Incident atrial fibrillation and adverse clinical outcomes during extended follow-up of participants recruited to the remote heart rhythm sampling using the AliveCor heart monitor to screen for atrial fibrillation: the REHEARSE-AF study.

Aims: Atrial fibrillation (AF) is an important risk factor for stroke, which is commonly asymptomatic, particularly in older patients, and often undetected until cardiovascular events occur. Development of novel technology has helped to improve detection of AF. However, the longer-term benefit of systematic electrocardiogram (ECG) screening on cardiovascular outcomes is unclear. Methods and results: In the original REHEARSE-AF study, patients were randomized to twice-weekly portable electrocardiogram (iECG) assessment or routine care. After discontinuing the trial portable iECG assessment, electronic health record data sources provided longer-term follow-up analysis. Cox regression was used to provide unadjusted and adjusted hazard ratios (HR) [95% confidence intervals (CI)] for clinical diagnosis, events, and anticoagulant prescriptions during the follow-up period. Over the median 4.2-year follow-up, although a greater number of patients were diagnosed with AF in the original iECG group (43 vs. 31), this was not significant (HR 1.37, 95% CI 0.86-2.19). No differences were seen in the number of strokes/systemic embolisms or deaths between the two groups (HR 0.92, 95% CI 0.54-1.54; HR 1.07, 95% CI 0.66-1.73). Findings were similar when restricted to those with CHADS-VASc ≥ 4. Conclusion: A 1-year period of home-based, twice-weekly screening for AF increased diagnoses of AF for the screening period but did not lead to increased diagnoses of AF or a reduction in cardiovascular-related events or all-cause death over a median of 4.2 years, even in those at highest risk of AF. These results suggest that benefits of regular ECG screening over a 1-year period are not maintained after cessation of the screening protocol.

Worldwide survey on implantation of and outcomes for conduction system pacing with His bundle and left bundle branch area pacing leads.

BACKGROUND: Adoption and outcomes for conduction system pacing (CSP), which includes His bundle pacing (HBP) or left bundle branch area pacing (LBBAP), in real-world settings are incompletely understood. We sought to describe real-world adoption of CSP lead implantation and subsequent outcomes. METHODS: We performed an online cross-sectional survey on the implantation and outcomes associated with CSP, between November 15, 2020, and February 15, 2021. We described survey responses and reported HBP and LBBAP outcomes for bradycardia pacing and cardiac resynchronization CRT indications, separately. RESULTS: The analysis cohort included 140 institutions, located on 5 continents, who contributed data to the worldwide survey on CSP. Of these, 127 institutions (90.7%) reported experience implanting CSP leads. CSP and overall device implantation volumes were reported by 84 institutions. In 2019, the median proportion of device implants with CSP, HBP, and/or LBBAP leads attempted were 4.4% (interquartile range [IQR], 1.9-12.5%; range, 0.4-100%), 3.3% (IQR, 1.3-7.1%; range, 0.2-87.0%), and 2.5% (IQR, 0.5-24.0%; range, 0.1-55.6%), respectively. For bradycardia pacing indications, HBP leads, as compared to LBBAP leads, had higher reported implant threshold (median [IQR]: 1.5 V [1.3-2.0 V] vs 0.8 V [0.6-1.0 V], p = 0.0008) and lower ventricular sensing (median [IQR]: 4.0 mV [3.0-5.0 mV] vs. 10.0 mV [7.0-12.0 mV], p < 0.0001). CONCLUSION: In conclusion, CSP lead implantation has been broadly adopted but has yet to become the default approach at most surveyed institutions. As the indications and data for CSP continue to evolve, strategies to educate and promote CSP lead implantation at institutions without CSP lead implantation experience would be necessary.

A fiber-coupled dispersion interferometer for density measurements of pulsed power transmission line electron sheaths on Sandia's Z machine.

A fiber-coupled Dispersion Interferometer (DI) is being developed to measure the electron density of plasmas formed in power flow regions, such as magnetically insulated transmission lines, on Sandia National Laboratories (SNL's) Z machine [D. B. Sinars et al., Phys. Plasmas 27, 070501 (2020)]. The diagnostic operates using a fiber-coupled 1550 nm CW laser with frequency-doubling to 775 nm. The DI is expected to be capable of line-average density measurements between ∼1013 and 1019 cm-2. Initial testing has been performed on a well-characterized RF lab plasma [A. G. Lynn et al., Rev. Sci. Instrum. 80, 103501 (2009)] at the University of New Mexico to quantify the density resolution lower limits of the DI. Initial testing of the DI has demonstrated line-average electron density measurements within 9% of results acquired via a 94 GHz mm wave interferometer for line densities of ∼1 × 1014 cm-2, despite significant differences in probe beam geometries. The instrument will next be utilized for measurements on a ∼1 MA-scale pulsed power driver {MYKONOS [N. Bennett et al., Phys. Rev. Accel. Beams 22, 120401 (2019)] at SNL} before finally being deployed on SNL's Z machine. The close electrode spacing (mm scale) on Z requires probe beam sizes of ∼1 mm, which can only be obtained with visible or near infrared optical systems, as opposed to longer wavelength mm wave systems that would normally be chosen for this range of density.

How to use a coagulation screen.

A coagulation screen is an important screening test when investigating a child who presents with easy bruising or bleeding. Interpretation of a coagulation screen can be challenging for clinicians. Evolution of the haemostasis system during childhood means normal ranges vary with age and needs to be interpreted alongside the clinical information. It is essential to consider preanalytical variables when interpreting a coagulation screen, and the reason for the investigation must always be considered. It is important that the sample is taken under optimal conditions, including sample technique, use of the correct bottle and prompt transport to the laboratory. An abnormal coagulation screen may indicate an underlying congenital bleeding disorder or an acquired bleeding disorder, or may be due to sampling error. Limitations of the coagulation screen are essential to be aware of, as some children with normal coagulation screen results may have bleeding disorders. Conversely, an abnormal coagulation screen does not always indicate a bleeding disorder.

Hydrophobic functional liquids based on trioctylphosphine oxide (TOPO) and carboxylic acids.

Trioctylphosphine oxide (TOPO) is a hydrophobic extracting agent used in a number of commercially important separations of valuable solutes from aqueous streams (with examples ranging from lanthanides, through gallium, to carboxylic acids). TOPO is traditionally used as a solute in kerosene, its extraction efficiency limited by its solubility in the organic diluents. In this work, eighteen hydrogen bond donors (HBDs) were screened for their capacity to liquefy TOPO, employing strategies used to design deep eutectic solvents (DES). The selected HBDs were all useful in separations and were designed to formulate solvent-free, hydrophobic, bi-functional liquid extracting agents. Some TOPO:HBD mixtures yielded hydrophobic liquids that offer potential to be extremely efficient extractants, incorporating high intrinsic concentrations of TOPO. Following this initial screening, two systems: TOPO:malonic acid and TOPO:levulinic acid, were selected for detailed physico-chemical characterisation across their complete compositional ranges. Phase diagrams, thermal stabilities and the mechanism of thermal decomposition are reported, along with densities and insights from 31P NMR spectroscopic studies. The work was concluded with a proof-of-concept demonstration of the use of the TOPO:malonic acid (2 : 1 mol ratio) mixture for the extraction of gallium from acidic chloride feedstock (simulated pre-digestate of zinc leach residue). The loading capacity of the TOPO:malonic acid extractant was three orders of magnitude greater than that of the literature benchmark, encouraging further application-oriented studies.

A support vector regression method for efficiently determining neutral profiles from laser induced fluorescence data.

A support vector regression (SVR) method is integrated with a collisional radiative (CR) model of helicon plasmas in the Helicon-Cathode (HelCat) linear plasma device to determine Ar i profiles based on metastable-pumped Laser Induced Fluorescence (LIF) measurements. A machine learning approach to the CR model allows for an efficient exploration of the input parameter space and can inherently incorporate probe and LIF measurement errors in profile inputs to which a CR model would normally be sensitive. A training set is created for mapping CR model outputs to Ar i input profiles using radial points as SVR input features and parameters of a sigmoidal-type function as output features. This SVR method may easily be adapted to other LIF pumping schemes and may even be used in conjunction with a CR model to validate electron temperature and density plasma profiles if neutral or ion profiles are already known.

Experimental Measurements of Ion Heating in Collisional Plasma Shocks and Interpenetrating Supersonic Plasma Flows.

We present time-resolved measurements of ion heating due to collisional plasma shocks and interpenetrating supersonic plasma flows, which are formed by the oblique merging of two coaxial-gun-formed plasma jets. Our study is repeated using four jet species: N, Ar, Kr, and Xe. In conditions with small interpenetration between jets, the observed peak ion temperature T_{i} is consistent with the predictions of collisional plasma-shock theory showing a substantial elevation of T_{i} above the electron temperature T_{e} and also the subsequent decrease of T_{i} on the classical ion-electron temperature-equilibration timescale. In conditions of significant interpenetration between jets, such that shocks do not apparently form, the observed peak T_{i} is still appreciable and greater than T_{e} but much lower than that predicted by collisional plasma-shock theory. Experimental results are compared with multifluid plasma simulations.

A comparison of choline:urea and choline:oxalic acid deep eutectic solvents at 338 K.

1:2 choline chloride:urea and 1:1 choline chloride:oxalic acid deep eutectic solvents are compared at 338 K using liquid-phase neutron diffraction with H/D isotopic substitution to obtain differential neutron scattering cross sections and fitting of models to the experimental data using Empirical Potential Structure Refinement. In comparison to the previously reported study of choline chloride:urea at 303 K, we observed significant weakening and lengthening of choline-OH⋯Cl- and choline-OH⋯hydrogen-bond acceptor correlations.

Frustrated Lewis pairs in ionic liquids and molecular solvents - a neutron scattering and NMR study of encounter complexes.

The presence of the weakly-associated encounter complex in the model frustrated Lewis pair solution (FLP): tris(tert-butyl)phosphine (P(tBu)3) and tris(pentafluorophenyl)borane (BCF) in benzene, was confirmed via PB correlation analysis from neutron scattering data. On average, ca. 5% of dissolved FLP components were in the associated state. NMR spectra of the FLP in benzene gave no evidence of such association, in agreement with earlier reports and the transient nature of the encounter complex. In contrast, the corresponding FLP solution in the ionic liquid, 1-decyl-3-methylimidazolium bistriflamide, [C10mim][NTf2], generated NMR signals that can be attributed to formation of encounter complexes involving over 20% of the dissolved species. The low diffusivity characteristics of ionic liquids is suggested to enhance high populations of encounter complex. The FLP in the ionic liquid solution retained its ability to split hydrogen.

Assessment of Remote Heart Rhythm Sampling Using the AliveCor Heart Monitor to Screen for Atrial Fibrillation: The REHEARSE-AF Study.

BACKGROUND: Asymptomatic atrial fibrillation (AF) is increasingly common in the aging population and implicated in many ischemic strokes. Earlier identification of AF with appropriate anticoagulation may decrease stroke morbidity and mortality. METHODS: We conducted a randomized controlled trial of AF screening using an AliveCor Kardia monitor attached to a WiFi-enabled iPod to obtain ECGs (iECGs) in ambulatory patients. Patients ≥65 years of age with a CHADS-VASc score ≥2 free from AF were randomized to the iECG arm or routine care (RC). iECG participants acquired iECGs twice weekly over 12 months (plus additional iECGs if symptomatic) onto a secure study server with overread by an automated AF detection algorithm and by a cardiac physiologist and/or consultant cardiologist. Time to diagnosis of AF was the primary outcome measure. The overall cost of the devices, ECG interpretation, and patient management were captured and used to generate the cost per AF diagnosis in iECG patients. Clinical events and patient attitudes/experience were also evaluated. RESULTS: We studied 1001 patients (500 iECG, 501 RC) who were 72.6±5.4 years of age; 534 were female. Mean CHADS-VASc score was 3.0 (heart failure, 1.4%; hypertension, 54%; diabetes mellitus, 30%; prior stroke/transient ischemic attack, 6.5%; arterial disease, 15.9%; all CHADS-VASc risk factors were evenly distributed between groups). Nineteen patients in the iECG group were diagnosed with AF over the 12-month study period versus 5 in the RC arm (hazard ratio, 3.9; 95% confidence interval=1.4-10.4; P=0.007) at a cost per AF diagnosis of $10 780 (£8255). There was a similar number of stroke/transient ischemic attack/systemic embolic events (6 versus 10, iECG versus RC; hazard ratio=0.61; 95% confidence interval=0.22-1.69; P=0.34). The majority of iECG patients were satisfied with the device, finding it easy to use without restricting activities or causing anxiety. CONCLUSIONS: Screening with twice-weekly single-lead iECG with remote interpretation in ambulatory patients ≥65 years of age at increased risk of stroke is significantly more likely to identify incident AF than RC over a 12-month period. This approach is also highly acceptable to this group of patients, supporting further evaluation in an appropriately powered, event-driven clinical trial. CLINICAL TRIAL REGISTRATION: URL: https://www.isrctn.com. Unique identifier: ISRCTN10709813.

Intermolecular structure and hydrogen-bonding in liquid 1,2-propylene carbonate and 1,2-glycerol carbonate determined by neutron scattering.

Neutron diffraction with isotopic substitution has been used to investigate the liquid structures of propylene carbonate and glycerol carbonate. C-HO[double bond, length as m-dash]C hydrogen-bonding motifs dominate the local structure of propylene carbonate, giving rise to the formation of head-to-tail correlated chains of molecules. In contrast, glycerol carbonate exhibits a more disordered structure with no overall dominant interactions in which the pendant hydroxyl function disrupts structure-making correlations present in propylene carbonate.

Prospects for x-ray polarimetry measurements of magnetic fields in magnetized liner inertial fusion plasmas.

Magnetized Liner Inertial Fusion (MagLIF) experiments, where a metal liner is imploded to compress a magnetized seed plasma may generate peak magnetic fields ∼10(4) T (100 Megagauss) over small volumes (∼10(-10)m(3)) at high plasma densities (∼10(28)m(-3)) on 100 ns time scales. Such conditions are extremely challenging to diagnose. We discuss the possibility of, and issues involved in, using polarimetry techniques at x-ray wavelengths to measure magnetic fields under these extreme conditions.

Multi-chord fiber-coupled interferometry of supersonic plasma jets (invited).

A multi-chord fiber-coupled interferometer is being used to make time-resolved density measurements of supersonic argon plasma jets on the Plasma Liner Experiment. The long coherence length of the laser (>10 m) allows signal and reference path lengths to be mismatched by many meters without signal degradation, making for a greatly simplified optical layout. Measured interferometry phase shifts are consistent with a partially ionized plasma in which both positive and negative phase shift values are observed depending on the ionization fraction. In this case, both free electrons and bound electrons in ions and neutral atoms contribute to the index of refraction. This paper illustrates how the interferometry data, aided by numerical modeling, are used to derive total jet density, jet propagation velocity (~15-50 km/s), jet length (~20-100 cm), and 3D expansion.

Multi-chord fiber-coupled interferometer with a long coherence length laser.

This paper describes a 561 nm laser heterodyne interferometer that provides time-resolved measurements of line-integrated plasma electron density within the range of 10(15)-10(18) cm(-2). Such plasmas are produced by railguns on the plasma liner experiment, which aims to produce µs-, cm-, and Mbar-scale plasmas through the merging of 30 plasma jets in a spherically convergent geometry. A long coherence length, 320 mW laser allows for a strong, sub-fringe phase-shift signal without the need for closely matched probe and reference path lengths. Thus, only one reference path is required for all eight probe paths, and an individual probe chord can be altered without altering the reference or other probe path lengths. Fiber-optic decoupling of the probe chord optics on the vacuum chamber from the rest of the system allows the probe paths to be easily altered to focus on different spatial regions of the plasma. We demonstrate that sub-fringe resolution capability allows the interferometer to operate down to line-integrated densities of the order of 5 × 10(15) cm(-2).

The HelCat dual-source plasma device.

The HelCat (Helicon-Cathode) device has been constructed to support a broad range of basic plasma science experiments relevant to the areas of solar physics, laboratory astrophysics, plasma nonlinear dynamics, and turbulence. These research topics require a relatively large plasma source capable of operating over a broad region of parameter space with a plasma duration up to at least several milliseconds. To achieve these parameters a novel dual-source system was developed utilizing both helicon and thermionic cathode sources. Plasma parameters of n(e) approximately 0.5-50 x 10(18) m(-3) and T(e) approximately 3-12 eV allow access to a wide range of collisionalities important to the research. The HelCat device and initial characterization of plasma behavior during dual-source operation are described.