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Introduction: Prior studies have shown that addition of posterior wall isolation (PWI) may reduce atrial fibrillation recurrence in patients with persistent atrial fibrillation. No data on PWI in paroxysmal AF (pAF) patients with normal left atrial voltage is available, to date. Objective: This study sought to evaluate the efficacy of PWI in addition to pulmonary vein isolation (PVI) in patients presenting with pAF and normal left atrial voltage. Methods: Consecutive patient registry analysis was performed on all patients with pAF and normal left atrial voltage undergoing initial radiofrequency ablation from November 1, 2018 to November 15, 2019. Primary endpoint was recurrence of atrial arrhythmia including AF, atrial tachycardia (AT), or atrial flutter (AFL). Results: A total of 321 patients were studied, 214 in the PVI group and 107 in the PWI + PVI group. Recurrence of any atrial arrhythmia occurred in 18.2% of patients in the PVI group and 16.8% in the PVI + PWI cohort (p = 0.58). At 1 year, recurrence was 14.0% in the PVI group and 15.0% in the PWI + PVI group (p = 0.96). There was a lower AT/AFL recurrence in the PVI + PWI group, not reaching significance (3.7% in the PWI + PVI group vs. 7.9% in PVI group, p = 0.31). Need for carina lesions predicted recurrence in the PVI‐only group. Conclusions: Addition of PWI to PVI in pAF patients undergoing their first ablation did not reduce the frequency of atrial arrhythmia recurrence. This warrants further study in a prospective trial. [ABSTRACT FROM AUTHOR]

Purpose: Catheter ablation procedures for atrial fibrillation (AF) were significantly curtailed during the peak of coronavirus disease 2019 (COVID-19) pandemic to conserve healthcare resources and limit exposure. There is little data regarding peri-procedural outcomes of medical procedures during the COVID-19 pandemic. We enacted protocols to safely reboot AF ablation while limiting healthcare resource utilization. We aimed to evaluate acute and subacute outcomes of protocols instituted for reboot of AF ablation during the COVID-19 pandemic. Methods: Perioperative healthcare utilization and acute procedural outcomes were analyzed for consecutive patients undergoing AF ablation under COVID-19 protocols (2020 cohort; n=111) and compared to those of patients who underwent AF ablation during the same time period in 2019 (2019 cohort; n=200). Newly implemented practices included preoperative COVID-19 testing, selective transesophageal echocardiography (TEE), utilization of venous closure, and same-day discharge when clinically appropriate. Results: Pre-ablation COVID-19 testing was positive in 1 of 111 patients. There were 0 cases ablation-related COVID-19 transmission and 0 major complications in either cohort. Pre-procedure TEE was performed in significantly fewer 2020 cohort patients compared to the 2019 cohort patients (68.4% vs. 97.5%, p <0.001, respectively) despite greater prevalence of persistent arrhythmia in the 2020 cohort. Same-day discharge was achieved in 68% of patients in the 2020 cohort, compared to 0% of patients in the 2019 cohort. Conclusions: Our findings demonstrate the feasibility of safe resumption of complex electrophysiology procedures during the COVID-19 pandemic, reducing healthcare utilization and maintaining quality of care. Protocols instituted may be generalizable to other types of procedures and settings. [ABSTRACT FROM AUTHOR]

Introduction: Heart failure (HF) is a major cause of morbidity and mortality throughout the world. Despite the significant progress in the prevention and treatment of HF, mortality rates still remain high. Device therapy for HF includes cardiac resynchronization therapy (CRT) and the use of an implantable cardioverter-defibrillator (ICD). Recently, a new device therapy for the treatment of HF became available, called cardiac contractility modulation (CCM). CCM is a new device therapy for patients with HF who do not qualify for CRT. It is implanted in a minimally invasive manner to improve the patient's morbidity. Optimizer Smart System is a new device that delivers CCM therapy. Areas covered: We review the function of the Optimizer Smart System, the data from the recent clinical trials, and discuss its efficacy and future projections in the treatment for HF. Expert opinion: CCM therapy provided with the Optimizer® Smart System is safe, feasible, and applicable to a wide range of patients with HF. To demonstrate the effectiveness of the Optimizer Smart System's use merits further large multicenter randomized controlled trials. [ABSTRACT FROM AUTHOR]

This multi-site study analysed self-reported involvement in property crime, drug dealing, and sex work, across five Canadian cities, among a sample of 677 illicit opioid and other drug users outside of treatment. First, we assessed drug-use patterns and the extent of illegal income-generating behaviour for each city. We then analysed factors and city interactions contributing to engagement in the respective criminal activities, including drug-use patterns, socio-economic characteristics, and other illegal activities. With this approach we explored city-specific patterns of crime prediction; thus we identified local drug–crime associations. The study sample was recruited by outreach and snowball methods and was assessed by standardized study protocols. Findings revealed substantial differences among the cities regarding both the extent and frequency of illegal activities. In regard to local differences, multiple logistic regression models revealed that crack use was strongly associated with property crime in Toronto, while cocaine use was strongly related with sex work in Montreal and Quebec City. This evidence points to local dynamics of drug cultures that are related to specific criminal activities. Implications for further research and intervention efforts are discussed. [ABSTRACT FROM AUTHOR]

This article presents the outcomes of an innovative vocational rehabilitation model designed for methadone-maintained patients - the Customized Employment Supports (CES) model. CES counselors work intensively with a small caseload of patients to overcome the vocational as well as non-vocational barriers that hinder employment, with the goal of attaining rapid job placement. A randomized clinical trial was implemented at two methadone treatment programs in New York City and was funded by the National Institute on Drug Abuse The study tested the hypothesis that patients assigned to the experimental (CES) condition would have better employment outcomes than those assigned to a control condition who received standard vocational counseling at the programs. The data were collected from May 2001 through April 2005. The efficacy sample for the analysis consisted of 168 patients who completed follow-up interviews. The sample was 58% male, 75% minority group, average age 45 years, and in methadone treatment for an average of five years. The results supported the hypothesis for two measures of employment; i.e., the CES group was significantly more likely than the control group to obtain both any paid employment and informal paid employment. However, there were no significant differences for competitive employment or total earnings. The study's limitations are noted. Implications of the findings for the improvement of vocational rehabilitation for addiction patients are discussed. [ABSTRACT FROM AUTHOR]

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An innovative employment counseling model, Customized Employment Supports, was developed for methadone-treatment patients, a population with historically low employment rates. The effectiveness of a key component of the model, "vocational fieldwork," the delivery of services in the community rather than only within the clinic, was assessed through a quasi-experimental study of the first 55 patients receiving the model in 2 clinics. Employment outcomes after 6 months were compared between patients who received vocational fieldwork (n = 18) and those who did not (n = 37). Logistic regression analysis demonstrated that patients receiving vocational fieldwork had significantly better outcomes for competitive work, informal work, and any paid work. [ABSTRACT FROM AUTHOR]

Traditionally, methadone-maintained patients have made only limited progress in vocational rehabilitation programs, largely because they encounter multiple individual-level barriers to their employment. The Customized Employment Supports (CES) model is designed to help patients overcome these employment barriers and attain paid work as soon as possible. To facilitate this transition, the model assigns CES counselors small caseloads so that, using intensive interventions, they can engage patients in a working alliance and enhance patients’ self-efficacy. Methods used to help patients increase their self-efficacy are derived from social psychological literature and include role modeling, persuasion, and minimizing emotional arousal. Because the transition to competitive work is a major change, many patients initially take smaller steps such as entering training programs and accepting informal employment. The CES model is being evaluated in a randomized clinical trial. [ABSTRACT FROM AUTHOR]

This article presents initial efficacy data for an innovative vocational rehabilitation model designed for methadone-maintained patients—the Customized Employment Supports (CES) model. In this model, a CES counselor works intensively with a small caseload of patients in order to overcome the vocational as well as nonvocational barriers that hinder their employment, with the goal of attaining rapid placement in competitive employment. The CES model was implemented at two Manhattan methadone treatment programs as part of a randomized clinical trial comparing the model's employment outcomes with those of standard vocational counseling. The study tested the hypothesis that patients in the experimental group will have better employment outcomes than those in the comparison group. The data were collected from May 2001 through September 2003. The sample consisted of the first 121 patients who had completed their 6-month follow-up interviews. The preliminary results supported the hypothesis for two indices of paid employment, i.e., the CES group was more likely to obtain both competitive employment and informal paid employment. The clinical trial is continuing. [ABSTRACT FROM AUTHOR]

Few methadone-maintained patients are employed, due to personal barriers and limited vocational services. With federal and state policy reforms compelling substance users to obtain work or risk losing public benefits, it is imperative to develop and test innovative vocational rehabilitation models. Designed for methadone patients, the Customized Employment Supports (CES) model integrates components of traditional vocational counseling in treatment, innovative vocational programs for the severely mentally ill, and case management techniques. This paper describes CES, its principles, essential elements, and stages of service delivery. The model features a small caseload [16], long service duration (up to 18 months), frequent counselor-patient contacts, fieldwork with patients, and rapid job search. Although the primary goal of CES is competitive employment, incremental and intermediate steps involving any productive activity are also valued. After establishing a working alliance, the CES counselor helps patients increase their self-efficacy, and addresses both vocational and non-vocational barriers to employment. The CES model may also contribute to non-vocational improvements, especially reductions in illicit drug use, excessive alcohol consumption, and criminality. The CES model has been implemented at two urban methadone-maintenance clinics as part of a five-year randomized clinical trial to test the model's efficacy by comparing it with standard vocational services. [ABSTRACT FROM AUTHOR]

The integration of a visible minority group into the American occupational structure; specifically, the sexual integration of science and engineering is investigated by comparing selected social characteristics of career with noncareer women and men with similar training in these fields. Deviation of science, and especially engineering, from the ideal-typical model of rational professions is indicated in the finding of significant "selective patterning" of careers and differential career success by sex of college graduate, which is evident when they first enter the labor market and becomes more pronounced during the course of their careers. It is suggested that discrepancies between occupational values of women employees and their perceptions of their actual work situation may indicate potential problems in their employment. Finally, possible adaptations to mitigate the effect of "deviant" sex status in the professional context are identified for two age groups of women scientists and engineers in terms of patterns in their temporal ordering of the events of college graduation, employment, marriage, and childbearing. [ABSTRACT FROM AUTHOR]

A list of names is presented as an acknowledgment of non-editorial board reviewers of this journal for 2008 including Geoffrey Abbott, Stuart Berger, and Jane Chen.

Reviews several videotapes. `I'm Starving'; `Deaf Heaven'; `Me and Mrs. Berger.'