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Initiation of anticoagulation therapy in ischemic stroke patients is contingent on a clinical diagnosis of atrial fibrillation (AF). Results from previous studies suggest thromboembolic risk may predate clinical manifestations of AF. Early identification of this cohort of patients may allow early initiation of anticoagulation and reduce the risk of secondary stroke.This study aims to produce a substrate-based predictive model using cardiac magnetic resonance imaging (CMR) and baseline noninvasive electrocardiographic investigations to improve the identification of patients at risk of future thromboembolism.CARM-AF is a prospective, multicenter, observational cohort study. Ninety-two patients will be recruited following an embolic stroke of unknown source (ESUS) and undergo atrial CMR followed by insertion of an implantable loop recorder (ILR) as per routine clinical care within 3 months of index stroke. Remote ILR follow-up will be used to allocate patients to a study or control group determined by the presence or absence of AF as defined by ILR monitoring.Baseline data collection, noninvasive electrocardiographic data analysis, and imaging postprocessing will be performed at the time of enrollment. Primary analysis will be performed following 12 months of continuous ILR monitoring, with interim and delayed analyses performed at 6 months and 2 and 3 years, respectively.The CARM-AF Study will use atrial structural and electrocardiographic metrics to identify patients with AF, or at high risk of developing AF, who may benefit from early initiation of anticoagulation.

We present an open-source software pipeline to create patient-specific left atrial (LA) models with fibre orientations and a fibrosis map, suitable for electrophysiology simulations. The semi-automatic pipeline takes as input a contrast enhanced magnetic resonance angiogram, and a late gadolinium enhanced (LGE) contrast magnetic resonance (CMR). Five operators were allocated 20 cases each from a set of 50 CMR datasets to create a total of 100 models to evaluate inter/intra-operator variability. Each output model consisted of (1) a labelled surface mesh open at the pulmonary veins (PV) and mitral valve (MV), (2) fibre orientations mapped from a diffusion tensor MRI human atlas, (3) fibrosis map from the LGE-CMR scan, and (4) simulation of local activation time (LAT) and phase singularity (PS) mapping. We evaluated reproducibility in our pipeline by comparing agreement in shape of the output meshes, fibrosis distribution in the LA body, and fibre orientations; simulations outputs were evaluated comparing total activation times of LAT maps, mean conduction velocity (CV), and structural similarity index measure (SSIM) of PS maps. Our workflow allows a single model to be created in 16.72 +/- 12.25 minutes. Results in this abstract are reported as inter/intra. Shape only differed noticeably with users' selection of the MV and the length of the PV from the ostia to the distal end; fibrosis agreement (0.91/0.99 ICC) and fibre orientation agreement (60.63/71.77 %) were high. LAT maps showed good agreement, the median of the absolute difference of the total activation times was 2.02ms/1.37ms. The average of the mean CV difference was -4.04mm/s / 2.1mm/s. PS maps showed a moderately good agreement with SSIM of 0.648/0.608. Although we found notable differences in the models due to user input, our tests show that operator variability was comparable to that of image resolution or fibre estimation., Comment: 17 pages, 7 figures, submitted for review at Journal of Computers in Biology and Medicine (in press)

Cardiac stereotactic body radiation therapy (cSBRT) is a non-invasive treatment modality that has been recently reported as an effective treatment for ventricular arrhythmias refractory to medical therapy and catheter ablation. The approach leverages tools developed and refined in radiation oncology, where experience has been accumulated in the treatment of a wide variety of malignant conditions. However, important differences exist between rapidly dividing malignant tumor cells and fully differentiated myocytes in pathologically remodeled ventricular myocardium, which represent the respective radiation targets. Despite its initial success, little is known about the radiobiology of the anti-arrhythmic effect cSBRT. Pre-clinical data indicates a late fibrotic effect of that appears between 3 and 4 months following cSBRT, which may result in conduction slowing and block. However, there is clear clinical evidence of an anti-arrhythmic effect of cSBRT that precedes the appearance of radiation induced fibrosis for which the mechanism is unclear. In addition, the data to date suggests that even the late anti-arrhythmic effect of cSBRT is not fully attributable to radiation.-induced fibrosis. Pre-clinical data has identified upregulation of proteins expected to result in both increased cell-to-cell coupling and excitability in the early post cSBRT period and demonstrated an associated increase in myocardial conduction velocity. These observations indicate a complex response to radiotherapy and highlight the lack of clarity regarding the different stages of the anti-arrhythmic mechanism of cSBRT. It may be speculated that in the future cSBRT therapy could be planned to deliver both early and late radiation effects titrated to optimize the combined anti-arrhythmic efficacy of the treatment. In addition to these outstanding mechanistic questions, the optimal patient selection, radiation modality, radiation dose and treatment planning strategy are currently being investigated. In this review, we consider the structural and functional effect of radiation on myocardium and the possible anti-arrhythmic mechanisms of cSBRT. Review of the published data highlights the exciting prospects for the development of knowledge and understanding in this area in which so many outstanding questions exist.

The effect of chronic ischemic scar on repolarization is unclear, with conflicting results from human and animal studies. An improved understanding of electrical remodeling within scar and border zone tissue may enhance substrate-guided ablation techniques for treatment of ventricular tachycardia. Computational modeling studies have suggested increased dispersion of repolarization during epicardial, but not endocardial, left ventricular pacing, in close proximity to scar. However, the effect of endocardial pacing near scarThe purpose of this study was to investigate the effect of scar and pacing location on local repolarization in a porcine myocardial infarction model.Six model pigs underwent late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging followed by electroanatomic mapping of the left ventricular endocardium. LGE-CMR images were registered to the anatomic shell and scar defined by LGE. Activation recovery intervals (ARIs), a surrogate for action potential duration, and local ARI gradients were calculated from unipolar electrograms within areas of late gadolinium enhancement (aLGE) and healthy myocardium.There was no significant difference between aLGE and healthy myocardium in mean ARI (304.20 ± 19.44 ms vs 300.59 ± 19.22 ms;Our findings suggest that changes in ARI are not an intrinsic property of surviving myocytes within scar, and endocardial pacing close to scar does not affect local repolarization.

BackgroundPoor psychological well-being among healthcare staff has implications for staff sickness and absence rates, and impacts on the quality, cost and safety of patient care. Although numerous studies have explored the well-being of hospice staff, study findings vary and the evidence has not yet been reviewed and synthesised. Using job demands-resources (JD-R) theory, this review aimed to investigate what factors are associated with the well-being of hospice staff.MethodsWe searched MEDLINE, CINAHL and PsycINFO for peer-reviewed quantitative, qualitative or mixed-methods studies focused on understanding what contributes to the well-being of hospice staff who provide care to patients (adults and children). The date of the last search was 11 March 2022. Studies were published from 2000 onwards in the English language and conducted in Organisation for Economic Co-operation and Development countries. Study quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis was conducted using a result-based convergent design, which involved an iterative, thematic approach of collating data into distinct factors and mapping these to the JD-R theory.ResultsA total of 4016 unique records were screened by title and abstract, 115 full-text articles were retrieved and reviewed and 27 articles describing 23 studies were included in the review. The majority of the evidence came from studies of staff working with adult patients. Twenty-seven individual factors were identified in the included studies. There is a strong and moderate evidence that 21 of the 27 identified factors can influence hospice staff well-being. These 21 factors can be grouped into three categories: (1) those that are specific to the hospice environment and role, such as the complexity and diversity of the hospice role; (2) those that have been found to be associated with well-being in other similar settings, such as relationships with patients and their families; and (3) those that affect workers regardless of their role and work environment, that is, that are not unique to working in a healthcare role, such as workload and working relationships. There was strong evidence that neither staff demographic characteristics nor education level can influence well-being.DiscussionThe factors identified in this review highlight the importance of assessing both positive and negative domains of experience to determine coping interventions. Hospice organisations should aim to offer a wide range of interventions to ensure their staff have access to something that works for them. These should involve continuing or commencing initiatives to protect the factors that make hospices good environments in which to work, as well as recognising that hospice staff are also subject to many of the same factors that affect psychological well-being in all work environments. Only two studies included in the review were set in children’s hospices, suggesting that more research is needed in these settings.PROSPERO registration numberCRD42019136721 (Deviations from the protocol are noted in Table 8, Supplementary material).

There is increasing evidence to suggest that atrial fibrillation is associated with a heightened risk of dementia. The mechanism of interaction is unclear. Atrial fibrillation-induced cerebral infarcts, hypoperfusion, systemic inflammation, and anticoagulant therapy-induced cerebral microbleeds, have been proposed to explain the link between these conditions. An understanding of the pathogenesis of atrial fibrillation-associated cognitive decline may enable the development of treatment strategies targeted towards the prevention of dementia in atrial fibrillation patients. The aim of this review is to explore the impact that existing atrial fibrillation treatment strategies may have on cognition and the putative mechanisms linking the two conditions. This review examines how components of the ‘Atrial Fibrillation Better Care pathway’ (stroke risk reduction, rhythm control, rate control, and risk factor management) may influence the trajectory of atrial fibrillation-associated cognitive decline. The requirements for further prospective studies to understand the mechanistic link between atrial fibrillation and dementia and to develop treatment strategies targeted towards the prevention of atrial fibrillation-associated cognitive decline, are highlighted.

AimsExisting strategies that identify post-infarct ventricular tachycardia (VT) ablation target either employ invasive electrophysiological (EP) mapping or non-invasive modalities utilizing the electrocardiogram (ECG). Their success relies on localizing sites critical to the maintenance of the clinical arrhythmia, not always recorded on the 12-lead ECG. Targeting the clinical VT by utilizing electrograms (EGM) recordings stored in implanted devices may aid ablation planning, enhancing safety and speed and potentially reducing the need of VT induction. In this context, we aim to develop a non-invasive computational-deep learning (DL) platform to localize VT exit sites from surface ECGs and implanted device intracardiac EGMs.Methods and resultsA library of ECGs and EGMs from simulated paced beats and representative post-infarct VTs was generated across five torso models. Traces were used to train DL algorithms to localize VT sites of earliest systolic activation; first tested on simulated data and then on a clinically induced VT to show applicability of our platform in clinical settings. Localization performance was estimated via localization errors (LEs) against known VT exit sites from simulations or clinical ablation targets. Surface ECGs successfully localized post-infarct VTs from simulated data with mean LE = 9.61 ± 2.61 mm across torsos. VT localization was successfully achieved from implanted device intracardiac EGMs with mean LE = 13.10 ± 2.36 mm. Finally, the clinically induced VT localization was in agreement with the clinical ablation volume.ConclusionThe proposed framework may be utilized for direct localization of post-infarct VTs from surface ECGs and/or implanted device EGMs, or in conjunction with efficient, patient-specific modelling, enhancing safety and speed of ablation planning.

Purpose Atrial fibrillation is associated with an increased risk of cognitive impairment. It is unclear whether the restoration of sinus rhythm with catheter ablation may modify this risk. We conducted a systematic review of studies comparing cognitive outcomes following catheter ablation with medical therapy (rate and/or rhythm control) in atrial fibrillation. Methods Searches were performed on the following databases from their inception to 17 October 2021: PubMed, OVID Medline, Embase and Cochrane Library. The inclusion criteria comprised studies comparing catheter ablation against medical therapy (rate and/or rhythm control in conjunction with anticoagulation where appropriate) which included cognitive assessment and/or a diagnosis of dementia as an outcome. Results A total of 599 records were screened. Ten studies including 15,886 patients treated with catheter ablation and 42,684 patients treated with medical therapy were included. Studies which compared the impact of catheter ablation versus medical therapy on quantitative assessments of cognitive function yielded conflicting results. In studies, examining new onset dementia during follow-up, catheter ablation was associated with a lower risk of subsequent dementia diagnosis compared to medical therapy (hazard ratio: 0.60 (95% confidence interval 0.42–0.88, p Conclusion The accumulating evidence linking atrial fibrillation with cognitive impairment warrants the design of atrial fibrillation treatment strategies aimed at minimising cognitive decline. However, the impact of catheter ablation and atrial fibrillation medical therapy on cognitive decline is currently uncertain. Future studies investigating atrial fibrillation treatment strategies should include cognitive outcomes as important clinical endpoints.

Vortex induced vibrations (VIV) of a circular cylinder have been investigated experimentally using a cyberphysical apparatus with m∗ = 8, ζ = 0.005, and Re = 4000. This study considers the application of proper orthogonal decomposition (POD) and spectral POD (SPOD) analysis to the wake dynamics of the low-mass-ratio VIV of a circular cylinder in the lower branch at U∗ = 7.5. SPOD has been previously shown to better separate frequency-centered modal dynamics, compared to POD. Coherent POD and SPOD modes were compared and the newly separated third SPOD mode pair was found to have a periodicity characteristic of vortex shedding and a peak in the temporal coefficient spectra at St = f D/U∞ = 0.2248. The literature has identified that the wake dynamics within the lower branch are synchronized to the cylinder motion; however the present study suggests that some hidden dynamics persist at the Strouhal frequency. Low order models based on the first eight POD and SPOD modes were compared, and it was found that the filtering operation in SPOD removes the uncorrelated stochastic energy component of the POD modes while producing a comparable representation of the coherent deterministic part of the wake dynamics. Using SPOD to separate the distinct frequency-centered dynamics into unique, interpretable mode pairs will simplify future efforts to develop sparse dynamical models of the flow.

Aims To assess the dose‐related effects of sotagliflozin, a novel dual inhibitor of sodium‐glucose co‐transporters‐1 and ‐2, in type 1 diabetes (T1D). Materials and methods In this 12‐week, multicentre, randomized, double‐blind, placebo‐controlled dose‐ranging trial, adults with T1D were randomized to once‐daily placebo (n = 36) or sotagliflozin 75 mg (n = 35), 200 mg (n = 35) or 400 mg (n = 35). Insulin was maintained at baseline doses. The primary endpoint was least squares mean (LSM) change in glycated haemoglobin (HbA1c) from baseline. Other endpoints included proportion of participants with ≥0.5% HbA1c reduction and assessments of 2‐hour postprandial glucose (PPG), weight, and urinary glucose excretion (UGE). Results From a mean baseline of 8.0% ± 0.8% (full study population), placebo‐adjusted LSM HbA1c decreased by 0.3% (P = .07), 0.5% (P

Secure email is increasingly being touted as usable by novice users, with a push for adoption based on recent concerns about government surveillance. To determine whether secure email is ready for grassroots adoption, we employ a laboratory user study that recruits pairs of novice users to install and use several of the latest systems to exchange secure messages. We present both quantitative and qualitative results from 28 pairs of novices as they use Private WebMail (Pwm), Tutanota, and Virtru and 10 pairs of novices as they use Mailvelope. Participants report being more at ease with this type of study and better able to cope with mistakes since both participants are “on the same page.” We find that users prefer integrated solutions over depot-based solutions and that tutorials are important in helping first-time users. Finally, our results demonstrate that Pretty Good Privacy using manual key management is still unusable for novice users, with 9 of 10 participant pairs failing to complete the study.

This editorial introduces the second of two special issues of Cultural Trends dedicated to identifying and interpreting numbers of visits to museums since the nineteenth century. The first exclusively considered UK museums – English museums, in particular. The present issue adds to that coverage of museum visiting in England, Wales and Scotland, as well as addressing visiting in France, Australia and New Zealand. The editorial reflects on the transnational and global dynamics that shaped the development and counting of museum visits.

Despite, or perhaps because of, being only 45 miles apart and of a similar size, Glasgow and Edinburgh are famous for their historical and cultural differences and notorious for their rival...

AIM To identify child and parent outcomes relevant to having a gastrostomy, and to specify outcomes believed to be particularly salient to type of diet (formula vs blended food). METHOD Twenty parents, two children (both 12y), and 41 professionals (dietitians [n=10]; nurses [n=12]; paediatricians [n=12]; speech and language therapists [n=7)]) were recruited. Parents and children were interviewed; professionals participated in focus groups. Children (2-18y) represented included those on formula (n=11), blended-food (n=7), and mixed (n=2) diets. All had been tube-fed for at least 6 months. Neurological, genetic, and metabolic conditions were represented. RESULTS Participants identified a range of children's outcomes relevant to a gastrostomy, including physical health, gastrointestinal symptoms, sleep, and time spent feeding. The children described experiences of exclusion caused by being tube-fed. Time, sleep, and emotional health were regarded as most salient to understanding parents' gastrostomy outcomes. Participants believed type of diet would most likely effect gastrointestinal symptoms, time spent feeding, sleep, and physical health. INTERPRETATION Findings indicate a number of refinements to, and allow further specification of, the current 'initial' core outcome set for tube-fed children. Findings also have implications for choice of outcomes measures. Further qualitative research with children and young people is needed. What this paper adds Sleep is a key outcome for children and parents. Gastrointestinal symptoms and physical health were regarded as outcomes most likely to be affected by type of diet. Well-being and participation were identified as key distal outcomes. Gastrostomies are complex interventions. Further specification of the core outcome set is possible.

The privacy guaranteed by secure messaging applications relies on users completing an authentication ceremony to verify they are using the proper encryption keys. We examine the feasibility of social authentication, which partially automates the ceremony using social media accounts. We implemented social authentication in Signal and conducted a within-subject user study with 42 participants to compare this with existing methods. To generalize our results, we conducted a Mechanical Turk survey involving 421 respondents. Our results show that users found social authentication to be convenient and fast. They particularly liked verifying keys asynchronously, and viewing social media profiles naturally coincided with how participants thought of verification. However, some participants reacted negatively to integrating social media with Signal, primarily because they distrust social media services. Overall, automating the authentication ceremony and distributing trust with additional service providers is promising, but this infrastructure needs to be more trusted than social media companies.

Vortex-induced vibrations of a circular cylinder has been investigated experimentally using a cyber-physical apparatus with m ∗ = 8 and ζ = 0.005 . The Reynolds number is held fixed at Re = 4000 , with the reduced velocity being modified via a change in the structural natural frequency in a cyber-physical controller. The study focus is on a detailed analysis of the wake dynamics in the desynchronization region of VIV, where the cylinder motion is no longer synchronized to the wake vortex shedding. The analysis is presented using Proper Orthogonal Decomposition (POD), Phase Averaging, and a novel technique that improves the POD approach by shifting the reference frame of the velocity field data. Each analysis approach is targeted towards efficiently extracting the coherent motions from the wake flow and developing a heuristic model that empirically links the dynamically relevant modes. The results demonstrate that coherent motions persist in the desynchronization region and involve the interaction of two frequencies: the vortex shedding frequency, f VS and the lock-in oscillation frequency of the cylinder, f o . The interaction between these two frequencies produces changes in the fluctuating field dynamics that are centered on the beat frequency, f VS - f o . When the vortex shedding frequency and oscillation frequency are in phase, the cylinder exhibits a strong dynamic response. As they move out of phase, the cylinder response decays. These dynamics of the wake are captured in the first six POD modes. Moreover, the amplitude of these modes is shown to be linked to POD modes representing low frequency variations in the base flow with time.

This chapter is written from the perspective of a practitioner and explores a range of paradoxes in museums and in the museological literature which may serve as starting points for conversations with philosophers. These include questions of definition and mission, intrinsic versus instrumental value, whether museums actively shape society or serve as a passive reflection, whether their main function is to produce liberating knowledge or express communal identities, whether traditional or progressive museums are the most ‘traditional’, whether museums are trying to serve idealized or real visitors and, ultimately, whether museums are rational or ritual institutions.

Pressure on UK local authority managed or funded cultural services has become a given at least since the Thatcherite rejection in the 1980s of the post-war consensus. While there was significant investment under New Labour, this was tied to economic and social policy in ways that reflected a continuation of underlying neoliberal principles (Hesmondhalgh et al, 2015a, b). Heightened by the global financial crisis of 2008, the current regime of austerity has created a continuous battle to retain and manage diminishing cultural services and grants to independent cultural organisations. In response, the cultural sector has over the past few decades become more aligned with wider economic and social development agendas (Gray, 2007; 2017, Throsby, 2010) and consequently has had to adapt organisational structures and approaches in order to reposition arts and culture. Kent Council’s recent transfer of culture into the economic development department, and the construction of narratives of its operations as “delivering economic growth, skills development and community wellbeing” (Witton, 2015) is a familiar move, replicated across the UK and internationally (Knell and Taylor, 2011; Grodach and Seman, 2013; Overmans and Noordegraf, 2014). In this context the experience of Glasgow City Council’s organisational change in how it supported arts, culture and sport is viewed as one of success, particularly in helping the city redefine its image enhancing its economic wellbeing and developing its cultural infrastructure. This case study focuses on Culture and Sport Glasgow (CSG) – branded now as Glasgow Life – which is the result of a series of major organisational shifts over the past 30 years and is widely seen as effective in supporting the wider strategy of urban redevelopment undertaken since the 1980s. Glasgow Life has avoided the need for large-scale closures of services such as libraries and museums and has been able to maintain or increase capital investment in new and refurbished facilities, despite the City being under financial pressures similar to those experienced by most UK local authorities. This case study explores how such success has been achieved and asks whether in adapting to the fiscal and political environment council services have faced, the Glasgow Life experience offers wider learning and insights – both to large scale civic services and to the cultural sector in general.

IntroductionPre hospital trauma care is often delivered by dual crewed ambulances supported by additional resources as necessary and available. Coordinating resuscitation of a critically injured patient may require multiple simultaneous actions. Equally, a large number of practitioners can hinder patient care if not coordinated.AimsTo describe a multi disciplinary, scaleabe approach to pre hospital trauma care suitable for small and large multi disciplinary teams. Methods The MCI medical team (as part of Motorsport Rescue Services) is a PHECC-registered multidisciplinary team, which provides medical cover at Motorcycle road racing events in Ireland. The MCI medical team has significant experience of major trauma and routinely performs prehospital anaesthesia for trauma patients. We have evolved a pit crew approach to trauma care with pre defined roles and interventions assigned to a five person team, three clinical members, a scribe and a team lead. The approach is both scalable and collapsible, meaning that if multiple patients are present, roles can be merged; if additional clinical input is required, roles can also be supplemented. Each team member carries equipment and medications specific to their role, allowing efficiencies at the patients side.ResultsThe pit crew approach to pre hospital trauma care has evolved over a decade and is routinely implemented at motorcycle road races in Ireland.ConclusionsThe pit crew trauma approach, although applicable to a pre defined five person team in unique circumstances, may also be applicable to ad hoc clinical teams that typically form in the pre hospital arena.

The Aboriginal Cultural Heritage Act 2003 challenged the hegemony that Western, archaeological methodologies has held over Indigenous cultural heritage in Australia. By choosing to relinquish state control and authority over cultural heritage in favour of the expertise of Indigenous people, the Act created a unique and innovative heritage policy. Over the 10 years the Act has been in force, it has seen a variety of approaches adopted as part of myriad projects. This has created a mature field of practice for investigation and analysis. This article examines and critiques the Act to determine its successes and weaknesses. In doing so, it offers opportunities for other policy-makers to consider as part of policy review.

Myocardial infarction (MI) survivors are at risk of complications including heart failure and malignant arrhythmias.We undertook serial imaging of swine following MI with the aim of characterizing the longitudinal left ventricular (LV) remodeling in a translational model of ischemia-reperfusion-mediated MI.Eight Yorkshire swine underwent mid left anterior descending coronary artery balloon occlusion to create an ischemia-reperfusion experimental model of MI.1.5T Philips Achieva scanner. Serial cardiac MRI was performed at 16, 33, and 62 days post-MI, including cine imaging, native and postcontrast TRegions of interest were selected on the parametric maps to assess native TParameters estimated at more than two timepoints were compared with a one-way repeated measures analysis of variance. Parametric mapping data were analyzed using a generalized linear mixed model corrected for multiple observations. A result was considered statistically significant at P 0.05.All animals developed anteroseptal akinesia and hyperenhancement on DB-LGE with a central core of nonenhancing tissue. Mean hyperenhancement volume did not change during the observation period, while the central core contracted from 2.2 ± 1.8 ml at 16 days to 0.08 ± 0.19 ml at 62 days (P = 0.008). Native TIn this swine model of MI, serial quantitative cardiac MR exams allow characterization of LV remodeling and scar formation.2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.

Atrial fibrillation (AF) is a common supraventricular arrhythmia which is commonly found in older adults. It is associated with an increased risk of stroke and has a detrimental effect on quality of life. Management of AF involves an attempt to reduce the increased risk of stroke and to treat the symptoms that result from a high (or low) ventricular rate as well as, in some cases, the atrial rhythm itself. The management of AF involves a comprehensive assessment of a patient’s individual stroke and bleeding risk and a careful documentation of the impact of their symptoms on quality of life. Treatment options range from conservative to highly invasive. Selecting the appropriate combination from the range of options necessitates an understanding of the risks and benefits of each, so that the patient and physician can jointly identify the most appropriate management strategy.

Highlights • Locally personalised atrial electrophysiology. • Predictive simulations. • Catheter measurements. • Clinical time scale. • Atrial fibrillation., Graphical abstract, Biophysical models of the atrium provide a physically constrained framework for describing the current state of an atrium and allow predictions of how that atrium will respond to therapy. We propose a work flow to simulate patient specific electrophysiological heterogeneity from clinical data and validate the resulting biophysical models. In 7 patients, we recorded the atrial anatomy with an electroanatomical mapping system (St Jude Velocity); we then applied an S1–S2 electrical stimulation protocol from the coronary sinus (CS) and the high right atrium (HRA) whilst recording the activation patterns using a PentaRay catheter with 10 bipolar electrodes at 12 ± 2 sites across the atrium. Using only the activation times measured with a PentaRay catheter and caused by a stimulus applied in the CS with a remote catheter we fitted the four parameters for a modified Mitchell–Schaeffer model and the tissue conductivity to the recorded local conduction velocity restitution curve and estimated local effective refractory period. Model parameters were then interpolated across each atrium. The fitted model recapitulated the S1–S2 activation times for CS pacing giving a correlation ranging between 0.81 and 0.98. The model was validated by comparing simulated activations times with the independently recorded HRA pacing S1–S2 activation times, giving a correlation ranging between 0.65 and 0.96. The resulting work flow provides the first validated cohort of models that capture clinically measured patient specific electrophysiological heterogeneity.

Magnetic resonance imaging (MRI) is the gold standard for defining myocardial substrate in 3D and can be used to guide ventricular tachycardia ablation. We describe the feasibility of using a prototype magnetic resonance-guided electrophysiology (MR-EP) system in a pre-clinical model to perform real-time MRI-guided epicardial mapping, ablation, and lesion imaging with active catheter tracking.Experiments were performed in vivo in pigs (n = 6) using an MR-EP guidance system research prototype (Siemens Healthcare) with an irrigated ablation catheter (Vision-MR, Imricor) and a dedicated electrophysiology recording system (Advantage-MR, Imricor). Following epicardial access, local activation and voltage maps were acquired, and targeted radiofrequency (RF) ablation lesions were delivered. Ablation lesions were visualized in real time during RF delivery using MR-thermometry and dosimetry. Hyper-acute and acute assessment of ablation lesions was also performed using native T1 mapping and late-gadolinium enhancement (LGE), respectively. High-quality epicardial bipolar electrograms were recorded with a signal-to-noise ratio of greater than 10:1 for a signal of 1.5 mV. During epicardial ablation, localized temperature elevation could be visualized with a maximum temperature rise of 35 °C within 2 mm of the catheter tip relative to remote myocardium. Decreased native T1 times were observed (882 ± 107 ms) in the lesion core 3-5 min after lesion delivery and relative location of lesions matched well to LGE. There was a good correlation between ablation lesion site on the iCMR platform and autopsy.The MR-EP system was able to successfully acquire epicardial voltage and activation maps in swine, deliver, and visualize ablation lesions, demonstrating feasibility for intraprocedural guidance and real-time assessment of ablation injury.

Outlier detection has been shown to be a promising machine learning technique for a diverse array of felds and problem areas. However, traditional, supervised outlier detection is not well suited for problems such as network intrusion detection, where proper labelled data is scarce. This has created a focus on extending these approaches to be unsupervised, removing the need for explicit labels, but at a cost of poorer performance compared to their supervised counterparts. Recent work has explored ways of making up for this, such as creating ensembles of diverse models, or even diverse learning algorithms, to jointly classify data. While using unsupervised, heterogeneous ensembles of learning algorithms has been proposed as a viable next step for research, the implications of how these ensembles are built and used has not been explored.

We present a comprehensive measurement study of the Steam gaming network, the first complete examination of any major gaming network, comprising all 108.7 million user accounts and 384.3 million owned games. We examine gamer behavior across the dimensions of social connectivity, playtime, game ownership, genre affinity, and monetary expenditure. As a whole, gamer behavior is highly diverse and characterized by heavy-tailed distributions. Most players exhibit modest behaviors in terms of the number of minutes played per day and the amount of money spent on games, though there is a long tail withoutliers, such as gamers who maximize achievements or playtime stats, or gamers who collect games they don't play. We find some strong correlations that show that players tend to befriend those who are similar in terms of popularity, playtime, money spent, and games owned. We collect a second snapshot of the Steam network and show that our findings are robust across both measurements. We conclude by relating these findings to other relevant studies, including gamer stereotypes, game addiction, and social networking.

We measure the prevalence and uses of TLS proxies using a Flash tool deployed with a Google AdWords campaign. We generate 2.9 million certificate tests and find that 1 in 250 TLS connections are TLS-proxied. The majority of these proxies appear to be benevolent, however we identify over 1,000 cases where three malware products are using this technology nefariously. We also find numerous instances of negligent, duplicitous, and suspicious behavior, some of which degrade security for users without their knowledge. Distinguishing these types of practices is challenging in practice, indicating a need for transparency and user awareness.

Low κ Organosilicate Glass (OSG) films are being proliferated into new IC device architectures with CMP requirements spanning a wide range (highly selective to non-selective, low polish rates to high polish rates). This study aims to understand the relationship between these OSG film properties (both bulk and surface) and their planarization response, especially removal rate (RR). Eight OSG films were polished along with TEOS oxide using two barrier slurries. The films ranged in carbon content from 8 to 24 % and in nanoindentation elastic modulus from 5.5 to 21.8 GPa. Counterintuitively, higher mechanical strength (i.e., hardness, elastic modulus) of the low κ film did not result in lower polish rates; but was in agreement with previously noted behavior [1]. Removal rates also did not correlate to key OSG film properties such as refractive index (RI), dielectric constant (κ), or total carbon content (by X-ray photoelectron spectroscopy). However, an inverse relationship was observed between RR and the bulk chemical bonding structure (Si-CH3/Si-O ratio) as determined by transmission infrared spectroscopy (FT-IR) measurements (see Figure 1). In addition, a correlation between RR and OSG film’s surface free energy post-polish (measured from water and diiodomethane contact angles) was also observed. Based on the above findings, a mechanistic understanding of low κ OSG polishing was developed. [1] L. Matz, M. Haas, M. O’Neill, R. Sawayda, A. Meyers, in Advanced Metallization Conference (AMC) (eds A. J. McKerrow, Y. Shacham-Diamand, S. Shingubara and Y. Shimogaki), Materials Research Society, Warrandale, PA, 463 (2009) Figure 1

This study sought to test the feasibility of a purpose-built, integrated software platform to process, analyze, and overlay cardiac magnetic resonance (CMR) data in real time within a combined cardiac catheter laboratory and magnetic resonance imaging scanner suite (X-MRI) to guide left ventricular (LV) lead implantation.Suboptimal LV lead position is a major determinant of poor cardiac resynchronization therapy (CRT) response, and the optimal site is highly patient specific. Pacing myocardial scar is associated with poorer outcomes; conversely, targeting latest mechanical activation (LMA) may improve them.Fourteen patients (age 74 ± 5.1 years; New York Heart Association functional class: 2.7 ± 0.4; 86% ischemic with ejection fraction 27 ± 7.6%; QRSd: 157 ± 19 ms) underwent CMR followed by immediate CRT implantation using derived scar and dyssynchrony data, overlaid onto fluoroscopy in an X-MRI suite. Rapid LV segmentation enabled detailed scar quantification, identification of LMA segments, and selection of myocardial targets. At coronary venography, the CMR-derived 3-dimensional shell was fused, enabling identification of viable venous targets subtended by target segments for LV lead placement.The platform was successful in all 14 patients, of whom 10 (71%) were paced in pre-procedurally defined target segments. Pacing in CMR-defined target segments (out of scar) showed a significant decrease in the LV capture threshold (mean difference: 2.4 [1.5 to 3.2]; p 0.001) and shorter paced QRS duration (mean difference: 25 [15 to 34]; p 0.001) compared with pacing in areas of CMR determined scar. In 5 (36%) patients with extensive scar in the posterolateral wall, CMR guidance enabled successful lead delivery in an alternative anatomically favorable site. Radiation dose and implant times were similar to historical controls (p = NS).Real-time CMR-guided LV lead placement is feasible and achievable in a single clinical setting and may prove helpful to preferentially select sites for LV lead placement.

Secure email is increasingly being touted as usable by novice users, with a push for adoption based on recent concerns about government surveillance. To determine whether secure email is for grassroots adoption, we employ a laboratory user study that recruits pairs of novice to install and use several of the latest systems to exchange secure messages. We present quantitative and qualitative results from 25 pairs of novice users as they use Pwm, Tutanota, and Virtru. Participants report being more at ease with this type of study and better able to cope with mistakes since both participants are "on the same page". We find that users prefer integrated solutions over depot-based solutions, and that tutorials are important in helping first-time users. Hiding the details of how a secure email system provides security can lead to a lack of trust in the system. Participants expressed a desire to use secure email, but few wanted to use it regularly and most were unsure of when they might use it., 34th Annual ACM Conference on Human Factors in Computing Systems (CHI 2016)

Glasgow’s reputation as a leader in culture-led urban regeneration dates from 1990, when it was European Capital of Culture. While this event successfully rebranded the city, accounts (both positive and negative) miss two key histories. First, in the Georgian and Victorian periods and even in the 1970s (when the city was at its nadir), Glasgow had a substantial tourist economy. Second, Glasgow’s rebranding as a cultural tourist destination was not just based on marketing of expensive events and new attractions targeting tourists, but was founded on substantial pre-existing assets of international quality which attracted large numbers of local people from all socio-economic groups. Glasgow’s use of cultural amenities for economic regeneration only worked because these formed part of an overall inclusive vision of civic life.

This article applies the idea that culture is a response to human awareness of mortality to museums through the lens of two contrasting approaches to understanding death and dying: Terror managemen...

This case study compares the controversies arising from two museum displays relating to the religion in Glasgow, written from the perspective of a practitioner involved in both. One, in 1993, involved the opening of the first museum of world religions in the UK and the other, in 2009, a programme of lesbian, gay, bisexual, transgender and intersex art in Glasgow’s Gallery of Modern Art. The main continuity amongst the protesters was that museums should represent Christianity and Christian values as the majority heritage of the country and not give ‘special treatment’ to minorities. The main changes over the period were: the appropriation by Christian protestors of the language of rights, and in particular a claim to a ‘right’ not to be offended; a resentment that putatively violent minority faiths were able to enforce greater respect than Christianity; and the way the Internet enabled protestors to organise and sustain a campaign over a long period. The article concludes with reflections on the implicatio...

The research on the health benefits of intensive engagement with creative and cultural activities through art therapy and workshops led by artists is well recognised in the literature on cultural impact. In general, this engagement involves small numbers and, in the current climate, is unlikely to receive sufficient investment to make a difference at a population level. Less recognised is an emerging field of epidemiological research on the health impact of ‘general cultural attendance’. This provides evidence that simply going to a museum, art gallery, film or concert on a regular basis increases longevity, and that culture is a separate variable. This article summarises this evidence and looks at the strategic implications for cultural organisations from the perspective of a practitioner. If cultural attendance can help address health inequalities, and if the best way to overcome the psychological and social barriers to cultural attendance is personal contact with a trusted guide, the article outlines a system where voluntary and statutory organisations can refer people to cultural organisations who might benefit from them. The former would need to be able to guarantee a high quality and friendly welcome that recognises the needs of first‐time users from excluded groups. Developed among a network of cultural organisations with voluntary and public sector partners, such a system could reach sufficient numbers to have a health impact on a population level.

The social impact of the arts, by Eleonora Belfiore and Oliver Bennett, Basingstoke, Palgrave, 2008, 240 pp., £45 (hardback), ISBN 978-0-230-57255-3 This short book is a great read, full of fascina...

Le dernier en date des musees ecossais a suscite bien des controverses, il a ete l'objet de critiques ou de louanges egalement vehementes. En presentant un large panorama de quelques-unes des grandes religions du monde, le musee St Mungo veut avant tout transmettre un vibrant message en faveur de la comprehension et du respect mutuels. L'auteur, conservateur principal (pour l'histoire) des musees de Glasgow, etait a la tete de l'equipe qui a concu le nouveau musee. Avant d'entrer au service des musees de la ville de Glasgow en 1990, il etait conservateur du musee Springburn, etablissement independant repute pour etre «le premier musee communautaire authentique de Grande-Bretagne».