 39 patients (25 of whom had a QTc interval >0.50 s1/2). A strong association between QTc prolongation and T wave alternans was observed (odds ratio 1.23 per 0.01-s1/2unit increase in QTc, p < 0.0001). Conditional logistic regression analyses with adjustment for age, gender, status and QTc value revealed that T wave alternans did not make a significant independent contribution to the risk of cardiac events. The risk of experiencing a major cardiac event was primarily related to length of QTc.Conclusions. T wave alternans, a marker of electrical instability and regional heterogeneity of repolarization, identifies a high risk subset of patients with prolonged repolarization. Patients with T wave alternans have an increased risk of cardiac events, but this risk is primarily related to the magnitude of repolarization delay (QTc prolongation). T wave alternans does not make an independent contribution to the risk of cardiac events after adjustment for QTc length

Cloud computing for teaching practice: a new design?

Recently researchers have shown an increased interest in cloud computing technology. It is becoming increasingly difficult to ignore cloud computing technology in education context. However rapid changes in information technology are having a serious effect on teaching framework designs. So far, however, there has been little discussion about cloud computing benefits in domains of teaching frameworks which propels us to study and redesign teaching frameworks considering cloud computing. The purpose of this paper is to review recent research into cloud computing and features which can be improved with this new technology. This paper studied several researches through literature to determine the main impact of cloud computing on "planning and preparation" and "instruction" domains as two main domains of teaching framework. Light will be then shed on the impact and potential benefits of cloud computing on teaching framework. The paper closes by proposing to design an evaluation table based on cloud computing artifacts to enhance teaching practice and highlights its offerings for educational institutions

Times of change, times of turbulence: seeking an ethical framework for curriculum development during critical transition in higher education

Rapid changes in academic work environments raise ethical dilemmas in supporting students, implementing policies, and developing professional practice. New teaching technologies require academics to consider community aspects of learning and teaching and impacts on student learning in networked environments. This paper critically reflects on recent experience at a small Australian regional university adapting teaching-notably through on-line environments- to respond to student learning need diversity. Applying Shapiro’s use of the ethics of care, critique, justice and the profession to examine ethical dilemmas associated with increasingly networked and on-line learning, the authors propose that an ethics of community will assist finding practical solutions to ethical dilemmas in curriculum development and delivery. This approach shifts from the individual as moral agent to ethical practice as communal processes. Considering community practices and processes can frame and critique learning and teaching approaches, policies and administration to assist students and staff develop ethical scholarship and professionalism