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Introduction: Artificial intelligence (AI) ECG arrhythmia mapping provides arrhythmia source localization using 12‐lead ECG data; whether this information impacts procedural efficiency is unknown. We performed a retrospective, case‐control study to evaluate the hypothesis that AI ECG mapping may reduce time to ablation, procedural duration, and fluoroscopy. Materials and Methods: Cases in which system output was used were retrospectively enrolled according to IRB‐approved protocols at each site. Matched control cases were enrolled in reverse chronological order beginning on the last day for which the technology was unavailable. Controls were matched based upon physician, institution, arrhythmia, and a predetermined complexity rating. Procedural metrics, fluoroscopy data, and clinical outcomes were assessed from time‐stamped medical records. Results: The study group consisted of 28 patients (age 65 ± 11 years, 46% female, left atrial dimension 4.1 ± 0.9 cm, LVEF 50 ± 18%) and was similar to 28 controls. The most common arrhythmia types were atrial fibrillation (n = 10), premature ventricular complexes (n = 8), and ventricular tachycardia (n = 6). Use of the system was associated with a 19.0% reduction in time to ablation (133 ± 48 vs. 165 ± 49 min, p = 0.02), a 22.6% reduction in procedure duration (233 ± 51 vs. 301 ± 83 min, p < 0.001), and a 43.7% reduction in fluoroscopy (18.7 ± 13.3 vs.33.2 ± 18.0 min, p < 0.001) versus controls. At 6 months follow‐up, arrhythmia‐ free survival was 73.5% in the study group and 63.3% in the control group (p = 0.56). Conclusion: Use of forward‐solution AI ECG mapping is associated with reductions in time to first ablation, procedure duration, and fluoroscopy without an adverse impact on procedure outcomes or complications. [ABSTRACT FROM AUTHOR]

Precipitation projections in transient climate change scenarios have been extensively studied over multiple climate model generations. Although these simulations have also been used to make projections at specific Global Warming Levels (GWLs), dedicated simulations are more appropriate to study changes in a stabilizing climate. Here, we analyze precipitation projections in six multi‐century experiments with fixed atmospheric concentrations of greenhouse gases, conducted with the UK Earth System Model and which span a range of GWLs between 1.5 and 5°C of warming. Regions are identified where the sign of precipitation trends in high‐emission transient projections is reversed in the stabilization experiments. For example, stabilization reverses a summertime precipitation decline across Europe. This precipitation recovery occurs concurrently with changes in the pattern of Atlantic sea surface temperature trends due to a slow recovery of the Atlantic Meridional Overturning Circulation in the stabilization experiments, along with changes in humidity and atmospheric circulation. Plain Language Summary: Climate model projections consistently predict that summer precipitation over Europe is expected to decline in the future as global temperatures rise under continued global warming. In our study, we use new climate model simulations that simulate a world where atmospheric concentrations of greenhouse gases are no longer increasing and the rise in global temperatures has slowed down. We show that the summer rainfall decline across Europe can, to some extent, be reversed if global temperatures were to stabilize. This has important implications for adaptation and planning decisions, particularly in so‐called climate change "hot‐spots" such as the Mediterranean. Key Points: Climate stabilization experiments show significant differences in projected precipitation compared to high‐emission transient scenariosNorthern European and Mediterranean projected summer drying is partially reversedEuropean summer precipitation changes are consistent with the atmospheric response to Atlantic SST changes [ABSTRACT FROM AUTHOR]

Summary: The principles of environmentally sustainable healthcare as applied to anaesthesia and peri‐operative care are well documented. Associated recommendations focus on generic principles that can be applied to all areas of practice. These include reducing the use of inhalational anaesthetic agents and carbon dioxide equivalent emissions of modern peri‐operative care. However, four areas of practice have specific patient, surgical and anaesthetic factors that present barriers to the implementation of some of these principles, namely: neuroanaesthesia; obstetric; paediatric; and cardiac anaesthesia. This narrative review describes these factors and synthesises the available evidence to highlight areas of sustainable practice clinicians can address today, as well as posing several unanswered questions for the future. In neuroanaesthesia, improvements can be made by undertaking awake surgery, moving towards more reusables and embracing telemedicine in quaternary services. Obstetric anaesthesia continues to present questions regarding how services can move away from nitrous oxide use or limit its release to the environment. The focus for paediatric anaesthesia is addressing the barriers to total intravenous and regional anaesthesia. For cardiac anaesthesia, a significant emphasis is determining how to focus the substantial resources required on those who will benefit from cardiac interventions, rather than universal implementation. Whilst the landscape of evidence‐based sustainable practice is evolving, there remains an urgent need for further original evidence in healthcare sustainability targeting these four clinical areas. [ABSTRACT FROM AUTHOR]

Splashed white in horses is characterized by extensive white patterning on the legs, face and abdomen and may be accompanied by deafness. To date, seven variants in microphthalmia‐associated transcription factor (MITF) and two variants in Paired Box 3 (PAX3) have been identified to explain this phenotype. A splashed white Thoroughbred stallion, whose sire and dam were not patterned, was hypothesized to have a de novo variant leading to his white coat pattern. A whole‐genome sequencing candidate gene approach identified two single nucleotide variants (SNVs) in SOX10, four SNVs in MITF and a 2.3 kb deletion in MITF with the alternative allele present in this stallion but absent in the other 18 horses analyzed. All six SNVs were annotated as modifiers and were not further considered. The deletion in MITF (NC_009159.3:g.21555811_21558139delinsAAAT) encompasses exon 9 encoding a part of the helix–loop–helix domain required for DNA binding. Sanger sequencing and parentage testing confirmed that this deletion was a de novo mutation of maternal origin. Consistent with the published nomenclature, we denote this likely causal variant as SW8. Genotyping three of this stallion's offspring identified SW8 only in the nearly all‐white foal that was confirmed deaf by brainstem auditory evoked response testing. This foal was also a compound heterozygote for dominant white variants (W20/W22), but to date, W variants alone have not been connected to deafness. SW8 marks the fourth de novo MITF variant in horses reported to cause white patterning. The link between deafness and all MITF variants with and without other variants impacting melanocyte development and function needs to be further explored. [ABSTRACT FROM AUTHOR]

This document is a response from the authors of a study on the impact of artificial intelligence (AI) arrhythmia mapping on various aspects of cardiac procedures. The authors address concerns raised by other researchers regarding the study's design and limitations. They acknowledge that the retrospective nature of the study may introduce unaccounted-for differences between the study patients and controls, but argue that it provided valuable early insights into the clinical benefits of AI. They also discuss the use of historical controls and the generalizability of the study's results. The authors conclude by emphasizing the need for prospective, randomized controlled trials to validate their findings. [Extracted from the article]

Changes in climate are usually considered in terms of trends or differences over time. However, for many impacts requiring adaptation, it is the amplitude of the change relative to the local amplitude of climate variability which is more relevant. Here, we develop the concept of "signal‐to‐noise" in observations of local temperature, highlighting that many regions are already experiencing a climate which would be "unknown" by late 19th century standards. The emergence of observed temperature changes over both land and ocean is clearest in tropical regions, in contrast to the regions of largest change which are in the northern extratropics—broadly consistent with climate model simulations. Significant increases and decreases in rainfall have also already emerged in different regions with the United Kingdom experiencing a shift toward more extreme rainfall events, a signal which is emerging more clearly in some places than the changes in mean rainfall. Plain Language Summary: Changes in climate are translated into impacts on society not just though the amount of change, but how this change compares to the variations in climate that society is used to. Here we demonstrate that significant changes, when compared to the size of past variations, are present in both temperature and rainfall observations over many parts of the world. Key Points: The signal of changes in observed temperature and rainfall due to global warming has clearly emerged in many regions and at mesoscalesTropical regions have experienced the largest changes in temperature relative to the amplitude of internal variabilitySignals of increasing extreme rainfall are emerging more quickly than signals in mean rainfall over many parts of the United Kingdom [ABSTRACT FROM AUTHOR]

Due to the current trend of decreasing contact hours and less emphasis being given to the basic science courses in the pre‐clinical years of medical education, it is essential that new approaches to teaching gross anatomy are investigated to ensure medical students are being adequately exposed to anatomical content. This study retrospectively analyzed practical examination data from four medical gross anatomy classes (N = 569) to ascertain which pedagogical approach, student participation in the dissection process, or interaction with prosected specimens is best for teaching the anatomy of the hand and foot. Data analysis involved the use of propensity score matching, a nonparametric preprocessing statistical approach which ensures accurate representation of the true treatment effect by balancing cohorts prior to statistical analysis. Statistical analysis indicated that those students who were exposed to the anatomy of the hand through interactions with prosected specimens performed 5.6% better (P = 0.012) while for the foot, students who interacted with prosections performed 13.0% better (P < 0.001). Although limited, data from this study suggest that utilizing prosections of the hand and foot seems to be a more advantageous pedagogical approach for teaching these regions than requiring students to dissect them. [ABSTRACT FROM AUTHOR]

Abstract: Recent studies of individual seasonal forecast systems have shown that the wintertime North Atlantic Oscillation (NAO) can be skillfully forecast. However, it has also been suggested that these skillful forecasts tend to be underconfident, meaning that there is too high a proportion of unpredictable noise in the forecasts. We assess the skill and overconfidence/underconfidence of the seasonal forecast systems contributing to the EUROpean Seasonal to Interannual Prediction (EUROSIP) multimodel ensemble system. Five of the seven systems studied have significant skill for forecasting the wintertime NAO at 2‐ to 4‐month lead times. Four of these skillful systems are underconfident for forecasting the NAO. A multimodel ensemble (ensemble size 126 members) is both skillful and clearly underconfident. Underconfidence becomes more pronounced as the ensemble size increases. Certain years in the hindcast period are well forecast by all or most models. This implies that common teleconnections and drivers of the NAO are being captured by the EUROSIP seasonal forecasts. [ABSTRACT FROM AUTHOR]

Cardiac pacing for vasovagal syncope (VVS) addresses the cardioinhibitory component of the reflex but cannot directly affect vasodepression, which occurs in every reflex even when hidden by dominant cardioinhibition. The randomized controlled trials of pacing in VVS have, after almost 2 decades, determined that a small number of patients can benefit because their vasodepressor component is not severe. Early studies compared pacing with no therapy yielding highly significant benefits. Subsequently, all study patients had implanted devices with half being switched off. No benefit was seen. The ISSUE-3 study found significant benefit (P < 0.039) in prevention of syncope recurrence in older patients. A sub-study later showed those with negative tilt tests, otherwise indistinguishable from tilt-positives, had 5% recurrence in 21 months (P < 0.004). There is acceptance that pacing must be dual chamber, but the question of how pacing is delivered remains open. Relying on falling heart rate is insufficient, probably because it occurs too late. Other algorithms which indirectly detect neuroendocrine changes earlier than heart rate fall may have useful application. In clinical terms, the patient to be considered for pacing should not be young and have severe symptoms. Ideally, tilt testing should be negative implying vasodepression of lesser severity and, therefore, yielding fewer syncope recurrences. When selecting pacing, additional concern must be given to regression to the mean of symptoms, severe to less severe. Patients seek help when they are at their worst. Moreover, many years of pacing are unlikely to be free of complications related to implanted hardware. [ABSTRACT FROM AUTHOR]

The article discusses a study regarding the causes of transient loss of consciousness (T-LOC) in patients with vasovagal syncope, the diagnosis of syncope, and the interpersonal aspect of medicine in understanding the physiology of syncope. Topics include the importance of the use of history taking as a diagnostic tool in syncope patients, the need for physicians to understand the impact of consultation on the daily life of a patient, and the logical benefit of the empathetic approach.

Since 2007 a large decline in Arctic sea ice has been observed. The large-scale atmospheric circulation response to this decline is investigated in ERA-Interim reanalyses and HadGEM3 climate model experiments. In winter, post-2007 observed circulation anomalies over the Arctic, North Atlantic and Eurasia are small compared to interannual variability. In summer, the post-2007 observed circulation is dominated by an anticyclonic anomaly over Greenland which has a large signal-to-noise ratio. Climate model experiments driven by observed SST and sea ice anomalies are able to capture the summertime pattern of observed circulation anomalies, although the magnitude is a third of that observed. The experiments suggest high SSTs and reduced sea ice in the Labrador Sea lead to positive temperature anomalies in the lower troposphere which weaken the westerlies over North America through thermal wind balance. The experiments also capture cyclonic anomalies over Northwest Europe, which are consistent with downstream Rossby wave propagation. [ABSTRACT FROM AUTHOR]

Converting gas-driven ventilators from oxygen to air: environmental implications According to Ford and Foale, using air as the driving gas would save 449,280 l.day SP -1 sp of oxygen in their 52 anaesthetic machine-department [1]. Based on Ford and Foale's work, we calculated the energy savings of converting the driving gas to air in routine circumstances (6 h.day SP -1 sp , 5 days.week SP -1 sp , 48 weeks.year SP -1 sp ); this would generate an annual energy saving of 363 kWh per ventilator. [Extracted from the article]

Current state-of-the-art climate models fail to capture accurately the path of the Gulf Stream and North Atlantic Current. This leads to a warm bias near the North American coast, where the modelled Gulf Stream separates from the coast further north, and a cold anomaly to the east of the Grand Banks of Newfoundland, where the North Atlantic Current remains too zonal in this region. Using an atmosphere-only model forced with the sea surface temperature (SST) biases in the North Atlantic, we consider the impact they have on the mean state and the variability in the North Atlantic European region in winter. Our results show that the SST errors produce a mean sea-level pressure response that is similar in magnitude and pattern to the atmospheric circulation errors in the coupled climate model. The work also suggests that errors in the coupled model storm tracks and North Atlantic Oscillation, compared to reanalysis data, can also be explained partly by these SST errors. Our results suggest that both the error in the Gulf Stream separation location and the path of the North Atlantic Current around the Grand Banks play important roles in affecting the atmospheric circulation. Reducing these coupled model errors could improve significantly the representation of the large-scale atmospheric circulation of the North Atlantic and European region. Copyright © 2012 Royal Meteorological Society [ABSTRACT FROM AUTHOR]

Ferlins are a family of multiple C2 domain proteins with emerging roles in vesicle fusion and membrane trafficking. Ferlin mutations are associated with muscular dystrophy (dysferlin) and deafness (otoferlin) in humans, and infertility in Caenorhabditis elegans (Fer-1) and Drosophila (misfire), demonstrating their importance for normal cellular functioning. Ferlins show ancient origins in eukaryotic evolution and are detected in all eukaryotic kingdoms, including unicellular eukaryotes and apicomplexian protists, suggesting origins in a common ancestor predating eukaryotic evolutionary branching. The characteristic feature of the ferlin family is their multiple tandem cytosolic C2 domains (five to seven C2 domains), the most of any protein family, and an extremely rare feature amongst eukaryotic proteins. Ferlins also bear a unique nested DysF domain and small conserved 60-70 residue ferlin-specific sequences (Fer domains). Ferlins segregate into two subtypes based on the presence (type I ferlin) or absence (type II ferlin) of the DysF and FerA domains. Ferlins have diverse tissue-specific and developmental expression patterns, with ferlin animal models united by pathologies arising from defects in vesicle fusion. Consistent with their proposed role in vesicle trafficking, ferlin interaction partners include cytoskeletal motors, other vesicle-associated trafficking proteins and transmembrane receptors or channels. Herein we summarize the research history of the ferlins, an intriguing family of structurally conserved proteins with a preserved ancestral function as regulators of vesicle fusion and receptor trafficking. [ABSTRACT FROM AUTHOR]

The article looks at examples of cultural hybridity as seen in Indonesian Gamelan music which contains aspects of Western music. The use of instruments common to Western popular music in Gamelan is discussed, including guitar and violin. The author also considers genres prevalent within fusion music, predominantly jazz and ethnic popular music.

The article discusses the integration of climate risk information in development planning as various sectors and countries are preparing for climate change impacts. It highlights information in which climate risk information can be used in adaptation assessments. It also describes knowledge gaps and opportunities for improving the uptake of climate risk information for the year 2020.

Synaptotagmin acts as the Ca2+ sensor for neuronal exocytosis. The cytosolic domain of human synaptotagmin 1 is composed of tandem C2 domains: C2A and C2B. These C2 domains modulate the interaction of synaptotagmin with the phospholipid bilayer of the presynaptic terminus and effector proteins such as the SNARE complex. Human synaptotagmin C2A-C2B has been expressed as a glutathione- S-transferase fusion protein in Escherichia coli. The purification, crystallization and preliminary X-ray analysis of this protein are reported here. The crystals diffract to 2.7 Å and belong to the orthorhombic space group P212121, with unit-cell parameters a = 82.37, b = 86.31, c = 140.2 Å. From self-rotation function analysis, there are two molecules in the asymmetric unit. The structure determination of the protein using this data is ongoing. [ABSTRACT FROM AUTHOR]

Oral examinations were performed on 102 patients receiving immunosuppressive drug therapy following renal transplantation. A further 111 control patients matched for age and sex, were also examined. The severity of dental caries of the 2 groups was compared by considering their decayed, missing and filled teeth (DMF-T), and the severity of periodontal disease was compared in terms of pocket depths, Plaque, Calculus and Sulcular Bleeding Indices, and Russell's Periodontal Index. When comparing the 2 groups, note was made of restorations involving the gingival margins, the presence of partial dentures and recent and current antibiotic therapy. No significant differences were found between the groups with regard to age, sex distribution, plaque levels, DMF and Russell's Periodontal Index. The immunosuppressed group had significantly less calculus, fewer restorations involving the gingival margins and significantly lower mean pocket depth. However, they did have more gingival recession than the controls and also a higher Sulcus Bleeding Index. All differences seen were maintained even when patients from both groups on antibiotics were eliminated from the analysis. Within the immunosuppressed group no relationship was found between the length of time the drugs were taken and the periodontal variables. The study indicates that patients on immunosuppressive therapy show no change in susceptibility to destructive periodontal disease. [ABSTRACT FROM AUTHOR]