An automated fractionation mapping algorithm for mapping of scar-based ventricular tachycardia.

BACKGROUND: Mapping and ablation of fractionated electrograms is a common treatment for scar-based ventricular tachycardia (VT). An automated algorithm has been developed for rapid "fractionation mapping." METHODS: Electroanatomic maps from 21 ablation procedures (14 scar-based VT and seven control idiopathic VT/premature ventricular contractions with normal voltage) were retrospectively analyzed using the Ensite Precision fractionation map (fMap; Abbott Laboratories; Abbott Park, IL, USA) algorithm. For each study, voltage maps and 30 fMaps were generated using combinations of parameters: width (5, 10, 20 ms), refractory time (15, 30 ms), sensitivity (0.1, 0.2 mV), and fractionation threshold (2, 3, 5). Parameter sensitivity was assessed by overlap of fractionated areas (fArea) with successful VT ablation sites (defined by entrainment and/or pace mapping). Specificity was assessed by presence of fractionated areas in control patients. RESULTS: Of the 30 fMap parameter sets tested, seven identified >50% of scar-based VT ablation sites, and 26 contained <5 cm2 fractionation on control fMaps. Three combinations of fMap width/refractory/sensitivity/threshold parameters met both of the above criteria, and 20/30/0.1/2 identified the most VT ablation sites (79%) and generated 42.3 ± 28.2 cm2 of fArea on scar-based VT maps compared with 4.9 ± 3.2 cm2 on control maps (P = .001). None of the control patients and 23% of the scar-based VT patients had VT recurrence at mean 15 month follow-up. CONCLUSION: Careful selection of signal processing parameters optimizes sensitivity and specificity of automated fractionation mapping for scar-based VT. Real-time use of fMap algorithms may reduce VT ablation procedure time and improve substrate modification, which may improve outcomes.

'They would rather not have known and me kept my mouth shut': The role of neutralisation in responding to the disclosure of childhood sexual abuse.

There is a well-established literature examining how perpetrators of child sexual abuse (CSA) neutralise the norms and beliefs that ordinarily prohibit such behaviours. However, there has been substantially less focus on how such techniques of neutralisation might also be applied by people and groups who were not directly involved in the abuse, who we might expect to be more supportive. Drawing on a thematic analysis of an open-ended survey (n=140) and semi-structured interviews (n=21) with adults who experienced childhood sexual abuse this paper examines societal responses to disclosure. Identifying three key techniques of neutralisation, it explores how families, professionals and institutions use wider discourses that deny the victim/survivor, deny or minimise harm and silence by appealing to loyalty. The results demonstrate how significant others can constrain, rather than support, the process of disclosure and recovering from CSA.

FUSIC HD. Comprehensive haemodynamic assessment with ultrasound.

FUSIC haemodynamics (HD) - the latest Focused Ultrasound in Intensive Care (FUSIC) module created by the Intensive Care Society (ICS) - describes a complete haemodynamic assessment with ultrasound based on ten key clinical questions: 1. Is stroke volume abnormal? 2. Is stroke volume responsive to fluid, vasopressors or inotropes? 3. Is the aorta abnormal? 4. Is the aortic valve, mitral valve or tricuspid valve severely abnormal? 5. Is there systolic anterior motion of the mitral valve? 6. Is there a regional wall motion abnormality? 7. Are there features of raised left atrial pressure? 8. Are there features of right ventricular impairment or raised pulmonary artery pressure? 9. Are there features of tamponade? 10. Is there venous congestion? FUSIC HD is the first system of its kind to interrogate major cardiac, arterial and venous structures to direct time-critical interventions in acutely unwell patients. This article explains the rationale for this accreditation, outlines the training pathway and summarises the ten clinical questions. Further details are included in an online supplementary appendix.

Counterevidence of crime-reduction effects from federal grants of military equipment to local police.

In 2017, the Trump Administration restored local law enforcement agencies' access to military weapons and some other types of surplus military equipment (SME) that had been prohibited by the Obama Administration. The Justice Department background paper used to justify this decision cited two papers published by the American Economic Association. These papers used SME data collected with a 2014 Freedom of Information Act request and concluded that SME, supplied to local law enforcement by the federal government via the 1033 Program, reduces crime. Here we show that the findings of these studies are not credible due to problems with the data. Using more detailed audit data on 1033 SME, we show that the 2014 data are flawed and that the more recent data provide no evidence that 1033 SME reduces crime.

Pre-validation of a MALDI MS proteomics-based method for the reliable detection of blood and blood provenance.

The reliable identification of blood, as well as the determination of its origin (human or animal) is of great importance in a forensic investigation. Whilst presumptive tests are rapid and deployed in situ, their very nature requires confirmatory tests to be performed remotely. However, only serological tests can determine blood provenance. The present study improves on a previously devised Matrix Assisted Laser Desorption Ionisation Mass Spectrometry (MALDI MS)-proteomics based method for the reliable detection of blood by enabling the determination of blood provenance. The overall protocol was developed to be more specific than presumptive tests and faster/easier than the gold standard liquid chromatography (LC) MS/MS analysis. This is considered a pre-validation study that has investigated stains and fingermarks made in blood, other biofluids and substances that can elicit a false-positive response to colorimetric or presumptive tests, in a blind fashion. Stains and marks were either untreated or enhanced with a range of presumptive tests. Human and animal blood were correctly discriminated from other biofluids and non-biofluid related matrices; animal species determination was also possible within the system investigated. The procedure is compatible with the prior application of presumptive tests. The refined strategy resulting from iterative improvements through a trial and error study of 56 samples was applied to a final set of 13 blind samples. This final study yielded 12/13 correct identifications with the 13th sample being correctly identified as animal blood but with no species attribution. This body of work will contribute towards the validation of MALDI MS based methods and deployment in violent crimes involving bloodshed.

Safer health care environments by design.

Health care environments can and are being designed to prevent injury, minimize human error, and actually promote improved health and safety. This article shows risk managers how evidence-based design is reducing medication error, staff injury, infection rates, patient falls, and more. Research knowledge can contribute to effective design solutions by simply clarifying a safety problem so solutions can be sought; it can inform the design process with potential solutions; or it can be part of a structured process where new research knowledge is created. This article shares specific examples of the types of research that can inform designing for a safer physical environment. A case study shows how one project in two phases benefited from engaging initially in a general way and later, in a highly structured process, to integrate the evidence to improve design for safety.

Catalytic Promiscuity of O-GlcNAc Transferase Enables Unexpected Metabolic Engineering of Cytoplasmic Proteins with 2-Azido-2-deoxy-glucose.

O-GlcNAc transferase (OGT) catalyzes the installation of N-acetylglucosamine (GlcNAc) O-linked to nucleocytoplasmic proteins (O-GlcNAc) within multicellular eukaryotes. OGT shows surprising tolerance for structural changes in the sugar component of its nucleotide sugar donor substrate, uridine diphosphate N-acetylglucosamine (UDP-GlcNAc). Here, we find that OGT uses UDP-glucose to install O-linked glucose (O-Glc) onto proteins only 25-fold less efficiently than O-GlcNAc. Spurred by this observation, we show that OGT transfers 2-azido-2-deoxy-d-glucose (GlcAz) in vitro from UDP-GlcAz to proteins. Further, feeding cells with per-O-acetyl GlcAz (AcGlcAz), in combination with inhibition or inducible knockout of OGT, shows OGT-dependent modification of nuclear and cytoplasmic proteins with O-GlcAz as detected using microscopy, immunoblot, and proteomics. We find that O-GlcAz is reversible within cells, and an unidentified cellular enzyme exists to cleave O-Glc that can also process O-GlcAz. We anticipate that AcGlcAz will prove to be a useful tool to study the O-GlcNAc modification. We also speculate that, given the high concentration of UDP-Glc within certain mammalian tissues, O-Glc may exist within mammals and serve as a physiologically relevant modification.

Digital Methodology to implement the ECOUTER engagement process.

ECOUTER ( Employing COncept ual schema for policy and Translation E in Research - French for 'to listen' - is a new stakeholder engagement method incorporating existing evidence to help participants draw upon their own knowledge of cognate issues and interact on a topic of shared concern. The results of an ECOUTER can form the basis of recommendations for research, governance, practice and/or policy. This paper describes the development of a digital methodology for the ECOUTER engagement process based on currently available mind mapping freeware software. The implementation of an ECOUTER process tailored to applications within health studies are outlined for both online and face-to-face scenarios. Limitations of the present digital methodology are discussed, highlighting the requirement of a purpose built software for ECOUTER research purposes.

Chondrogenic Effect of Intra-articular Hypertonic-Dextrose (Prolotherapy) in Severe Knee Osteoarthritis.

BACKGROUND: Dextrose injection is reported to improve knee osteoarthritis (KOA)-related clinical outcomes, but its effect on articular cartilage is unknown. A chondrogenic effect of dextrose injection has been proposed. OBJECTIVE: To assess biological and clinical effects of intra-articular hypertonic dextrose injections (prolotherapy) in painful KOA. DESIGN: Case series with blinded arthroscopic evaluation before and after treatment. SETTING: Physical medicine and day surgery practice. PARTICIPANTS: Symptomatic KOA for at least 6 months, arthroscopy-confirmed medial compartment exposed subchondral bone, and temporary pain relief with intra-articular lidocaine injection. INTERVENTION: Four to 6 monthly 10-mL intra-articular injections with 12.5% dextrose. MAIN OUTCOME MEASURES: Visual cartilage growth assessment of 9 standardized medial condyle zones in each of 6 participants by 3 arthroscopy readers masked to pre-/postinjection status (total 54 zones evaluated per reader); biopsy of a cartilage growth area posttreatment, evaluated using hematoxylin and eosin and Safranin-O stains, quantitative polarized light microscopy, and immunohistologic cartilage typing; self-reported knee specific quality of life using the Western Ontario McMaster University Osteoarthritis Index (WOMAC, 0-100 points). RESULTS: Six participants (1 female and 5 male) with median age of 71 years, WOMAC composite score of 57.5 points, and a 9-year pain duration received a median of 6 dextrose injections and follow-up arthroscopy at 7.75 months (range 4.5-9.5 months). In 19 of 54 zone comparisons, all 3 readers agreed that the posttreatment zone showed cartilage growth compared with the pretreatment zone. Biopsy specimens showed metabolically active cartilage with variable cellular organization, fiber parallelism, and cartilage typing patterns consistent with fibro- and hyaline-like cartilage. Compared with baseline status, the median WOMAC score improved 13 points (P = .013). Self-limited soreness after methylene blue instillation was noted. CONCLUSIONS: Positive clinical and chondrogenic effects were seen after prolotherapy with hypertonic dextrose injection in participants with symptomatic grade IV KOA, suggesting disease-modifying effects and the need for confirmation in controlled studies. Minimally invasive arthroscopy (single-compartment, single-portal) enabled collection of robust intra-articular data. LEVEL OF EVIDENCE: IV.

Psychiatric probation orders: failed provision or future panacea?

The psychiatric probation order has been a sentencing option for the courts for over fifty years. Many authors have lamented its underuse and described the inability of psychiatric and probation services to work together in a collaborative and effective way. The aim of this study was to describe probationers who had passed through Elliott House, a specialist bail and probation hostel for mentally disordered offenders. A retrospective case note review of all individuals who have been resident at Elliott House as a condition of a probation order was conducted. The individuals were mostly young, single men with a severe mental illness and comorbid substance misuse. As a group their previous contact with psychiatric services was irregular. A probation order at Elliott House appeared to provide social support and stability along with a period of regular psychiatric treatment and follow-up. The results suggest that psychiatric probation orders, if properly managed, can be a useful tool for both health and probation services in the short term.

Priorities for research on meningococcal disease and the impact of serogroup A vaccination in the African meningitis belt.

For over 100 years, large epidemics of meningococcal meningitis have occurred every few years in areas of the African Sahel and sub-Sahel known as the African meningitis belt. Until recently, the main approach to the control of these epidemics has been reactive vaccination with a polysaccharide vaccine after an outbreak has reached a defined threshold and provision of easy access to effective treatment but this approach has not prevented the occurrence of new epidemics. Meningococcal conjugate vaccines, which can prevent meningococcal carriage and thus interrupt transmission, may be more effective than polysaccharide vaccines at preventing epidemics. Because the majority of African epidemics have been caused by serogroup A meningococci, a serogroup A polysaccharide/tetanus toxoid protein conjugate vaccine (PsA-TT) has recently been developed. Results from an initial evaluation of the impact of this vaccine on meningococcal disease and meningococcal carriage in Burkina Faso have been encouraging. To review how the research agenda for meningococcal disease in Africa has been changed by the advent of PsA-TT and to define a new set of research priorities for study of meningococcal infection in Africa, a meeting of 41 scientists was held in Dakar, Senegal on April 24th and 25th 2012. The research recommendations developed during the course of this meeting are presented in this paper. The need for enhanced surveillance for meningitis in defined populations with good diagnostic facilities in African countries at risk of epidemics was identified as the highest priority. This is needed to determine the duration of protection against serogroup A meningococcal disease provided by PsA-TT and to determine the risk of disease and carriage caused by meningococci of other serogroups. Other research areas given high priority included identification and validation of serological correlates of protection against meningococcal disease and carriage, development of improved methods for detecting carriage and epidemiological studies aimed at determining the reasons underlying the peculiar epidemiology of meningococcal disease in the African meningitis belt. Minutes and working papers from the meeting are provided in supplementary tables and some of the presentations made at the meeting are available on the MenAfriCar consortium website (www.menafricar.org) and on the web site of the Centers for Disease Control (www.cdc.gov).

Failure and life cycle evaluation of watering valves.

Automated watering systems provide a reliable source of ad libitum water to animal cages. Our facility uses an automated water delivery system to support approximately 95% of the housed population (approximately 14,000 mouse cages). Drinking valve failure rates from 2002 through 2006 never exceeded the manufacturer standard of 0.1% total failure, based on monthly cage census and the number of floods. In 2007, we noted an increase in both flooding and cases of clinical dehydration in our mouse population. Using manufacturer's specifications for a water flow rate of 25 to 50 mL/min, we initiated a wide-scale screening of all valves used. During a 4-mo period, approximately 17,000 valves were assessed, of which 2200 failed according to scoring criteria (12.9% overall; 7.2% low flow; 1.6% no flow; 4.1% leaky). Factors leading to valve failures included residual metal shavings, silicone flash, introduced debris or bedding, and (most common) distortion of the autoclave-rated internal diaphragm and O-ring. Further evaluation revealed that despite normal autoclave conditions of heat, pressure, and steam, an extreme negative vacuum pull caused the valves' internal silicone components (diaphragm and O-ring) to become distorted and water-permeable. Normal flow rate often returned after a 'drying out' period, but components then reabsorbed water while on the animal rack or during subsequent autoclave cycles to revert to a variable flow condition. On the basis of our findings, we recalibrated autoclaves and initiated a preventative maintenance program to mitigate the risk of future valve failure.

A survey of psychiatrists' attitudes to schizoaffective disorder.

Objective. Schizoaffective disorder is an established diagnosis in both ICD-10 and DSM-IV, but research evidence relating to its nosological status and aetiology is conflicting. This study aimed to examine the attitudes of practising consultant psychiatrists, and to see whether there is a consensus about its classification and value in everyday clinical psychiatry. Method. A questionnaire was mailed to 2000 consultant psychiatrists drawn randomly from the membership list of the Royal College of Psychiatrists in the United Kingdom. Respondents were asked to rate their level of agreement with a series of statements about schizoaffective disorder and give some basic demographic data. Results. Of over 800 respondents, almost all reported using the diagnosis in clinical practice, but a small minority reported that they never use the diagnosis. Most psychiatrists considered the diagnosis to be clinically useful but there was little agreement about its nature, its relationship to other mental illnesses, its aetiology, or its characteristic clinical features. Conclusions. Schizoaffective disorder is an established diagnosis in psychiatric practice and is valued by clinicians but there is little consensus of opinion or practice in relation to it. Psychiatrists should be careful to use the diagnosis in accordance with current classificatory schemes, and further research should continue to investigate both its conceptual validity and its use in clinical practice.

The UN committee on the rights of the child and refugees : One NGO's experience with the reporting process

During 1994 and 1995, the Inter-Church Committee for Refugees (ICCR) developed a brief to the UN Committee on the rigths of the child. The brief was to assist the committee in its examination of Canada's first report required under the convention on the rights of the child. The article describes the brief, the process ICCR entered into and the resulting "report card" from the UN Committee. Some follow-up work is described briefly (AU)