Diskussionspapier: Ergebnisse der Normenprüfung zum Berliner Wahlrecht im Rahmen der "Expertise für ein Artikelgesetz zur Umsetzung der UN-Behindertenrechtskonvention im Land Berlin" des Projektes "Monitoring-Stelle Berlin"

Das Diskussionspapier gibt die Ergebnisse der Normenprüfung des Berliner Wahlgesetzes und der Wahlordnung am Maßstab der UN-Behindertenrechtskonvention (UN-BRK) wieder. Die Monitoring-Stelle fordert darin, das Wahlrecht auf alle (volljährigen) Menschen mit Behinderungen auszuweiten. Von Wahlrechtsausschlüssen betroffen sind Menschen mit Behinderungen, die unter Betreuung in allen Angelegenheiten stehen, sowie Menschen, die im Maßregelvollzug in einem psychiatrischen Krankenhaus untergebracht sind. In dem Papier macht die Monitoring-Stelle deutlich, dass die derzeit im Berliner Wahlgesetz geregelten Ausschlüsse von Menschen mit Behinderungen nicht mit der UN-BRK vereinbar sind. Neben dem Wahlrecht für die genannten Personen fordert die Monitoring-Stelle verbesserte Regelungen zur barrierefreien Ausgestaltung der Wahlen, beispielsweise bezüglich der Barrierefreiheit von Wahllokalen, Wahlbenachrichtigungen, Wahlmaterialien und Stimmzetteln

Cybersecurity Policy Development at the State Level: A Case Study of Middle Tennessee

Cybersecurity is a growing threat not only to nations, critical infrastructure, and major entities, but also to smaller organizations and individuals. The growing number of successful attacks on all manner of U.S. targets highlights the need for effective and comprehensive policy from the local to federal level, though most research focuses on federal policy issues, not state issues. The purpose of this study was to examine the effectiveness of the decision-making process within the current cybersecurity policy environment in a southern state of the United States. Sabatier\u27s advocacy coalition framework served as the theoretical framework for the study. Data were collected through 5 semistructured interviews with individuals who were either elected or appointed officials, emergency managers, or subject matter experts. These data were transcribed, then coded and analyzed with McCracken\u27s analytic categorization procedure. Participants recognized that the federal government provides some resources but acknowledged that action at the state level is largely funded through the state resulting in a network of dissimilar policies and protocols in states across the country. Findings also revealed that state leadership in some locations better grasps what resources are needed and is more likely to earmark in order to plan for unanticipated cybersecurity needs of the public. Analysis of study data also highlighted areas for future study and identified needed resources or areas of opportunity for creating a more comprehensive and effective cybersecurity policy environment. Implications for positive social change include recommendations for state and federal decision makers to engage in community partnerships in order to more effectively protect the public from cybersecurity threats

Wearable cardioverter-defibrillator as bridging to ICD in pediatric hypertrophic cardiomyopathy with myocardial bridging - a case report

Background: There is only limited experience with wearable cardioverter-defibrillators (WCD) in pediatric patients. We report on the successful application of a WCD in an adolescent patient with hypertrophic cardiomyopathy and myocardial bridging. Case presentation: A 15-year-old girl presented with a history of recurrent syncope, dyspnea, and vertigo with exercise. Diagnostic work-up revealed non-obstructive hypertrophic cardiomyopathy and signs of myocardial ischemia with exercise. Given this high-risk constellation, the patient was scheduled for prophylactic implantation of an implantable cardioverter-defibrillator (ICD). One month after initial presentation and days prior to the planned ICD implantation, the patient collapsed during an episode of sustained ventricular tachycardia (VT) while running. VT was terminated by WCD shock delivery. Following this event, computerized tomography scan revealed myocardial bridging of the left anterior descending coronary artery causing a 90% stenosis in systole. After coronary surgery, life threatening arrhythmias have not recurred, but due to progressive heart failure, the patient underwent successful heart transplantation after 2 years. Conclusions: The reported case highlights the importance and applicability of WCDs and the potentially malign nature of myocardial bridging in pediatric high-risk patients

Lentivirus-mediated antagomir expression for specific inhibition of miRNA function

Micro RNAs (miRNA) regulate gene expression by hybridization and recruitment of multi-protein complexes to complementary mRNA target sequences. miRNA function can transiently be antagonized by antagomirs—chemically modified oligonucleotides complementary to individual miRNAs. Here, we describe the induction of stable loss-of-function phenotypes for specific miRNAs by lentivirus-mediated antagomir expression. Lentivirally expressed antagomirs are transcribed from a H1-promoter located within the lentiviral 3′LTR and were directed against miRNAs encoded on the polycistronic miR17-92 transcript. Functional silencing of miR-18a, miR-19b and miR-20a by the corresponding antagomirs specifically relieves miRNA-mediated reporter gene repression. Inhibition of miRNA function correlates to reduction of ‘miRNA’ amplification by miRNA-specific quantitative RT-PCR. Furthermore, protein expression of E2F-1, a known miR-20 target, is enhanced by lentivirally expressed anti-miR-20 antagomirs in a dose-dependent manner, whereas over-expression of miR-20a reduces E2F-1 levels. Finally, combined over-expression of specific miRNAs and antagomirs reveals individual and complementary functions of miR-18a and miR-20a and demonstrates specific miRNA impact on cell proliferation in a cell culture model

Electrophysiological findings during re-do procedures after single-shot pulmonary vein isolation for atrial fibrillation with pulsed field ablation

Background: Pulsed field ablation (PFA) is a novel ablation technology recently adopted in the treatment of atrial fibrillation (AF). Currently, little is known about the durability of PFA ablation lesions. Methods: We investigated patients who underwent redo-ablation due to recurrent AF/atrial-flutter or tachycardia (AFL/AT) following PVI with PFA. We report electrophysiological findings and ablation strategy during redo-ablation. Results: Of 447 patients undergoing index PVI with PFA, 14 patients (age: 61.9±10.8 years; 7 (50.0%) males; left atrial volume index (n=10): 39.4±14.6 mL/m2) were referred for redo-ablation. Initial indication was paroxysmal-AF in 7 patients, persistent-AF in 6 and long-standing-persistent-AF in one patient. Mean time-to-recurrence was 4.9±1.9 months. Three patients received additional posterior-wall-isolation during index PFA. Twelve (85.7%) patients suffered AF recurrence and 5/12 had concomitant AFL. In the remaining 2 patients, one had a (box-dependent) AFL, and one had an atypical AT. No patients had all PVs reconnected. Reconnection in zero, one, two or three PVs was found in 35.7%, 21.4%, 14.3%, and 28.6% of patients, respectively. All 7 patients with zero or one reconnection with AF recurrence received additional/repeat posterior-wall-isolation during re-ablation, while in the others, PVs were re-isolated. Patients with only AFL/AT had no reconnection of PVs, and the substrate was successfully ablated. Conclusions: Durable PVI (all PV’s isolated) was observed in over one-third of patients at re-do. The predominant recurrent arrhythmia following PVI-only was AF. Concomitant (35.7%) or isolated (14.3%) AFL/AT recurrence was observed in 50% of patients.</p

Physical activity is reduced prior to ventricular arrhythmiasin patients with a wearable cardioverter defibrillator

The utility of accelerometer�based activity data to identify patients at risk of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) has not previously been investigated. The aim of the current study was to determine whether physical activity is associated with manifesting spontaneous sustained VT/VF requiring emergent defibrillation in patients with an ejection fraction of ≤35%

Sudden cardiac death while waiting: do we need the wearable cardioverter-defibrillator?

Sudden cardiac death (SCD) is the most frequent cause of cardiovascular death in industrialized nations. Patients with cardiomyopathy are at increased risk for SCD and may benefit from an implantable cardioverter-defibrillator (ICD). The risk of SCD is highest in the first months after myocardial infarction or first diagnosis of severe non-ischemic cardiomyopathy. On the other hand, left ventricular function may improve in a subset of patients to such an extent that an ICD might no longer be needed. To offer protection from a transient risk of SCD, the wearable cardioverter-defibrillator (WCD) is available. Results of the first randomized clinical trial investigating the role of the WCD after myocardial infarction were recently published. This review is intended to provide insight into data from the VEST trial, and to put these into perspective with studies and clinical experience. As a non-invasive, temporary therapy, the WCD may offer advantages over early ICD implantation. However, recent data demonstrate that patient compliance and education play a crucial role in this new concept of preventing SCD