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Following the traditional doctrine of the "regulatory state", regulatory agencies should be given very focused mandates and stay away from the politicized realm of distributive policies and decisions. An opposing perspective would state that if regulatory agencies can contribute to economic redistribution, positive results such as network expansion, economies of scale, and fiscal efficiency will ultimately lead to lower levels of regulatory failure. This article tests whether, in countries of high socio‐economic inequality, such as Brazil, the active incorporation of distributive considerations by regulatory agencies leads to lower levels of failure. Through the analysis of the activities of seven Brazilian network regulatory agencies, the article develops theory‐driven expectations and tests these expectations using crisp set Qualitative Comparative Analysis (csQCA). It concludes that not prioritizing redistribution is a necessary but not a sufficient condition for regulatory agencies' failure. In most types of failure, a lack of priority to redistribution leads to failure when combined with low regulatory capacity and low levels of competence. [ABSTRACT FROM AUTHOR]

Background: Incomplete atrial lesions resulting in pulmonary vein‐left atrium reconnection after pulmonary vein antrum isolation (PVAI), are related to atrial fibrillation (AF) recurrence. Unfortunately, during the PVAI procedure, fluoroscopy and electroanatomic mapping cannot accurately determine the location and size of the ablation lesions in the atrial wall and this can result in incomplete PVAI lesions (PVAI‐L) after radiofrequency catheter ablation (RFCA). Aim: We seek to evaluate whether cardiac magnetic resonance (CMR), immediately after RFCA of AF, can identify PVAI‐L by characterizing the left atrial tissue. Methods: Ten patients (63.1 ± 5.7 years old, 80% male) receiving a RFCA for paroxysmal AF underwent a CMR before (<1 week) and after (<1 h) the PVAI. Two‐dimensional dark‐blood T2‐weighted short tau inversion recovery (DB‐STIR), Three‐dimensional inversion‐recovery prepared long inversion time (3D‐TWILITE) and three‐dimensional late gadolinium enhancement (3D‐LGE) images were performed to visualize PVAI‐L. Results: The PVAI‐L was visible in 10 patients (100%) using 3D‐TWILITE and 3D‐LGE. Conversely, On DB‐STIR, the ablation core of the PAVI‐L could not be identified because of a diffuse high signal of the atrial wall post‐PVAI. Microvascular obstruction was identified in 7 (70%) patients using 3D‐LGE. Conclusion: CMR can visualize PVAI‐L immediately after the RFCA of AF even without the use of contrast agents. Future studies are needed to understand if the use of CMR for PVAI‐L detection after RFCA can improve the results of ablation procedures. [ABSTRACT FROM AUTHOR]

The c.40_42delAGA variant in the phospholamban gene (PLN) has been associated with dilated and arrhythmogenic cardiomyopathy, with up to 70% of carriers experiencing a major cardiac event by age 70. However, there are carriers who remain asymptomatic at older ages. To understand the mechanisms behind this incomplete penetrance, we evaluated potential phenotypic and genetic modifiers in 74 PLN:c.40_42delAGA carriers identified in 36,339 participants of the Lifelines population cohort. Asymptomatic carriers (N = 48) showed shorter QRS duration (− 5.73 ms, q value = 0.001) compared to asymptomatic non-carriers, an effect we could replicate in two different independent cohorts. Furthermore, symptomatic carriers showed a higher correlation (rPearson = 0.17) between polygenic predisposition to higher QRS (PGSQRS) and QRS (p value = 1.98 × 10–8), suggesting that the effect of the genetic variation on cardiac rhythm might be increased in symptomatic carriers. Our results allow for improved clinical interpretation for asymptomatic carriers, while our approach could guide future studies on genetic diseases with incomplete penetrance. [ABSTRACT FROM AUTHOR]

The scaling of urban climate action and its governance is rapidly becoming a central focus in the urban climate governance literature and policy debates. Building on the broader scaling literature and inspired by related initiatives in other fields, this article calls for the development of a systematic "science of scaling" for urban climate governance. Such a science of scaling may help to give a better understanding of how well-performing urban climate action and its governance can be multiplied, accelerated and broadened (ie horizontal and vertical scaling and scaling out, up and down), and it may help to uncover scaling trajectories towards systemic change in cities (ie deep scaling). [ABSTRACT FROM AUTHOR]

Symbolic commitment is commonly acknowledged in the literature to be important for sustainability governance. Academics express high hopes and expectations of symbolic commitment as a means to strengthen sustainability institutions. Policy makers and bureaucrats see it as being necessary in order to keep an issue on the agenda. However, little is known about how symbolic commitment contributes to institutional resilience. This study examines the rise and fall of national institutions for implementing sustainability agendas in Germany, Finland, and the UK in the context of fluctuating symbolic commitment. Interviews with 56 policy actors and documentary analysis uncovered the creative role of bureaucrats in securing symbolic commitment. The risks of relying on symbolic commitment can be reduced by considering the impact of economic austerity and the loss of institutional memory. [ABSTRACT FROM AUTHOR]

Aims: Arrhythmogenic right ventricular cardiomyopathy (ARVC) patients have an increased risk of ventricular arrhythmias (VA). Four implantable cardioverter-defibrillator (ICD) recommendation algorithms are available The International Task Force Consensus ('ITFC'), an ITFC modification by Orgeron et al. ('mITFC'), the AHA/HRS/ACC guideline for VA management ('AHA'), and the HRS expert consensus statement ('HRS'). This study aims to validate and compare the performance of these algorithms in ARVC.Methods and Results: We classified 617 definite ARVC patients (38.5 ± 15.1 years, 52.4% male, 39.2% prior sustained VA) according to four algorithms. Clinical performance was evaluated by sensitivity, specificity, ROC-analysis, and decision curve analysis for any sustained VA and for fast VA (>250 b.p.m.). During 6.4 [2.8-11.5] years follow-up, 282 (45.7%) patients experienced any sustained VA, and 63 (10.2%) fast VA. For any sustained VA, ITFC and mITFC provide higher sensitivity than AHA and HRS (94.0-97.8% vs. 76.7-83.5%), but lower specificity (15.9-32.0% vs. 42.7%-60.1%). Similarly, for fast VA, ITFC and mITFC provide higher sensitivity than AHA and HRS (95.2-97.1% vs. 76.7-78.4%) but lower specificity (42.7-43.1 vs. 76.7-78.4%). Decision curve analysis showed ITFC and mITFC to be superior for a 5-year sustained VA risk ICD indication threshold between 5-25% or 2-9% for fast VA.Conclusion: The ITFC and mITFC provide the highest protection rates, whereas AHA and HRS decrease unnecessary ICD placements. ITFC or mITFC should be used if we consider the 5-year threshold for ICD indication to lie within 5-25% for sustained VA or 2-9% for fast VA. These data will inform decision-making for ICD placement in ARVC. [ABSTRACT FROM AUTHOR]

Voluntary programmes provide city networks with a central link to their city members. These voluntary programmes provide cities with benefits (e.g., knowledge, recognition, access to resources) if they meet the city network's programme requirements. This article seeks to understand how city networks make trade‐offs between programme benefits and requirements to attract cities to the programmes they offer. We do so by analysing 55 voluntary programmes offered by 22 climate‐related city networks using qualitative comparative analysis (QCA). We are particularly interested in the design of voluntary programmes that attract large numbers of participants. We find three main insights. First, programmes with a clear, single benefit are more attractive to city members than programmes with a broad range of benefits. Second, the combination of programme requirements and commitments allows city networks to target cohorts of cities based on their capacities and needs. Finally, cities are attracted to programmes that do not explicitly ask for direct results. [ABSTRACT FROM AUTHOR]

Aims: Arrhythmogenic right ventricular cardiomyopathy (ARVC) patients have an increased risk of ventricular arrhythmias (VA). Four implantable cardioverter-defibrillator (ICD) recommendation algorithms are available The International Task Force Consensus ('ITFC'), an ITFC modification by Orgeron et al. ('mITFC'), the AHA/HRS/ACC guideline for VA management ('AHA'), and the HRS expert consensus statement ('HRS'). This study aims to validate and compare the performance of these algorithms in ARVC., Methods and Results: We classified 617 definite ARVC patients (38.5 ± 15.1 years, 52.4% male, 39.2% prior sustained VA) according to four algorithms. Clinical performance was evaluated by sensitivity, specificity, ROC-analysis, and decision curve analysis for any sustained VA and for fast VA (>250 b.p.m.). During 6.4 [2.8-11.5] years follow-up, 282 (45.7%) patients experienced any sustained VA, and 63 (10.2%) fast VA. For any sustained VA, ITFC and mITFC provide higher sensitivity than AHA and HRS (94.0-97.8% vs. 76.7-83.5%), but lower specificity (15.9-32.0% vs. 42.7%-60.1%). Similarly, for fast VA, ITFC and mITFC provide higher sensitivity than AHA and HRS (95.2-97.1% vs. 76.7-78.4%) but lower specificity (42.7-43.1 vs. 76.7-78.4%). Decision curve analysis showed ITFC and mITFC to be superior for a 5-year sustained VA risk ICD indication threshold between 5-25% or 2-9% for fast VA., Conclusion: The ITFC and mITFC provide the highest protection rates, whereas AHA and HRS decrease unnecessary ICD placements. ITFC or mITFC should be used if we consider the 5-year threshold for ICD indication to lie within 5-25% for sustained VA or 2-9% for fast VA. These data will inform decision-making for ICD placement in ARVC., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.)