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Summary: Hypertrophic cardiomyopathy (HCM) is the most common inherited heart disease that is characterized by left ventricular hypertrophy unexplained by secondary causes. Based on international epidemiological data, around 20,000–40,000 patients are expected to be affected in Austria. Due to the wide variety of clinical and morphological manifestations the diagnosis can be difficult and the disease therefore often goes unrecognized. HCM is associated with a substantial reduction in quality of life and can lead to sudden cardiac death, especially in younger patients. Early and correct diagnosis, including genetic testing, is essential for comprehensive counselling of patients and their families and for effective treatment. The latter is especially true as an effective treatment of outflow tract obstruction has recently become available in the form of a first in class cardiac myosin ATPase inhibitor, as a noninvasive alternative to established septal reduction therapies. The aim of this Austrian consensus statement is to summarize the recommendations of international guidelines with respect to the genetic background, pathophysiology, diagnostics and management in the context of the Austrian healthcare system and resources, and to present them in easy to understand algorithms. [ABSTRACT FROM AUTHOR]

Context: Large carnivore reintroductions often face unique challenges, as they can conflict with human interests and face public opposition. To increase the probability of success, reintroduction programs can use strategic communications to increase public support and achieve conservation goals. Aims: Although there is initial research testing theoretically-grounded messages on generating support for reintroductions, there is much to learn about the efficacy of messaging strategies, particularly how specific themes perform against each other. Despite the established importance of local support for successful reintroductions, there is little research examining local versus non-local communities' responses to different messaging. This study fills these gaps by examining how strategic messaging can be employed to increase public support for a potential red wolf (Canis rufus) reintroduction in Ozark National Forest, Arkansas, USA. Methods: We used an online survey panel of 844 Arkansas respondents to test five randomly assigned messages: a descriptive control and four treatments related to trust in the U.S. Fish and Wildlife Service (USFWS); red wolf benefits to humans; red wolf benefits to the ecosystem; and mitigating perceived red wolf risks. We compared Ozark National Forest-adjacent landowner (ONFALO) respondents to all other respondents to understand the effects of messaging on local versus non-local communities. Key results: Our findings indicated significant differences among ONFALO respondents and other respondents. We found key differences in how messaging induced these two groups. Additionally, our pre-test-post-test approach demonstrated ONFALO were less influenced by messaging about a potential reintroduction than other respondents. Finally, we found that ONFALO respondents agreed with negative statements about red wolves more often than other respondents. Conclusions: Overall, we conclude that messaging that highlights red wolf information may increase ONFALO respondents' support for a potential red wolf reintroduction, and that efforts to increase self-efficacy in risk mitigation, and messaging related to ecosystem benefits of red wolves may also be beneficial. Implications: Our results demonstrate the need for messaging related to wildlife reintroductions to be strategically tailored based on the audience, where specific attention should be paid to local community values and concerns. This study explores how different theoretically-grounded messages influence public support for a potential red wolf (Canis rufus) reintroduction to the Ozark National Forest, AR, USA. Specifically, we compared results between landowners adjacent to Ozark National Forest and all other Arkansas resident respondents. Our results provide evidence that highlighting information about the species, the ecosystem benefits they offer, and how to mitigate potential risks may be the best options for increasing levels of support among populations local to a wildlife reintroduction. Photograph by ucumari photography. [ABSTRACT FROM AUTHOR]

Long-term data on ustekinumab in real-life Crohn's disease patients are still missing, though randomized controlled trials demonstrated it as a favorable therapeutic option. We aimed to evaluate ustekinumab's clinical efficacy, drug sustainability, and safety in a prospective, nationwide, multicenter Crohn's disease patient cohort with a three-year follow-up. Crohn's disease patients on ustekinumab treatment were consecutively enrolled from 9 Hungarian Inflammatory Bowel Disease centers between January 2019 and May 2020. Patient and disease characteristics, treatment history, clinical disease activity (Harvey Bradshaw Index (HBI)), biomarkers, and endoscopic activity (Simple Endoscopic Score for Crohn's Disease (SES-CD)) were collected for three-years' time. A total of 148 patients were included with an overall 48.9% of complex behavior of the Crohn's disease and 97.2% of previous anti-TNF exposure. The pre-induction remission rates were 12.2% (HBI), and 5.1% (SES-CD). Clinical remission rates (HBI) were 52.2%, 55.6%, and 50.9%, whereas criteria of an endoscopic remission were fulfilled in 14.3%, 27.5%, and 35.3% of the subjects at the end of the first, second, and third year, respectively. Dose intensification was high with 84.0% of the patients on an 8-weekly and 29.9% on a 4-weekly regimen at the end of year 3. Drug sustainability was 76.9% during the follow-up period with no serious adverse events observed. Ustekinumab in the long-term is an effective, sustainable, and safe therapeutic option for Crohn's disease patients with severe disease phenotype and high previous anti-TNF biological failure, requiring frequent dose intensifications. [ABSTRACT FROM AUTHOR]

Aims The aim of the study is to assess the impact of the baseline plaque composition on the DREAMS 3G luminal late loss and to compare the serial plaque changes between baseline and 6 and 12 months (M) follow-up. Methods and results A total of 116 patients were enrolled in the BIOMAG-I trial. Patients were imaged with optical coherence tomography (OCT) pre- and post-DREAMS 3G implantation and at 6 and 12 M. OCTPlus software uses artificial intelligence to assess composition (i.e. lipid, calcium, and fibrous tissue) of the plaque. The differences between the OCT-derived minimum lumen area (MLA) post-percutaneous coronary intervention and 12 M were grouped into three terciles. Patients with larger MLA differences at 12 M (P = 0.0003) had significantly larger content of fibrous tissue at baseline. There was a reduction of 24.8% and 20.9% in lipid area, both P < 0.001, between the pre-DREAMS 3G OCT and the 6 and 12 M follow-up. Conversely, the fibrous tissue increased by 48.4% and 36.0% at 6 and 12 M follow-up, both P < 0.001. Conclusion The larger the fibrous tissue in the lesion at baseline, the larger the luminal loss seen at 6 and 12 M. Following the implantation of DREAMS 3G, favourable healing of the vessel coronary wall occurs as shown by a decrease in the lipid area and an increase in fibrous tissue. [ABSTRACT FROM AUTHOR]

(1) Background: Mechanical circulatory support (MCS) in myocardial infarction-associated cardiogenic shock is subject to debate. This analysis aims to elucidate the impact of MCS's timing on patient outcomes, based on data from the PREPARE CS registry. (2) Methods: The PREPARE CS prospective registry includes patients who experienced cardiogenic shock (SCAI classes C–E) and were subsequently referred for cardiac catheterization. Our present analysis included a subset of this registry, in whom MCS was used and who underwent coronary intervention due to myocardial infarction. Patients were categorized into an Upfront group and a Procedural group, depending on the timing of MCS's introduction in relation to their PCI. The endpoint was in-hospital mortality. (3) Results: In total, 71 patients were included. MCS was begun prior to PCI in 33 (46%) patients (Upfront), whereas 38 (54%) received MCS during or after the initiation of PCI (Procedural). The groups' baseline characteristics and hemodynamic parameters were comparable. The Upfront group had a higher utilization of the Impella® device compared to extracorporeal membrane oxygenation (67% vs. 33%), while the Procedural group exhibited a balanced use of both (50% vs. 50%). Most patients suffered from multi-vessel disease in both groups (82% vs. 84%, respectively; p = 0.99), and most patients required a complex PCI procedure; the latter was more prevalent in the Upfront group (94% vs. 71%, respectively; p = 0.02). Their rates of complete revascularization were comparable (52% vs. 34%, respectively; p = 0.16). Procedural CPR was significantly more frequent in the Procedural group (45% vs. 79%, p < 0.05); however, in-hospital mortality was similar (61% vs. 79%, respectively; p = 0.12). (4) Conclusions: The upfront implantation of MCS in myocardial infarction-associated CS did not provide an in-hospital survival benefit. [ABSTRACT FROM AUTHOR]

Background: Cardiogenic shock (CS) exhibits high (~50%) in-hospital mortality. The recently published Extracorporeal life Support in Cardiogenic Shock (ECLS-SHOCK) trial demonstrated the neutral effects of the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) on all-cause death, as well as on all secondary outcomes in subjects presenting with myocardial-infarction (MI)-related CS. Here, we compared ECLS-SHOCK eligibility criteria with a real-world cohort of CS patients. Methods and Results: ECLS-SHOCK eligibility criteria were applied to a prospective single-center CS registry (the PREPARE CS registry) consisting of 557 patients who were consecutively admitted to the catheterization laboratory (cath lab) of the Medical University of Graz, Austria, due to CS (SCAI C-E). Overall use of mechanical circulatory support (MCS) in this cohort was 19%. Sixty-nine percent of the entire cohort had MI-related CS, 38% of whom would have met ECLS-SHOCK eligibility criteria, thus representing only 27% of the PREPARE CS registry. Exclusion from the ECLS-SHOCK trial was based on patients with initial lactate values below 3 mmol/L (n = 168; 43.6%), aged over 80 years (n = 65; 16.9%), and with a duration of cardiopulmonary resuscitation (CPR) exceeding 45 min (n = 22; 5.7%). The 30-day mortality of patients of the PREPARE CS registry who met the ECLS-SHOCK eligibility criteria was 57.0%, compared to 48.4% of patients in the ECLS-SHOCK trial. The patients' baseline characteristics, however, differed considerably with respect to type of infarction, age, and gender. Conclusions: In a real-world cohort of patients with MI-related CS, only 38% of patients met the eligibility criteria of the ECLS-SHOCK trial. Thus, the impact of the use of VA-ECMO on outcome parameters in MI-related CS, as observed in the ECLS-SHOCK trial, may differ in a more heterogeneous real-world CS population of the PREPARE CS registry. [ABSTRACT FROM AUTHOR]

Since the publication of the 2015 EAPCI consensus on rotational atherectomy, the number of percutaneous coronary interventions (PCI) performed in patients with severely calcified coronary artery disease has grown substantially. This has been prompted on one side by the clinical demand for the continuous increase in life expectancy, the sustained expansion of the primary PCI networks worldwide, and the routine performance of revascularization procedures in elderly patients; on the other side, the availability of new and dedicated technologies such as orbital atherectomy and intravascular lithotripsy, as well as the optimization of the rotational atherectomy system, has increased operators' confidence in attempting more challenging PCI. This current EAPCI clinical consensus statement prepared in collaboration with the EURO4C-PCR group describes the comprehensive management of patients with heavily calcified coronary stenoses, starting with how to use non-invasive and invasive imaging to assess calcium burden and inform procedural planning. Objective and practical guidance is provided on the selection of the optimal interventional tool and technique based on the specific calcium morphology and anatomic location. Finally, the specific clinical implications of treating these patients are considered, including the prevention and management of complications and the importance of adequate training and education. [ABSTRACT FROM AUTHOR]

This document is a special issue of the Journal of Clinical Medicine titled "Coronary Artery Disease Interventions." It aims to provide recent advances in the interventional and pharmacological strategies for patients with severe ischemic heart disease. The issue covers topics such as arterial access techniques, novel stents, optimal stenting techniques for bifurcation lesions, the impact of coronary calcification on outcomes, and the effect of complex percutaneous coronary interventions on ischemic and bleeding events. It also includes discussions on the use of extracorporeal membrane oxygenation in patients with cardiogenic shock and the long-term outcomes of ECMO survivors. The issue concludes with reviews on coronary microcirculation and coronary no-reflow after PCI. The authors express their gratitude to the reviewers, authors, and journal staff for their contributions. [Extracted from the article]

The optimal duration of dual antiplatelet therapy (DAPT) in high bleeding risk (HBR) patients undergoing percutaneous coronary intervention (PCI) with implantation of the Orsiro Mission stent remains unclear. The BIOFLOW-DAPT (clinicaltrials.gov, NCT04137510) trial is a prospective, multi-center, randomized controlled study designed to assess the safety of the Orsiro Mission versus the Resolute Onyx stent in HBR patients. Patients are treated with DAPT (aspirin and a P2Y12 inhibitor) for 1 month, followed by a single antiplatelet therapy (SAPT). The primary endpoint is the composite of cardiac death, myocardial infarction, and definite or probable stent thrombosis at 1 year. With a final sample size of 1948 HBR patients, this study is powered to assess the noninferiority of the Orsiro Mission stent with respect to the primary study endpoint. The BIOFLOW-DAPT is the first randomized clinical trial investigating 1-month DAPT duration in HBR patients after implantation of the Orsiro Mission stent. Trial Registration: ClinicalTrials.gov number, NCT04137510 Study design and key features. Patient selection starts before the index PCI, when consented patients will be randomized to the Orsiro Mission or the Resolute Onyx stent with mandated 1-month DAPT. At 1 month, eligibility is reassessed and if met, patients will discontinue DAPT and continue with P2Y12 inhibitor or aspirin monotherapy. PCI, percutaneous coronary intervention; DAPT, dual antiplatelet therapy; DES, drug-eluting stent; HBR, high bleeding risk; P2Y12i, P2Y12 inhibitor; ST, stent thrombosis [ABSTRACT FROM AUTHOR]

Background: Percutaneous closure of patent foramen ovale (PFO) is conventionally performed under continuous transesophageal echocardiographic (TEE) guidance. We aimed to evaluate whether a simplified procedural approach, including pure fluoroscopy‐guidance and final TEE control, as well as an aimed 'next‐day‐discharge' is comparable with the conventional TEE‐guided procedure in terms of periprocedural and intermediate‐term outcomes. Methods: All patients who underwent a PFO closure at our center between 2010 and 2022 were retrospectively included. Prior to June 2019 cases were performed with continuous TEE guidance (TEE‐guided group). Since June 2019, only pure fluoroscopy‐guided PFO closures have been performed with TEE insertion and control just prior to device release (fluoroscopy‐guided group). We analyzed procedural aspects, as well as long term clinical and echocardiographic outcomes. Results: In total 291 patients were included in the analysis: 197 in the TEE‐guided group and 94 in the fluoroscopy‐guided group. Fluoroscopy‐guided procedures were markedly shorter (48 ± 20 min vs. 25 ± 9 min; p <.01). There was no difference in procedural complications, including death, major bleeding, device dislodgement, stroke or clinically relevant peripheral embolization between the two groups (.5% vs. 0%; p =.99). Hospital stay was also shorter with the simplified approach (2.5 ± 1.6 vs. 3.5 ± 1.2 days; p <.01), allowing 85% same‐day discharges during the last 12 months of observation period. At 6 ± 3 months echocardiographic follow‐up a residual leakage was described in 8% of the TEE‐guided cases and 2% of the fluoroscopy‐guided cases (p =.08). Conclusion: While a complete TEE‐free PFO closure might have potential procedural risks, our approach of pure fluoroscopy‐guided with a brisk final TEE check seems to be advantageous in terms of procedural aspects with no sign of any acute or intermediate‐term hazard and it could offer an equitable compromise between the two worlds: a complete TEE procedure and a procedure without any TEE. [ABSTRACT FROM AUTHOR]

Background: As a preventive procedure, minimizing periprocedural risk is crucially important during left atrial appendage closure (LAAC). Methods: We included consecutive patients receiving LAAC at nine centres and assessed the relationship between baseline characteristics and the acute procedural outcome. Major procedural complications were defined as all complications requiring immediate invasive intervention or causing irreversible damage. Logistic regression was performed and included age and left-ventricular function. Furthermore, the association between acute complications and long-term outcomes was evaluated. Results: A total of 405 consecutive patients with a median age of 75 years (37% female) were included. 47% had a history of stroke. Median CHA2DS2-VASc score was 4 (interquartile range, 3–5) and the median HAS-BLED score was 3 (2–4). Major procedural complications occurred in 7% of cases. Low haemoglobin (OR 0.8, 95% CI 0.65–0.99 per g/dL, p = 0.040) and end-stage kidney disease (OR 13.0, CI 2.5–68.5, p = 0.002) remained significant in multivariate analysis. Anaemia (haemoglobin < 12 and < 13 g/dL in female and male patients) increased the risk of complications 2.2-fold. Conclusions: The major complication rate was low in this high-risk patient population undergoing LAAC. End-stage kidney disease and low baseline haemoglobin were independently associated with a higher major complication rate. [ABSTRACT FROM AUTHOR]

Background. Atherosclerosis is a systemic arterial disease with heterogeneous involvement in all vascular beds; however, studies examining the relationship between coronary and radial artery calcification are lacking. The purpose of this study was to assess the relationship between the two sites and the prognostic value of radial artery calcification (RC) for coronary artery disease. Methods. This is a single-center, retrospective cross-sectional study based on Doppler ultrasound of radial artery (RUS) and coronary artery angiography (CAG). We included a total of 202 patients undergoing RUS during distal radial access and CAG at the same procedure, between December 2020 and May 2021, from which 103 were found having RC during RUS (RC group) and 99 without (NRC group). Coronary calcifications were evaluated either by angiography examination (moderate and severe), positive CT (>100 Agatson units), or intracoronary imaging (IVUS, OCT). Results. A significant correlation was observed between radial calcification and coronary calcification variables (67.3% vs. 32.7%, p = 0.001). The correlation between risk factors such as age, smoking, chronic kidney disease, and diabetes mellitus was higher while sex did not play a role. The need of PCI and/or CABG was higher in the RC group (60% vs. 44%, p = 0.02). RC, therefore, predicts the extent and severity of coronary artery disease. Conclusion. RC may be frequently associated with calcific coronary plaques. These findings highlight the potential beneficial examination of radial arteries whenever CAD is suspected. [ABSTRACT FROM AUTHOR]

Agroforestry has potential for strengthening the climate change resilience of smallholder farmers in Southeast Asia. In Indonesia, the food security challenges faced by smallholders will likely worsen due to climate change impacts. Agroforestry provides and option for strengthening climate change resilience, while contributing to food access, income, health, and environmental stability. To evaluate the evidence for such benefits, this systematic review identifies 22 peer-reviewed articles published between 2000 and 2019 which assess agroforestry's contributions to food security in Indonesia, mostly in Java or Sumatra. Analysis of the studies indicate that traditional and commercial agroforestry contribute to food security in diverse ways: for example, traditional homegardens offer 20% more dietary diversity than commercial counterparts, while commercial homegardens may contribute up to five times more income. Agri-silviculture contributions fall along a timber versus non-timber forest product continuum that displays a similar tradeoff between diversity and income. Those systems with a commercial focus may receive 54% of their income from a single commodity crop such as coffee, while traditional systems allow greater access to plants with medicinal benefits. Nearly all agroforestry systems offered indirect benefits for food security, such as allowing more off-farm work than traditional agriculture and contributing to environmental stability: users of agroforestry were found by one study to collect 83% less fuelwood from natural forests. One study highlighted that agroforestry options have up to 98% greater net present value (for periods over 30 years) compared to slash and burn style agriculture. However, very few studies of Indonesian agroforestry focused explicitly on financial analysis and food security, indicating the need for further research. Given the similar situations faced by many Southeast Asia countries, our findings contribute to emerging trends throughout the region regarding the relationship between agroforestry and food security. [ABSTRACT FROM AUTHOR]

Using visual world eye-tracking, we examined whether adults (N = 58) and children (N = 37; 3;1–6;3) use linguistic focussing devices to help resolve ambiguous pronouns. Participants listened to English dialogues about potential referents of an ambiguous pronoun he. Four conditions provided prosodic focus marking to the grammatical subject or to the object, which were either additionally it-clefted or not. A reference condition focussed neither the subject nor object. Adult online data revealed that linguistic focussing via prosodic marking enhanced subject preference, and overrode it in the case of object focus, regardless of the presence of clefts. Children's processing was also influenced by prosodic marking; however, their performance across conditions showed some differences from adults, as well as a complex interaction with both their memory and language skills. Offline interpretations showed no effects of focus in either group, suggesting that while multiple cues are processed, subjecthood and first mention dominate the final interpretation in cases of conflict. [ABSTRACT FROM AUTHOR]

Materialist scholarship on postcolonial literature's relationship with global publishing industries has radically altered the ways in which we conceive of writers' and texts' postcolonial agency. Its interest in the foreclosures of the marketplace has made it difficult to identify texts and practices of reading alike as postcolonial, as textualist traditions have long done so. Yet, even if somewhat devalued by materialist postcolonialisms, reading remains valuable, particularly because it presents opportunities for self-reconstitution and political self-recognition. Indeed, it is precisely because reading is not material or textual, but hybrid, that it holds such ethical and political potential. This essay departs from materialist and textualist postcolonial scholars' tendency to prescribe strategies of reading, instead concerning itself with describing reading as it actually takes place. Drawing on Wolfgang Iser's reader-response theory, in conjunction with affect theory and theories of the ethics and politics of reading, the essay develops an innovative model of reading, which understands readers as comprising a reading self and a self-in-the-world. This model of reading reasserts postcolonial literatures' agencies at the site of consumption as well as democratizes reading by undermining prescriptions of reading and meaning. [ABSTRACT FROM AUTHOR]

There is increasing excitement in the healthcare field about using behavioral data and healthcare analytics for disease risk prediction, clinical decision support, and overall improvement of personalized medicine. However, this excitement has not effectively translated to improved clinical outcomes due to knowledge gaps, a lack of behavioral risk models, and resistance to evidence-based practice. Reportedly, only 10–20% of clinical decisions are known to be evidence-based and this problem is further highlighted by the fact that the US spends more money on healthcare per person than any other nation, while still wrestling with poor health outcomes. Critics say there are inadequate technological resources and analytical education for clinicians to make behavioral data useful in the medical world. Healthcare technology innovators often neglect important aspects of the reality of integrating clinical data into electronic healthcare solutions. In this study, we developed a decision tree model using R statistical software to predict diabetes since it is among the top causes of death in the US, can be poorly managed, and provides an opportunity for improvement using analytics. This study examined behavioral data and healthcare analytics for use in clinical applications, demonstrating that health information professionals can develop behavioral risk factor prediction models to bridge the gap. Results indicated that decision trees are effective in classifying diabetes in an individual at up to 89.36% accuracy. [ABSTRACT FROM AUTHOR]

This article argues that Gayatri Chakravorty Spivak's notion of planetarity is premised on a practice of reading. Reading for the planet involves deferring the world in order to participate in the text world and its latent re(-)production of ourselves and our world. To the extent that this ethical attention moves us toward different horizons of thinking and feeling, it may also engender political action in the public realm. Reading for Spivak is therefore an important foundation for revolutionary politics and, ultimately, the production of the planet to which we aspire as readers. I proceed to evaluate the planetary efficacy of Spivak's complementary teaching praxis. I show that the aesthetic education she provides does not enable but rather forecloses the experience of literariness and its associated ethics and politics. In response to the limits of professional reading and the worldliness of Spivak's fieldwork in India, I conclude by thinking about the value of deprofessionalization. [ABSTRACT FROM AUTHOR]

Copyright of Herz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Gambling on sporting events is an illegal activity in Iran, and this phenomenon is widespread. Taking its point of departure from Control and Rational Choice Theories, this study examines the effects of self-control, social bonding, and rational choice on both gambling behavior and pro-gambling orientations. From a sample of 417 gamblers from the city of Rasht (the capital city of the Guilan province, one of Iran's largest cities) and using structural modeling analysis, we investigated how various theoretically derived parameters predict gambling behavior and gambling orientations. The results showed significant, negative associations between our latent variables (self-control, social bonding, and rational choice) and respondents' self-reported gambling behavior and pro-gambling orientations. Moreover, self-control, social bonding, and rational choice combined to account for 54% of the variance of self-reported gambling and 49% of the variance in respondents' pro-gambling orientations. Measures of the total standardized effects showed that self-control was more strongly associated with both gambling behavior and a pro-gambling orientation than either social bonding or rational choice. [ABSTRACT FROM AUTHOR]

This article proposes a literary canon founded on dialectical principles, using South Africa as our historical example. In order to do so, we first trace the development of dialectical thought, moving from Georg Wilhelm Friedrich Hegel to Karl Marx to Steve Biko; from Eurocentrism to class consciousness to Black Consciousness. Second, we plot the influence of Hegel and Marx as well as Sartre and Fanon on Biko's elaboration of dialectics for the Black Consciousness Movement. Third, and in response to Marxist critiques of Black Consciousness, we register the moment of class consciousness that underpins Biko's politics, especially his critique of institutions. Finally, and based on our exposition of Biko's reading of Hegel via Marx and Sartre, we suggest a 'polythetic' dialectic to rework the post-Apartheid literary canon and to accommodate intersectional complexity within it. The canon, in our model, does not emerge from a settled consensus, but instead re-coalesces on every occasion that it is submitted to contestation or is approached via conflicts in the social. A transitive or dialectical canon might variously retain or negate institutionally-privileged texts while still making them momentarily visible via the 'popular' traditions of struggle that contest institutional privilege. [ABSTRACT FROM AUTHOR]

Discusses the fabrication and electrical performance of an all refractory niobium-nitrogen medium scale integrated circuit process. Fabrication of Josephson junctions; Plasma etching of in situ radio frequency sputter deposited trilayers of niobium-nitrogen/magnesium-oxygen/niobium-nitrogen; Use of a deposited silicon dioxide film for wiring and resistor insulation.

Clinical benefit of invasive functionally guided revascularization has been mostly investigated and proven for percutaneous coronary intervention. It has never been prospectively evaluated whether a systematic fractional flow reserve (FFR) assessment is also beneficial in guiding coronary artery bypass graft surgery (CABG). The objective of the GRAft patency after FFR-guided versus angiography-guIded CABG (GRAFFITI) trial was to compare an FFR-guided revascularization strategy to the traditional angiography-guided revascularization strategy for patients undergoing CABG. Patients were enrolled with significantly diseased left anterior descending or left main stem and at least one major coronary artery with angiographically intermediate stenosis (30-90% diameter stenosis) that was assessed by FFR. Thereafter, while the FFR values were kept concealed, cardiac surgeons decided their intended procedural strategy based on the coronary angiography alone. At this point, patients underwent 1:1 randomization to either an FFR-guided or an angiography-guided CABG strategy. In case the patient was randomized to angiography-guided arm, cardiac surgeons kept their intended procedural strategy, i.e., CABG was guided solely on the basis of the coronary angiography. In case the patient was randomized to the FFR-guided arm, FFR values were disclosed to the surgeons who revised the surgical protocol according to the functional significance of each coronary stenosis. The primary endpoint of the trial was the rate of graft occlusion at 12 months, assessed by coronary computed tomography or coronary angiography. The secondary endpoints were (1) length of postoperative hospital stay; (2) changes in surgical strategy depending upon FFR results (in FFR-guided group only); and (3) rate of major adverse cardiac and cerebrovascular events, i.e., composite of death, myocardial infarction, stroke, and any revascularization during the follow-up period. This study is the first prospective randomized trial investigating potential clinical benefits, associated with FFR-guided surgical revascularization. Trial registration: NCT01810224 [ABSTRACT FROM AUTHOR]

This paper discusses ergodic properties and circular statistical characteristics in neuronal spike trains. Ergodicity means that the average taken over a long time period and over smaller population should equal the average in less time and larger population. The objectives are to show simple examples of design and validation of a neuronal model, where the ergodicity assumption helps find correspondence between variables and parameters. The methods used are analytical and numerical computations, numerical models of phenomenological spiking neurons and neuronal circuits. Results obtained using these methods are the following. They are: a formula to calculate vector strength of neural spike timing dependent on the spike train parameters, description of parameters of spike train variability and model of output spiking density based on assumption of the computation realized by sound localization neural circuit. Theoretical results are illustrated by references to experimental data. Examples of neurons where spike trains have and do not have the ergodic property are then discussed. [ABSTRACT FROM AUTHOR]

The aim of this review is to highlight the role of invasive functional evaluation in patients in whom coronary artery bypass graft (CABG) is indicated, and to examine the clinical evidence available in favour of fractional flow reserve (FFR) adoption in these patients, outline appropriate use, as well as point out potential pitfalls. FFR after CABG will also be reviewed, highlighting its correct interpretation and adoption when applied to both native coronary arteries and bypass grafts. Practice European guidelines support the use of FFR to complement coronary angiography with the highest degree of recommendation (Class IA) for the assessment of coronary stenosis before undertaking myocardial revascularization when previous non-invasive functional evaluation is unavailable or not conclusive. As a result, FFR has been adopted in routine clinical practice to guide clinicians decision as to whether or not perform a revascularization. Of note, due to the increasing confidence of the interventional cardiologists, FFR guidance is also being implemented to indicate or guide CABG. This is in anticipation of supportive clear-cut evidence, since recommendations for FFR adoption were based on randomized clinical trials investigating percutaneous coronary intervention (PCI) strategies in which patients with typical indications for CABG were excluded (e.g. left main disease, valvular disease, and coronary anatomy unsuitable for PCI). Based on the critical appraisal of the literature, FFR can play an important role in risk stratification and determining management strategy of patients either before or after CABG. [ABSTRACT FROM AUTHOR]

Copyright of Obstetrică şi Ginecologie is the property of Societatea de Obstetrica si Ginecologie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

While heart failure is one of the leading causes of mortality and morbidity, our tools to provide ultimate treatment solutions are still limited. Recent developments in new devices are designed to fill this therapeutic gap. The scope of this review is to focus on two particular targets, namely (1) left ventricular geometric restoration and (2) atrial depressurization. (1) Reduction of the wall stress by shrinking the ventricular cavity has been traditionally attempted surgically. Recently, the Parachute device (CardioKinetix Inc., Menlo Park, CA, USA) has been introduced to restore ventricular geometry and cardiac mechanics. The intervention aims to partition distal dysfunctional segments that are non-contributory to the ventricular mechanics and forward cardiac output. (2) Diastolic heart failure is characterized by abnormal relaxation and chamber stiffness. The main therapeutic goal achieved should be the reduction of afterload and diastolic pressure load. Recently, new catheter-based approaches were proposed to reduce left atrial pressure and ventricular decompression: the InterAtrial Shunt Device (IASDTM) (Corvia Medical Inc., Tewksbury, MA, USA) and the V-Wave Shunt (V-Wave Ltd, Or Akiva, Israel). Both are designed to create a controlled atrial septal defect in symptomatic patients with heart failure. While the assist devices are aimed at end-stage heart failure, emerging device-based percutaneous or minimal invasive techniques comprise a wide spectrum of innovative concepts that target ventricular remodeling, cardiac contractility or neuro-humoral modulation. The clinical adoption is in the early stages of the initial feasibility and safety studies, and clinical evidence needs to be gathered in appropriately designed clinical trials. [ABSTRACT FROM AUTHOR]