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Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Boston Scientific Medical device company St. Paul, Minnesota, USA Introduction The PRAETORIAN trial showed that the subcutaneous implantable cardioverter defibrillator (S-ICD) is noninferior to the transvenous ICD (TV-ICD) with respect to device-related complications and inappropriate shocks in a conventional ICD population. It is unknown whether there is a difference in quality of life (QoL) between the two patient groups. The generator size and implant location differ between both devices. This may cause a variation in mental health status and pain perception between treatment arms, in particular in older patients, patients with low BMI, and females. Purpose This prespecified analysis of the PRAETORIAN trial compares the impact of the S-ICD and TV-ICD on QoL. Methods In the PRAETORIAN trial, 849 patients were randomised to S-ICD (n=426) or TV-ICD (n=423) therapy. QoL was prospectively measured at baseline, discharge and 12 and 30 months after ICD implant, by measuring cardiac-specific physical functioning with the Duke Activity Status Index (DASI) and psychological and physical well-being with the 36-Item Short Form Health Survey (SF-36, divided in 8 subscales). Patients who completed the questionnaires at baseline were included in this analysis. At each time point the mean change in score from baseline was calculated. Subgroups were made based on age (tertiles, < 58, 58-67 and >67 years), BMI categories ( Results A total of 823/849 patients completed the QoL questionnaires at baseline. Questionnaires were also completed by these patients at discharge (92%), 12 months (85%) and 30 months (69%). There was no difference in QoL between the arms at any time point (p>0.05, figure). Age, BMI and sex were not associated with a difference between the arms in SF-36 subscale bodily pain (p=0.73, 0.72 and 0.92 respectively), or SF-36 subscale mental health (p=0.15, 0.39 and 0.76) at 30 months. Similar results were seen at discharge and 12 months. Conclusion There were no differences in QoL between S-ICD and TV-ICD treatment in the first 30 months after implant. In addition, no differences in pain and mental health were seen in older patients, patients with low BMI and females. These results confirm that the S-ICD is a good alternative for the TV-ICD.

We aimed to evaluate the effect of defibrillator component positioning on high-voltage impedance. In two human specimens with BMI 19.1 kg/m and 31.4 kg/m , shocks were administered with a subcutaneous implantable cardioverter-defibrillator (S-ICD) and an automated external defibrillator placed in various positions. High-voltage impedance increased with more fat tissue between the defibrillator components, or with air in the subcutaneous pocket of the S-ICD. High-voltage impedance was lowest when defibrillator components were placed anteriorly, but due to adjacent positioning, the electrical current will not be transmitted through the myocardium and effective defibrillation is unlikely. In conclusion, positioning of defibrillator components greatly affects high-voltage impedance, but the course of the current should always be considered.

Background: The Apple Watch (AW) is the first commercially available wearable device with built-in electrocardiogram (ECG) electrodes to perform a single-lead ECG to detect atrial fibrillation (AF). Methods: Patients with AF who were scheduled for electrical cardioversion (ECV) were included in this study. The AW ECGs were obtained pre-ECV and post-ECV. In case of an unclassified recording, the AW ECG was obtained up to 3 times. The 12-lead ECG was used as the reference standard. Sensitivity, specificity, and kappa coefficient were calculated. Results: In total, 74 patients were included. Mean age was 67.1 ± 12.3 years and 20.3% were female. In total 65 AF and 64 sinus rhythm measurements were obtained. The first measurement with the AW showed a sensitivity of 93.5% and specificity of 100% (κ = 0.94). A second measurement resulted in a sensitivity of 94.6% and specificity of 100% (κ = 0.95). A third measurement resulted in a sensitivity of 93% and a specificity of 96.5% (κ = 0.90). Adjudication of unclassified recordings by a physician reduced the total unclassified recordings from 27.9% to 1.6%, but also reduced the accuracy. The kappa coefficient for unclassified single-lead ECGs was 0.58. Conclusion: The single-lead ECG of the AW shows a high accuracy for identifying AF in a clinical setting. Repeating the recording once decreases the total of unclassified recordings; however, a third recording resulted in a lower accuracy and the occurrence of false-positive measurements. Unclassified results of the AW can be reduced by physicians’ interpretation of the single-lead ECG; however, the interrater agreement is only moderate.

According to the Kunming-Montreal Global Biodiversity Framework, a “Whole-of-Society” approach is needed to initiate transitions to a nature-positive society. Many look at civil society to initiate and accelerate such transitions. In this article, we investigate strategies from Civil Society Actors (CSAs) to contribute to transformative change, with specific focus on Tiny Forests and Beach Clean-Ups in the Netherlands. Results show that CSAs have a clear Theory of Change to achieve their goals, and act upon that vision through assembling power and resources, developing policy-relevant environmental knowledge, mobilising public support and media coverage and initiating innovative sustainable practices. Adopting mosaic governance approaches, CSAs strategically position themselves in social and institutional networks, connecting professionals and citizens for political leverage. However, our findings show that the step from local impact towards transition remains a large one and the contribution of CSAs should be valued as emergent, co-produced and part of a broader transition movement.

Gender-fair language (GFL) aims to fight women’s invisibilisation and can be applied through the feminisation of job titles, to counteract the masculine bias induced by masculine generics. This preregistration pertains to data collection regarding experiment 1 : assessment of the influence of GFL on STEM and care jobs with explicit measures. After conducting a pretest and aimed to include it in a paper, reviewers found insufficient that the data did not include an a priori power analysis and the participants' demographics. Hence, we will conduct a conceptual replication of this pre-test and this is its pre-registration. We measure how generic vs. gender-fair wording of jobs titles influences the estimated proportion of women and men in a given job.

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Background The subcutaneous implantable cardioverter-defibrillator (S-ICD) is developed to overcome lead-related complications and systemic infections, inherent to transvenous ICD (TV-ICD) therapy. The PRAETORIAN trial demonstrated that the S-ICD is non-inferior to the TV-ICD with regard to the combined primary endpoint of inappropriate shocks and complications. This prespecified secondary analysis evaluates all complications in the PRAETORIAN trial. Methods and results The PRAETORIAN trial is an international, multicentre, randomized trial in which 849 patients with an indication for ICD therapy were randomized to receive an S- ICD (N = 426) or TV-ICD (N = 423) and followed for a median of 49 months. Endpoints were device-related complications, lead-related complications, systemic infections, and the need for invasive interventions. Thirty-six device-related complications occurred in 31 patients in the S-ICD group of which bleedings were the most frequent. In the TV-ICD group, 49 complications occurred in 44 patients of which lead dysfunction was most frequent (HR: 0.69; P = 0.11). In both groups, half of all complications were within 30 days after implantation. Lead-related complications and systemic infections occurred significantly less in the S-ICD group compared with the TV-ICD group (P < 0.001, P = 0.03, respectively). Significantly more complications required invasive interventions in the TV-ICD group compared with the S-ICD group (8.3% vs. 4.3%, HR: 0.59; P = 0.047). Conclusion This secondary analysis shows that lead-related complications and systemic infections are more prevalent in the TV-ICD group compared with the S-ICD group. In addition, complications in the TV-ICD group were more severe as they required significantly more invasive interventions. This data contributes to shared decision-making in clinical practice.

Background: Volunteers make a huge contribution to the health and wellbeing of the population and can improve satisfaction with care especially in the hospice setting. However, palliative and end-of-life-care volunteer services in the hospital setting are relatively uncommon. The iLIVE Volunteer Study, one of eight work-packages within the iLIVE Project, was tasked with developing a European Core Curriculum for End-of-Life-Care Volunteers in hospital. Aim: Establish an international consensus on the content of a European Core Curriculum for hospital end-of-life-care volunteer services which support patients in the last weeks of life. Design: Delphi Process comprising the following three stages: 1. Scoping review of literature into palliative care volunteers. 2. Two rounds of Delphi Questionnaire. 3. Nominal Group Meeting. Setting/participants: Sixty-six participants completed the Round 1 Delphi questionnaire; 75% (50/66) took part in Round 2. Seventeen participants attended the Nominal Group Meeting representing an international and multi-professional group including, clinicians, researchers and volunteer coordinators from the participating countries. Results: The scoping review identified 88 items for the Delphi questionnaire. Items encompassed organisational issues for implementation and topics for volunteer training. Three items were combined and one item added in Round 2. Following the Nominal Group Meeting 53/87 items reached consensus. Conclusion: Key items for volunteer training were agreed alongside items for implementation to embed the end-of-life-care volunteer service within the hospital. Recommendations for further research included in-depth assessment of the implementation and experiences of end-of-life-care volunteer services. The developed European Core Curriculum can be adapted to fit local cultural and organisational contexts.

We strongly recommend to limit ATP therapy to a single sequence and first observe the efficacy in the individual patient. After a positive effect of ATP is established, ATP programming may be safely extended.

Introduction The Apple Watch (AW) is one of the first commercially available wearable with built-in electrocardiogram (ECG) electrodes to perform a single-lead ECG to detect atrial fibrillation (AF). The AW ECG application showed to have a high rate of unclassifiable notifications. The interpretation of the single-lead ECG by a physician can possibly reduce the total of unclassifiable notifications and contribute to the overall accuracy to detect AF. Methods This was a prospective, non-randomized, single center observational study to evaluate the accuracy and interrater agreement of the single-lead ECG of the AW. Patients scheduled for cardioversion for atrial fibrillation were asked for participation. The AW series 6 was used with WatchiOS 7.2 or 7.3 and ECG algorithm version 2.0. A single-lead ECG was obtained pre-conversion and, when cardioversion was successful, post-conversion. All single-lead ECGs and 12-lead ECGs were adjudicated by two physicians, agreement was reached by consensus. The AW single-lead ECG notification was compared to the physicians “gold-standard” interpretation of the 12-lead ECG. Sensitivity and specificity of the AW single-lead ECG and Kappa coefficient were calculated. Results In total, 74 patients were included. Mean age was 67.1±12.3 years and 20.3% were female. In total 65 AF and 64 sinus rhythm (SR) single-lead ECG measurements were obtained. Of these measurements, 27.9% (36/129) showed an unclassifiable notification. The AW ECG notification showed a sensitivity of 93.5% to detect AF and a specificity of 100% to detect SR (K= 0.94). After adjudication of the unclassifiable notifications by two independent physicians 1.6% (2/129) of the measurements remained unclassifiable. When including the by the physicians adjudicated unclassifiable recordings the sensitivity to diagnose AF was 89.2% and the specificity to detect SR was 93.8% (K=0.83). The adjudication of all single-lead ECGs by the two physicians showed a sensitivity of 90.6% to detect AF and specificity of 95.2% to detect SR (K= 0.83) (Table 1). All SR and AF notification by the AW were similarly adjudicated by the two physicians. The kappa coefficient for interrater agreement between both physicians was 0.69 for all single-lead ECGs and 0.58 for unclassifiable notifications specific. Conclusion Unclassifiable notifications of the AW can be reduced by physicians interpretation of the single-lead ECG, however the interrater agreement is only moderate. The physicians interpretation of the single-lead ECGs did not increase the accuracy to detect AF and the clinical relevance of the single-lead ECG, in addition to the AW notification, should therefore be questioned. Funding Acknowledgement Type of funding sources: None.