Implementation of a zero fluoroscopic workflow using a simplified intracardiac echocardiography guided method for catheter ablation of atrial fibrillation, including repeat procedures

Objective Pulmonary vein isolation (PVI) is the cornerstone of the interventional treatment of atrial fibrillation (AF). Traditionally, during these procedures the catheters are guided by fluoroscopy, which poses a risk to the patient and staff by ionizing radiation. Our aim was to describe our experience in the implementation of an intracardiac echocardiography (ICE) guided zero fluoroscopic (ZF) ablation approach to our routine clinical practice. Methods We developed a simplified ICE guided technique to perform ablation procedures for AF, with the aid of a 3D electroanatomical mapping system. The workflow was implemented in two phases: (1) the Introductory phase, where the first 16 ZF PVIs were compared with 16 cases performed with fluoroscopy and (2) the Extension phase, where 71 consecutive patients (including repeat procedures) with ZF approach were included. Standard PVI (and redoPVI) procedures were performed, data on feasibility of the ZF approach, complications, acute and 1-year success rates were collected. Results In the Introductory phase, 94% of the procedures could be performed with complete ZF with a median procedure time of 77.5 (73.5–83) minutes. In one case fluoroscopy was used to guide the ICE catheter to the atrium. There was no difference in the complication, acute and 1-year success rates, compared with fluoroscopy guided procedures. In the Extension phase, 97% of the procedures could be completed with complete ZF. In one case fluoroscopy was used to guide the transseptal puncture and in another to position the ICE catheter. Acute success of PVI was achieved in all cases, 64.4% patients were arrhythmia free at 1-year. Acute major complications were observed in 4 cases, all of these occurred in the redo PVI group and consisted of 2 tamponades, 1 transient ischemic attack and 1 pseudoaneurysm at the puncture site. The procedures were carried out by all members of the electrophysiology unit in the Extension phase, including less experienced operators and electrophysiology fellows (3 physicians) under the supervision of the senior electrophysiologist. Consequently, procedure times became longer [90 (75–105) vs 77.5 (73.5–85) min, p = 0.014]. Conclusions According to our results, a ZF workflow of AF ablations can be successfully implemented into the routine practice of an electrophysiology laboratory, without compromising safety and effectivity.

COVID-19 And Erythrocyte Aggregates: An Intensivists Experience When Being Affected

COVID-19 pandemic has killed over 310,000 individuals as of 17 May 2020. Healthcare providers are profoundly vulnerable to be contaminated instead of taking every single careful step. Although the respiratory tract and the lungs are the target organs some complications may develop even at the introductory phase of this sickness course. Hemoconcentration with raised serum ferritin levels is one of the dangerous conditions that may occur from chronic hypoxia and severe dehydration because of increased insensible loss due to continuous excessive perspirations. Recent posthumous pulmonary tissue studies revealed that the viral infective mechanism, as well as the miniaturized erythrocyte aggregates, are additionally a significant contributing phenomenon to create acute respiratory distress syndrome (ARDS). Hematological issues require to deal proactively alongside other vital organ protection protocols for better outcomes. This article will depict the disease sequence of an intensivist working in a corona unit after being infected by COVID-19.

COVID-19 And Erythrocyte Aggregates: An Intensivists Experience When Being Affected

COVID-19 pandemic has killed over 310,000 individuals as of 17 May 2020. Healthcare providers are profoundly vulnerable to be contaminated instead of taking every single careful step. Although the respiratory tract and the lungs are the target organs some complications may develop even at the introductory phase of this sickness course. Hemoconcentration with raised serum ferritin levels is one of the dangerous conditions that may occur from chronic hypoxia and severe dehydration because of increased insensible loss due to continuous excessive perspirations. Recent posthumous pulmonary tissue studies revealed that the viral infective mechanism, as well as the miniaturized erythrocyte aggregates, are additionally a significant contributing phenomenon to create acute respiratory distress syndrome (ARDS). Hematological issues require to deal proactively alongside other vital organ protection protocols for better outcomes. This article will depict the disease sequence of an intensivist working in a corona unit after being infected by COVID-19.

Assessing prior knowledge types as predictors of academic achievement in the introductory phase of biology and physics study programmes using logistic regression

Background Increasingly, high dropout rates in science courses at colleges and universities have led to discussions of causes and potential support measures of students. Students’ prior knowledge is repeatedly mentioned as the best predictor of academic achievement. Theory describes four hierarchically ordered types of prior knowledge, from declarative knowledge of facts to procedural application of knowledge. This study explores the relevance of these four prior knowledge types to academic achievement in the introductory phase of the two science subjects, biology and physics. Results We assessed the knowledge types at the beginning and student achievement (measured by course completion) at the end of the first study year. We applied logistic regression models to evaluate the relationship between the knowledge types and academic achievement. First, we controlled for a well-established predictor of academic achievement (high school grade point average). Second, we added the knowledge types as predictors. For biology, we found that only knowledge about principles and concepts was a significant predictor in the first year. For physics, knowledge about concepts and principles as well as the ability to apply knowledge to problems was related to academic achievement. Conclusion Our results concerning the knowledge types, which are of special relevance in biology and physics studies, could lead to effective measures, e.g. for identifying at-risk students and course guidance. Furthermore, the results provide a profound starting point for controlled intervention studies that systematically foster the identified relevant knowledge types in each subject and aim at a theory- and empirical-based optimization of pre- and introductory courses.

Sysmä Community Currency: An Analysis of its Success from the Perspectives of Purposes, Stakeholders and Promotion

The article is a case study of a local currency, recently introduced in the rurally situated municipality of Sysmä, Finland. As a small community suffering a gradual population decline since the 1960s, Sysmä municipality has begun to innovate with several projects this millennium. Here, we analyse as a narrative and from the viewpoint of experienced tensions, the introductory phase of one of these projects, which strictly is a hyper-local currency acting as a system of account. It is noted that there are unclarities regarding the purpose of the scheme, and that different stakeholders and other observers do have varying ideas about this purpose. Political decisions over limiting rights of issuance of the local currency to locally registered businesses; and its exclusive use for local association subsidies have created some challenges to the acceptance of the currency. Further, the currency has limited uptake due to technical issues, injudicious use of the marketing mix and difficulties with innovating in a rural area. Noting these issues and the peculiarity of the scheme amidst other typical European local currency schemes, the article also points out benefits of the scheme and potential future developments.

Competences in Context: Students’ Expectations and Reflections as Guided by the Mobile Application Reflect.UP

Mobile applications are suitable as a structural possibility for students beginning their studies. Using the app Reflect.UP, students are encouraged to reflect on the organization, contents, and objectives of their studies. This article focuses on how students can acquire the academic ability to consider their own actions, which is an intrinsic component of academic professionalization. The work examines how a competency framework is derived through study regulations and module descriptions, and how subsequent questions for students’ reflection are systematically created using this framework. Next, the hybrid mobile application Reflect.UP and its underlying software components are introduced, stimulating students’ reflections on study content and objectives. The data gathered through the practical use of Reflect.UP is evaluated, and then the ensuing conclusions drawn from students’ problems and learning processes for organizing the course of studies are explored. In addition, this paper reflects on the strengths and weaknesses of a mobile application as a sociological and technological compound for structural support of the introductory phase of education.

Investigation of the Impact on Throughput of Connected Autonomous Vehicles with Headway Based on the Leading Vehicle Type

Although the future era of autonomous driving is seen as a solution for many of the current problems in traffic; the introductory phase, with low penetration rates of connected-autonomous vehicles (CAVs), might lead to lower capacities. This forecast is based on certain assumptions that the CAVs can operate more efficiently when communicating and cooperating—already proved in real tests—therefore in practice, they can keep smaller following headways. However, it is envisioned that they might keep larger headways to other conventional vehicles for safety reasons. Lower connected-autonomous vehicle (CAV) penetration rates lead to a reduction in the overall vehicle throughput, then with increasing penetration rates, throughput is recovered and eventually improved. Simulations demonstrate that the impact on vehicle throughput depends on the car following headway and penetration rate. Based on this potential reduction in the maximum throughput for low penetration rates, the aim of this paper is the mitigation of this phenomenon at urban intersections through a possible managing solution to sort CAVs and a pre-set green-time start. A microsimulation model has been calibrated using PTV Vissim to reflect this operating solution, using new possibilities as leading vehicle class dependent headway settings and formula-based routing for sorting vehicles at a two-lane intersection entry. This approach allows the formation of platoons at intersections and uses their effectiveness even at low CAV penetration rates. The tested scenario is simplified to through traffic without turnings maneuvers and the results show that the potential loss in throughput is canceled and reductions in the control delay can reach 17% for oversaturated conditions.

Bodybuilding and Fitness Doping in Transition. Historical Transformations and Contemporary Challenges

This article describes and analyses the historical development of gym and fitness culture in general and doping use in this context in particular. Theoretically, the paper utilises the concept of subculture and explores how a subcultural response can be used analytically in relation to processes of cultural normalisation as well as marginalisation. The focus is on historical and symbolic negotiations that have occurred over time, between perceived expressions of extreme body cultures and sociocultural transformations in society—with a perspective on fitness doping in public discourse. Several distinct phases in the history of fitness doping are identified. First, there is an introductory phase in the mid-1950s, in which there is an optimism connected to modernity and thoughts about scientifically-engineered bodies. Secondly, in the 1960s and 70s, a distinct bodybuilding subculture is developed, cultivating previously unseen muscular male bodies. Thirdly, there is a critical phase in the 1980s and 90s, where drugs gradually become morally objectionable. The fourth phase, the fitness revolution, can be seen as a transformational phase in gym culture. The massive bodybuilding body is replaced with the well-defined and moderately muscular fitness body, but at the same time there are strong commercialised values which contribute to the development of a new doping market. Finally, it is possible to speculate on the development of a fifth phase, in which fitness doping is increasingly being filtered into mainstream gym and fitness culture, influencing the fitness doping demography.