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Remote Monitoring (RM) of cardiac implantable electronic devices (CIEDs) is recommended in management of Atrial Fibrillation (AF), which is a recognized risk factor for thromboembolism. We tried to elucidate whether stroke incidence observed in a large, remotely monitored population was consistent with the CHA2DS2VASc risk profile.Data from 1650 patients [76% male, age 72 (63-68), CHA2DS2VASc score 3.0 (2.0-4.0)] enrolled during the HomeGuide study and monitored with a daily-transmission RM system providing automatic alerts for AF, were analysed. Of those, 25% had a pacemaker and 75% an implantable cardioverter defibrillator with or without cardiac resynchronization. Estimations of the expected thromboembolic events were based on the population CHA2DS2VASc score profile used in a computer-simulated Markov model.Eight thromboembolic events were observed with a 4-year cumulative stroke rate of 0.8% (confidence interval, 0.4%-1.5%). Simulations returned from 18.7 to 17.1 expected events, depending on the AF duration assumed to trigger anticoagulation (one-sample log-rank p0.03). During the study period, 681 (84%) AF episodes and 129 (16%) atrial tachycardias were detected in 291 patients (18%): 93% of episodes were detected remotely in 269 patients, 66% of whom had no history of AF. Medical interventions were necessary in 305 episodes, 85% of which were detected remotely. Reaction time was 1 (0-6) days for remotely-detected episodes and 33 (14-121) days for episodes detected in clinic (p0.0001).In a large CIED population followed remotely for up to 4years, the incidence of thromboembolic events was less than half the estimations based on the CHA2DS2VASc risk profile.

[EN] The KM3NeT research infrastructure, currently under construction in the Mediterranean Sea, will host neutrino telescopes for the identification of neutrino sources in the Universe and for studies of the neutrino mass hierarchy. These telescopes will house hundreds of thousands of photomultiplier tubes that will have to be operated in a stable and reliable fashion. In this context, the stability of the dark counts has been investigated for photomultiplier tubes with negative high voltage on the photocathode and held in insulating support structures made of 3D printed nylon material. Small gaps between the rigid support structure and the photomultiplier tubes in the presence of electric fields can lead to discharges that produce dark count rates that are highly variable. A solution was found by applying the same insulating varnish as used for the high voltage bases directly to the outside of the photomultiplier tubes. This transparent conformal coating provides a convenient and inexpensive method of insulation., The authors acknowledge the financial support of the funding agencies: Centre National de la Recherche Scientifique (CNRS), Commission Europeenne (FEDER fund and Marie Curie Program), Institut Universitaire de France (IUF), IdEx program and UnivEarthS Labex program at Sorbonne Paris Cite (ANR-10-LABX-0023 and ANR-11-IDEX-0005-02), France; The General Secretariat of Research and Technology (GSRT), Greece; Istituto Nazionale di Fisica Nucleare (INFN), Ministero dell'Istruzione, dell'Universita e della Ricerca (MIUR), Italy; Agence de l'Oriental and CNRST, Morocco; Stichting voor Fundamenteel Onderzoek der Materie (FOM), Nederlandse organisatie voorWetenschappelijk Onderzoek (NWO), the Netherlands; National Authority for Scientific Research (ANCS), Romania; Plan Estatal de Investigacion (refs. FPA2015-65150-C3-1-P, -2-P and -3-P, (MINECO/FEDER)), Severo Ochoa Centre of Excellence and MultiDark Consolider (MINECO), and Prometeo and Grisolia programs (Generalitat Valenciana), Spain.

The pacemaker (PM) and implantable cardioverter-defibrillator (ICD) Registry of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) monitors the main epidemiological data in real-world practice. The survey for the 2014 activity collects information about demographics, clinical characteristics, main indications for PM/ICD therapy and device types from the Italian collaborating centers.The Registry collects prospectively national PM and ICD implantation activity on the basis of European cards.PM Registry: data about 24 680 PM implantations were collected (19 480 first implant and 5200 replacements). The number of collaborating centers was 208. Median age of treated patients was 81 years (75 quartile I; 86 quartile III). ECG indications included atrioventricular conduction disorders in 45.3% of first PM implants, sick sinus syndrome in 23.1%, atrial fibrillation plus bradycardia in 11.7%, other in 19.9%. Among atrioventricular conduction defects, third-degree atrioventricular block was the most common type (22.7% of first implants). Use of single-chamber PMs was reported in 26.9% of first implants, of dual-chamber PMs in 63.6%, of PMs with cardiac resynchronization therapy (CRT) in 1.7%, and of single lead atrial-synchronized ventricular stimulation (VDD/R PMs) in 7.8%. ICD Registry: data about 17 116 ICD implantations were collected (11 274 first implants and 5842 replacements). The number of collaborating centers was 424. Median age of treated patients was 71 years (62 quartile I; 77 quartile III). Primary prevention indication was reported in 72.3% of first implants, secondary prevention in 27.7% (cardiac arrest in 10.1%). A single-chamber ICD was used in 32.2% of first implants, dual-chamber in 37.1% and biventricular in 30.7%.The PM and ICD Registry appears fundamental for monitoring PM and ICD utilization on a large national scale with rigorous examination of demographics and clinical indications. The PM Registry showed stable electrocardiographic and symptom indications, with an important prevalence of dual-chamber pacing. The use of CRT-PM regards a very limited number of patients. The ICD Registry documented a large use of prophylactic and biventricular ICD, reflecting a favorable adherence to trials and guidelines in clinical practice.

International audience; The results of the analysis of the reactions 78,86Kr +40,48 Ca at 10 AMeV are presented. The experiment was performed at the INFN Laboratori Nazionali del Sud (LNS) in Catania by using the 4π multidetector CHIMERA, with beams delivered by the Superconductive Cyclotron. The competition among the various disintegration paths and in particular the isospin effects on the decay modes of the produced composite systems are investigated; this provides information about fundamental nuclear quantities such as level density, fission barrier and viscosity. Different isotopic composition and relative richness are observed among the reaction products of the two systems. An odd-even staggering effect is present in the charge distributions, in particular for the light fragments produced by the neutron-poor system. The kinematical characteristics of the IMF seem to indicate a high degree of the relaxation of the formed system. Besides, global features analysis seems to show some differences in the contribution arising from the various reaction mechanisms for the two reactions.

CRT Patient Characteristics and Outcomes. Introduction: The characteristics and outcomes of patients who undergo cardiac resynchronization therapy (CRT) device implantation in current clinical practice may differ from those of reference trial populations. Study objectives were to assess 2-year outcomes in a population implanted with a CRT plus defibrillator device in accordance with the standard of care and to evaluate any independent association between clinical variables and outcome. Methods and Results: A total of 406 patients enrolled at 35 centers in Italy were followed up prospectively for 2 years. All patient management decisions were left to the treating physician's discretion, in accordance with clinical practice. ACTION-HF patients had a better baseline clinical status than patients enrolled in the COMPANION study: shorter HF history (1 vs 3.5 years, P

Patients with permanent atrial fibrillation (AF) who undergo cardiac resynchronization therapy (CRT) may spontaneously recover sinus rhythm during follow-up. We tested the feasibility and efficacy of electrical cardioversion attempted after 3 months of CRT in patients with permanent AF and measured the long-term maintenance of sinus rhythm. Twenty-eight consecutive patients with permanent AF in whom CRT defibrillators had been implanted were scheduled for internal electrical cardioversion after 3 months (group A) and were compared with a control group of 27 patients (group B). In group A, 22 patients (79 %) were eligible for cardioversion; sinus rhythm was restored in 18 (82 %) of these, with no procedural complications. After 12 months, 16 patients (58 %) in group A were in sinus rhythm, compared with one group B patient who spontaneously recovered sinus rhythm (4 %, p

Aims The aims of the study are to develop a cost-minimization analysis from the hospital perspective and a cost-effectiveness analysis from the third payer standpoint, based on direct estimates of costs and QOL associated with remote follow-ups, using Merlin@home and Merlin.net, compared with standard ambulatory follow-ups, in the management of ICD and CRT-D recipients. Methods and results Remote monitoring systems can replace ambulatory follow-ups, sparing human and economic resources, and increasing patient safety. TARIFF is a prospective, controlled, observational study aimed at measuring the direct and indirect costs and quality of life (QOL) of all participants by a 1-year economic evaluation. A detailed set of hospitalized and ambulatory healthcare costs and losses of productivity that could be directly influenced by the different means of follow-ups will be collected. The study consists of two phases, each including 100 patients, to measure the economic resources consumed during the first phase, associated with standard ambulatory follow-ups, vs. the second phase, associated with remote follow-ups. Conclusion Remote monitoring systems enable caregivers to better ensure patient safety and the healthcare to limit costs. TARIFF will allow defining the economic value of remote ICD follow-ups for Italian hospitals, third payers, and patients. The TARIFF study, based on a cost-minimization analysis, directly comparing remote follow-up with standard ambulatory visits, will validate the cost effectiveness of the Merlin.net technology, and define a proper reimbursement schedule applicable for the Italian healthcare system. Trial registration: NCT01075516.

Soils are studied with the aim to predict future climatic scenarios and find the best guidelines to manage terrestrial ecosystems for the mitigation of the atmospheric CO2 rising. Carbon constituting soil organic matter (SOM) behaves as a cohort of different pools, characterized by a specific C turnover time. Both natural and anthropogenic occurring 14C reach the soil through plant littering, becoming a valid tool to trace SOM dynamics. In this study we present a series of Accelerator Mass Spectrometry (AMS) 14C measurements on SOM samples obtained by means of different laboratory protocols used for the isolation of soil pools from bulk soil (fractionation protocols). Radiocarbon signature of SOM fractions is used as a keyhole to look at the more effective fractionation procedure and comparison among measured 14C on SOM fractions revealed important indications for the proposal of a novel fractionation protocol. Our data put in evidence how particle size controls the recalcitrance of ancient SOM carbon pools. © 2009 Elsevier B.V. All rights reserved.

Contribution of Radiocarbon Dating to the Chronology of Eneolithic in Campania (Italy) The paper presents new and important 14C data from eight Eneolithic sites in Campania measured at the Centre for Isotopic Research of Cultural and Environmental Heritage (CIRCE) AMS laboratory in Caserta (Italy). Twenty-four 14C determinations on bone and charcoal are used here for chronological reconstruction of human habitation and dating of some volcanic eruptions affecting the settlement activity. Our research has shed new light on absolute chronology of the whole Campanian Eneolithic, a period of profound cultural transformations triggered by introduction and use of metals, in particular copper.

Actinide isotopes are present in environmental samples at ultra-trace levels (236U concentration is quoted to be on the order of pg/kg or fg/kg). Their detection requires the resolution of mass spectrometry (MS) techniques, but only accelerator mass spectrometry (AMS) has the sensitivity required. In order to perform the isotopic ratio measurements of actinides, such as 236U/238U, an upgrade of the Center for Isotopic Research on Cultural and Environmental Heritage accelerator (CIRCE) in Caserta, Italy, has been performed. The system was originally equipped for radiocarbon AMS measurements. The main difficulty of AMS measurement of 236U is the intense neighboring beam of 238U. Although most of the 238U ions are suppressed by means of magnetic and electrostatic elements, a small fraction of this intense beam can interfere with the rare isotopes. This paper reports the preliminary results of the 236U/238U isotopic ratio measurement limit (–11), aimed also to better understand the origin of background ions. For this purpose, a large 16-strip silicon detector providing spatial resolution has been used. In addition, calculations to assess the performance of the system obtained by adding a high-resolution time of flight-energy (TOF-E) detector are discussed.

The CIRCE AMS system started operation in March 2005. The measurement of isotopic ratios 14C/12C in samples of archaeological and environmental interest has rapidly attained high precision and accuracy levels in routine operation. The results of the intercomparison campaign in the framework of the VIRI program, as well as the outcome of a statistical analysis of the about 200 control measurements performed with standard samples, have shown the capability of the whole system for high precision measurements (δR/R

We show the potentiality of coupling together different compound-specific isotopic analyses in a laboratory experiment, where (13)C-depleted leaf litter was incubated on a (13)C-enriched soil. The aim of our study was to identify the soil compounds where the C derived from three different litter species is retained. Three (13)C-depleted leaf litter (Liquidambar styraciflua L., Cercis canadensis L. and Pinus taeda L., delta(13)C(vsPDB) approximately -43 per thousand), differing in their degradability, were incubated on a C4 soil (delta(13)C(vsPDB) approximately -18 per thousand) under laboratory-controlled conditions for 8 months. At harvest, compound-specific isotope analyses were performed on different classes of soil compounds [i.e. phospholipids fatty acids (PLFAs), n-alkanes and soil pyrolysis products]. Linoleic acid (PLFA 18:2omega6,9) was found to be very depleted in (13)C (delta(13)C(vsPDB) approximately from -38 to -42 per thousand) compared to all other PLFAs (delta(13)C(vsPDB) approximately from -14 to -35 per thousand). Because of this, fungi were identified as the first among microbes to use the litter as source of C. Among n-alkanes, long-chain (C27-C31) n-alkanes were the only to have a depleted delta(13)C. This is an indication that not all of the C derived from litter in the soil was transformed by microbes. The depletion in (13)C was also found in different classes of pyrolysis products, suggesting that the litter-derived C is incorporated in less or more chemically stable compounds, even only after 8 months decomposition.

The pretreatment of samples for radiocarbon measurements, transforming a variety of materials into graphite solid targets, represents a critical point in the accelerator mass spectrometry (AMS) procedure. We describe the new, state-of-the-art CIRCE AMS preparation laboratory, particularly the setup and optimization of an alternative method, the zinc reduction method, for graphite target production, compared to the more common hydrogen reduction method. Measured 14C values on standard and blank samples reduced via zinc reaction revealed mean background levels, accuracy, and sensitivity comparable to those obtained by our conventional hydrogen reaction lines. Zinc line reduction at the CIRCE laboratory represents an effective and powerful alternative to the conventional hydrogen reduction, ensuring higher sample throughput with lower costs at a comparable performance level. © 2008 by the Arizona Board of Regents on behalf of the University of Arizona.

A new AMS system has been installed at Center for Isotopic Research on Cultural and Environmental Heritage (CIRCE) in Caserta/ Italy. It was built by National Electrostatics Corp. Middleton, WI/USA, and arrived at CIRCE in the middle of January 2005; the installation and the acceptance tests were completed at the end of February 2005. At first, the system is intended for Radiocarbon AMS; for future Al and Be AMS only minor upgrades are needed and the magnets are designed to bend heavy isotopes like Uranium. Concerning Radiocarbon AMS, the first measurements of unknown samples, prepared in the internal preparation laboratory, already yielded results of high precision and C-14 dating is in full swing. (c) 2007 Elsevier B.V. All rights reserved.

International audience; The study of the decay modes competition of the compound systems produced in thecollisions 78Kr+40Ca and 86Kr+48Ca at 10AMeV is presented. In particular, the N/Z entrance channelinfluence on the decay paths of the compound systems, directly connected to the isospin influence, isinvestigated. The experiment was performed at the INFN Laboratori Nazionali del Sud (LNS) inCatania by using the 4π multi-detector CHIMERA. Charge, mass, angular distributions andkinematical features of the reaction products were studied. The analysis shows some differences in thecontribution arising from the various reaction mechanisms for the neutron poor and neutron richsystems. Comparison with theoretical statistical and dynamical models are presented for the twosystems. Besides a study of the influence of the energy on the entrance channel is performed for the78Kr+40Ca reaction, by comparing the results of this experiment to those obtained for the same systemat 5.5 AMeV with the INDRA device at GANIL.

International audience; We present here one recent CIRCE (Centre for Isotopic Research on Cultural and Environmental Heritage)– Caserta (Italy) project on cultural heritage field, analysing several mice bones, discovered in the MajorTemple on the acropolis of Cumae (Napoli, Southern Italy). The bones were found in a vase linked to theholy context. In order to know their dating and formulate an hypothesis on their presence on the site, if itwas an accidental rodent inclusion (believed on the base of archaeological context to have occurredduring building abandonment periods (IV–V or XIII centuries AD)) or an intentional and ritual remain,the bones were 14C dated by AMS at CIRCE. The results indicate that the mice bones date to the IV centuryBC and are contemporaneous with building construction. This dating seems to exclude an accidentalrodent presence and it supports the hypothesis of Apollo veneration in the temple, based on the alreadyknown link between mice and Apollo worship rituals.

Accurate selection of patients with left bundle branch block (LBBB) may help increasing response to cardiac resynchronization therapy (CRT). There is no agreement on LBBB definition. The aim of the study was to investigate the prevalence of 'true-LBBB' according to Strauss in patients undergoing CRT.The study population included 414 consecutive patients (71.9% men; mean age 69.7 ± 9.6 years), who underwent CRT according to 2010 European Society of Cardiology (ESC) guidelines. Patients were classified into three groups: traditional LBBB according to American Heart Association, LBBB according to Strauss and intraventricular conduction delay (IVCD). Subsequently, they were re-classified into classes of recommendations, according to the current 2013 ESC Guidelines. Traditional LBBB was recorded in 229 patients (55%), an LBBB according to Strauss in 153 (37%) and an IVCD in 32 (8%). Patients with an LBBB according to Strauss showed a significantly more prolonged QRS duration (P 0.001), greater baseline end-systolic and end-diastolic volumes (P = 0.011 and P = 0.013, respectively) compared with those with IVCD. The prevalence of mid-QRS notching in at least two contiguous leads was 100% in LBBB according to Strauss; 24% in traditional LBBB and 21.9% in IVCD (P 0.001). At multivariate analysis, PR interval less than 200 ms and QRS of at least 150 ms were independent predictors of mid-QRS notching [odds ratio (OR) 1.78; 95% confidence interval (95% CI) 1.10-2.88; P = 0.02 and OR 2.88; 95% CI 1.80-4.62;P 0.0001]. Applying stricter criteria for LBBB according to Strauss, a significant reduction in Class I recommendation and an increase in Class II was observed (90.1 vs. 37%; P 0.0001 and 9.9 vs. 63%; P 0.0001).Applying stricter criteria, only 37% of patients undergoing CRT showed a true-LBBB according to Strauss. Accurate identification of true-LBBB may have a potential additional value in better selecting patients.

Changes in electrical activation sequence are known to affect the timing of cardiac mechanical events. We aim to demonstrate that these also modify global properties of the intraventricular blood flow pattern. We also explore whether such global changes present a relationship with clinical outcome. Methods and results We investigated 30 heart failure patients followed up after cardiac resynchronization therapy (CRT). All subjects under- went echocardiography before implant and at follow-up after 6+ months. Left ventricular mechanics was investigated at follow-up during active CRT and was repeated after a temporary interruption ,5 min later. Strain analysis, per- formed by speckle tracking, was used to assess the entity of contraction (global longitudinal strain) and its synchronicity (standard deviation of time to peak of radial strain). Intraventricular fluid dynamics, by echographic particle image velo- cimetry, was used to evaluate the directional distribution of global momentum associated with blood motion. The dis- continuation of CRT pacing reflects into a reduction of deformation synchrony and into the deviation of blood flow momentum from the base-apex orientation with the development of transversal flow-mediated haemodynamic forces. The deviation of flow momentum presents a significant correlation with the degree of volumetric reduction after CRT. Conclusion Changes in electrical activation alter the orientation of blood flow momentum. The long-term CRT outcome correlates with the degree of re-alignment of haemodynamic forces. These preliminary results suggest that flow orientation could be used for optimizing the biventricular pacing setting. However, larger prospective studies are needed to confirm this hypothesis.

Background The implantation strategy appears to play a pivotal role in determining response to cardiac resynchronization therapy (CRT). Objective The aim of our study was to determine the association between anatomic and electrical interlead distance and clinical outcome after CRT implantation. Methods We included 216 first-time CRT recipients with left bundle branch block and sinus rhythm. On implantation, the electrical interlead distance (EID), defined as the time interval between spontaneous peak R waves detected at the right ventricular (RV) and left ventricular (LV) pacing sites, was measured. The anatomic distance between the RV and LV lead tips was determined on chest radiographs. Results The mean EID was 74 ± 41 ms, and the mean horizontal corrected interlead distance (HCID) was 125 ± 73 mm. After 12 months, 87 patients (40%) displayed an improvement in their clinical composite score. The cutoff values that best predicted an improved clinical status were as follows: 84 ms for EID (area under the curve 0.59; confidence interval [CI] 0.52-0.66; P =.026) and 90 mm for HCID (area under the curve 0.62; CI 0.55-0.69; P =.004). On multivariate analysis, only EID >84 ms (hazard ratio 0.36; CI 0.14-0.89; P =.028) and HCID >90 mm (hazard ratio 0.45; CI 0.23-0.90; P =.025) were significantly associated with the composite endpoint of death or cardiovascular hospitalization. In particular, the presence of both conditions (EID

The Accelerator Mass Spectrometry (AMS) is the most sensitive technique, compared either to the Inductively Coupled Plasma (ICP-MS) or Thermal Ionization (TI-MS) mass spectrometer, for the actinide (e.g. (236)U, (x)Pu isotopes) measurements. They are present in environmental samples at the ultra trace level since atmospheric tests of Nuclear Weapons (NWs) performed in the past, deliberate dumping of nuclear waste, nuclear fuel reprocessing, on a large scale, and operation of Nuclear Power Plants (NPPs), on a small scale, have led to the release of a wide range of radioactive nuclides in the environment. At the Center for Isotopic Research on Cultural and Environmental heritage (CIRCE) in Caserta, Italy, an upgraded actinide AMS system, based on a 3-MV pelletron tandem accelerator, has been developed and routinely operated. At CIRCE a charge state distribution as a function of terminal voltage, the beam emittance, measured in the 20° actinides dedicated beam line, as well as the energy and position validation of the U ions were performed in order to determine the best measurement conditions. A (236)U/(238)U isotopic ratio background level of about 5×10(-12) or 3×10(-13), depending on the Time of Flight-Energy (TOF-E) configurations, as well as the spatial distribution of the (235)U, (238)U interferences ions and a (236)U contamination mass of about 0.5 fg have been determined.

Increased risk of thrombo-embolism following cardioversion foratrial fibrillation (AF) is well recognized. Therefore, anticoagulation isconsidered mandatory before elective cardioversion for AF of N48 h orAF of unknown duration. Vitamin K antagonists (VKAs) (INR 2.0 to3.0) are recommended for at least 3 weeks prior to and 4 weeks aftercardioversion, regardless of the CHA2DS2-VASc score and the method(electrical or pharmacological) used to restore sinus rhythm [1,2].Therisk of thromboembolic events is high (up to 7%) if anticoagulation isinadequate, and is reduced to less than 1% if adequate anticoagulationis achieved [3]. Recently, new oral anticoagulants (NOACs) have beenintroduced intheclinical practiceandsuggestedalso inpatientsunder-going electrical cardioversion for AF. In this context compliance andadherence to treatment are crucial, as these drugs have a relativelyshort half-life. In fact patients missing more than one drug assumptioncannotbeconsideredunderanadequatetherapeuticregimen.Moreover,differently from VKA treatment, that can be followed through INRmeasurements,there are no effective hemoreological tests to assessther-apeutic anticoagulation. One way to assess the ef ficacy of anticoagulationtherapy is the direct search for left atrial thrombus by means oftransesophageal echocardiography (TEE). The aim of our study was toevaluate the incidence of left atrial (LA) thrombus in patients referredfor electrical cardioversion, while on treatment with NOACs, using apre-procedural TEE.Between January 2014 and December 2014 we collected the TEEdata of 219 consecutive patients with persistent AF referred to sevenItalian centers for elective electrical cardioversion, while on NOACs forat least 3 weeks before electrical cardioversion. This study followedtheprinciplesoutlinedinthelatestupdateoftheDeclarationofHelsinkiand all patients signed informed consent. This study was approved byour Institutional Review Boards. Main exclusion criteria were a historyof thromboembolic events, a history of LA thrombus diagnosed byTEE, a TEE procedure performed in the 21 days before starting NOACtherapy, and the need for anticoagulation other than AF. TEE wasperformed with a 5–7-MHz multiplane transducer connected to anultrasoundsystem.Multiplestandardtomographicplaneswereimaged.TheLAappendagepeakflowvelocity,presenceofthrombiintheLA,andseverityofspontaneousechocontrastintheLAweredetermined.Atrialcavityorappendagethrombiwereconsideredtobepresentwhenwell-circumscribed, echodense, intracavitary masses that were acousticallydistinct from the underlying endocardium and pectinate muscles wereidentified.The clinical characteristics of the study population are summarizedin Table 1. The mean duration of AF was 6.2 ± 4.3 months, and themean duration of NOAC therapy was 4.1 ± 3 months. NOACs usedwere dabigatran (86 patients, 39%), rivaroxaban (61 patients, 28%),and apixaban (73 patients, 33%). The daily dabigratan dose was220mgin21patients,and300mgin65patients;thedailyrivaroxabandose was 15 mg in 2 patients, and 20 mg in 59 patients; the dailyapixaban dose was 5 mg in 1 patient, and 10 mg in 72 patients. The

Aims Device replacement at the time of battery depletion of implantable cardioverter-defibrillators (ICDs) may carry a considerable risk of complications and engenders costs for healthcare systems. Therefore, ICD device longevity is extremely important both from a clinical and economic standpoint. Cardiac resynchronization therapy defibrillators (CRT-D) battery longevity is shorter than ICDs. We determined the rate of replacements for battery depletion and we identified possible determinants of early depletion in a series of patients who had undergone implantation of CRT-D devices. Methods and results We retrieved data on 1726 consecutive CRT-D systems implanted from January 2008 to March 2010 in nine centres. Five years after a successful CRT-D implantation procedure, 46% of devices were replaced due to battery depletion. The time to device replacement for battery depletion differed considerably among currently available CRT-D systems from different manufacturers, with rates of batteries still in service at 5 years ranging from 52 to 88% (log-rank test, P < 0.001). Left ventricular lead output and unipolar pacing configuration were independent determinants of early depletion [hazard ratio (HR): 1.96; 95% 95% confidence interval (CI): 1.57–2.46; P < 0.001 and HR: 1.58, 95% CI: 1.25–2.01; P < 0.001, respectively]. The implantation of a recent-generation device (HR: 0.57; 95% CI: 0.45–0.72; P < 0.001), the battery chemistry and the CRT-D manufacturer (HR: 0.64; 95% CI: 0.47–0.89; P = 0.008) were additional factors associated with replacement for battery depletion. Conclusion The device longevity at 5 years was 54%. High left ventricular lead output and unipolar pacing configuration were associated with early battery depletion, while recent-generation CRT-Ds displayed better longevity. Significant differences emerged among currently available CRT-D systems from different manufacturers. [10.1093/europace/euv225][1] [1]: /lookup/doi/10.1093/europace/euv225

Hemodynamic forces represent an epigenetic factor during heart development and are supposed to influence the pathology of the grown heart. Cardiac blood motion is characterized by a vortical dynamics, and it is common belief that the cardiac vortex has a role in disease progressions or regression. Here we provide a preliminary demonstration about the relevance of maladaptive intra-cardiac vortex dynamics in the geometrical adaptation of the dysfunctional heart. We employed an in vivo model of patients who present a stable normal heart function in virtue of the cardiac resynchronization therapy (CRT, bi-ventricular pace-maker) and who are expected to develop left ventricle remodeling if pace-maker was switched off. Intra-ventricular fluid dynamics is analyzed by echocardiography (Echo-PIV). Under normal conditions, the flow presents a longitudinal alignment of the intraventricular hemodynamic forces. When pacing is temporarily switched off, flow forces develop a misalignment hammering onto lateral walls, despite no other electro-mechanical change is noticed. Hemodynamic forces result to be the first event that evokes a physiological activity anticipating cardiac changes and could help in the prediction of longer term heart adaptations.

(7)Be decays via electron capture and therefore its half-life is expected to depend on the electron density at the nucleus. We measured the (7)Be half-life in palladium, tungsten, zirconium and tantalum metals, in order to investigate the influence of the quasi-free electrons in metals on the probability of electron capture. The (7)Be samples were obtained implanting a 4.85 MeV pure radioactive (7)Be ion beam. The (7)Be half-life was determined measuring the 478 keV gamma decay following the electron capture by means of HPGe detectors. In order to reduce systematic errors, we planned to perform independent measurements in three different laboratories: Naples (Italy), Bochum (Germany) and Debrecen (Hungary). On the basis of the first results, we do not find a (7)Be half-life change within the experimental errors of 0.4%. RI Fulop, Zsolt/B-2262-2008

The electron screening in the d(d,p)t reaction has been studied for the deuterated metal Pt at a target temperature T = 20 degrees C to 340 degrees C, and for Co at T = 20 degrees C and 200 degrees C. The enhanced electron screening decreases with increasing temperature, where the data agree with the plasma model of Debye applied to the quasi-free metallic electrons. The data represent the first observation of a temperature dependence of a nuclear cross-section. We also measured the screening effect for the deuterated metal Ti (an element of group 4 of the periodic table) at T = -10 degrees C to 200 degrees C: above 50 degrees C the hydrogen solubility dropped to values far below unity and a large screening effect became observable. Similarly, all metals of groups 3 and 4 and the lanthanides showed a solubility of a few percent at T = 200 degrees C (compared to T = 20 degrees C) and a large screening became also observable. Within the Debye model the deduced number of valence electrons per metallic atom agrees with the corresponding number from the Hall coefficient, for all metals investigated. RI Fulop, Zsolt/B-2262-2008; Aliotta, Marialuisa /H-2567-2012

A systematic analysis of efficiency, reproducibility and accuracy of cryogenic purification of CO(2) from air samples for isotopic analyses is presented. The technical characteristics of the cryogenic line are given in detail. To study the cryogenic process, three different operating parameters are considered: flow rate of the gas entering the line, pressure of the gas in the line, and CO(2)-trap shape. Experimental results demonstrate that efficiency, reproducibility and accuracy strongly depend on the CO(2)trap shape. Moreover, a dependence of reproducibility and accuracy on the flow rate of the gas is found, but not on its pressure. High precision (< or =0.02 per thousand for delta(13)C and < or =0.05 per thousand for delta(18)O) and good accuracy (

For improved cross-section measurements of the reaction 12C(α,γ)16O in inverted kinematics, a recoil separator ERNA is developed at the 4MV Dynamitron tandem accelerator in Bochum to detect directly the 16O recoils with high efficiency. Due to the emission of the capture γ-rays, the kinematically forward directed 16O recoils are described by an angle and energy spread. Thus, the acceptances in angle and energy of ERNA must cover these spreads in order to extract reliable cross-section values. We report on such acceptance measurements over the energy range Ecm=0.7-5.0 MeV, using an 16O pilot beam. © 2003 Elsevier B.V. All rights reserved.

Studies of the charge state distribution of low energy (< 1.5 MeV/u), low Z (< 13) heavy ions passing through hydrogen and helium gas of varying target pressure have been performed using separate windowless gas target systems at TRIUMF and the University of Naples. Semi-empirical relationships have been deduced to estimate the equilibrium charge state distributions as a function of beam energy. From these distributions, cross-sections for the relevant charge changing reactions have been deduced. (C) 2002 Elsevier Science B.V. All rights reserved.

For the study of astrophysically relevant capture reactions in the underground laboratory LUNA a newsetup of high sensitivity has been implemented. The setup includes a windowless gas target, a 4p BGO summing crystal, and beam calorimeters. The setup has been recently used to measure the d(p,g) 3 He cross-section for the first time within its solar Gamowpeak, i.e. dow n to 2.5 keV c.m. energy. The features of the optimized setup are described. r 2002 Elsevier Science B.V. All rights reserved.

An experiment was performed at the Nuclear Power Plant of Garigliano (Caserta, Italy) to study the transfer of radionuclides from a contaminated soil to a lettuce crop and to check the validity of the generally accepted assumption of constant uptake. Measurements of specific activities of 137Cs, 60Co, and 40K were periodically performed by sampling plants during a growth period of 48 days. The specific activity was analysed as a function of plant mass and growth time to gain information on the dependence of radionuclide sorption on plant growth stage. The results (time-dependent uptake rate) were interpreted using a dynamic model which generalizes the transfer factor. In this model, the time dependence of the transfer factor is characterized by three parameters obtained from a non linear least-squares fit to the data. The resulting values were found to be dependent on the radionuclide. The relative growth rate of lettuce plants plays an important role in the transport process: maximum radionuclide transport occurs at 12 d for 60Co and 137Cs and 28 d for 40K. © 2002 Elsevier Science Ltd. All rights reserved.

The pacemaker (PM) and implantable cardioverter-defibrillator (ICD) Registry of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) monitors the main epidemiological data in real-world practice. The survey for the 2013 activity collects information about demographics, clinical characteristics, main indications for PM/ICD therapy and device types from the Italian collaborating centers.The Registry collects prospectively national PM and ICD implantation activity on the basis of European cards.PM Registry: data about 25 419 PM implantations were collected (19 134 first implant and 6285 replacements). The number of collaborating centers was 275. Median age of treated patients was 80 years (74 quartile I; 86 quartile III). ECG indications included atrioventricular conduction disorders in 43.6% of first PM implants, sick sinus syndrome in 24.7%, atrial fibrillation plus bradycardia in 12.9%, other in 18.8%. Among atrioventricular conduction defects, third-degree atrioventricular block was the most common type (23.2% of first implants). Use of single-chamber PMs was reported in 27.2% of first implants, of dual-chamber PMs in 62.6%, of PMs with cardiac resynchronization therapy (CRT) in 1.8%, and of single lead atrial-synchronized ventricular stimulation (VDD/R PMs) in 8.4%. ICD Registry: data about 16 519 ICD implantations were collected (11 474 first implants and 5045 replacements). The number of collaborating centers was 430. Median age of treated patients was 71 years (63 quartile I; 77 quartile III). Primary prevention indication was reported in 76% of first implants, secondary prevention in 24.0% (cardiac arrest in 7.8%). A single-chamber ICD was used in 27.2% of first implants, dual-chamber in 35.9% and biventricular in 36.8%.The PM and ICD Registry appears fundamental for monitoring PM and ICD utilization on a large national scale with rigorous examination of demographics and clinical indications. The PM Registry showed stable electrocardiographic and symptom indications, with an important prevalence of dual-chamber pacing. The use of CRT-PM regards a very limited number of patients. The ICD Registry documented a constant increase in prophylactic and biventricular ICD use, reflecting a favorable adherence to trials and guidelines in clinical practice.

Non-radiative transitions in nuclear capture reactions between light nuclei play a relevant role in stellar nuclear astrophysics, where nuclear processes occur at typical energies from tens to hundreds of keV. At higher energies, instead, the E0 contributions may be shadowed by more intense transitions. The experimental study of E0 transitions requires a specific detection setup, able to uniquely identify events where an electron-positron pair is produced. A compact ΔE-E charged-particle spectrometer based on two silicon detectors has been designed to be installed in the jet gas target chamber of the recoil mass separator ERNA (European Recoil separator for Nuclear Astrophysics) at the CIRCE laboratory of Caserta, Italy. The detector design, its performances and the first foreseen applications are described.

Prior studies have suggested that a substantial number of eligible heart failure (HF) patients fail to receive β‐blocker therapy, or receive it at a suboptimal dose. The aim of this study is to assess the benefit of a predefined management program designed for β‐blocker up‐titration, evaluating the synergistic effect of cardiac resynchronization therapy (CRT) and β‐blockers in a HF population. The Resynchronization Therapy and β‐Blocker Titration (RESTORE) study is a prospective, case‐control, multicenter cohort study designed to test the hypothesis that a β‐blocker up‐titration strategy based on a predefined management program maximizes the beneficial effect of CRT, increasing the number of patients reaching the target dose of β‐blockers and improving their clinical outcome. All study patients receive an implantable defibrillator for CRT delivery in accordance with current guidelines. Enrollments started in December 2011 and are scheduled to end in December 2014. Approximately 250 consecutive patients will be prospectively enrolled in 6 Italian centers and followed up for 24 months after implantation. The primary endpoint is to demonstrate that CRT may allow titration of β‐blockers until the optimal dose, or at least to the effective dose, in patients with HF. This study might provide important information about the benefit of a predefined management program for β‐blocker up‐titration in patients receiving CRT. Moreover, assessment of health‐care utilization and the consumption of resources will allow estimating the potential utility of remote monitoring by means of an automated telemedicine system in facilitating the titration of β‐blockers in comparison with a standard in‐hospital approach.

This study aimed to assess manpower and resource consumption of the HomeGuide workflow model for remote monitoring (Biotronik Home Monitoring [HM], Biotronik SECo. KG, Berlin, Germany) of cardiac implantable electronic devices in daily clinical practice.The model established a cooperative interaction between a reference nurse (RN) for ordinary management, and a responsible physician (RP) for medical decisions in each outpatient clinic. RN reviewed remote transmissions and alerts, addressing critical cases to the RP.A total of 1,650 patients were enrolled in 75 sites: 25% pacemakers (PM), 22% dual-, 27% single-chamber implantable defibrillators (ICD), 2% PM with cardiac resynchronization therapy (CRT), and 24% ICD-CRT. During a median follow-up of 18 (10-31) months, 3,364 HM sessions were performed (74% by the RN, 26% by the RP) to complete 18,478 remote follow-ups. Median duration of remote follow-ups was 1.2 (0.6-2.0) minutes, corresponding to a manpower of 43.3 (4.2-94.8) minutes/month every 100 patients for nurses and 10.2 (0.1-31.1) for physicians (P0.0001). RN submitted 15% of remote transmissions to RP, who decided unscheduled follow-ups in 12% of the cases. The median manpower for phone calls was 1.9 (0.8-16.5) minutes/month every 100 contacted patients. There were 2.84 in-hospital visits/patient, 0.46 of which triggered by HM findings. A cumulative per-patient HM follow-up time of 15.4 minutes (20% of total follow-up time) allowed remote detection of 73% of actionable events.HM implemented in the HomeGuide workflow model required1 hour/month every 100 patients to detect the majority of actionable events with limited administrative workload.

The absolute cross section σ ( E ) for the radiative capture reaction 7 Be(p, γ ) 8 B at the center-of-mass energies E =0.32 to 2.61 MeV has been measured using a 7 Be target deposited on a Cu backing and observing the β -delayed α -particles from 8 B. The backing causes a loss of less than 1% of the 8 B residual nuclides. The resulting astrophysical S ( E ) factor at zero energy, S (0)=18.4±1.6 eV b, is consistent only with a restricted data set from previous work.

An excitation function of the ground-state gamma (0)-ray capture transition in C-12(alpha, gamma)O-16 at theta (gamma) = 90 degrees was obtained in far geometry using six Ge detectors, where the study of the reaction was initiated in inverse kinematics involving a windowless gas target. The detectors observed predominantly the El capture amplitude. The data at E = 1.32 to 2.99 MeV lead to an extrapolated astrophysical S factor S-E1(E-0) = 90 +/- 15 keV b at E-0 = 0.3 MeV (for the case of constructive interference between the two lowest E1 sources), in good agreement with previous works. However, a novel Monte Carlo approach in the data extrapolation reveals systematic differences between the various data sets such that a combined analysis of all available data sets could produce a biased estimate of the S-E1(E-0) value. As a consequence, the case of destructive interference between the two lowest E1 sources with S-E1(E-0) = 8 +/- 3 keV b cannot be ruled out rigorously.

The El amplitude of the transition to the ground state in the C-12(alpha, gamma)O-16 capture reaction was measured in the energy range E-cm=1.3 to 3.0 MeV using an intense C-12 beam in combination with a windowless He-4 gas target and an array of six 70% HPGe detectors. The detectors were placed in a ring-shaped geometry around the target at a distance of 17 cm on a plane perpendicular to the beam axis. A target length of 5.3 cm was defined by a 12.5 cm thick lead shielding. Passive and active shielding was used to achieve the necessary suppression of the beam induced and cosmic background. The results of this measurement and their extrapolation to the relevant energy during the helium burning phase in massive stars are reported.

The production of very neutron-deficient isotopes near 100Sn has been investigated by using on-line mass separation of evaporation residues produced by heavy-ion induced complete-fusion reactions. We measured the cross sections for 99Cd, 100In, 101Sn and 102In via 58Ni+58Ni fusion reactions followed by cluster emission, and via 58Ni+50Cr fusion reactions accompanied by evaporation of protons, neutrons or α particles. Both types of reactions yield similar cross sections for the production of exotic nuclei near 100Sn. The data are discussed in comparison with results obtained from statistical-model calculations.

For improved measurements of the key astrophysical reaction C-12(alpha, gamma)O-16 in inverted kinematics, a recoil separator ERNA is being developed at the 4 MV Dynamitron tandem accelerator in Bochum to detect directly the O-16 recoils with about 50% efficiency. Calculations of the ion beam optics including all filtering and focusing elements of ERNA are presented. Since the C-12 projectiles and the O-16 recoils have essentially the same momentum, and since the C-12 ion beam emerging from the accelerator passes through a momentum filter (analysing magnet), the C-12 ion beam must be as free as possible from O-16 contamination for ERNA to succeed. In the present work, the O-16 contamination was reduced from a level of 1 x 10(-11) to a level below 2 x 10(-29) by the installation of Wien filters both before and after the analysing magnet. The measurement of these and other beam specifications involved other parts of the final ERNA layout - sequentially a Wien filter, a 60 degrees dipole magnet, another Wien filter, and a Delta E-E telescope. The setup led to a measured suppression factor of 5 x 10(-18) for the C-12 ion beam. The experiments also indicate that an almost free choice of the charge state for the O-16 recoils is possible in the separator.

Background:QT interval dispersion has been proposed as a simple noninvasive predictor of ventricular arrhythmias and sudden death. Patients with thalassemia major are at increased risk for sudden death. However, the independent effect of increased QT dispersion on the risk of sudden death in thalassemia major is not known. This study sought to test the hypothesis that an abnormal QT dispersion predicts sudden death in patients with thalassemia major. Methods:QT dispersion was measured in 13 consecutive patients with thalassemia major who had sudden death at a mean age of 16.1 ± 2.8 years, and in 13 survivors matched for age, gender, examination year, and transfusion therapy. Results:Patients who died suddenly had significantly greater QT dispersion (59 ± 29 ms) than patients who survived (29 ± 13 ms; P = 0.002). A cut-off value of 50 ms for QT dispersion had a sensitivity of 54%, a specificity of 92%, a positive predictive value of 87%, a negative predictive value of 67% and a predictive accuracy of 73% in identifying patients at risk of sudden death. With multiple regression analysis, QT dispersion was the only independent predictor of sudden death. Conclusions:QT dispersion is a useful marker of risk of sudden death in patients with thalassemia major. A.N.E. 1999;4(3):295–300