Pattern and timing of the coronary sinus activation to guide rapid diagnosis of atrial tachycardia after atrial fibrillation ablation

BACKGROUND Atrial tachycardias (AT) during or after ablation of atrial fibrillation frequently pose a diagnostic challenge. We hypothesized that both the patterns and the timing of coronary sinus (CS) activation could facilitate AT mapping. METHODS AND RESULTS A total of 140 consecutive postpersistent atrial fibrillation ablation patients with sustained AT were investigated by conventional mapping. CS activation pattern was defined as chevron or reverse chevron when the activations recorded on both the proximal and the distal CS dipoles were latest or earliest, respectively. The local activation of mid-CS was timed with reference to Ppeak-Ppeak (P-P) interval in lead V1. A ratio, mid-CS activation time to AT cycle length, was computed. Of 223 diagnosed ATs, 124 were macroreentrant (56%) and 99 were centrifugal (44%). When CS activation was chevron/reverse chevron (n=44; 20%), macroreentries were mostly roof dependent. With reference to P-P interval, mid-CS activation timing showed specific consistency for peritricuspid and perimitral AT. Proximal to distal CS activation pattern and mid-CS activation at 50% to 70% of the P-P interval (n=30; 13%) diagnosed peritricuspid AT with 81% sensitivity and 89% specificity. Distal to proximal CS activation and mid-CS activation at 10% to 40% of the P-P interval (n=44; 20%) diagnosed perimitral AT with 88% sensitivity and 75% specificity. CONCLUSIONS The analysis of the patterns and timing of CS activation provides a rapid stratification of most likely macroreentrant ATs and points toward the likely origin of centrifugal ATs. It can be included in a stepwise diagnostic approach to rapidly select the most critical mapping maneuvers.

An IEEE 802.11 energy efficient mechanism for continuous media applications

The widespread deployment of wireless mobile communications enables an almost permanent usage of portable devices, which imposes high demands on the battery of these devices. Indeed, battery lifetime is becoming one the most critical factors on the end-users satisfaction when using wireless communications. In this work, the optimized power save algorithm for continuous media applications (OPAMA) is proposed, aiming at enhancing the energy efficiency on end-users devices. By combining the application specific requirements with data aggregation techniques, {OPAMA} improves the standard {IEEE} 802.11 legacy Power Save Mode (PSM) performance. The algorithm uses the feedback on the end-user expected quality to establish a proper tradeoff between energy consumption and application performance. {OPAMA} was assessed in the OMNeT++ simulator, using real traces of variable bitrate video streaming applications, and in a real testbed employing a novel methodology intended to perform an accurate evaluation concerning video Quality of Experience (QoE) perceived by the end-users. The results revealed the {OPAMA} capability to enhance energy efficiency without degrading the end-user observed QoE, achieving savings up to 44 when compared with the {IEEE} 802.11 legacy PSM.

Virtual photon-photon scattering

Based on analyticity, unitarity, and Lorentz invariance the contribution from hadronic vacuum polarization to the anomalous magnetic moment of the muon is directly related to the cross section of e+e− → hadrons. We review the main difficulties that impede such an approach for light-by-light scattering and identify the required ingredients from experiment. Amongst those, the most critical one is the scattering of two virtual photons into meson pairs. We analyze the analytic structure of the process γ*γ* → ππ and show that the usual Muskhelishvili–Omnès representation can be amended in such a way as to remain valid even in the presence of anomalous thresholds.

Climate sensitivity of Mediterranean pine growth reveals distinct east-west dipole

The European Mediterranean region is governed by a characteristic climate of summer drought that is likely to increase in duration and intensity under predicted climate change. However, large-scale network analyses investigating spatial aspects of pre-instrumental drought variability for this biogeographic zone are still scarce. In this study we introduce 54 mid- to high-elevation tree-ring width (TRW) chronologies comprising 2186 individual series from pine trees (Pinus spp.). This compilation spans a 4000-km east–west transect from Spain to Turkey, and was subjected to quality control and standardization prior to the development of site chronologies. A principal component analysis (PCA) was applied to identify spatial growth patterns during the network's common period 1862–1976, and new composite TRW chronologies were developed and investigated. The PCA reveals a common variance of 19.7% over the 54 Mediterranean pine chronologies. More interestingly, a dipole pattern in growth variability is found between the western (15% explained variance) and eastern (9.6%) sites, persisting back to 1330 AD. Pine growth on the Iberian Peninsula and Italy favours warm early growing seasons, but summer drought is most critical for ring width formation in the eastern Mediterranean region. Synoptic climate dynamics that have been in operation for the last seven centuries have been identified as the driving mechanism of a distinct east–west dipole in the growth variability of Mediterranean pines.

Changes of Root Length and Root-to-Crown Ratio after Apical Surgery: An Analysis by Using Cone-beam Computed Tomography

INTRODUCTION Apical surgery is an important treatment option for teeth with post-treatment periodontitis. Although apical surgery involves root-end resection, no morphometric data are yet available about root-end resection and its impact on the root-to-crown ratio (RCR). The present study assessed the length of apicectomy and calculated the loss of root length and changes of RCR after apical surgery. METHODS In a prospective clinical study, cone-beam computed tomography scans were taken preoperatively and postoperatively. From these images, the crown and root lengths of 61 roots (54 teeth in 47 patients) were measured before and after apical surgery. Data were collected relative to the cementoenamel junction (CEJ) as well as to the crestal bone level (CBL). One observer took all measurements twice (to calculate the intraobserver variability), and the means were used for further analysis. The following parameters were assessed for all treated teeth as well as for specific tooth groups: length of root-end resection and percentage change of root length, preoperative and postoperative RCRs, and percentage change of RCR after apical surgery. RESULTS The mean length of root-end resection was 3.58 ± 1.43 mm (relative to the CBL). This amounted to a loss of 33.2% of clinical and 26% of anatomic root length. There was an overall significant difference between the tooth groups (P < .05). There was also a statistically significant difference comparing mandibular and maxillary teeth (P < .05), but not for incisors/canines versus premolars/molars (P = .125). The mean preoperative and postoperative RCRs (relative to CEJ) were 1.83 and 1.35, respectively (P < .001). With regard to the CBL reference, the mean preoperative and postoperative RCRs were 1.08 and 0.71 (CBL), respectively (P < .001). The calculated changes of RCR after apical surgery were 24.8% relative to CEJ and 33.3% relative to CBL (P < .001). Across the different tooth groups, the mean RCR was not significantly different (P = .244 for CEJ and 0.114 for CBL). CONCLUSIONS This CBCT-based study demonstrated that the RCR is significantly changed after root-end resection in apical surgery irrespective of the clinical (CBL) or anatomic (CEJ) reference levels. The lowest, and thus clinically most critical, postoperative RCR was observed in maxillary incisors. Future clinical studies need to show the impact of resection length and RCR changes on the outcome of apical surgery.

Federally regulated institutional review boards: The aspects of a "model" IRB---Is the current system in need of a tune up or complete overhaul?

Institutional Review Boards (IRBs) are the primary gatekeepers for the protection of ethical standards of federally regulated research on human subjects in this country. This paper focuses on what general, broad measures that may be instituted or enhanced to exemplify a "model IRB". This is done by examining the current regulatory standards of federally regulated IRBs, not private or commercial boards, and how many of those standards have been found either inadequate or not generally understood or followed. The analysis includes suggestions on how to bring about changes in order to make the IRB process more efficient, less subject to litigation, and create standardized educational protocols for members. The paper also considers how to include better oversight for multi-center research, increased centralization of IRBs, utilization of Data Safety Monitoring Boards when necessary, payment for research protocol review, voluntary accreditation, and the institution of evaluation/quality assurance programs. ^ This is a policy study utilizing secondary analysis of publicly available data. Therefore, the research for this paper focuses on scholarly medical/legal journals, web information from the Department of Health and Human Services, Federal Drug Administration, and the Office of the Inspector General, Accreditation Programs, law review articles, and current regulations applicable to the relevant portions of the paper. ^ Two issues are found to be consistently cited by the literature as major concerns. One is a need for basic, standardized educational requirements across all IRBs and its members, and secondly, much stricter and more informed management of continuing research. There is no federally regulated formal education system currently in place for IRB members, except for certain NIH-based trials. Also, IRBs are not keeping up with research once a study has begun, and although regulated to do so, it does not appear to be a great priority. This is the area most in danger of increased litigation. Other issues such as voluntary accreditation and outcomes evaluation are slowing gaining steam as the processes are becoming more available and more sought after, such as JCAHO accrediting of hospitals. ^ Adopting the principles discussed in this paper should promote better use of a local IRBs time, money, and expertise for protecting the vulnerable population in their care. Without further improvements to the system, there is concern that private and commercial IRBs will attempt to create a monopoly on much of the clinical research in the future as they are not as heavily regulated and can therefore offer companies quicker and more convenient reviews. IRBs need to consider the advantages of charging for their unique and important services as a cost of doing business. More importantly, there must be a minimum standard of education for all IRB members in the area of the ethical standards of human research and a greater emphasis placed on the follow-up of ongoing research as this is the most critical time for study participants and may soon lead to the largest area for litigation. Additionally, there should be a centralized IRB for multi-site trials or a study website with important information affecting the trial in real time. There needs to be development of standards and metrics to assess the performance of the IRBs for quality assurance and outcome evaluations. The boards should not be content to run the business of human subjects' research without determining how well that function is actually being carried out. It is important that federally regulated IRBs provide excellence in human research and promote those values most important to the public at large.^

A practice-based culminating experience with Texas Children's Hospital: A hospital's journey to baby-friendly status

Breastfeeding and the use of human milk are widely accepted as the most complete form of nutrition for infants. Breastfeeding is shown to be associated with many positive health outcomes for both infants and mothers. Healthy People 2000 goals to increase breastfeeding rates in the early postpartum period to 75% fell short, with only 64% of mothers meeting this objective. Lack of support from healthcare providers, and unsupportive hospital policies and practices are noted as barriers to the initiation and duration of breastfeeding. The purpose of this study was to evaluate implementation of the BFHI Ten Steps to Successful Breastfeeding at Texas Children's Hospital. ^ The Baby-Friendly Hospital Initiative (BFHI) was developed in 1991 by the World Health Organization and the United Nations Children's Fund (UNICEF) to ensure that healthcare facilities offering maternity services adhere to the Ten Steps of Successful Breastfeeding and the International Code of Marketing of Breast-Milk Substitutes, and create legislation to protect the rights of breastfeeding women. The instrument used in this study was the BFHI 100 Assessment Tool created by Dr. Laura Haiek, Director of Public Health in Monteregie, Quebec, and her staff at Health and Social Services Agency of Quebec. The BFHI 100 tool utilizes 100 different indicators of compliance with BFHI through questionnaires administered to staff and administrators, pregnant and postpartum mothers, and an observer. ^ The study concluded that although there is much room for improvement in educating breastfeeding mothers, overall, the mothers interviewed were satisfied with their level of care in regards to breastfeeding support. Areas of improvement include staff training, as some nursing staff admitted to relying on the lactation consultants to provide most of the breastfeeding education for mothers. Only a small percentage of mothers interviewed reported that their baby “roomed-in” on average of 22 hours per day during their hospital stay. Staff encouragement of the rooming-in practice will help to increase the proportion of mothers who allow their babies to room-in. The current breastfeeding policy will also need to be revised and strengthened to be compliant with the Ten Steps. Ideally, Baby-Friendly practices will become the norm after staff are trained and policy revisions are made. Staff training and acceptance of breastfeeding as optimal nutrition for infants are the most critical factors that will ultimately drive change for the organization. ^

Mechanisms Underlying the Heterogeneous Sensitivities of Cancer Cells to Proteasome Inhibitors

The mechanisms underlying cellular response to proteasome inhibitors have not been clearly elucidated in solid tumor models. Evidence suggests that the ability of a cell to manage the amount of proteotoxic stress following proteasome inhibition dictates survival. In this study using the FDA-approved proteasome inhibitor bortezomib (Velcade®) in solid tumor cells, we demonstrated that perhaps the most critical response to proteasome inhibition is repression of global protein synthesis by phosphorylation of the eukaryotic initiation factor 2-α subunit (eIF2α). In a panel of 10 distinct human pancreatic cancer cells, we showed marked heterogeneity in the ability of cancer cells to induce eIF2α phosphorylation upon stress (eIF2α-P); lack of inducible eIF2α-P led to excessive accumulation of aggregated proteins, reactive oxygen species, and ultimately cell death. In addition, we examined complementary cytoprotective mechanisms involving the activation of the heat shock response (HSR), and found that induction of heat shock protein 70 kDa (Hsp72) protected against proteasome inhibitor-induced cell death in human bladder cancer cells. Finally, investigation of a novel histone deacetylase 6 (HDAC6)-selective inhibitor suggested that the cytoprotective role of the cytoplasmic histone deacetylase 6 (HDAC6) in response to proteasome inhibition may have been previously overestimated.

Productividad del pasto llorón con riego limitado : oasis norte de Mendoza (Argentina)

Ante la realidad de la cada vez más aguda escasez de agua en el oasis norte mendocino durante la primavera, que dificulta el manejo racional de los cultivos existentes, surge la necesidad -en el ámbito de la producción forrajera- de una especie de reducido requerimiento hídrico y que compita lo menos posible con los cultivos tradicionales, en particular en la época más crítica. Se ha experimentado con el pasto llorón para averiguar su respuesta a la aplicación de riegos limitados durante el período invernal. Se presentan los resultados de producción de materia seca así como las observaciones de la dinámica vegetacional. Se concluye que para el oasis norte de Mendoza la aplicación de riegos durante el período invernal que completen 200 mm, permite la supervivencia del cultivo con una densidad de aproximadamente 60 plantas por m2 y una producción entre 3 200 y 4 000 kg de materia seca por ha y por año.

Mössbauer characterisation of sediments from ODP Sites 128-798 and 128-799

57Fe Mössbauer spectra for 26 sediment and 6 carbonate concretion samples from Sites 798 and 799 were recorded at 293 K. Most spectra were deconvolved to two quadrupole doublets without magnetic hyperfine structure. Typical Mössbauer parameters were: isomer shift (I.S.) = 0.34 mm/s and quadrupole splitting (Q.S.) = 0.64 mm/s for the paramagnetic Fe3+ component (partly, pyrite); I.S. = 1.13 mm/s and Q.S. = 2.64 mm/s for the high-spin Fe2+ component derived from iron-bearing aluminosilicates. A few spectra included other high-spin Fe2+ components ascribed to iron-bearing carbonate minerals (e.g., ferroan magnesite), according to the Mössbauer parameters for Fe2+ in the carbonate concretions. We present the distribution of iron among different chemical forms as a function of depth. These data might indicate changes of depositional and diagenetic conditions.

Terrestrial organic matter in marine sediments of the Central Equatorial Atlantic

Terrestrial organic matter (OM) in pelagic sediments is discussed with regard to depositional processes and land-sea interactions in the modern and past glacial/interglacial Equatorial Atlantic. Special emphasis is placed on a critical evaluation of different analytical approaches (C/N, Rock-Eval Pyrolysis, stable carbon isotopes, palynology, organic petrology, and selected biomarkers) which are currently used for the qualitative and quantitative assessment of terrigenous organic carbon. If binary mixing equations are used to calculate terrestrial and marine proportions of organic carbon, we consider the definition of endmember values to be most critical since these values may be biased by a great number of independent controls. A combination of geochemical methods including optical studies (organic petrology and palynology) is therefore suggested to evaluate each individual proxy. Organic geochemical analyses performed on sediments from the modern and Late Quaternary Equatorial Atlantic evidence fluctuations in eolian supply of terrigenous OM related to changes in intensity of the trade winds. Quantification of this organic fraction leads to differing proportions depending on the approach applied, i.e. the organic carbon isotopic composition or maceral analyses. Modern distribution of terrigenous OM reveals a decrease in supply towards the basin contributing less than a fifth of the total OM in pelagic areas. Organic geochemical data indicate that sedimentation in the modern northeastern Brasil Basin is affected by lateral advection of reworked OM probably from southern source areas. Glacial/interglacial deposits from the pelagic Equatorial Atlantic (ODP Site 663), covering isotopic stages 12 and 11, reveal that deposition of terrigenous OM was higher under past glacial conditions, in correspondence to generally enhanced dust fluxes. Proportions of terrigenous OM, however, never exceed 50% of the total OM according to maceral analyses. Other estimates, recently proposed by Verardo and Ruddiman (1996), are considered to be too high probably for analytical reasons. Palynological records in the Equatorial Atlantic parallel dust records. Increased portions of grass pollen suggest the admixture of C4-plant material under modern and past glacial conditions. It is therefore assumed, as one possible interpetation, that C4-plant debris has an effect on sedimentary d13Corg and might explain differences between isotopic and microscopic quantitative estimates. Using the difference between these two records, we calculate that maximum supply of C4-material remains below 20% of the total OM for the deep modern and past glacial/interglacial Equatorial Atlantic.

The modulating effect of light intensity on the response of the coccolithophore Gephyrocapsa oceanica to ocean acidification

Global change leads to a multitude of simultaneous modifications in the marine realm among which shoaling of the upper mixed layer, leading to enhanced surface layer light intensities, as well as increased carbon dioxide (CO2) concentration are some of the most critical environmental alterations for phytoplankton. In this study, we investigated the responses of growth, photosynthetic carbon fixation and calcification of the coccolithophore Gephyrocapsa oceanica to elevated inline image (51 Pa, 105 Pa, and 152 Pa) (1 Pa ~ 10 µatm) at a variety of light intensities (50-800 µmol photons/m**2/s). By fitting the light response curve, our results showed that rising inline image reduced the maximum rates for growth, photosynthetic carbon fixation and calcification. Increasing light intensity enhanced the sensitivity of these rate responses to inline image, and shifted the inline image optima toward lower levels. Combining the results of this and a previous study (Sett et al. 2014) on the same strain indicates that both limiting low inline image and inhibiting high inline image levels (this study) induce similar responses, reducing growth, carbon fixation and calcification rates of G. oceanica. At limiting low light intensities the inline image optima for maximum growth, carbon fixation and calcification are shifted toward higher levels. Interacting effects of simultaneously occurring environmental changes, such as increasing light intensity and ocean acidification, need to be considered when trying to assess metabolic rates of marine phytoplankton under future ocean scenarios.

Age models and summer sea surface temperature and winter sea ice concentration for the EPILOG-LGM time slice in the Pacific Southern Ocean

Sea surface temperatures and sea-ice extent are the most critical variables to evaluate the Southern Ocean paleoceanographic evolution in relation to the development of the global carbon cycle, atmospheric CO2 variability and ocean-atmosphere circulation. In contrast to the Atlantic and the Indian sectors, the Pacific sector of the Southern Ocean has been insufficiently investigated so far. To cover this gap of information we present diatom-based estimates of summer sea surface temperature (SSST) and winter sea-ice concentration (WSI) from 17 sites in the polar South Pacific to study the Last Glacial Maximum (LGM) at the EPILOG time slice (19,000-23,000 cal. years BP). Applied statistical methods are the Imbrie and Kipp Method (IKM) and the Modern Analog Technique (MAT) to estimate temperature and sea-ice concentration, respectively. Our data display a distinct LGM east-west differentiation in SSST and WSI with steeper latitudinal temperature gradients and a winter sea-ice edge located consistently north of the Pacific-Antarctic Ridge in the Ross sea sector. In the eastern sector of our study area, which is governed by the Amundsen Abyssal Plain, the estimates yield weaker latitudinal SSST gradients together with a variable extended winter sea-ice field. In this sector, sea-ice extent may have reached sporadically the area of the present Subantarctic Front at its maximum LGM expansion. This pattern points to topographic forcing as major controller of the frontal system location and sea-ice extent in the western Pacific sector whereas atmospheric conditions like the Southern Annular Mode and the ENSO affected the oceanographic conditions in the eastern Pacific sector. Although it is difficult to depict the location and the physical nature of frontal systems separating the glacial Southern Ocean water masses into different zones, we found a distinct temperature gradient in latitudes straddled by the modern Southern Subtropical Front. Considering that the glacial temperatures north of this zone are similar to the modern, we suggest that this represents the Glacial Southern Subtropical Front (GSSTF), which delimits the zone of strongest glacial SSST cooling (>4K) to its North. The southern boundary of the zone of maximum cooling is close to the glacial 4°C isotherm. This isotherm, which is in the range of SSST at the modern Antarctic Polar Front (APF), represents a circum-Antarctic feature and marks the northern edge of the glacial Antarctic Circumpolar Current (ACC). We also assume that a glacial front was established at the northern average winter sea ice edge, comparable with the modern Southern Antarctic Circumpolar Current Front (SACCF). During the glacial, this front would be located in the area of the modern APF. The northward deflection of colder than modern surface waters along the South American continent leads to a significant cooling of the glacial Humboldt Current surface waters (4-8K), which affects the temperature regimes as far north as into tropical latitudes. The glacial reduction of ACC temperatures may also result in the significant cooling in the Atlantic and Indian Southern Ocean, thus may enhance thermal differentiation of the Southern Ocean and Antarctic continental cooling. Comparison with temperature and sea ice simulations for the last glacial based on numerical simulations show that the majority of modern models overestimate summer and winter sea ice cover and that there exists few models that reproduce our temperature data rather well.

The effects of long (C20/22) and short (C18) chain omega-3 fatty acids on keel bone fractures, bone biomechanics, behavior, and egg production in free-range laying hens.

Keel fractures in the laying hen are the most critical animal welfare issue facing the egg production industry, particularly with the increased use of extensive systems in response to the 2012 EU directive banning conventional battery cages. The current study is aimed at assessing the effects of 2 omega-3 (n3) enhanced diets on bone health, production endpoints, and behavior in free-range laying hens. Data was collected from 2 experiments over 2 laying cycles, each of which compared a (n3) supplemented diet with a control diet. Experiment 1 employed a diet supplemented with a 60:40 fish oil-linseed mixture (n3:n6 to 1.35) compared with a control diet (n3:n6 to 0.11), whereas the n3 diet in Experiment 2 was supplemented with a 40:60 fish oil-linseed (n3:n6 to 0.77) compared to the control diet (n3:n6 to 0.11). The n3 enhanced diet of Experiment 1 had a higher n3:n6 ratio, and a greater proportion of n3 in the long chain (C20/22) form (0.41 LC:SC) than that of Experiment 2 (0.12 LC:SC). Although dietary treatment was successful in reducing the frequency of fractures by approximately 27% in Experiment 2, data from Experiment 1 indicated the diet actually induced a greater likelihood of fracture (odds ratio: 1.2) and had substantial production detriment. Reduced keel breakage during Experiment 2 could be related to changes in bone health as n3-supplemented birds demonstrated greater load at failure of the keel, and tibiae and humeri that were more flexible. These results support previous findings that n3-supplemented diets can reduce fracture likely by increasing bone strength, and that this can be achieved without detriment to production. However, our findings suggest diets with excessive quantities of n3, or very high levels of C20/22, may experience health and production detriments. Further research is needed to optimize the quantity and type of n3 in terms of bone health and production variables and investigate the potential associated mechanisms.

SCA security verification on wireless sensor network node

Side Channel Attack (SCA) differs from traditional mathematic attacks. It gets around of the exhaustive mathematic calculation and precisely pin to certain points in the cryptographic algorithm to reveal confidential information from the running crypto-devices. Since the introduction of SCA by Paul Kocher et al [1], it has been considered to be one of the most critical threats to the resource restricted but security demanding applications, such as wireless sensor networks. In this paper, we focus our work on the SCA-concerned security verification on WSN (wireless sensor network). A detailed setup of the platform and an analysis of the results of DPA (power attack) and EMA (electromagnetic attack) is presented. The setup follows the way of low-cost setup to make effective SCAs. Meanwhile, surveying the weaknesses of WSNs in resisting SCA attacks, especially for the EM attack. Finally, SCA-Prevention suggestions based on Differential Security Strategy for the FPGA hardware implementation in WSN will be given, helping to get an improved compromise between security and cost.