Podcasts about IKS

Dass die Governance von Schlachthöfen scheitern kann, hatte ich ja bereits in Folge #290 behandelt. Ein neuer Fall in bayerischen Schlachthöfen bestätigt meine damalige Einschätzung. In diesem Podcast beschäftige ich mich daher erneut mit der Frage, wie die Governance gestärkt werden kann. Dazu analysiere ich die von der Politik vorgebrachten Argumente und vorgeschlagenen Maßnahmen, z.B. die für die Zukunft geforderten flächendeckenden Kontrollen. Komisch, dass das bisher mit den über alle Regierungsbezirke verteilten 85 bayerischen Veterinärämtern nicht der Fall sein soll. Zusätzlich lasse ich Sie an meinen Überlegungen teilhaben, wie die Internen Kontrollverfahren und die Governance für Schlachthöfe gestärkt werden könnte. Ich wünsche Ihnen viel Spaß beim Zuhören und erfolgreiche Prüfungsprozesse!

In today's episode, host Sandy Vance chats with Vijay Venkatesan, Chief Technology Officer, IKS Health. Everyone's talking about healthcare AI — but not everyone's doing it the same way. We explain how IKS Health's approach to technology and digital transformation sets it apart from other players in the space. Sandy and Vijay dive deep into the future of AI in healthcare, IKS Health technology strategies, AI workflow optimization, the blending of AI and human expertise, how AI is transforming healthcare, AI safety in healthcare, and responsible AI implementation.In this episode, they talk about:What is AI in healthcare?Where AI will take healthcare in 2025 and beyondIKS Health's differentiators and its approach to technologyThe guardrails that IKS Health follows and the opportunities healthcare may have when we evaluate safety and make the right choices when applying AIWhy AI workflows are importantIKS Health defines AI differently from competitorsThe importance of the balance between human-in-the-loop and AIReducing friction in the healthcare journeyA Little About Vijay:Vijay Venkatesan is the Chief Technology Officer at IKS Health, where he leads the charge in building scalable, future-ready platforms that power efficiency, innovation, and meaningful client impact. With over 15 years in healthcare technology leadership, Vijay is a visionary force behind the deployment of advanced solutions like Generative AI, machine learning, and big data analytics to tackle some of the industry's most complex challenges.At IKS Health, he drives the company's end-to-end technology strategy — from evolving the tech stack and aligning engineering with business growth, to fostering a bold culture of innovation. Vijay is passionate about assembling world-class teams, forging strategic partnerships, and ensuring IKS remains on the cutting edge of healthcare transformation.

This podcast is the audio version of the Gear Garage Live Show, where we answer submitted questions and talk all things whitewater. Topics and links that Zach talked about in this episode Answer Questions River Rescue Gear at River Hardware Some of the Questions that Zach covered in the Q&A section of this episode Topic: Highwater Middle Fork of the Salmon I'm invited on a MFS trip June 10. Super psyched! The trip leader wants to cap the trip at 5 feet, but I bet it will be higher. I'm pushing for a careful safe trip, even if higher than 5 feet. I feel up to the challenge 100%. The crew is solid. Any thoughts on flows and wisdom of going? I hate the idea of the permit being canceled. Thanks! Topic: Guide Shoes What about guides wearing Chacos... Do you have any thoughts about that? Topic: Rope Selection You've covered a lot on static line length and diameter on your previous videos, and I'm curious to hear more about material and buoyancy. On whitewater gear you offer the sterling super static 2 rope, but I don't believe that's a high floating material, and is quite a bit heavier without being stronger than some other equivalent 3/8" ropes like ultra line. Can you review a bit more on rope design/materials vs use in whitewater rescue applications? Sterling looks to be the standard in ropes, and their ultra line appears like the best overall option for weight/strength vs flotation. Only downside I can see is that ultra line is not available in sizes other than 1/4" and 3/8" if someone needs 11mm or larger. Topic: 18' Raft Owyhee What's your low flow cutoff for getting a medium to lightly loaded 18' raft down the Lower Owhyee? I'm able to make technical moves just not interested in getting high centered or squeezed all the time and having to get out to shove a whole bunch. Nuisance rapid for instance. Does an 18' even fit between boulders at flows less than 1K CFS? I'm 5 days out from launch and flows have been very slowly dropping, currently around 1300 CFS to 1400 CFS with no major precip in forecast. Motoring out and my 18' has the registration. Have a smaller raft with fishing frame and registration but its not rigged to motor and would like to avoid that hassle of frame changeover and assembly if possible. Thanks for your insights! Topic: IK Safety Thanks for this channel; it is an excellent resource for people like me who are new to rafting. Two buddies and I took the NWRC Class III rowing school last year, which was awesome. The Lower Salmon was one of the rivers the instructors recommended as a good first private trip, so we are planning a multi-day trip with our families on the Lower Salmon in mid-July. We will have three rafts. We have several high school kids in our group. I am considering bringing two or three inflatable kayaks for them to use if they want more excitement than riding in the rafts. Everyone will be in helmets and PFDs. The kids are strong swimmers and comfortable in the water. I have three questions: Where should we put the IKs in the group? I am thinking between the middle and last raft as that would leave two downstream rafts in case they swim. Would having three IKs in the water at one time be too many given we only have three rafts? Could you talk about how trip leaders monitor IKs on your commercial trips.

Auch wenn Silvester schon einige Zeit her ist, möchte ich das Thema der Todesfälle in der Silvesternacht 2024/2025 in diesem Podcast behandeln. Konkret geht es um die Kugelbomben. Auf der Informationsgrundlage von zwei Artikeln betrachte ich das IKS für diese professionellen Feuerwerkskörper und – so viel sei verraten – erläutere dessen Versagen und meine vermuteten Ursachen bzw. Gründe hierfür. Damit ist es für eine Interne Revision jedoch nicht getan. Es bleibt zu fragen, Ideen zu entwickeln und mit dem Revisionspartner zu diskutieren, wie das IKS verbessert werden könnte. Welche Ideen haben Sie? Führen Sie diese gerne in einem Kommentar aus. Hier gibt es kein "Richtig" oder "Falsch" sondern nur (hoffentlich eine Vielzahl an) Möglichkeiten, die insgesamt das IKS stärken. Ich hoffe, dieser Fall inspiriert Sie dazu, das von Ihnen zu prüfende IKS zu hinterfragen und insbesondere den zugrundeliegenden expliziten und impliziten Annahmen auf den Grund zu gehen. Ich wünsche Ihnen viel Spaß beim Zuhören und erfolgreiche Prüfungsprozesse!

This podcast is the audio version of the Gear Garage Live Show, where we answer submitted questions and talk all things whitewater. Topics and links that Zach talked about in this episode River Hardware Answer Questions Some of the Questions that Zach covered in the Q&A section of this episode Topic: Selway Low Water Boat Selection Does your "bigger is better" advice for the Middle Fork Salmon also apply to Selway low-water trips? Is a 16 or 18 foot boat still ideal, or is the nature of the river different enough to change the advice? Also, what is a general rule for the cut-off flow to switch out of rafts and into IKs and packrafts? Love the show, and thanks for all the advice and entertainment! Topic: Whitewater Helmets Zach, I'm looking to buy a new helmet for rafting. Can you talk about a few hemlets that you have tried and what would be your top 3 recommendations? Topic: Cat Frame I was wondering if you had any recommendations for a day frame for my 12x22 cat, I am looking for something lightweight but durable that's narrower than 68 inches. Topic: SPORT LINES!! Mayhaps you could add your take on a lingering question within the rank and file of the rafting community; Sport Lines only count if you call them out beforehand correct? Otherwise it's just a blown line??

Novinářka, podcasterka a trendspotterka, kterou baví psát velké příběhy. Ten její začal studiem marketingu na IKSŽ a přes četné zkušenosti ji zanesl až do křesla šéfredaktorky časopisu ELLE. Směje se nahlas, nikam nechodí bez knížky a vždycky se nejvíc těší na dezert... nebo na champagne. Bez příslibu obého pozvání do Celetné on Air přijala Thea Prokop.Jak se mění redakce módních časopisů? Čím ji ovlivnila startupová kultura? Proč není feminismus over? Jak nás ovlivňují trendy? A proč podle ní nejsou žurnalistika a marketing protipóly? Nejen na to se ptaly moderátorky Nikola Fialová a Barbora Kohoutová v nahrávacím studiu v Kampusu Hybernská. Poslechněte si poslední epizodu roku 2024 až do konce, ať vám neuteče závěrečné věštění z křišťálové koule. Přejeme příjemný poslech, další obsah najdete na našem Instagramu: https://www.instagram.com/celetnaonair/?igsh=MWl1dGdycm9uOW9wdQ%3D%3D&fbclid=IwZXh0bgNhZW0CMTAAAR0_4IQs7wJMhX7AQN_uaVER4wiePaNUMgO0EXTYE1I4BAsR9H4uAL8q_60_aem_Tox4yl-Kyfqj2OQhBaDO-g

¡Vótame en los Premios iVoox 2024! Finalizamos esta serie de cuatro programas con los que hemos descubierto junto a sus autores las mejores listas de ejército que han cosechado gran éxito en los torneos de golden tickets españoles. ¿Qué tiene de especial esta lista de Caballeros Imperiales que ha logrado dominar la Gran Final del Iberian Open 2024, uno de los golden tickets para el Campeonato Mundial de Games Workshop? Lo descubrimos junto a su autor OuX. No olvides seguir el Campeonato Mundial de Warhammer en nuestro twitch, en directo desde Atlanta, del 21 al 24 de noviembre: https://www.twitch.tv/lavozdehorus/ ¿Te gusta lo que hacemos y quieres apoyarnos y de paso participar en el sorteo mensual de 400€ en material de Warhammer 40k? Dale al botón de "Apoyar" en iVoox. Tendrás una participación por 2,99€, tres participaciones por 4,99€, siete participaciones por 9,99€, y otras siete por cada bloque de 9,99€. Más detalle en nuestra web, https://www.lavozdehorus.com/ 00:00:00 Presentación e introducción 00:09:04 La lista de IKs que ha dominado la Gran Final del Iberian Open 2024 01:17:13 El futuro de esta lista y posibles adaptaciones La lista completa puede verse aquí: https://pastebin.com/h4DbbgQT Escúchanos mientras pintas minis o mientras sacas el perro a pasear. No importa el momento, pero cuenta con nosotros para ser tu programa semanal de referencia sobre Warhammer 40.000. La música de este podcast está licenciada en Jamendo y Dark Fantasy Studio. El corte de fondo inicial es licencia Creative Commons de Royalty Free Kings utilizada con permiso de su autor Mark Petrie. El resto de temas musicales son licencia Creative Commons de Scott Buckley o usados con permiso de su autor, Fernando Amat. Escucha el episodio completo en la app de iVoox, o descubre todo el catálogo de iVoox Originals

Little Wars FM officially turns 50! Our Patreon fans voted on the topic for our 50th podcast, and here it is. Miles and Ed chat with the International Kriegsspiel Society about all things Kriegsspiel. They'll go into the origins of the game, which was first released in 1824 by a Prussian staff officer, and track the evolution of the rules since the 1800s. Today, members of the society run Kriegsspiel events online. This enables players from around the world to join, as well as providing modern tools for fog of war and limited communication. If you want to see a short recap of an event that Miles and Ed both played, there's a YouTube AAR available. The IKS YouTube channel also has much longer videos, like this complete playthrough of Perryville (it's well over 2 hours long). We've talked about the possibility of filming a Kriegsspiel for the channel one day. Is that something you'd find interesting? There are no miniatures or gorgeous 3D terrain...it's just maps and blocks! But the fog of war element makes these events exciting every time. Have you played in a Kriegsspiel-style game in person or online? And are you interested in joining one of the IKS events sometime? If so, we'll leave a link to those fine folks right here! We hope you enjoy episode #50 of Little Wars FM!

Å bruke droner i søk og redningsaksjoner har blitt mer og mer vanlig, og med stor suksess. Men hvilken nytte kan dronene gi utover å søke etter savnede mennesker, og hvilke utfordringer får resten av redningstjenesten når stadig flere droner fyller luftrommet over et skadested. Om episodenI denne episoden snakker vi om bruk av ubemannede fartøy og deres plass i redningskjeden. Droner har for alvor inntatt tjenesten, og på fagsamlingen ULENDT møttes mange av droneaktørene som bistår i redningstjenesten i dag. En av de største dronene som brukes er "Cargo"-dronen til Midt-Norge 110-sentral IKS. Med en løftekapasitet på opp mot 40 kilo og lange rekkevidde har den blitt et viktig verktøy for å løse fraktoppdrag på steder det er vanskelig å komme til. Vi snakker også om sikkerhet og hvordan man skal få samspillet med de andre aktører til å fungere best mulig. Norsk Folkehjelp forteller om hvordan de bruker droner i søk og redning, og hvilke utfordringer de møter når de er ute på en aksjon.Gjester i denne episoden er:Sverre Hogstad, Basesjefpilot på 110 sentralen Midt-Norge.Mathias Weber, selger i Boston Group og frivillig dronepilot i Norsk Folkehjelp.Morten Hammeren, Paramedic og basesjef i Innlandet droneberedskap, Initiativtaker ULENDT.NyhetsbrevGå ikke glipp av nyttig informasjon om episodene våre. Meld deg på nyhetsbrevet vårt her! eller send en sms til 09044 med kodeord FAG og din egen epostadresse.Kapittelinndeling(00:36) - Introduksjon til episoden (01:49) - Sverre Hogstad om Cargodronen (11:18) - Å bruke cargodronen (13:57) - Mathias Weber i Norsk Folkehjelp (20:36) - Morten Hammeren om utfordringer med droner (24:41) - Dronebruk i fremtiden

Drama, Tränen und VAR-Wahnsinn! In der neuen GMS-Episode zerlegen Marcel, Hamcon und Mr.IKS die bittere Niederlage der deutschen Nationalmannschaft gegen Spanien und diskutieren heiß über den VAR, der mal wieder für Wirbel sorgte. Was erwartet euch in dieser Folge? - Die bittere Niederlage gegen Spanien im Detail - VAR-Entscheidungen: Fehlentscheidungen oder richtige Entscheidungen? - Analyse der deutschen Mannschaft: Was lief schief? - Ausblick auf die Zukunft: Was muss sich ändern? Und natürlich jede Menge GMS-typischer Humor und Unterhaltung! Schaut euch die neue Folge jetzt an und lasst eure Kommentare da! #GMS #Fussball #EM2024 #Deutschland #VAR #Enttäuschung #Analyse #Zukunft #Humor #Unterhaltung P.S.: Vergesst nicht, den Daumen nach oben zu drücken

Wir alle wissen, dass für jeden Part des IKS klare und eindeutige Berichtslinien notwendig sind. Falls Ihnen das Ihr Revisionspartner jemals nicht glauben sollte, dann erzählen Sie doch von folgendem Fall. Boeing hat(te) folgende Schwächen im IKS bzw. Qualitätsmanagement: - keinen einheitlichen und klaren Weg für die Mitarbeiter, über Qualitätsmängel zu berichten - Mängel bei der Qualitätsaufsicht - Probleme bei der Qualitätskontrolle der Produktion - Verstöße gegen Vorgaben der Überwachung der Produktion, dem Umgang mit Bauteilen sowie der Produktkontrolle Genau für den Fall, dass mal etwas übersehen oder Mängel nicht sofort identifiziert werden können, gibt es die Möglichkeit, dass Mitarbeitende intern Qualitätsmängel an das Qualitätsmanagement melden können. Das ist sozusagen die Sicherung der Qualitätskontrolle. Bei Boeing hat diese Sicherung nicht funktioniert, u.a. weil es keinen einheitlichen und klaren Weg für die Mitarbeitenden gab, über auftauchende Probleme oder Qualitätsmängel zu berichten. Natürlich könnte es sein, dass die Mitarbeitenden auch bei einheitlichen und klaren Berichtswegen nichts berichtet hätten. Das ist dann jedoch primär eine Frage der Unternehmenskultur und nicht primär eine Frage des Qualitätsmanagements. Selbstverständlich spielt die Unternehmenskultur bei der Ausgestaltung des Qualitätsmanagements ebenfalls eine Rolle. Was ich von der Unternehmenskultur von Boeing halte, das wissen Sie bereits. Ich wünsche Ihnen viel Spaß beim Zuhören und erfolgreiche Prüfungsprozesse!

Wed, 01 May 2024 03:45:00 +0000 https://jungeanleger.podigee.io/1480-borsepeople-im-podcast-s12-13-carola-bendl-tschiedel ea3adf08c516d41e1eecf3bccf1462ee Carola Bendl-Tschiedel ist Non-Financial Risk Lead bei der bank99 und amtierende Staatsmeisterin im Marathon. Wir beginnen mit dem Sport, weil ihr Staatsmeistertitel erst wenige Wochen her ist und sprechen auch über Rekordlerin Julia Mayer. Dann aber natürlich Business: Seibersdorf, OMV, T-Systems, lange Jahre bei Raiffeisen und jetzt, weiter in Gelb, bei der Post-Tochter bank99. Wir machen einen Deep Dive in die Non Financial Risks, erklären cSpcM, IKS, die vielen Facetten aus ESG. Spannend! http://www.bank99 Nr. 1 unter http://www.audio-cd.at/sportwochepodcast mit https://audio-cd.at/page/podcast/3905/ (Spowo 4.2.23) About: Die Serie Börsepeople findet im Rahmen von http://www.audio-cd.at und dem Podcast "Audio-CD.at Indie Podcasts" statt. Es handelt sich dabei um typische Personality- und Werdegang-Gespräche. Die Season 12 umfasst unter dem Motto „24 Börsepeople“ 24 Talks. Presenter der Season 12 ist Re:Guest, https://www.reguest.io/de/buchungssoftware-hotel/1-0.html .Welcher der meistgehörte Börsepeople Podcast ist, sieht man unter http://www.audio-cd.at/people. Der Zwischenstand des laufenden Rankings ist tagesaktuell um 12 Uhr aktualisiert. Bewertungen bei Apple (oder auch Spotify) machen mir Freude: https://podcasts.apple.com/at/podcast/audio-cd-at-indie-podcasts-wiener-boerse-sport-musik-und-mehr/id1484919130 . 1480 full no Christian Drastil Comm.

Wie kann es sein, dass Routinesituationen gefährlich werden? Stellen Sie sich vor, Ihr Revisionspartner zitiert eine Statistik und sagt: "Sehen Sie, in der Vergangenheit ist ja so gut wie nichts passiert." "Die Einzelfälle, die Sie identifiziert haben, haben nichts miteinander zu tun!" "Sie übertreiben mit Ihren Feststellungen! Das IKS ist ok!" Die Folgefragen, die für die Interne Revision daraus resultieren, lauten: - Welche Rahmenbedingungen galten in dem Zeitraum auf den sich die Statistik bezieht? - Welche Anforderungen gab es für das IKS - Wie war damals das IKS ausgestaltet? - Gab es da auch einen Fachkräftemangel? - War die Infrastruktur adäquat? - War genug Geld für ein angemessenes IKS vorhanden? - Bestätigten interne und externe Prüfungen die Angemessenheit des IKS? - Wurden die Rahmenbedingungen, die dieser Statistik unterliegen, in jüngster Vergangenheit eingehalten? Denn wenn sich Ihr Revisionspartner auf eine Statistik der hohen Sicherheit verlässt, dann muss er oder sie auch die Rahmenbedingungen dieser Statistiken einhalten und bestehende Standards einhalten. Hält sich der Revisionspartner nicht an diese Standards (Zertifizierungen, Qualitätskontrollen, ausreichend erfahrenes Personal, ...) kann eine Interne Revision aus verschiedenen, scheinbar nicht zusammenhängenden Einzelfällen einen Zusammenhang herstellen. Wie, erfahren Sie in diesem Podcast. Ich wünsche Ihnen viel Spaß beim Zuhören und erfolgreiche Prüfungsprozesse!

Namasté! OM! Badabim Badaboom! Stian Stinaldo som denne episoden ikke tar en prat med Lasse Gustavsson, som forrige gjest sa jeg "selvfølgelig" måtte ta en prat med. Da han enda ikke har gitt meg noe tilbakemelding, derfor valgte jeg og fokusere på "de grønne lungene" også kalt som Furulunden. I denne episoden forklarer jeg litt om de forskjellige skogene som er lokalisert i Furulundsområdet, og at det er forskjell på både Foreningen Furulundens Venner og Dugnadsgjengen. Hvem kom først, hva arbeider de med? Fikk også pratet litt med 3 hyggelige damer som var ute og gikk tur like ved Risøbank IKS. Dette er en podcast uten noen form for reklame, så jeg setter enormt stor pris på om du deler den videre. Dugnadsgjengen har ikke noen facebook side såvidt jeg kan se og finne, men både foreningen furulundens venner og risøbank iks har det så deres link finner du du under her. Episoden starter nede på Lordens stranda, og avsluttes i fugleabboreet/matingsplassen til fuglene i Furulundskogen der skogen først ble plantet. Lytt og del gjerne med bestemor og bestefar. Da denne episoden innholder masse naturlyder og er som balsam for sjela https://www.facebook.com/furulundensvenner?mibextid=ZbWKwL https://www.facebook.com/profile.php?id=100063715500230&mibextid=ZbWKwL https://www.facebook.com/TufteparkiFurulunden?mibextid=ZbWKwL Kanskje Norges flotteste "grønne lunger"? --- Send in a voice message: https://podcasters.spotify.com/pod/show/stian-stinaldo/message

In Episode 40 of The Hindu Parenting Podcast, Matrushree Ananthalakshmi, Co-Founder of Anaadi Foundation explains IKS - Indian Knowledge Systems.Indian Knowledge Systems (IKS) is quite the buzzword now, but what exactly constitutes IKS (other than Yoga and Ayurveda)? Anaadi Foundation has a set of IKS books specially designed for children, which can be used to teach kids at home. Learn more about the books, the topics covered and how we can teach children all about the scientific heritage of Bharat (India). What is the system of modern Gurukul education like? How does it differ from the mainstream schooling? Ananthalakshmi ji also shares a message especially for parents. Timestamps:1:25: What is IKS?12:03: Details on IKS Books for Children20:37: About Anaadi Foundation28:41 : Location of Anaadi Dharma Gurukula and integration with the mainstream36:53: Training people in Bharatiya pedagogy39:13: Samskara Journal42:24 : Indigenous Education Systems around the world46:06 : Message for ParentsGeneral Information:For comments and podcast suggestions, please use the comments tab or write to us at contact@hinduparenting.orgPlease note that questions will not be answered on email.Do subscribe to our Substack and follow our social media handles:Twitter: hinduparentingInstagram: hinduparentingTelegram: t.me/hinduparentingThreads: hinduparentingFacebook: facebook.com/hinduparentingFacebook group: facebook.com/groups/hinduparentingKoo: hinduparentingWe also have a new Whatsapp channel.The opinions expressed by guests on The Hindu Parenting Podcast are their personal opinions and Hindu Parenting does not assume any responsibility or liability for the accuracy, completeness, suitability or validity of anything shared on our platform by them.Copyright belongs to Hindu Parenting Get full access to Hindu Parenting at hinduparenting.substack.com/subscribe

Das Interne Kontrollsystem (IKS) gehört zu den wichtigsten Sicherheitsnetzen eines Unternehmens. Dessen Erstellung muss sorgfältig und vollständig erfolgen. Dadurch stoßen Standard-Office-Programme wie Word und Excel an ihre Grenzen. Erstellung, Aktualisierung und Nutzung sind nur mit einer Spezialsoftware praktikabel. Zu den professionellen Tools, die seit Jahren am Markt eingesetzt werden, gehört Opti.Tax. Als Entwicklungspartner für [...] Der Beitrag Software für Internes Kontrollsystem: entwickelt mit IKS-Expertise erschien zuerst auf hsp Handels-Software-Partner GmbH.

Per Lenborg kan se tilbake på en lang karriere i bransjen etter at han startet som renovatør i 1973. Han har mang en god historie å fortelle fra sine år i bl.a. Oslo kommune, ROAF (Romerike avfallsforedling IKS) og Avfall Norge. I ukas Sirkulér-episode snakker han med Anna Fagerheim, som begynte som rådgiver i Avfall Norge i 2020 med en fersk master fra NMBU. Hva slags syn har de to på bransjen slik den er i dag, og slik den bør være i en sirkulær fremtid? Hosted on Acast. See acast.com/privacy for more information.

Stimulating Q & A session at the Young Academicians Conclave where topics covered were: How can Rajiv Malhotra guide for a curriculum for Indic Knowledge Systems (IKS) at under graduate level? How to guide students to combine academics and activism in national interest? Can AI algorithms be trained to project our framework? Is fundamental research or application framework more important for scientific study? Can we rely on ChatGPT produced output with respect to IKS? How to nip fake narratives at their source itself before they become accepted as the gospel truth? How can we resurrect Indic Knowledge Systems using the language (English) of those who were responsible for destroying it in the first place? How to register more patents from Indian universities like they do in foreign universities? Do we have any contemporary achievements to fall back on instead of always talking about the glory of ancient India when we talk of IKS? How to make contemporary achievements if any, more attractive to youngsters? How to encourage students to be innovative in STEM in India? Snakes in the Ganga - http://www.snakesintheganga.com Varna Jati Caste - http://www.varnajaticaste.com The Battle For IIT's - http://www.battleforiits.com Power of future Machines - http://www.poweroffuturemachines.com 10 heads of Ravana - http://www.tenheadsofravana.com To support Infinity Foundation's projects including the continuation of such episodes and the research we do: इनफिनिटी फ़ौंडेशन की परियोजनाओं को अनुदान देने के लिए व इस प्रकार के एपिसोड और हमारे द्वारा किये जाने वाले शोध को जारी रखने के लिए: http://infinityfoundation.com/donate-2/ --- Support this podcast: https://podcasters.spotify.com/pod/show/rajivmalhotrapodcast/support

In diesem Podcast betrachte ich die Governance der WADA auf Basis von zwei Artikeln aus der SZ vom 17.03.2023 und vom 31.03.2023 zum Fall Mario Vuskovic. Selbstverständlich nutze ich dafür den Blickwinkel der Internen Revision. Was wäre, wenn die WADA eine Interne Revision hätte, und Sie würden dort arbeiten? Welche Prüfungsfeststellungen hätten Sie? Wie ist die Governance der WADA gestaltet? Wie steht es um das IKS der WADA, um schwarze Schafe zu identifizieren? Wie finanziert sich die WADA? Wie werden die WADA-Testlabore vergütet? Welche möglichen Abhängigkeiten könnten in Bezug auf die Testergebnisse bestehen? Was meinen Sie auf Basis der beiden Artikel: Würde die WADA Ihre Fragen und Rückmeldungen hören wollen? Falls Sie in der Internen Revision der WADA arbeiten, würde ich Sie gerne interviewen. Bitte melden Sie sich bei mir. Ich wünsche Ihnen viel Spaß beim Zuhören und erfolgreiche Prüfungsprozesse!

Hosted by the India Knowledge Consortium, this was a path-breaking discussion with lively Q&A. Held at Nehru Center, London. Rajiv Malhotra explained the past 30 years of activities in the field of IKS, the challenges it faces, and the breakthrough potential before us. Snakes in the Ganga - http://www.snakesintheganga.com Varna Jati Caste - http://www.varnajaticaste.com The Battle For IIT's - http://www.battleforiits.com Power of future Machines - http://www.poweroffuturemachines.com 10 heads of Ravana - http://www.tenheadsofravana.com To support Infinity Foundation's projects including the continuation of such episodes and the research we do: इनफिनिटी फ़ौंडेशन की परियोजनाओं को अनुदान देने के लिए व इस प्रकार के एपिसोड और हमारे द्वारा किये जाने वाले शोध को जारी रखने के लिए: http://infinityfoundation.com/donate-2/ --- Support this podcast: https://podcasters.spotify.com/pod/show/rajivmalhotrapodcast/support

In Part 5 of the Mental Health Series, we chat with Dr Mala Kapadia, an expert on Indic psychology about perspectives on mental health from within the Hindu tradition.Dr Mala Kapadia, Ph.D. is Director, Anandi Transdisciplinary Research Initiatives, Palani, Coimbatore. She is Principal Investigator in a research project under IKS, MoE, Government of India. The project encompasses creating a framework and Index of Wellbeing and Happiness, based on Hitayu and Sukhayu constructs from Ayurveda. She has designed curriculums based on the same for higher education.Dr. Mala Kapadia's academic journey is through Psychology, Literature, Human Resources, Yoga, Ayurveda, Film and Video Production. She was an adjunct professor at S.P. Jain School of Global Management at Dubai, Singapore, Sydney and Mumbai campuses from 2005 to 2020. Her career has been through research, education, journalism, HR and consulting. Dr. Mala's area of research is Indic wisdom for the betterment of humanity. Her strength is integrating wisdom of India with modern theories and research in the fields of Wellness & Well-being, Emotional Intelligence, Positive psychology, Leadership and Feminine Energy. Education psychology through Ayurveda and Yoga is an integral research area and one of the focus areas of her current work along with creating Indic frameworks and course curriculums for integration into mainstream courses.General InformationSubscribers are requested to look for The Hindu Parenting notification emails for new podcasts/posts in their email promotions/spam tab and personally move these into the main inbox. Thereafter all posts will be delivered to their main inbox. Thank you!For questions that you'd like us to address, please use the form below:Hindu Parenting QuestionsFor comments and suggestions, please use the comments tab or write to us at contact@hinduparenting.orgPlease note that questions will not be answered on email.Do subscribe to our substack and follow us on our social media handlesTwitter: hinduparentingInstagram: hinduparentingTelegram: t.me/hinduparentingFacebook: facebook.com/hinduparentingFacebook group: facebook.com/groups/hinduparentingKoo: hinduparenting Get full access to Hindu Parenting at hinduparenting.substack.com/subscribe

Anfang des Jahres ereignete sich in Griechenland das schwerste Zugunglück in der Geschichte des Landes, als in der Nacht zum 01.03.2023 bei voller Fahrt ein Personen- und ein Güterzug zusammenstießen. Mindestens 46 Menschen starben. Kein Wunder also, dass die Schuldfrage gestellt wurde. Gerade als Interne Revision werden wir unternehmensintern auch manchmal beauftragt, den genauen Hergang zu ermitteln und die Schuldfrage zu klären. Bitte lassen Sie sich nicht dazu verleiten, den einfachen Weg zu gehen und vorschnell auf menschliches Versagen abzustellen. Der vordergründig Schuldige in diesem Fall wäre der Stationsvorsteher, dem bei der manuell vorzunehmenden Weichenstellung eventuell ein Fehler unterlaufen ist. Stellen Sie stattdessen die unbequemen Fragen. Blicken Sie gerade bei Schadenfällen unbedingt immer auf die Kontextbedingungen und fragen Sie sich, wie die von Ihnen identifizierten Kontextbedingungen dazu beigetragen haben könnten, den Schadenfall zu ermöglichen oder zu verhindern. In diesem Fall, gab es jahrelange Missstände: - Sparmaßnahmen im gesamten Land seit der Finanzmarktkrise in 2008 - Aufgrund der Armut wurden in 2011 freiliegende Kupferkabel gestohlen. - Seit 2011 funktionierte daher das elektronische Leitsystem nicht mehr, das die Lokführer gewarnt oder sogar zur automatischen Abschaltung der Züge geführt hätte. - eine Runderneuerung des gesamten Systems wurde seit 2017 verzögert Aus welchen möglicherweise sogar nachvollziehbaren Gründen ließ der griechische Staat bzw. die griechische Bahn seit 12 Jahren zu, dass ein manueller Eingriff nötig war und die Folgen eines manueller Fehler nicht durch die Technik verhindert wurden? Hier bestehen definitiv deutliche Lücken im IKS! Wer ist für das IKS zuständig? Welche Ansprüche wurden an das IKS gestellt? Wer hat die bis zur Instandsetzung des elektronischen Leitsystems bestehenden Schwächen akzeptiert und aus welchen Gründen? Ja, man kommt unweigerlich früher oder später zu Themen, die mit den Werten und der Organisationskultur zu tun haben. Diese gilt es anzugehen. Ich gebe zu, dass das nicht einfach ist. Das sollte uns aber nicht davon abhalten, diese Fragen zu stellen. Und ich finde es auch nicht schlimm, wenn die Interne Revision an Grenzen stößt. Was sie in jedem Fall leisten kann, ist eine Darstellung des Kontexts und der schwierigen Gemengelage, einschließlich aller verschiedenen Perspektiven. Das ist auch eine Form von Objektivität, die den Diskussionsprozess versachlichen und verbessern kann. Über Veränderungen der Rahmenbedingungen, kann sich dann auch die Organisationskultur positiv verändern. Vielen Dank, dass Sie zu einer besseren Welt beitragen! Ich wünsche Ihnen viel Spaß beim Zuhören und erfolgreiche Prüfungsprozesse!

In diesem Podcast beleuchte ich Governance rund um das Thema Berufskrankheit. Grundlage ist der Artikel von Daniel Drepper aus der SZ vom 23.12.2022. Anlässlich der zahlreichen Long-Covid Fälle beleuchtet er verschiedene Institutionen, die darüber entscheiden, ob eine beantragte Berufskrankheit letztlich als solche anerkannt wird. Als wäre es ein IKS innerhalb einer einzelnen Organisation, analysiere ich bestehende Interessenkonflikte und Lücken in der Governance über die verschiedenen Verbände und Institutionen hinweg. Mein Fazit lautet: Wir dürfen in unseren Prüfungen nicht nur einzelne Komponenten betrachten. Wie bei diesem Thema zu sehen ist, sollten wir immer auch die Zusammenhänge im Großen Ganzen betrachten, um mögliche Lücken an den Schnittstellen zwischen den Institutionen erkennen zu können. Es ist extrem schade, dass Ermittler, Prüfer und Interne Revisoren innerhalb der einzelnen Teilbereiche kaum etwas tun können, um die Lücken im Zusammenspiel aller Komponenten der Governance zu beheben. Wenn es Ihnen im Rahmen Ihrer Aufgaben möglich sein sollte, an dieser Situation etwas zu ändern, dann bitte ich Sie, etwas dagegen zu unternehmen. Versuchen Sie, bestehende Interessenkonflikte zu reduzieren und die Governance insgesamt zu stärken. Vielen Dank! Ich wünsche Ihnen viel Spaß beim Zuhören und erfolgreiche Prüfungsprozesse!

V zatím nejdelší epizodě se dostaneme pod kůži legendárnímu podcasterovi Čestmíru Strakatému. Bavíme se o tom, jak vnímal zatím nejvyhrocenější volby, s jejichž kandidáty dělal nespočet rozhovorů a o tom, proč nikoho nevolil (a jestli se to při příštích volbách změní). Rovněž se dozvíme, co dělá na IKSŽ a jak se mu studují (či studovala?) mediální studia na Hollaru. Moderují Aidan Macready (@mekrydy) a Anet Kopčanová (@anetakopcanova). Sledujte nás na Instagramu: instagram.com/celetnaonair

Die Betriebsprüfung wandelt sich. Das bedeutet, dass auf Kanzleien und Mandanten neue Anforderungen zukommen. Doch was bedeutet die Modernisierung der Betriebsprüfung konkret? Darüber hat Viktor Rebant in „hsp live um 11“ mit Paul Liese gesprochen. Als IKS-Fachmann und Dozent der hsp Academy zum Thema Internes Kontrollsystem nahm Viktor auch die Rolle [...] Der Beitrag Modernisierung der Betriebsprüfung und die Rolle des IKS erschien zuerst auf hsp Handels-Software-Partner GmbH.

Studerer eller arbeider du ein annan plass i landet? Men samtidig vurderer å busette deg og arbeide i Sunnhordland? Då vil eg anbefale å lytte til denne episoden med Nina Haara Matre i Bu i Sunnhordland. I dag er episoden laga i eit kommersielt samarbeid med Atheno og Sunnhordlandsrådet IKS. Nyttårstreff

Se studentskou ombudsmankou pro IKSŽ jsme si sedli, abychom o ní toho co nejvíce zjistili: co všechno dělá v iRozhlasu (spoiler: zastává 4 pozice), jestli se jí víc líbilo v Itálii nebo Finsku, a co měla v letošním Spotify Wrapped

Leif Bjørnar Seppola intervjues om Storfjord og medeierskapet i Halti kvenkultursenter IKS

I denne episoden fortsetter vi med andre og siste del av intervjuet med Teodor Janson og Frank Jørstad, som skrev manuset til Kvääniteatteri sin debutforestilling «Näkymätön kansa – Det usynlige folket». Vi byr på fjerde del av «Kvensk lydkurs» fra 2016, og spør: Er kvensk et «tullespråk»? Det er Kainun institutti – Kvensk institutt, Halti kvenkultursenter IKS og Storfjord språksenter som står bak kurset. Videre byr vi på et lite utdrag fra et foredrag Laila Lanes, som straks slipper boken «To prosent norsk», holdt tidligere i høst. I forbindelse med foredraget fikk vi også noen ord med Elling Vatne fra Olmavankka/Manndalen, som er leder i Kåfjord kvenforening.

I denne episoden sender vi tredje del av «Kvensk lydkurs» fra 2016. Det er Kainun institutti – Kvensk institutt, Halti kvenkultursenter IKS og Storfjord språksenter som står bak kurset. Vi har snakket med Jorid Jakobsen fra Sneskavla 4H i Båtsfjord. I forkant av premieren av «Näkymätön kansa – Det usynlige folket» snakket vi med skuespillerne Sara Maria Lindbach, Ørjan Steinsvik, Ivar Beddari og Astrid Serine Hoel, og byr i tillegg på første del av et intervju med manusforfatterne Teodor Janson og Frank Jørstad.

Pengarah Pihak Berkepentingan Ekuiti Nasional Berhad (Ekuinas) Hizwani Hassan menjelaskan, syarikat terbabit membangunkan program-program usahawan terutama IKS. Jelas beliau, apabila sesebuah IKS berkembang, pelbagai faktor mempengaruhi perniagaan termasuk adaptasi teknologi dan dana untuk melabur dalam teknologi.

Pengarah Pihak Berkepentingan Ekuiti Nasional Berhad (Ekuinas) Hizwani Hassan menjelaskan, syarikat terbabit membangunkan program-program usahawan terutama IKS. Jelas beliau, apabila sesebuah IKS berkembang, pelbagai faktor mempengaruhi perniagaan termasuk adaptasi teknologi dan dana untuk melabur dalam teknologi.

Industri kreatif dan akademik berpisah tiada.  Di Universiti Pendidikan Sultan Idris (UPSI) , pelajarnya mulakan inisiatif untuk membantu IKS. Bagaimana ia dilakukan?  #AWANInews #MalaysiaBangkit

Dnešním hostem podcastu Celetná on Air je Petr Vrána. Petr je členem oblastní rady a místního sdružení ODS a kandiduje do letošních komunálních voleb za Neratovice; je také redaktorem webu neralisty.cz a studentem marketingu na IKSŽ. Epizodu vedou moderátorky Anet Kopčanová a Michaela Meyerová.

Hostem epizody je Tea Sofia, nadaná zpěvačka a prvačka IKSŽ.

CoA - Daniel Stach, moderátor České televize, vyučující na IKSŽ a velký sportovec

Hostem epizody je Kateřina Etrychová, všestranná novinářka, která se po absolvování IKSŽ vrátila zpět jako vyučující předmětu Krizová žurnalistika. V rozhovoru se mimo jiné dozvíte, jaká byla její cesta do médií, jak vzpomíná na studium a jak vidí IKSŽ "ze správné strany katedry".

Bianka Machová je studentka mediálních studií na IKSŽ, umělkyně a jedna ze čtyř PUMA HEROES. V epizodě nám poví o tomto projektu, ale také o Budějovickému Majálesu i její další tvorbě.

Nach dem Eklat beim olympischen Mixed Team Staffel-Wettbewerb im Skispringen muss man sich fragen, ob die FIS eine Interne Revision hat. Denn diese hätte sicherlich festgestellt, dass das bestehende IKS offenbar nicht als ausreichend bewertet werden kann. Revisoren wissen folgendes: 1. Es kommt nicht nur auf eine passende Regelung an. 2. Alle Kontrolleure in der zweiten Verteidigungslinie sollten die Regeln möglichst identisch auslegen. 3. Den Kontrollierten ist die Auslegung vorab zu kommunizieren. Würde also die FIS über eine funktionierende Interne Revision verfügen, wären die Schwächen des IKS aufgedeckt worden. Da dem nicht so war, lautet meine Antwort: Ja, die FIS benötigt eine Interne Revision. Der Podcast schließt mit meinen Prüfungsideen zu dem Thema. Ich wünsche Ihnen viel Spaß beim Zuhören und erfolgreiche Prüfungsprozesse!

Prof. Joy Sen, head of IKS centre, says his claim is based on ancient Indian texts, research is not about 'BJP or RSS', but about ‘righting history of human knowledge'. ----more---- https://theprint.in/india/iit-kgp-is-now-attempting-to-prove-that-ancient-india-inspired-pythagoras-theorem-msmes/824138/

Témata: Vývoj IKSŽ, dějiny (nejen) médií, obsese českého diváka s nemocničním prostředí, tipy a triky na příjmací zkoušky na mediální studia.

No programa de hoje: - Joe Burrow, o Matt Ryan 2.0? - Os Bills estavam no pique Cain Velasquez contra Junior Cigano (surra homérica) - O jogo de Tampa só serviu pra Brady melhorar o bronzeado - IKS tentou, mas não conseguiu entregar o jogo: o McCarthismo é pífio/patético - Mahomes ligou o modo turbo ou os Steelers que eram muito fracos? - Todo café do mundo para Sean McVay é pouco >> Assine nosso site! Aproveite a promoção no plano anual: R$ 1,90 por 30 dias para você testar, depois virando assinatura anual– assine o quanto antes e tenha o dobro de podcasts e textos exclusivos: profootball.com.br/assinar Inscreva-se no canal do Telegram: http://t.me/curtiantonyPlaylist e músicas que usamos no podcast: https://open.spotify.com/playlist/44ZYQj9HMrQPJOcyDHPwyL?si=fa10afc06e8a4a1d

V dnešní epizodě Lili a Anastasia zpovídaly děkanku Fakulty sociálních věd UK Alici Němcovou Tejkalovou. Jak vzpomíná na garanta žurnalistiky Filipa Lába? Jak bude dál působit na fakultě a na IKSŽ poté, co vyprší její děkanské období? A v neposlední řadě se uchazeči o studium na specializaci Žurnalistiky dozví tipy, jak nepohořet na ústním kole přijímaček.

Last February, Leiden University Libraries (UBL) acquired a rare Chinese manuscript dating back to the Ming Dynasty. Three Chinese Studies students got the opportunity to decipher the edict (dated 1582) during their internships. In this UBLpodcast they share their findings. The Imperial edict is part of the former collection of well-known sinologist and author of detective-novels Robert van Gulik. Thanks to a large private donation and support by our Friends Foundation, the UBL was able to purchase the piece. The edict – written on silk – praises the parents of Zhao Fan, a civil servant with a good reputation. The reigning emperor honors Zhao's father, his father's deceased first wife, and Zhao's mother for the upbringing of their son. De students studied various aspects of the document. Mauk Evertse, the first interviewee in this podcast, describes the physical characteristics of the document. Next, Iks van Eijndhoven gives some historical context about the Ming Dynasty. And finally, Jelle Kuiper describes how he managed to translate the Chinese text. During their internship, the three students were mentored by Hilde De Weerdt, Professor of Chinese History, Lin Fan, Lecturer in Chinese Art, and Marc Gilbert, Chinese Studies Librarian.

Das Thema Internes Kontrollsystem kann im heftigsten Fall ein Unternehmen retten. Daher sollte das IKS sowieso schon einen hohen Stellenwert einnehmen. Allerdings platziert IKS-Experte Viktor Rebant sein massives, dreistündiges E-Learning-Modul übers Interne Kontrollsystem im Weiterbildungskurs Digitalisierungsberater:in der hsp Academy. Aber wieso? Zu den Gründen und Inhalten hat er sich in „hsp live um 11“ ausführlich [...] Der Beitrag Internes Kontrollsystem: Deshalb ist IKS ein Digitalisierungsthema erschien zuerst auf hsp Handels-Software-Partner GmbH.

V dnešní epizodě se pobavíme s bývalým studentem MKPR a současným pedagogem na IKSŽ, Štěpánem Soukeníkem, o spoustě zajímavých témat. Například přijde řeč na jeho práci ve Facebooku, na jeho studentský život, na jeho zkušenosti z Islandu a v neposlední řadě probereme i postavení a počínání Ruska v minulých týdnech.

Durch die jüngsten gesetzlichen Entwicklungen im Zuge des Regierungsentwurfes eines Gesetzes zur Stärkung der Finanzmarktintegrität gewinnt das sog. IKS, das interne Kontrollsystem eines Unternehmens, zunehmend an Bedeutung. Grund dafür ist das Bestreben des Gesetzes, gerade interne Kontrollen zu stärken, um sie neben weiteren Schutzmechanismen gegen eine zunehmende Manipulation der Bilanzen einzusetzen. Wir haben Frau Bernadette Reuss gefragt, welche konkreten Vorteile Sie in einer Transformation der Internen Kontrollsysteme für Unternehmerinnen und Unternehmer sieht. +++ Mehr zu diesem Thema finden Sie in unserer Zeitschrift der Aufsichtsrat.

Sejam bem-vindos ao sétimo arquivo de áudio perdido que virou podcast da Livraria LeiaNovosBR! No episódio de hoje você tem acesso à entrevista da atrapalhado funcionário Caio Amaro (@caiohamaro) com o autor Guilherme L. A. Pimenta! Guilherme L. A. Pimenta é natural de Belo Horizonte e formado em Design, mas escreve desde que se viu apaixonado por criar imagens com palavras. Hoje autor e redator, tem livros publicados de maneira independente como "O Espectro de Iks" e "Sempre a Oeste". Estamos aprendendo a organizar as coisas novamente, então aqui estão os links importantes comentados no episódio: Twitter: @pepperputz Site do Autor Guilherme L. A. Pimenta E-book Sempre a Oeste! E-book Unha e Pele  E-book O Espectro de Iks  E-book O General da Tempestade A livraria LeiaNovosBR está aberta 6 horas por dia, 8 dias por semana, em turnos intermitentes com horário de almoço fixo, mas intervalos livres para cafezinhos. Você pode tentar entrar em contato conosco por sinais de fumaça (desde que originária de churrasco vegano), por cartas endereçadas à caixa postal ou, em casos extremos, tentar contato pelo nosso twitter ou no e-mail leianovosbr@gmail.com Créditos Nem só de duendes e sacis é feita a equipe da LeiaNovosBr! Esse capítulo da nossa livraria só foi possível pela ajuda dos nossos colaboradores incríveis. Pauta e gravação: Carol Vidal e Caio Amaro Arte da Vitrine: Daielyn Cris Bertelli Edição: Senhor Basso E pela ajuda das pessoas que nos apoiam: Rodrigo Leite Airechu Melisa de Sá Cláudia Rodrigues Priscila Rubia Nilda Lucas Domingos Carolina Mendes Abner De Souza Marina Jardim Carol Vidal Dayse Cristhina Leandro Gomes Francisco Faria Thiago Ruediger Marina Kondratovich Allan Felipe Lu Bento Clecius Duran Laine Lilica Lara Prado Alessandra Rocha Igor Bajo Ricardo Brunoro Amauri Silva Contribua para o LeiaNovosBR  O LeiaNovosBR é um podcast quinzenal no qual dois funcionários de uma livraria mágica bagunçada entrevistam autores nacionais e ele faz parte do site Leitor Cabuloso. Contribua para o projeto, conheça as recompensas em  catarse.me/leitor_cabuloso ou no Picpay em https://picpay.me/leitorcabuloso. Banner do site Leitor Cabuloso em um fundo claro de uma imagem de livros empilhados. Na parte superior central há a frase "Literatura é resistência!" em azul. No centro do banner há a logo colorida do Leitor Cabuloso, composta pela imagem de um punho erguido amarelo saindo de um livro azul ao lado do nome 'Leitor Cabuloso'. Abaixo dessa logo há 4 ícones, o primeiro é de um papel e uma caneta com a legenda "Contos", o segundo é de uma estrela com a legenda "Resenhas", o terceiro é de várias estrelas com a legenda "Colunas" e o último é de um microfone com fones de ouvido com a legenda "Podcasts". Na parte inferior da imagem há a frase "Apoie em catarse.me/leitor_cabuloso" seguido do ícone colorido da plataforma Catarse.

Sejam bem-vindos ao sétimo arquivo de áudio perdido que virou podcast da Livraria LeiaNovosBR! No episódio de hoje você tem acesso à entrevista da atrapalhado funcionário Caio Amaro (@caiohamaro) com o autor Guilherme L. A. Pimenta! Guilherme L. A. Pimenta é natural de Belo Horizonte e formado em Design, mas escreve desde que se viu apaixonado por criar imagens com palavras. Hoje autor e redator, tem livros publicados de maneira independente como "O Espectro de Iks" e "Sempre a Oeste". Estamos aprendendo a organizar as coisas novamente, então aqui estão os links importantes comentados no episódio: Twitter: @pepperputz Site do Autor Guilherme L. A. Pimenta E-book Sempre a Oeste! E-book Unha e Pele  E-book O Espectro de Iks  E-book O General da Tempestade A livraria LeiaNovosBR está aberta 6 horas por dia, 8 dias por semana, em turnos intermitentes com horário de almoço fixo, mas intervalos livres para cafezinhos. Você pode tentar entrar em contato conosco por sinais de fumaça (desde que originária de churrasco vegano), por cartas endereçadas à caixa postal ou, em casos extremos, tentar contato pelo nosso twitter ou no e-mail leianovosbr@gmail.com Créditos Nem só de duendes e sacis é feita a equipe da LeiaNovosBr! Esse capítulo da nossa livraria só foi possível pela ajuda dos nossos colaboradores incríveis. Pauta e gravação: Carol Vidal e Caio Amaro Arte da Vitrine: Daielyn Cris Bertelli Edição: Senhor Basso E pela ajuda das pessoas que nos apoiam: Rodrigo Leite Airechu Melisa de Sá Cláudia Rodrigues Priscila Rubia Nilda Lucas Domingos Carolina Mendes Abner De Souza Marina Jardim Carol Vidal Dayse Cristhina Leandro Gomes Francisco Faria Thiago Ruediger Marina Kondratovich Allan Felipe Lu Bento Clecius Duran Laine Lilica Lara Prado Alessandra Rocha Igor Bajo Ricardo Brunoro Amauri Silva Contribua para o LeiaNovosBR  O LeiaNovosBR é um podcast quinzenal no qual dois funcionários de uma livraria mágica bagunçada entrevistam autores nacionais e ele faz parte do site Leitor Cabuloso. Contribua para o projeto, conheça as recompensas em  catarse.me/leitor_cabuloso ou no Picpay em https://picpay.me/leitorcabuloso. Banner do site Leitor Cabuloso em um fundo claro de uma imagem de livros empilhados. Na parte superior central há a frase "Literatura é resistência!" em azul. No centro do banner há a logo colorida do Leitor Cabuloso, composta pela imagem de um punho erguido amarelo saindo de um livro azul ao lado do nome 'Leitor Cabuloso'. Abaixo dessa logo há 4 ícones, o primeiro é de um papel e uma caneta com a legenda "Contos", o segundo é de uma estrela com a legenda "Resenhas", o terceiro é de várias estrelas com a legenda "Colunas" e o último é de um microfone com fones de ouvido com a legenda "Podcasts". Na parte inferior da imagem há a frase "Apoie em catarse.me/leitor_cabuloso" seguido do ícone colorido da plataforma Catarse.

Bernadette ist Senior Managerin im Bereich Risk & Regulatory und zweifache Mutter. Im Podcast sprechen wir über Risk Consulting, die Transformation des Internen Kontrollsystems und Skateboarden. Außerdem: Welche Erfolgsfaktoren haben ihre Karriere beeinflusst? Warum spielt der Standort des Arbeitsplatzes für sie keine Rolle?

V téte epizodě se můžete těšit na pohodový pokec třeba o práci copywritera nebo o její kariéře v modelingové agentuře CRUSH.MODELS a o práci modelky jako samotné. Řeč bude i o focení během momentální pandemické situace. Tinka nás zasvětila do podcastu @podslupkou, kterého je součástí a vysvětlila jaké je pro ní být "banánovým dítětem". Samozřejmě se můžete těšit i na diskuzi o sociálních médiích, o influencer marketingu a o samotném studiu na IKSŽ.

Au programme de l'émission du 27 janvier 21 : Un retour sur archives avec Nathalie Soussana, musicienne et collecteuse, venue en mars 2017 présenter le livre-disque Berceuses et comptines berbères (Didier jeunesse, 2016) ; et de nombreuses chroniques La nouveauté discographique – chronique de Véronique Soulé – c’est au début Le bal des loups – de Patric Rochedy, un CD édité par Oui’dire, décembre 2020, à écouter à partir de 10/12 ans Patric Rochedy a choisi ces cinq contes pour la place qu’ils donnent au loup, entre bête sauvage et bête empreinte de sagesse. De sa voix profonde, souriante, matînée d’un petit accent chantant du Sud, Patric Rochedy embarque ses auditeurs, accompagné par le violon ou les percussions de Virginie Basset, et par la contrebasse de Johan Jacquemoud. On le suit sur les traces du loup, dans les paysages enneigés, dans les cafés et les auberges du village où les rumeurs courent à propos de l’animal. Patric Rochedy sait captiver tout autant qu’il fait frissonner. Les p’tits papiers d’Estelle – La revue de presse d’Estelle Laurentin – c’est vers 10 mn Estelle s’intéresse aux effets de la pandémie sur les bébés et les naissances... Livre et chansons : Un Retour sur archives avec Nathalie Soussana, collecteuse de Berceuses et comptines berbères (Didier jeunesse, 2016) – c’est vers 20 mn Pour ce Retour sur archives, voici la diffusion d’un entretien réalisé dans cette émission il y a quelque temps, en mars 2017, sans lien avec une quelconque actualité. Comptines et berceuses berbères. 27 chansons du Maroc et d’Algérie, édité par Didier jeunesse en 2016, fait partie de cette collection de livres disque sur les comptines du monde entier, dont nous parlons souvent dans cette émission, et dont la qualité ne faiblit pas. Des comptines et des berceuses de tous les coins du monde, collectées selon les titres par Chantal Grozléziat ou par Nathalie Soussana. Celui-ci est signé Nathalie Soussana, et avec elle nous remontons à la genèse de ce livre disque. Grands livres pour petites personnes - chronique de Elsa Gounot - c'est vers 52 mn Plasticus Maritimus, d'Ana Pêgo, Isabel Minhós Martins et Bernardo P. Carvalho, L’école des loisirs, 2020 "Avec Plasticus Maritimus, on se retrouve entre documentaire, beau livre illustré, récit, journal personnel et appel à l'engagement, ce qui fait de ce livre un objet aussi passionnant qu'intrigant dans son fond comme dans sa forme." Lecture - par Lionel Chenail - c'est vers 60 mn Des kilomètres à la ronde – Vinca Van Eecke – Seuil, 2020 On a écouté-Le meneur de loups – Patric Rochedy – Le bal des loups – CD, Ou’dire, décembre 2020 -Dans la vie faut pas s’en faire – Jacques Dutronc -Ssendu / Bayannu karkanuu / Iks mimi / Ay a lxi inu [Nathalie Soussana, Jean-Christophe Hoarau] – Berceuses et comptines berbères – livre-CD, Didier jeunesse, 2016

Naše pozvání přijal docent Filip Láb, garant žurnalistiky na IKSŽ. V této epizodě se dozvíte, jaká byla cesta docenta Lába na Fakultu sociálních věd, oblíbené střípky Alexe Jonese a mimo jiné i třeba jak televize Nova pojala konspirační fenomén chemtrails.

Ve dvoudílné speciální epizodě určené pro uchazeče IKSŽ jsme si do podcastu pozvali profesora Martina Štolla, garanta komunikačních studií a mediálních studií. Jaká byla cesta profesora Martina Štolla na FSV? Jaký byl jeho studentský život? A proč vlastně studovat na IKSŽ? Dojde mimo jiné i na otázky publika. To vše a mnohem více v první části dvoudílného podcastu!

Paul J. Wang: Welcome to the monthly podcast! On the Beat for Circulation: Arrhythmia and Electrophysiology. I'm Dr. Paul Wang, Editor-in-Chief. With some of the key highlights from this month's issue. Paul J. Wang: In our first paper, Demilade Adedinsewo and associates assess the accuracy of an artificial intelligence-enabled electrocardiogram [AI-ECG] to identify patients presenting with dyspnea who have left ventricular LV systolic function (defined as LV ejection fraction ≤35%) in the emergency department [ED]. Patients were included if they had at least one standard 12-lead electrocardiogram [ECG] acquired on the date of the ED visit and an echocardiogram performed within 30 days of presentation. Patients with prior LV systolic dysfunction were excluded. A total of 1,606 patients were included. Meantime from ECG echocardiogram was one day. The AI-ECG algorithm identified LV systolic dysfunction with an area under the curve [AUC] of 0.89 and accuracy of 85.9%. Sensitivity was 74%, specificity 87%, negative predictive value 97%, and positive predictive value 40%. To identify an ejection fraction less than 50%, the AUC was 0.85, sensitivity 86%, sensitivity 63%, and specificity 91%. NT-proBNP alone with a cutoff greater than 800 identified LV systolic function with an AUC of 0.80 by comparison. Paul J. Wang: In our next paper, Mahmood Alhusseini and associates hypothesize that convolutional neural networks [CNN] may enable objective analysis of intracardiac activation in atrial fibrillation [AF]. They perform panoramic recording of bi-atrial electrical signals in AF and use the Hilbert-transform to produce 175,000 image grids in 35 patients labeled for a rotational activation by experts who showed consistency, but with variability (kappa [κ]=0.79). In each patient, ablation terminated atrial fibrillation. A CNN was developed and trained on 100,000 AF image grids validated on 25,000 grids, and then tested on a separate 50,000 grids. They found in a separate test cohort of 50,000 grids, CNN reproducibly classified AF image grids into those with or without rotational sites with 95.0% accuracy. This accuracy exceeded that of support vector machines, traditional linear discriminant, and k-nearest neighbor statistical analyses. To probe the CNN, they applied gradient weighted class activation mapping, which revealed that the decision logic closely mimicked rules used by experts (C statistic 0.96). The authors concluded that convolutional neural networks improve the classification of intercardiac AF maps compared to other analyses and agreed with expert evaluation. Paul J. Wang: In our next paper, Kenji Okubo and associates examined whether late potential LP, abolition and ventricular tachycardia [VT] non-inclusive ability predicted long-term outcomes in patients with non-ischemic cardiomyopathy [NICM] undergoing VT ablation. The total 403 patients with NICM (523 procedures) who underwent VT ablation from 2010 to 2016 were included. The underlying structural disease consists of dilated cardiomyopathy (DCM, 49%), arrhythmogenic right ventricular cardiomyopathy (ARVD 17%), postmyocarditis (14%), valvular heart disease (8%), congenital heart disease (2%), hypertrophic cardiomyopathy (2%), and others (5%). Epicardial access was performed in 57% of patients. At baseline, the LPs were present in 60% of patients, and a VT was either inducible or sustained/incessant in 85% of the cases. At the end of the procedure LP abolition was achieved in 79% of cases in VT noninducability in 80%. After a multivariate analysis, the combination of LP abolition and VT noninducibility was independently associated with free survival from VT (hazard ratio, 0.45, p = 0.0002) and cardiac death (hazard ratio 0.38, P = 0.005). The benefit of LP abolition of preventing the VT recurrence in ARVD and postmyocarditis appeared superior to that observed for DCM. Paul J. Wang: In our next paper, Domenico Corradi, Jeffrey Saffitz and associates hypothesize that structural molecular changes in atrial myocardium that correlate with myocardial injury and precede and predict postoperative atrial fibrillation [POAF] may identify new molecular pathways and targets for prevention of this common morbid complication. Right atrial appendage [RAA] samples were prospectively collected during cardiac surgery from 239 patients enrolled in the OPERA trial. 35.2% of patients experienced POAF compared to the non-POAF group. They were significantly older and more likely to have chronic obstructive pulmonary disease or heart failure. They had a higher Euro score and more often underwent valve surgery. No differences in atrial size were observed between POAF and non-POAF patients. The extent of atrial interstitial fibrosis, cardiomyocyte myocytolysis, cardiomyocyte diameter, glycogen storage, or connection 43 distribution at the time of surgery, was not significantly associated with the incidents of POAF. None of these histopathological abnormalities were correlated with level of NT pro-BNP, hs-cTnT, CRP, or oxidative stress biomarkers. The authors concluded that in sinus rhythm patients undergoing cardiac surgery, histopathological changes in RAA do not predict POAF. They did not also correlate with biomarkers of cardiac function, inflammation, and oxidative stress. Paul J. Wang: In our next paper, Mark McCauley, Liang Hong, Arvind Sridhar, and associates hypothesize that obesity decreases sodium channel NAF 1.5 expression via enhanced oxidative stress, thus reducing the sodium current and enhancing susceptibility to atrial fibrillation [AF]. They studied a diet induced obese [DIO] mouse model. Pacing induced AF in 100% of DIO mice versus 25% in controls (P 20 ms shorter than the other sites, and/or induction of AF/atrial tachycardia during measurements. LVA ablation was performed in the LA-LVA patients during the follow-up period of a mean of 62 weeks, the EP test-guided group had a significantly lower recurrence rate (19%,11/57 versus 41%, 22/54, P=0.012) and a higher Kaplan-Meier AF/AT-free survival curve compared with controls (P=0.01). No significant differences in the recurrence, and AF/AT-free survival curves between PWI (positive EP test) and non-PWI (negative EP test) subgroups were observed. Therefore, PWI for positive EP tests reduced the AF/AT recurrence in the EP test-guided group. A stepwise Cox proportional hazard analysis identified EP test-guided ablation as a factor, reducing recurrence rates. The recurrence rates in LA-LVA ablation group and EP test-guided group were similar. Paul J. Wang: In our next study, Jinxuan Lin and associates assess whether simultaneous pacing of the left and right bundle branch areas may achieve more synchronous ventricular activation than just bundle pacing alone. In symptomatic bradycardia patients, the distal electrode of the bipolar pacing lead was placed at the left bundle branch area via a transventricular-septal approach. This was used to pace the left bundle branch area, while the ring electrode was used to pace the right bundle branch area. Bilateral bundle branch area pacing [BBBP] was achieved by stimulating the cathode and anode in various configurations. BBBP was successfully performed in 22 out of 36 patients. Compared with LBBP, BBBP resulted in greater shortening of QRS duration (109.3 vs 118.4 ms, P < 0.001). LBBP resulted in paced RBBB configuration with a DRVAT of 115 ms and interventricular conduction delay of 34.0 ms. BBBP fully resolved the RBBB morphology in 18 patients. In the remaining 4 patients, RBBP pacing partially corrected the right bundle branch block. Paul J. Wang: In our next paper, Ramanathan Parameswaran, Jonathan Kalman, Geoffrey Lee and associates recorded 2-minute long segments of simultaneous inter-operative mapping of endo- and epicardial lateral right atrial [RA] wall in patients with persistent atrial fibrillation [AF] using 2 high-density grid catheters (16 electrodes, 3 mm spacing). Filtered unipolar and bipolar electrograms [EGMS] of continuous 2-minute AF recordings and electrodes locations were exported for phase analysis. They defined endocardial-epicardial dissociation [EED] as phase differences of ≥20 ms between paired endo- and epi electrodes. Wavefronts [WF] were classified as single rotations, that is single wavefront, focal waves, or disorganized activity as per standard criteria. Endo-Epi wave fronts were simultaneously compared on dynamic phase maps. Complex fractionated electrograms were defined as bipolar electrograms with directional changes occupying at least 70% of the sample area. 14 patients with persistent AF underwent cardiac surgery are included. EED was seen in 50.3% of phase maps with significant temporal heterogeneity. Disorganized activity (endo 41.3%, epi 46.8%, P = 0.0194) and single wave (endo 31.3 versus epi 28.1, P = 0.129) were the dominant patterns. Transient rotations (endo 22%, epi 19.2%, P = 0.169, mean duration 590 ms) and non-sustained focal waves (endo 1.2% and epi 1.6%, P = 0.669) were also observed. Apparent transmural migration of rotational activations (n=6) from the epi- to the endocardium was seen in 2 patients. EGM fractionation was significantly higher in the epicardium than endocardium (61.2% versus 51.6%, P < 0.0001). The authors concluded that simultaneous endo-epi phase mapping of prolonged human persistent AF recordings showed significant EED marked temporal heterogeneity, discordant and transitioning wavefronts patterns and complex fractionations. No sustained focal activity was observed. Such complex 3-dimensional interactions provide insights into why endocardial mapping alone may not fully characterize the AF mechanism and why endocardial ablation may not be sufficient. Paul J. Wang: In our next paper, Andrew Beaser and associates hypothesize that intravascular ultrasound [IVUS] could accurately visualize and quantify intravascular lead adherence and degree of intravascular lead adherence correlates with transvenous lead extraction difficulty. Serial imaging of leads occurred prior to transvenous lead extraction using IVUS. Intravascular lead adherence areas were classified as high or low grade. Degree of extraction difficulty was assessed using 2 metrics and correlated with intravascular lead adherence grade. Lead extraction difficulty was calculated for each patient and compared to IVUS findings. 158 vascular segments in 60 patients were analyzed: 141 (89%) low grade versus 17 (11%) high grade. Median extraction time (low = 0 versus high grade 97 seconds, P < 0.001) and median laser pulsations delivered (low = zero versus high grade 5,852, P < 0.001) were significantly higher in the high-grade segments. Most patients with low lead extraction difficulty score had low intravascular lead adherence grades. 86% of patients with high lead extraction difficulty score had low IVUS grade, and the degree of transvenous lead extraction difficulty was similar to patients with low IVUS grades and lead extraction difficulty scores. Paul J. Wang: In our next paper, András Bratincsák, and associates sought to create the foundation of normative ECG standards in the young using Z-scores. 102 ECG variables were collected from a retrospective cohort of 27,085 study subjects with no known heart conditions, age zero to 39 years. The cohort was divided into 16 age groups by gender. Median interquartile range and range were calculated for each variable adjusted to body surface area. Normative standards were developed for all 102 ECG variables, including heart rate; P, R, and T axis; R-T axis deviation; PR interval, QS duration, QT, and QTc interval; P, Q, R, S, and T amplitudes in 12 leads; as well as QRS and T wave integrals. Incremental Z-score values between negative 2.5 and 2.5 were calculated to establish the upper and lower limits of normal. Historical ECG interpretive concepts were reassessed and new concepts observed. The author summarized that electronically acquired ECG values based on the largest pediatric and young adult cohort ever compiled provide the first detailed, standardized, quantitative foundation of traditional and novel ECG variables. Paul J. Wang: In our next paper, Jungmin Hwang and associates hypothesize that suppressing the late sodium current may counterbalance the reduced repolarization reserve in long QT syndrome [LQTS] and prevent early depolarization [EAD] and polymorphic ventricular tachycardia [PVT]. They tested the effects of selective late sodium channel blocker GS967 on polymorphic ventricular tachycardia [PVT] induction in a transgenic rabbit model of type two using intact heart optical mapping, cellular electrophysiology, and confocal calcium imaging and computer modeling. They found that GS967 reduced ventricular fibrillation [VF] induction under a rapid pacing protocol (7 out of 14 hearts in control versus 1 out of 14 at 100 nanomolar) without altering action potential duration [APD] or restitution and dispersion. GS967 suppressed PVT incidents by reducing calcium mediated EADs and focal activity during isoproterenol perfusion (at 30 nanomolar, 7 out of 12 and a 100 nanomolar, 8 out of 12 without EADs and PVTs). Confocal calcium imaging of LQT myocytes revealed GS967 shortened calcium transient duration by accelerating sodium calcium exchanger mediated calcium efflux from cytosol, thereby reducing EADs. Computer modeling revealed the inward late sodium current potentiates EADs in the LQT setting through providing additional depolarizing currents through action potential plateau phase, and increasing intracellular sodium that decreases the depolarizing sodium calcium exchanger, thereby suppressing the action potential plateau and delaying the activation of slowly activating delayed rectifier current, IKS. Suggesting important roles in the late sodium current in regulating intracellular sodium. Thus, the authors concluded that selective late sodium channel blockade by GS967 prevents EADs and abolishes PVT in LQT rabbits by counterbalancing the reduced repolarization reserve and normalizing intracellular sodium. Paul J. Wang: In our next paper, Pietro Lazzerini, Mohamed Boutjdir and associates, hypothesize that systemic inflammation per se can significantly prolong QTc during infection via cytokine-mediated changes in potassium channel expression. They found in patients with acute infections, regardless of concomitant QT-prolonging anti-microbial therapy, QTc was significantly prolonged but rapidly normalized in parallel to C-reactive protein [CRP] and cytokine level reduction. Consistently, in Torsades de Pointes cohort, concomitant acute infections were prevalent 30% despite only a minority (25%) of these cases were treated with QT-prolonging anti-microbials. KCN J2, potassium channel expression in peripheral blood mononuclear cells was strongly correlated to that in ventricles, inversely associated to CRP and interleukin one changes in acute infection patients. The authors concluded that acute infection, systemic inflammation rapidly induces cytokine-mediated ventricular electrical remodeling and significant QTc prolongation, regardless of concomitant antimicrobial therapy. Paul J. Wang: In a research letter, Christophe Beyls and associates examined the risk of bradycardia and critically ill COVID-19 patients treated with Lopinavir [LPV], a protease inhibitor of HIV-1, and Ritonavir [RTV], another protease inhibitor that strongly inhibits hepatic cytochrome P 450 [CYP3A4] activity in order to increase the Lopinavir plasma concentration. During the first month of the outbreak, patients admitted to the ICU with positive PCR for COVID-19 received LPV (200 mg)/RVT (50 mg) twice daily for 10 days. Bradycardia was defined as heart rate below 60 for a period of more than 24 hours. All patients were monitored 24 hours a day for all hemodynamic parameters, including heart rate with a five-lead ECG. Monitors were linked to a computerized system allowing to extract hemodynamic data. LPV/RTV plasma concentration was monitored using analytic method, combining high propensity performance, liquid chromatography and tandem mass spectrometry at 72 hours and every 72 hours. They prospectively included 41 COVID-19 patients who received LPV/RTV treatment. Nine or 22% patients experienced bradycardia. No patients had a pre-existing nodal pathology on the ECG on admission. Among the 9 patients with bradycardia, 8 or 88% were sinus bradycardia and one (12%) third-degree AV block. Causality may be considered as bradycardia occurred at least 48 hours after LPV/RTV initiation, bradycardia resolved after discontinuation or dose reduction and no alternative cause was found. Patients who presented with bradycardia were older, had a higher RTV plasma concentration and a lower lymphocyte count. In our study, no correlation was found between RTV plasma concentration, LPV plasma concentration, and mean heart rate at day three. No patient had bradycardia in the first 48 hours after LPV/RTV administration. For patients with LPV RTV plasma level overdose, the dose of LPV RTV was divided by two until the next dose. For the patient with third degree AV block LPV/RTV was stopped. None of the patients had any known cytochrome CYP3A4-inhibiting drugs. The authors concluded that the results suggest that RTV plasma overdose in elderly critical ill patients may increase the risk of bradycardia. Paul J. Wang: In a research letter, Emily Zeitler and associates surveyed cardiac implantable device [CID] patients. A total of 109 patients were approached to participate, nine declined. Most respondents were white (79%), male (60%) with a mean age of 73 years. The median number of correct responses to the 11 factual questions was six. Respondents held some common misconceptions. For example, 25% of respondents believe that FDA determines the cost of the device. Trust in the FDA was high; 67% of respondents agreed "I trust the FDA". Respondents mostly agreed "the FDA would not approve my device unless it was a hundred percent safe". Only 6% of respondents agreed, "we would be better off if there was no FDA," and a similarly small fraction disagreed with "when it comes to medical devices, the U.S. does the best job in the world at keeping people safe". Most respondents, 69% demonstrated fear of device recalls by agreeing with "if there was a recall of all are part of my device, I think I would be worried or scared." On average, respondents were comfortable sacrificing some privacy for device surveillance, 75% agreed with "once the device has been approved, the FDA should continue to monitor for signs that there are problems with the device even if it means that private health information about me is collected". Respondents seemed to believe that the FDA was risk averse; 56% believed that the FDA does not approve devices unless they're a hundred percent safe. This is in contrast to trends shifting the demonstration of safety to post-approval settings and expanding acceptable forms of data for regulatory approval. Paul J. Wang: In a research letter, Laura Rottner, Christoph Sinning and associates examined novel high resolution imaging system based on a wide band dielectric technology, and reports the first clinical experience of feasibility and reliability of cryoballoon [CB] occlusion tool as compared to fluoroscopic and 3D transesophogeal [TEE] assessment during pulmonary vein isolation [PVI]. In consecutive patients with symptomatic atrial fibrillation [AF], cryoballoon-based ablation was performed with a novel 3D wide-band dielectric imaging system. Pulmonary vein [PV] occlusion was assessed with fluoroscopy in 3D-TEE and concomitantly correlated with the novel CB occlusion tool. The endpoint was defined as persistent PV isolation verified by spiral mapping catheter recordings 30 minutes after the last CB application. A total of 36 (90%) of PVs in 10 patients with paroxysmal (40%) and persistent (60%) were analyzed. In all patients, a normal PV anatomy with four separate PVs was documented. Visualization via 3D-TEE was feasible in 80% septal PVs and 100% of lateral PVs. In 67% of PVs, total PV occlusion was confirmed by all 3 imaging modalities. In 17% of PVs, incomplete PV occlusion was initially demonstrated by TEE and 3D dielectric imaging, whereas fluoroscopy suggested complete occlusion in initial analysis. After repositioning of the CB at 3 PVs, complete PV occlusion was verified by all three modalities. In 3 out of 36 (8%), no occlusion was initially seen by any imaging modality, for which the CB was repositioned resulting in total PV occlusion as confirmed by all three modalities. Two out of 36 PVs (6%) were confirmed to be occluded via fluoroscopy in 3D-TEE, but not by the CB occlusion tool. There was only one out of 36 PVs (3%), which were confirmed to be included by the CB tool and 3D-TEE, but not by fluoroscopy. A negative and positive predictive value of 1.0 and 0.6 was seen when comparing PV occlusion by the novel occlusion tool compared to PV collusion, verified by fluoroscopy and 3D-TEE. Paul J. Wang: In a special report, Jun Hirokami, and associates aim to clarify the spatial correlations between fractionated potential detected by Lumipoint with non-PV trigger. They enrolled 30 symptomatic atrial fibrillation [AF] patients who underwent non pulmonary vein [PV] foci ablation. 4 patients underwent the first procedure, 17 underwent second procedure and eight underwent third procedure, and one underwent a fourth procedure. They highlighted the fractionated signal area in atrial muscle [FAAM] during sinus rhythm and atrial pacing, thereby producing a digital FAAM map. They retrospectively applied Lumipoint to 30 patients in order to clarify the relationship between FAAM and non-pulmonary vein [PV] foci. Non-PV foci were successfully identified in all patients. They identified four patients with multiple non-PV foci. Of these four patients, one had non-PV foci at the superior vena cava and left arterial anterior wall. One had non-PV foci at the SVC and LA bottom wall. And two had non-PV foci at the SVC and interatrial septum. They only analyze 30 non-PV foci unrelated to SVC because the SVC isolation was routinely performed for non-PVC foci at the SVC. In order to analyze the correlation between FAAM and location of non-PV triggers, they determined the cutoff points of peaks slider, which non-PV triggers were completely located within the FAAM in. The accuracy of predicting location of the non-PV triggers was summarized using area under the receiver operating curve, a UROC curve. The optimal cutoff point of peak sliders to predict the location of non-PV was determined by the Youden Index. The Youden Index established the optimal cutoff point of the maximum peaks slider was 7; sensitivity was 0.906 and specificity 0.770. The peaks slider 7 was the most accurate predictor fractionated signals location area to the location of non-PV triggers. (area under the curve 0.902). The mean area of peaks slider 7 was six centimeters squared or 4.3% of the atrium. The authors concluded that the proof-of-concept observational study demonstrated that novel visualization tool of FAAM map successfully identified non-PV triggers that did not induce atrial fibrillation and/or non-PV foci, which potentially serve as substrates for AF maintenance. Paul J. Wang: In a special report, Leslie Saxon and associates update their prior publication providing further detail on mitigation adoption rates for the entirety of the U.S. patient population with implanted cardiac rhythm management devices falling under FDA cyber security advisories from any device manufacturer. They also provided limited data on known cybersecurity mitigation adoption outside the U.S. They report a unique complication resulting for introducing firmware to already implanted devices. Discuss how evolving FDA policies towards firmware mitigation adoption may increasingly determine how and when updates occur. They found that patients under 50 years of age and those over 80 years were less likely to receive the software upgrades, and male versus females had greater rates of upgrades. The upgrade rates varied according to U.S. Region and date of implant. Resynchronization devices were less likely to receive the upgrade, as were pacemaker dependent patient. Those ICD patients initially falling under the battery advisers were upgraded more frequently. The number of advisory patients followed in clinic was a significant predictor for firmware upgrade adoption, particularly for pacemakers that were often upgraded in smaller size clinics. Overall, only 24% of devices for all groups, and 22% of devices not impacted by the battery advisory were upgraded. For Abbott devices, the home communicator cyber security vulnerabilities were mitigated with an automatic software patch that was updated using the Merlin network, and adoption rates were nearly a hundred percent. For the entire patient cohort with impacted pacemaker and ICDs, U.S. and global adoption rates remain low at 24 to 35% with a low rate of complications. Most reported complications for pacemakers and ICD were symptoms (transient palpitations, dizziness, or syncope) that resulted from the temporary change in mode to VVI or transient loss of programmer telemetry while performing the upgrade (pacemaker 0.05%; ICD 0.01%). Globally, a total of 9 pacemakers and 8 ICDs required replacement, as a result of performing the firmware upgrade due to irreversible reversion to a backup pacing mode and loss of defibrillation therapy (ICDs). Analysis of the returned ICD pulse generaotrs found at 7 cases, the cause related to a capacitor bond failure that was exposed only when extended telemetry as required by the upgrade. The failure mechanism was an isolated component failure in the remaining ICD. The programmer based test has recently been FDA approved and can be performed prior to firmware upgrade to identify ICD patients at risk for capacitor bond failure. A total of 256 ICDs were susceptible to loss of RF telemetry after receiving a firmware update, and this has since been mitigated with a software patch. For Medtronic programmers, the initial mitigation responses of cybersecurity advisory was to take the programmers off the network. The network connection was enhanced with one or more security protections provided to the programmers using a flash drive, so the programmers can now be secured from potential cyber intrusion when connected to the network. Medtronic ICDs are currently being upgraded. The upgrade is being provided to impacted patients automatically when the device is interrogated with the programmer during follow-up. Metronic is introducing upgrades in phased approach with all expected to be completed by the beginning of 2021. There are 9% or 55,000 ICDs under this advisory that cannot receive the update due to design or safety constraints. Since the 2017 Abbott advisories identify cybersecurity vulnerabilities in pacemakers and ICDs with the potential for exploits have been increased, including 2 additional FDA advisories issued for another manufacturer. Medtronic's connected communication product and implantable defibrillators in the past 12 months. The authors comment that a recent report and a smaller number of Abbott impacted pacemaker and ICD patients from Canada reported marked differences in mitigation adoption rates between pacemakers and ICDs. This was due to an increase incremental clinical familiarity and comfort with performing the updates as experience and education surrounding these issues evolve. The authors indicate that automating cybersecurity updates without process in place for determining safety, for alerting patients or clinicians that have been delivered, may also be associated with yet unknown risks. Newer generation devices and communication protocols may render cyber security, advisories less frequent as cybersecurity integration is considered an essential aspect of device design. Paul J. Wang: In a review article, Albert Feeny and associates discuss the use of artificial intelligence [AI] and machine learning [ML] in medicine, which are currently areas of intense exploration showing potential to automate human tasks or even perform tasks beyond human capabilities. The first objective of this review is to provide the novice reader with a literacy of AI/ML methods, and to provide a foundation of how one may conduct an ML study. The review provides a technical overview of some of the most commonly used terms, challenges in AI/ML studies with reference to recent studies in cardiac electrophysiology to illustrate key points. The second objective of this review is to use examples from the recent literature to discuss how AI and ML are changing clinical practice and research in cardiac electrophysiology with emphasis on disease detection and diagnosis, prediction, and patient outcomes and novel characterization of disease. The final objective is to highlight important considerations and challenges for appropriate variation, adoption, and deployment of AI technologies and practice. Paul J. Wang: That's it for this month! We hope that you will find the journal to be the go-to place for everyone interested in the field! See you next time! This program is copyright American Heart Association 2020. Thank you.  

I Haugaland brann og redning IKS har de nå en informasjonskampanje om brannvern i jula. Vi snakker med Ole-Martin Norstrand fra forebyggende avdeling.

Från 15 aktiva till 150. I veckans podd så berättar Anna Mannelqvist om Vårby IKs resa under de senaste tio åren. Föreningen testade att göra något annorlunda och nu blomstrar verksamheten. Lyssna och se om du kan ta med dig något tips till din idrottsförening.

Med Jakob Olofsson-Adelin I avsnitt 37 så får ni träffa Jakob Olofsson-Adelin tränare i Jönköping IKs herrlag, han berättar om vilken innebandy han förespråkar, mot vilken typ av motstånd den passar bäst, vilka egenskaper spelarna behöver behärska för att passa in i spelet samt hur man ska träna för bli en sådan spelare. Vi pratar […]

Dags för ett nytt  avsnitt av Europatips podden - Snick Snack med Tim Lidell, som presenteras av MinAndel.se. Inför helgen Europatips gästas hans av Västervik IKs stabile back Alexander Anderberg och tillsammans har det ett skönt Snick Snack och skapar helgens system. Skön lyssning!

Ordfører i Haugesund Arne-Christian (Ap) utelukker ikke at Haugesund også kan bli med i Haugaland brann- og redning IKS.

Nu jau par tradīciju kļuvušas atvērtās dienas laukos, kas šogad notiks no 20. līdz 23. augustam, ar mērķi popularizēt dzīvi laukos un nobaudīt lauku labumus. Kā izbaudīt unikālo iespēju un ciemoties saimniecībās, kur citkārt ciemiņus neuzņem, pastāstīs Latvijas lauku tūrisma asociācijas "Lauku ceļotājs" prezidente Asnāte Ziemele, Zaiga Apse no stādaudzētavas "Liepas", keramikas darbnīca Laima Ceramics vadītāja Laima Grigone, Andrejs Nika no saimniecības Amberfarm un biedrības “Iks parks” pārstāve Anna Roddate.

HSRC Seminar: The Role of Research in Harnessing Indigenous Knowledge Systems (IKS) for Rural Transformation and Technological Innovations in South Africa 28 May 2020 
Online seminar Overview: Indigenous knowledge systems (IKS) are gaining currency as new strategies for Africa's development. IKS is a unique system of knowledge owned, inherited or developed by close groups, communities or individuals of common historical or genetic origin. For generations past and present, IKS have driven healthcare, food and nutritional, safety and security, housing construction, and ecosystem management practices in Africa's rural communities. Yet, colonialism and religion have labelled IKS as fetish, cultic, primitive and superstitious practices. This seminar explores nuances that would reverse the rapid demise of IKS; exploit the synergy between research and IKS; and interrogate how IKS and research interface would provoke technological innovations for rural transformation in South Africa. Presenter: Prof. Francis O.C. Nwonwu, HSRC
 Chair: Carol van Wyk, Department of Science and Innovation For more information and to download seminar presentation: http://bit.ly/iksseminar

Tupan, c'est la rencontre d'un petit gars né d'un père musicien, qui a grandit dans une favelas au Brésil, et du hip hop des années 90. Voyageur infatigable, improvisateur de talent et passionné d'écriture, Tupan a su mêler les sonorités de l'hémisphère sud et le verbe acerbe de l'occident. Son rap se situe entre le franc parlé de Rocca, rappeur franco-colombien, et la plume sincère et aiguisée de Fabe. Le parcours de Tupan est riche en expériences. Il a passé notamment plus de 2 ans au Burkina Faso. Il y fit de nombreuses scènes et de multiples rencontres musicales. En France, le jeune rappeur fait feu de tous bois. Il participe entre autres, à la finale des End of the Weak à Lyon en 2013 (compétition international d'improvisation) et au tremplin Miz'Ampli dont il est lauréat. Il apparaît sur l'album « Pieces to the Puzzle » de Crown (GrimReaperz) au coté d'Akhenaton, PMD (EPMD), Flynt, Scylla, Demi Portion... Avec "Itinérance d'un mélomane" (2016), son premier réel album, il fait le constat du monde dans lequel nous vivons. Une monde avec ses noirceurs, ses contradictions mais aussi sa beauté. Tupan fait également partie du collectif drômois Le Fondla classe. Un crew inspiré par le "bom-bap" fin des années 90. Il était alors composé de Tupan, 2Taf, iKs, Le Zink, Nezzi, EDi, Baldik, Mk (mc's) et de Meloman (dj-beatmaker). Pour Z Interview, le rappeur franco-brésilien revient sur ses racines, sur son parcours solo et au sein du collectif Le Fond'La classe. Une rencontre à micro ouvert avec un jeune artiste à la plume alerte et à la prose inspirée. Un artiste qui développe son art sur scène, sur albums ainsi qu'à l'occasion d'ateliers d'écriture qu'il anime. Une interview réalisée tout en ambiance et en contraste, réalisée par Fabrice Bérard en marge de son concert à Aubenas lors de la fête de la musique. tupanmcbrasileiro.wixsite.com Soutenez-nous !

Wann kommt denn endlich das wirklich autonom fahrende Auto? Mario Trapp ist der Leiter des gerade in München neu gegründeten Instituts für Kognitive Systeme (IKS). Er erklärt, wieso es um viel mehr geht als künstliche neuronale Netze und schlaue Algorithmen, damit sich Maschinen in der echten Welt "intelligent" verhalten. Und wie sie sicher werden.

The reality of Oneness, that we all exist in relation to everything, is an awareness that has roots in both Indigenous and Western approaches. The African approach is Ubuntu. Joining Janet is Dr. Mmatheo Motsisi, from Johannesburg Africa. Trained in both Western and Chinese Medicine, she is also initiated as an Indigenous Knowledge system practitioner (IKS) as a Shaman/Sangoma/Diviner. Together they explore Ubuntu and its healing approach to our human community.

Bonjour à toutes et tous ! Voici le Podcast #178 de GeekOrama ! Cette semaine, Octokom a profité du changement de saison pour s'envelopper dans les limbes automnales avec un jeu plateforme narratif certes plutôt sombre mais qui a sur le guider vers la lumière. Iks... Ah ? Ah bah tiens, non... Addycylette a passé sa semaine à chercher des petits gugusses cachés dans un décor phoniquement très rigolo ! Un instant culture animé par notre Ikson, où notre podcasteur revient sur la carrière d'une dame qui a offert tout son talent au monde du jeu vidéo ! Bonne écoute ! ^_^

”Johan Sellberg-Wiland”. #208 är den stora inför Allsvenskan-specialen och ett mastodontavsnitt som, med utgångspunkt i ”biblarne”, går igenom varje lag i Allsvenskan. Under resans gång synas även panelens tabelltips och till slut ringas känslorna inför Sirius säsongsstart in. Dessutom: en otrolig djupdykning i Kalmar, treaper, Peo Ljung-hat och kärlek, Adi Nalic-besvikelse, MP-debatt, det lättslagna IKS, ”Peter Peter”, ”Samovecchia” och Lars försöker sluta slå fast saker. Medverkande: Oskar Bernövall, Johann Bernövall, Lars Olsson, Tommy Tornberg, Axel Vinter Persson.

Meine Mutter hat mir von ihrem Ärger mit ihrem Hausarzt erzählt. Das brachte mich ins Nachdenken über - Interne Kontrollsysteme (IKS) - Rückkopplungsschleifen - Regelkreise - und natürlich über die Interne Revision. Dieser Podcast erläutert - worauf Sie achten sollten, wenn Sie ein IKS prüfen - wann ein Regelkreis wirklich geschlossen ist - was Sie tun können, wenn die Rückkopplung durch den Vorstand ausbleibt oder Eskalationsprozesse verpuffen Ich wünsche Ihnen viel Spaß beim Zuhören und erfolgreiche Prüfungsprozesse!

Hvem skulle trodd at Norge fikk sitt første oljeraffineri allerede i 1863 ? Mer enn hundre år før Norge ble en oljenasjon. Vil du høre mer om det, kan du bli med Ulf Aanonsen og programleder Øyvind Arntsen på en spasertur ved Risøbank i neste utgave av MUSEUM. For mer enn 150 år siden var det røyk og damp og oljesøl overalt på Kanelstranda i det som i dag er et vakkert turområde like utenfor Mandal. Der det i dag er flotte strender, vandrestier og badeplasser ble det bygget to store fabrikker tidlig på 1860-tallet. Et oljeraffineri og en fabrikk for parafinlamper. - Her bygde Salvesenbrødrene et helt oljeraffineri, men uten å ha patentet i orden, sier styreleder Ulf Aanonsen i Risøbank Interkommunale Selskap. I MUSEUM vandrer vi rundt i turområdet på Risøbank hvor Aanonsen forteller om hvordan to brødre i Mandals berømte Salvesenfamilien kom hjem fra Skottland og utnyttet et hull i de skotske patentrettighetene. - Det var vel ingen som hadde tenkt på muligheten av at noen kunne frakte kull helt fra Skottland for å raffinere det her i Norge, sier Aanonsen. Kullet var spesielt oljerikt og het «cannel coal». Kanskje er det et hint til hvorfor det heter «kanelstranda», hvem vet. Produktet var parafin til lamper, tjære og kunstgjødsel. Men først og fremst parafin. Salvesenbrødrene var godt etablert i Skottland og drev handel over hele verden med kull og hvalolje og i flere år gikk også virksomheten på Risøbank godt. - Men så ble fabrikken utkonkurrert og prisene på parafin sank så mye at «Parafin Oil Company» begynte å importere råolje til raffinering istedenfor kull. Og da fikk de driftige Salvesenbrødrene bygget Norges aller første oljetanker. Det var fortsatt seil på den tiden, men det var også Norges første jernskip med dobbel bunn, sier Aanonsen. I MUSEUM får vi også høre om Risøbank IKS og det flotte huset som Lord Salvesen, Edward Theodore Salvesen, fikk bygd som familiens feriested i 1901. I dag er huset fredet av Riksantikvaren og området der raffineriet lå er kjøpt av staten og brukes til turformål. - Dette var feriestedet til en av de store handelsfamiliene i Skottland, utvandret fra Mandal, og i mange år i privat eie. Men da Staten kjøpte det og kommunen overtok driften, så er stedet åpent for alle. Nå ynder vi å si at når du kommer hit, så kommer du ikke som gjest. Da kommer du hjem til deg selv, sier daglig leder Håkon Sødal. Sendt første gang 23/2 2019, Programleder Øyvind Arntsen

- Bonjour à toutes et tous. Voici le Podcast #141 de Geek0rama ! Pourquoi il fallait que j'en prende ?!! Octokom a fait Piou piou piou avec un renard, un poulet, une lapine, et des tas d'autres animaux mignons, remontés à bloc pour sauver leur monde ! Un shooter action très accrocheur ! Iks... Heu ! ... Addycyclette, et oui ! A jouéà un titre riche en émotions, à la trame narrative exceptionnelle qui transporte le joueur vers des horizons qui changent nos habitudes de joueuses et joueurs. Un instant culture animé par notre Mister Culture, où Ikson chante les louanges d'un grand nom de la musique vidéo-ludique. Bonne écoute :)

Dr Paul Wang:   Welcome to the monthly podcast, On The Beat for Circulation: Arrhythmia and Electrophysiology. I'm Dr Paul Wang, editor-in-chief, with some of the key highlights from this month's issue.                                 In our first paper, Ruairidh Martin and associates used ultra-high-density mapping to access the ventricular tachycardia circuit dependent upon re-entry, with scar regions in 36 tachycardias in 31 patients. The author has found that 11 of the ventricular tachycardia circuits and isthmuses were single-loop, and 25 were double-loop. Three had two entrances, five had two exits, and fifteen had dead-end activation. Isthmuses were defined by barriers which included anatomical obstacles, lines of block, and slow conduction in 27 out of 36 isthmuses. The barrier to conduction in isthmus appeared to be partially functional in 75% of circuits. Isthmus voltage is often higher in ventricular tachycardia than in sinus or paced rhythms. The authors found that conduction velocity in the VT isthmus slowed at the isthmus entrances and exits when compared with mid-isthmus. The mean conduction velocity was 0.08 meters per second in entrance zones, 0.29 meters per second in isthmus regions, p < 0.0001, and 0.11 meters per second in exit regions. P = 0.002.                                 In our next paper Daniel Duprez and associates found that plasma collagen biomarkers, particularly at elevated levels, were associated with excess risk of atrial fibrillation. In a stratified sample of the Multi-Ethnic Study of Atherosclerosis (MESA), initially age 45 to 84 years, the authors examined in 3,071 participants plasma Procollagen Type III N-Terminal Propeptide, also known as P3NP, which reflects collagen synthesis in degradation in Collagen Type I Carboxy-Terminal Telopeptide, also known as ICTP, which reflects collagen degradation at baseline. The authors aimed to determine if the levels of these biomarkers were associated with incident atrial fibrillation in participants initially free of overt cardiovascular disease. Incident atrial fibrillation in ten-year follow-up was based on a hospital ICD code for atrial fibrillation or atrial flutter, in or outpatient Medicare claims, or ECG ten years after baseline. The authors found that baseline levels of these markers were positively related, both p < 0.0001 to incident atrial fibrillation in a model adjusting for age, race, ethnicity, and sex. These findings were attenuated but remain statistically significant after further adjustment for systolic blood pressure, height, body mass index, smoking, and renal function.                                 In our next paper, Ahmet Adiyaman and associates conducted a randomized controlled trial comparing the safety and efficacy of minimally invasive thoracoscopic pulmonary vein isolation with left atrial appendage ligation versus percutaneous catheter ablation pulmonary vein isolation. In 52 patients with symptomatic paroxysmal or early persistent atrial fibrillation, paroxysmal atrial fibrillation was present in 74% of patients. The authors found that percutaneous pulmonary vein isolation with a 56% single procedure arrhythmia-free survival at two years was not inferior to minimally invasive thoracoscopic pulmonary vein isolation with left atrial appendage ligation, which had a 29% arrhythmia freedom, p = 0.059. Procedure-related major adverse events occurred in 21% of patients undergoing minimally invasive thoracoscopic pulmonary vein isolation, compared to none undergoing percutaneous catheter ablation with p = 0.029.                                 In the next paper, Richard Ang and associates examined whether the glucagon-like peptide-1 receptor agonist exendin 4 has an effect on ventricular action potential duration in susceptibility to ventricular arrhythmia in the rat heart in vivo and ex vivo. Ventricular monophasic action potentials recorded in anesthetized rats in vivo in isolated profused rat hearts in sinus rhythm and/or ventricular pacing. In vivo systemic administration of exendin 4 increased heart rate and this effect was abolished by beta adrenoceptor blockade. Despite causing sympathetic activation, exendin 4 increased axon potential duration at 90% repolarization, APD90, during ventricular pacing by 7% and reversed the effect of beta adrenoceptor agonist Dobutamine on APD90. In isolated profused hearts, 3 nanomolar exendin 4 increased APD90 by 14% with no effect on heart rate. Exendin 4 also reduced ventricular arrhythmia inducibility in conditions of beta adrenoceptor stimulation with Isoproterenol. Exendin 4 effects on action potential duration in ventricular arrhythmia susceptibility were prevented in conditions of muscarinic receptor blockade or inhibition of nitric oxide synthase. The authors concluded that glucagon-like peptide-1 receptor activation effectively reverses the effects of beta adrenoceptor stimulation on cardiac ventricular excitability and reduces ventricular arrhythmic potential. The effect of glucagon-like peptide-1 receptor activation on the ventricular myocardium is indirect, mediated by acetylcholine and nitric oxide, and, therefore, might be explained by stimulation of cardiac parasympathetic neurons.                                 In our next paper, Michael Barkagan and associates examined the role of modulating baseline impedance on ablation lesion dimension. Radiofrequency ablation was performed using an irrigated catheter at a fixed power setting of 30 watts 20 seconds and a multi-step impedance load from 100 to 210Ω ex vivo in 20 swine hearts and in vivo in the right atrium and in thigh preparations. Ablation was performed using similar power settings at three baseline impedances: low, 90 to 130Ω; intermediate, 131 to 180Ω; and high, 181 to 224Ω. The relationship between baseline impedance, current, and lesion dimensions were examined. Baseline impedance had a strong negative correlation with current squared for all of these experimental models with R either -0.93 or -0.94. Lesion dimensions at similar power setting were directly related to current squared with R = 0.853 for width and R = 0.814 for depth. In thigh muscle lesion depth was greatest at low impedance, 8.2 millimeters, compared to 6.5 millimeters and intermediate impedance and 4.2 millimeters at high impedance, p < 0.0001. In right atrial lines, low baseline impedance resulted in wider lines, 7.2 millimeters, relative to intermediate 5.8 millimeters and high impedance, 4.7 millimeters, p < 0.0001.                                 In the next study, Virginie Dubes and David Benoist and associates examined the origin of ventricular arrhythmias in animal model of repair of tetralogy of Fallot. They studied six piglets undergoing tetralogy of Fallot repair-like surgery compared to five sham-operated piglets. Twenty-three weeks post-surgery, the authors found that right ventricular dysfunction was present, while left ventricular function was preserved in tetralogy of Fallot pigs. Optical mapping showed longer action potential duration on the tetralogy of Fallot left ventricular epicardial and endocardium. Epicardial conduction velocity was significantly reduced in the longitudinal direction but not the transverse direction in tetralogy of Fallot ventricles compared to sham. Elevated collagen content was found in left ventricular basal and apical sections from the tetralogy of Fallot pigs. The tetralogy of Fallot left ventricles had a lower threshold for arrhythmia induction using incremental pacing protocols.                                 In our next study, Meera Varshneya and associates sought to understand the individual roles of slow and rapid delayed rectifier potassium currents, IKS and IKR, and quantify how effectively each stabilize the actions potential, protecting cells against arrhythmias across multiple species. The authors compared ten mathematical models describing ventricular myocytes from human, rabbit, canine, and guinea pig. They examined variability within heterogeneous cell population, tested the susceptibility of cells to a pro-rhythmic behavior, and studied how IKS and IKR responded to changes in the action potential. They found, one, models of higher baseline IKS exhibited less cell-to-cell variability in action potential duration; two, models with higher baseline IKS were less susceptible to early afterdepolarizations induced by depolarizing perturbations; three, as action potential durations lengthened, IKS increases more profoundly than IKR, thereby providing negative feedback that resists excessive action potential duration prolongation; and four, the increase in IKS that occurs during β-Adrenergic stimulation is critical for protecting cardiac myocytes from early afterdepolarizations under these conditions. The authors concluded that slow, delayed rectifier current is uniformly protected across a variety of cell types, suggesting that IKS enhancement could be potentially anti-arrhythmic.                                 In our final paper, Piotr Podziemski and Stef Zeemering and associates performed a direct one-to-one comparison between phase and activation time mapping in high-density epicardial direct contact mapping files of human atrial fibrillation. The authors examined 38 unipolar electrum files of ten seconds duration recorded in 20 patients with atrial fibrillation using a 16 x 16 electrode array placed on the epicardial surface of the left atrial posterior wall or right atrial free wall. Using sinusoidal recomposition and Hilbert Transform, 138 phase singularities were detected, with 104 out of 138 phase singularities detected within on electro distance, 1.5 millimeters, from a line of conduction block between non-rotating wave fronts determined by activation mapping. Only 18 rotating wave fronts were detected out of 8,219 detected waves based on wave mapping. Fourteen out of these 18 cases were detected as phase singularities in phase mapping. Phase analysis of filter electrograms produced by simulated wave fronts separated by conduction block also identified phase singularities on the line of conduction block. The authors found that phase singularities identified by phase analysis of filter epicardial electrograms colocalized with conduction block lines identified by activation mapping. The authors concluded that detection of phase singularity using phase analysis has a low specificity for identifying rotating wave fronts using activation mapping of human atrial fibrillation.                 That's it for this month. We hope that you'll find the journal to be the go-to place for everyone interested in the field. See you next time.

GKE container-native load balancing enables Google Cloud load balancers to target Pods directly, rather than the VMs that host them, and to evenly distribute their traffic. Product manager Ines Envid and staff software engineer Neha Pattan explain how. Do you have something cool to share? Some questions? Let us know: web: kubernetespodcast.com mail: kubernetespodcast@google.com twitter: @kubernetespod Chatter of the week Adam meets Orlando Craig meets a Banksy News of the week GKE Private Clusters are GA Announcing Cloud NAT and Container-Native Load Balancing Amazon Elastic Container Service for Kubernetes now supports dynamic admission controllers Fast Kubernetes development with Skaffold 0.16.0 New Cloud Foundry support for Kubernetes Managing Kubernetes from O’Reilly; sign up for a free e-book version courtesy of Heptio Days of Kubernetes 1.12 Past: Volume snapshots, RuntimeClass and topology-aware volume provisioning Kubedex: GKE vs EKS vs AKS vs IKS vs ACCSK New Relic acquires Coscale Links from the interview GKE container-native load balancing: Launch blog post Documentation Configuring services with an annotation to preserve source IP VPC-native clusters with Alias IPs Network Endpoint Groups

Dr Paul Wang:                   Welcome to the monthly podcast, On the Beat for Circulation: Arrhythmia and Electrophysiology. I'm Dr Paul Wang, Editor-in-Chief, with some of the key highlights from this month's issue. In our first paper this month, Shaan Khurshid and associates determine the frequency of rhythm abnormalities in 502,627 adults in the UK Biobank, a national prospective cohort. They found that 2.35% had a baseline rhythm abnormality. The prevalence increased with age, with 4.84% of individuals aged 65 to 73 years having rhythm abnormalities. During over three million person- years of follow up, nearly 16,000 new rhythm abnormalities were detected. Atrial fibrillation was the most frequent with three per thousand person-years. Bradyarrhythmia with almost one per thousand person-years. Conduction system disease is about one per one thousand years. Supraventricular and ventricular arrhythmias, each about one half per one thousand person-years. Older age was associated with a hazard ratio of 2.35 for each 10 year increase. Male sex, hypertension, chronic kidney disease and heart failure were all associated with new rhythm abnormalities. In our next paper, Fabien Squara and associates evaluated a method of determining the septal or free wall positioning of pacemaker or ICD leads during fluoroscopy. They compared in 50 patients a classical approach using posterior anterior, right anterior oblique 30 degrees, and left anterior oblique 40 degrees fluoroscopic imaging’s to 50 patients undergoing an individualized left anterior oblique or LAO approach. This individualized LAO approach view provided a true view of the interventricular septum. This angle was defined by the degree of LAO that allowed the perfect superimposition of the RV apex, using the tip of the right ventricular lead, temporarily placed at the apex, and one of the superior vena cava, inferior vena cava access using a guide wire. Transthoracic echo was used to confirm position of the right ventricular lead. Septal, or free wall, right ventricular lead positioning was correctly identified in 96% of patients in the individualized group, versus 76% in the classical group. P equals 0.004. For septal lead positioning fluoroscopy had 100% sensitivity, and an 89.5 specificity in an individualized group, versus 91.4% sensitivity, and a 40% specificity in the classical group. In our next paper, Elsayed Soliman and associates examined the lifetime risk of atrial fibrillation based on race and socioeconomic status. In the atherosclerosis risk in communities, ARIC, cohort, of 15,343 participants without atrial fibrillation, patients were recruited in 1987 to 1989, when they were 45 to 64 years of age, and followed through 2014. The authors identify 2,760 atrial fibrillation cases during a mean follow up of 21 years. The authors found that the lifetime risk of atrial fibrillation in the ARIC cohort was approximately one in three among whites, and one in five among African Americans. And, the socioeconomic status was inversely associated with cumulative incidents of atrial fibrillation before the last decades of life. In our next paper, Jonathan Steinberg and associates sought to determine the impact of atrial fibrillation episode duration threshold on atrial fibrillation incidents and burden in pacemaker patients in a prospective registry. In 615 pacemaker patients was device detected atrial fibrillation over a mean follow up of 3.7 years, 599 had one or more atrial fibrillation episodes of 30 seconds duration, with a mean number of 22 episodes. At 12 months, freedom from atrial fibrillation ranged from 25.5% to 73.1%, based on a duration threshold from 30 seconds up to 24 hours. Of patients with a first episode of 30 seconds to two minutes, 35.8% were free from subsequent episodes greater than two minutes at 180 days. The mean atrial fibrillation burden of 0.2% for patients with first episodes between 30 seconds and 3.8 hours, was significantly less than the 9.5% burden for those with greater than 3.8 hours. The authors concluded that small differences in atrial fibrillation episode duration definition can significantly affect the perceived incidents of atrial fibrillation impact reported outcomes, including atrial fibrillation success. An initial atrial fibrillation episode of 30 seconds does not predict clinically meaningful atrial fibrillation burden. In the next paper, Hongwu Chen and Linsheng Shi and associates examined the distinct electrophysiologic features of bundle branch reentrant ventricular tachycardia in patients without structural heart disease. They described nine patients, mean age 29.6 years, with normal left ventricular function and bundle branch reentrant ventricular tachycardia, with a right bundle branch block pattern in one patient, and left bundle branch block patterns in nine patients. In all left bundle branch block pattern ventricular tachycardia, the mean ventricular tachycardia cycling was 329.3 milliseconds, and the median HV interval during tachycardia was longer than that of baseline, 78 versus 71 milliseconds. The H to right bundle interval during ventricular tachycardia was slightly shorter, however, the right bundle to ventricular interval was markedly longer than that during sinus rhythm, 50 versus 30 milliseconds. In six patients with three dimensional mapping of the left ventricle, a slow anterograde, or retrograde conduction over the left His-Purkinje system with normal myocardial voltage was identified. In addition, Purkinje related ventricular tachycardias were also induced in five patients. Ablation was applied to the distal left bundle branch block in patients with baseline left bundle branch block, and in one narrow QRS patient with sustained Purkinje related ventricular tachycardia, while right bundle branch was targeted in other patients. During a mean follow up at 31.4 months, frequent premature ventricular contractions occurred in one patient, and new ventricular tachycardia developed in the other patient. In the next paper, Michel Haissaguerre and associates examined detailed mapping in 24 patients who survived idiopathic ventricular fibrillation. They used multi-electrode body surface recordings to identify the drivers maintaining ventricular fibrillation, and analyze electrograms in the driver regions, using endocardial and epicardial catheter mapping during sinus rhythm. Ventricular fibrillation occurred spontaneous in three patients, and was induced in 16, while VF was non-inducible in five. Ventricular fibrillation mapping demonstrated reentrant and focal activities, 87% and 13% respectively. The activities were dominant in one ventricle in nine patients, while they were biventricular in the others. During sinus rhythm, areas of abnormal electrograms were identified in 15 out of 24 patients, or 62.5%, revealing localized structural alterations, in the right ventricle in 11, the left ventricle in one, in both in three. They covered a limited surface, 13 centimeters squared, representing 5% of the total surface, and recorded predominantly on the epicardium. 76% of these areas were co-located with ventricular fibrillation drivers. In nine patients without structural alterations, the authors observed a high incidence of Purkinje triggers, seven out of nine, versus four out of 15. Catheter ablation resulted in arrhythmia-free outcomes in 15 out of 18 patients at a 17 month follow up. In our next paper, David Spar and associates describe the effectiveness, safety, and compliance of the wearable cardioverter defibrillator in the identification and treatment of life-threatening ventricular arrhythmias in all US pediatric patients who wore a wearable defibrillator from 2009 to 2016, ages less than 18 years. The 455 patients had a median age of 15 years, median duration of wearable cardioverter defibrillator use of 33 days, and median patient wear time of 20.6 hours per day. The study population was divided into two groups, 63 patients with an ICD problem, or 392 patients without an ICD problem. The wear time was greater than 20 hours in both groups. There were seven deaths, or 1.5%. All patients were not wearing the wearable cardioverter defibrillator at the time of death. Eight patients, 1.8%, received at least one wearable cardioverter defibrillator shock treatment. Of the six patients who had appropriate therapy, there were seven episodes of either polymorphic ventricular tachycardia, or ventricular fibrillation, with a total of 13 treatments delivered. All episodes were successfully converted, and the patient survived. In our next paper, Marc Lemoine and associates used human-induced pluripotential stem cell-derived cardiomyocytes to examine differences in repolarization reserve. The authors compared the contribution of IKs and IKr on action potential durations in human left ventricular tissue, and the human induced pluripotential stem cell derived cardiomyocytes, or IPS-derived engineered heart tissue. They found that the IPS-derived heart tissue showed spontaneous diastolic depolarization in action potential duration, which were sensitive to low concentrations of Ivabradine. IKr block by E-4031 prolonged action potential duration 90 with similar EC50 in both the IPS-derived heart tissue and the human left ventricular tissue. But a larger effect size in the IPS-derived heart tissue, 281 milliseconds versus 110 milliseconds, in the human left ventricular tissue. While IKr block alone evoked early after depolarizations, it triggered activity in 50% of the IPS-derived heart tissue. Slow pacing reduced extracellular potassium blocking of IKr, IKs and IK1 were necessary to induce early after depolarizations in human left ventricular tissue. In accordance with their clinical safety, Moxifloxacin and Verapamil did not induce EADs in IPS-derived heart tissue. In both IPS-derived heart tissue and human left ventricular tissue, IKs block by HMR 1556 prolonged action potential duration 90 slightly in the combined presence of E-4031 and isoprenaline. In our next paper, Elizabeth Saarel and associates sought to obtain contemporary digital ECG measurements in healthy children from North America to evaluate the effects of sex and race, and to compare the results to commonly published data sets, using 2400 digital ECGs, collected for children less than 18 years of age with normal electrocardiograms at 19 centers in the pediatric heart network. The authors found that the QTc in lead II was greater for females compared to males for age groups three years or older, for whites compared to African Americans, for ages 12 years or older. The R wave amplitude in V6 was greater for males compared to females for age groups 12 years and greater; for African Americans compared to white or other race categories for age groups three years or greater; and greater compared to commonly used public data set groups for ages 12 years and greater. In our next paper, Pyotr Platonov and associates examined T-wave morphology as a possible predictor of cardiac events in patients with type 2 long QT syndrome mutation carriers with normal QTc intervals. The authors compared 154 LQT2 mutation carriers with QTc less than 360 milliseconds in men, and less than 470 milliseconds in women, with 1007 unaffected family members. Flat, notched, or negative T-waves in leads II or V5 on baseline ECG were considered abnormal. Using Cox regression analysis, the associations between T-wave morphology, the presence in mutations in the poor region of KCNH2, and the risk of cardiac events defined that syncope aborted cardiac arrest, defibrillator therapy, or sudden cardiac arrests were assessed. The authors found that LQT2 female carriers with abnormal T-wave morphology had a threefold increased risk of cardiac events compared to LQT2 female carriers with normal T-waves, while this association was not seen in males. LQT2 males with poor location of mutations had a six-fold increased risk of cardiac events than non-poor location males, while no such association was found in females. In our last paper, Yaniv Bar-Cohen and associates describe a percutaneous pacemaker entirely implanted in the pericardium, using a sheath for sub-xiphoid access to the pericardial space, and a miniaturized camera with fiber optic illumination, the micro-pacemakers were successfully implanted in six pigs. All animals were studied during follow up, survived without symptoms. That's it for this month. We hope that you'll find the Journal to be the go-to place for everyone interested in the field. See you next time!  

Welcome to Episode 4 of the All Things Coheed podcast! In this episode we discuss In Keeping Secrets of Silent Earth: 3 - The Comic Series!!! Moving through the story issue-by-Issue we break down all 12 issues, discuss art style, variant covers, overall opinions and a healthy dose of tangent shenanigans including some fun talk about the upcoming tour! You can purchase select physical issues of the IKS series here: http://merchnow.com/catalogs/the-amory-wars Digital Ultimate Edition here: https://comixology.com/The-Amory-Wars-In-Keeping-Secrets-of-Silent-Earth-3-Ultimate-Edition/digital-comic/518182 Preorder the Ultimate Edition Hardcover here: https://amazon.com/dp/1684151570/ref=cm_sw_r_cp_api_66cNAbDRXPQX3 View all variant covers of the series here: https://heavensfence.wordpress.com/comics/in-keeping-secrets-of-silent-earth-3/ Buy tickets to the upcoming tour with Taking Back Sunday & The Story So Far here: http://coheedandcambria.com/summertour Thanks to our friend and aspiring voice actor, Jim Slayton (https://twitter.com/Jimmy_Hindrance) for the excerpt reading from the Ghansgraad, and to Brendan Millerick (http://twitter.com/redbridgeroad) for our rockin' new logo! Find us on Facebook: http://facebook.com/allthingscoheed Find us on Twitter: http://twitter.com/AllThingsCoh33d Thanks for listening!!

Dr Wong:             Welcome to the monthly podcast, "On The Beat, for Circulation: Arrhythmia, and Electrophysiology." I'm doctor Paul Wong, editor in chief, with some of the key highlights from this month's issue. We'll also here from Dr. Suraj Kapa reporting on new research from the latest journal articles in the field.                                 In our first article, Mathew Daly and associates examine whether a high-resolution, 9 French, infrared thermography catheter can continuously image esophageal temperatures during atrial fibrillation catheter ablation. The infrared temperature catheter was inserted nasally or orally into the esophagus, adjacent to the left atrium. Endoscopy was performed within 24 hours to document esophageal injury. Thermal imaging showed that 10 out of 16 patients experienced one or more events where the peak esophageal temperature was greater than 40 degrees centigrade. Three patients experienced temperatures greater than 50 degrees centigrade and one experienced greater than 60 degrees centigrade. Analysis of temperature data from each subject's maximal thermal event revealed high radius, 2.3 degrees centigrade per millimeter and rates of change 1.5 degrees centigrade per second, with an average length of esophageal involvement of 11.0 millimeters.                                 Endoscopy identified three distinct thermal lesions, all in patients with temperatures greater than 50 degrees centigrade, all resolving within two weeks. The authors concluded that infrared thermography, high-resolution mapping of esophageal temperatures during catheter ablation may be performed. Esophageal thermal injury occurs with temperatures greater than 50 degrees centigrade, and was associated with large spacial-temporal gradients.                                 In our next article, Nitesh Sood and associates reported on the real-world incidence and predictors of perioperative complications in transvenous lead extractions involving ICD leads in the NCDR ICD registry. Lead extraction was defined as removal of leads implanted for greater than one year. Predictors of major perioperative complication for all extraction procedures, 11,304, and for high voltage leads, 8,362, or 74% across 762 centers were analyzed, using univariate and multivariate logistic regression. Major complications occurred in 258, or 2.3% of the extraction procedures. Of these, 258 procedures with a complication, 41 or 16% required urgent cardiac surgery. Of these, 14 or 34% died during surgery. Among the total 98, or 0.9% deaths reported, 18 or 0.16% of the total occurred during extraction.                                 In multivariate, logistic regression analysis of all extractions, female sex, admission other than electively for the procedure, three or more leads extracted, longer implant duration, dislodgement of other leads, patients' clinical status, requiring lead extraction, such as infection or perforation, were associated with increased risk of complications. For high voltage leads, smaller lead diameter, a flat versus round coil shape, in greater proximal surface coil area, were multivariate predictors of major perioperative complications.                                 The rate of major complications and mortality with transvenous lead extraction is similar in the real world compared to single center studies from high volume centers. There remains a significant risk of urgent cardiac surgery with a very high mortality, and planning for appropriate cardiothoracic surgical backup is imperative.                                 In our next paper, Bence Hegyi and associates, have reported on the repolarization reserve in failing rabbit ventricular myocytes, and the role of calcium and beta-adrenergic effects on delayed and inward rectifier potassium currents. The authors measured the major potassium currents, IKr, IKs, IK1, and their calcium and beta-adrenergic dependence in rabbit ventricular myocytes, in chronic pressure, in volume overload, induced heart failure, and compared them to age-matched controls.                                 The authors made a number of observations. One, action potential duration was significantly prolonged only at lower pacing rates, 0.2 to 1 Hertz, in heart failure under physiological ionic conditions and temperature. Two, beat to beat variability of action potential duration was also significantly increased in heart failure. Three, both IKr and IKs were significantly regulated in heart failure under action potential clamp but only when cytosolic calcium was not buffered. Four, CaMKII inhibition abolished IKs upregulation in heart failure, but did not affect IKr. Five, IKs response to beta-adrenergic stimulation was also significantly diminished in heart failure, and, six, IK1 was also decreased in heart failure regardless of calcium buffering, CaMKII inhibition or beta-adrenergic stimulation.                                 These observations changed when cytosolic calcium was buffered. The action potential prolongation in heart failure was also significant in higher pacing rates. The authors concluded that in heart failure, calcium dependent up regulation of IKr and IKs counter-balances the reduced IK1, maintaining the repolarization reserve, especially at higher heart rates. In physiologic conditions, unlike conditions of strong cytosolic calcium buffering. Under beta-adrenergic stimulation, reduced IKs responsiveness, severely limits the integrated repolarizing potassium current in repolarization reserve in heart failure, increasing the arrhythmia propensity.                                 In the next paper, Christopher Piorkowski and associates report on the feasibility of a combined endo-epicardial catheter approach for mapping the ablation of atrial fibrillation. The authors studied 59 patients with permanents pulmonary veins isolation and had further symptomatic recurrences of paroxysmal atrial fibrillation, persistent atrial fibrillation, or atrial tachycardia. These patients underwent repeat ablation using bi-atrial endo- and epicardial mapping and ablation. Identification of arrhythmia substrates and selection of ablation strategy were based on sinus rhythm voltage mapping. In all patients, endo-epicardial mapping ablation were feasible using standard technologies of catheter access, three dimensional mapping, and radiofrequency ablation.                                 Epicardial mapping and ablation did not add procedural risk. Exclusively, epicardial low voltage substrate were found in 14% of patients. For the first time, novel epicardial conduction abnormalities located in the epicardial fiber network were described in human patients, 19% of the cohort. Epicardial ablation was needed in 80% of the patients. Over 23 months of follow up, freedom from arrhythmia recurrence was 73%. The authors used continuous monitoring and three months blanking period. Freedom from ATR of greater than two minutes was defined as the primary end-point.                                 The authors concluded that endo-epicardial mapping ablation was feasible and safe. Epicardial ablation increases transient mortality of ablation lesions. Further studies will be needed to demonstrate reproducibility and long-term outcomes, and how the technique compares to other methods.                                 In the next article, Michael Wolf and associates examined the long-term results of substrate modification for ablation of ventricular tachycardia using substrate elimination, targeting local, abnormal ventricular activities, or LAVA, post-myocardial infarction. They reported on 159 consecutive patients undergoing first ablation, age 65, 92% with ICDs, 54% with storms, and 73% with appropriate shocks. LAVA were identified in 92% and VT was inducible in 73%. Complete LAVA elimination after ablation was achieved in 64% and non-inducibility was achieved in 85%. During a median follow-up of 47 months, single procedure, ventricular free survival was 55%, 10% storms, and 19% shocks. The ventricular arrhythmia free survival was 73% after one year and 49% after five years.                                 Complete LAVA elimination was associated with improved outcomes, ventricular arrhythmia free survival of 82% at one year and 61% at five years. The subgroup treated with multi-electrode mapping and real-time image integration had improved ventricular arrhythmia free survival, 86% at one year and 65% at four years. Repeat procedures were also performed in 18% of patients. The outcomes improved, 69% ventricular arrhythmia free survival during a median follow-up of 46 months.                                 In a single center study, substrate modification, targeting LAVA for post myocardial infarction ventricular tachycardia resulted in a substantial reduction in ventricular tachycardia storm and ICDs shocks with up to 49% of patients free of arrhythmias at five years after a single procedure. Complete LAVA elimination, multi-electrode mapping, and real-time integration were associated with improved ventricular arrhythmia free survival.                                 In the next paper, Jean-Baptiste Gourraud and associates examined the safety and feasibility of transvenous lead extraction in adults with congenital heart disease over a 20 year period at a single center. The authors reported on 71 transvenous lead extraction procedures in 49 patients with adult congenital heart disease, mean age 38 years in which a total of 121 leads were extracted. The primary indication for extraction were infection in 48%, lead failure in 31%. A laser sheath was required in 46% and a femoral approach in 8%. Complete transvenous lead extraction was achieved in 92% of the leads. 49% of the patients had transposition of the great arteries. In multivariate analysis, lead duration was predictive of transvenous lead extraction failure. No perioperative death or pericardial effusion was observed. Subpulmonary, atrioventricular valve regurgitation increased in eight patients, five of whom had TGA and were independently associated with ICD leak or valvular vegetation.                                 After a median of 54 months of follow up after the first lead extraction, three deaths occurred independently from lead management. The authors concluded that despite complex anatomical issues, transvenous lead extraction can be achieved successfully in most adult congenital heart disease patients using advanced extraction techniques. Subpulmonary AV valve regurgitation is a prevalent complication, particularly in patients with transposition of the great arteries.                                 In the next paper, Gabriela Orgeron and associates examined the incidence of ventricular arrhythmias and follow-up in ARVC patients grouped by the level of indication for ICD placement, based on the 2015 International Task Force Consensus Statement Risk Stratification Algorithms for ICD Placement in arrhythmogenic right ventricular dysplasia/cardiomyopathy. In 365 of arrhythmogenic right ventricular dysplasia/cardiomyopathy patients, the authors found that the algorithm accurately differentiates survival from any sustained VT/VF among the four risk groups, p < 0.001. Patients with a Class I indication had significantly worst survival from VT/VF than patients with a Class IIa indication or a Class IIb. However, the algorithm did not differentiate survival free from VF or V flutter between patients with Class I and Class II indications. Adding Colter results, less than 100 PVCs per 24 hours to the classification, helps differentiate the risk.                                 Patients with a high PVCs burden, greater than 1000 PCVs per 24 hours had a poor survival from both VT/VF and VF and V flutter.                                 In the next paper, Takeshi Kitamura and associates studied eight patients that had bi-atrial tachycardia, a rare form of atrial macroreentrant tachycardia, in which both atria form a critical part of the circuit and were mapped using an automatic, high resolution, mapping system. 708 patients had a history of persistent atrial fibrillation, including septal or anterior left atrial ablation before developing bi-atrial tachycardia. One of the patients had a history of atrial septal path closure with a massively enlarged right atrium. The authors found that 9 atrial tachycardias, with a median cycle length of 334 milliseconds had three different types. Three were peri-mitral and peri-tricuspid reentrant circuit, three utilized the right atrial septum in a peri-mitral circuit, and three utilized only the left atrium and the left right atrial septum.                                 Catheter ablation successfully terminated eight of the nine bi-atrial tachycardias. The authors found that all patients who developed bi-atrial tachycardia had an electrical obstacle on the intraseptal left atrium, primarily from prior ablation lesions.                                 In our next paper, Kwang-No Lee and associates randomized 500 patients with paroxysmal atrial fibrillation to one of two strategies after pulmonary vein isolation. One, elimination of non-PV triggers in 250 patients, group A, or, two, step-wise substrate modification using complex fractionated atrial electrogram or linear ablation until non-inducibility of atrial tachyarrhythmias was achieved, 250 patients in group B. Recurrence of atrial tachyarrhythmias was higher in group B compared to group A. 32% of patients in group A experienced at least one episode of recurrent atrial tachyarrhythmia after the single procedure, compared to 43.8% in group B. P-value of 0.012 after a median follow-up of 26 months. Competing risk analysis showed that the cumulative incidence of atrial tachycardia was significantly higher in group B compared to group A (p= 0.007).                                 The authors concluded that elimination triggers as the end-point of ablation in paroxysmal atrial fibrillation patients decreased long-term recurrence of atrial tachyarrhythmias compare to non-inducibility approach achieved by additional empiric ablation.                                 In our final paper of the month, Roland Tilz and associates reported on 10 year outcome after circumferential pulmonary vein isolation using a double lasso and three dimensional electro anatomic mapping technique. From 2003 to 2004, 161 patients with symptomatic drug refractory paroxysmal atrial fibrillation underwent electro-anatomical mapping guided circumferential pulmonary vein isolation. The procedure end-point was absence of pulmonary vein spikes thirty minutes after isolation, after a single procedure and a median follow up of 129 months, stable sinus rhythm was present in 32.9% of patients based on Holter-ECGs and telephonic interviews. After multiple procedures, mean 1.73 and median follow up of 123.4 months, stable sinus rhythm was seen in 62.7% of patients. Progression towards persistent atrial fibrillation was observed in 6.2%.                                 The authors concluded that although the 10-year single procedure outcome in patients with paroxysmal atrial fibrillation was low, 32.9%, it increased to 62.7% after multiple procedures and the progression rate to persistent atrial fibrillation was remarkably low.                                 That's it for this month but keep listening. Suraj Kapa will be surveying all journals for the latest topics of interest in our field. Remember to download the podcast, "On the beat." Take it away Suraj. Dr Kapa:               Thank you Paul, and welcome back everybody to Circulation’s “On the Beat”, where we'll be discussing hard hitting articles across the electrophysiology literature.                                 Today, we'll be reviewing 22 separate articles of particular interest, published in January 2018. The new year saw plenty of articles that are of particular interest either for the future of our field of for present management of our patients. First, within the realm of atrial fibrillation, we'll review several articles within the realm of anticoagulation and left atrial appendage occlusion.                                 The first article we'll review is by Yong et al in the American Heart Journal, volume 195, entitled "Association of insurance type with receipt of oral anticoagulation in insured patients with atrial fibrillation: A report from the American College of Cardiology NCDR PINNACLE registry." In this publication, the author sought to evaluate the effect of insurance type on the appropriate receipt of anticoagulant therapy, specifically looking at warfarin versus NOACs. They reviewed retrospectively over 360,000 patients and found significant differences in appropriate prescription of anticoagulants, irrespective of which anticoagulant was considered. Medicaid patients received less appropriate anticoagulant prescription than those who were privately insured on Medicare or military insured. Furthermore, those on military or private insurances had a higher rate of NOAC prescription than those with Medicare.                                 Furthermore, there was an even wider disparity in NOAC use than warfarin use amongst differently insured patients. These data are important in that they highlight potential variability in appropriate management of patients based on insurance type. Of course, there are many issues that might impact this, such as health care access or available pharmacy coverage of specific medications. Furthermore, the authors do not dive into the impact on outcomes based on the therapy availability.                                 The next article we'll review is by Jazayeri et al, entitled "Safety profiles of percutaneous left atrial appendage closure and lysis: An analysis of the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database from 2009 to 2016" published in the Journal of Cardiovascular Electrophysiology in volume 29 issue 1. Here, the authors sought to evaluate the overall safety profiles of procedures performed with different percutaneous left atrial appendage occlusion devices, including LARIAT and WATCHMAN. They review 356 unique reports and compared outcomes pre- and post- approval of the WATCHMAN device. The look at the specific composite outcome of stroke, TIA, pericardiocentesis, cardiac surgery, and death. They noted that this composite outcome occurred more frequently with WATCHMAN than with LARIATs, and this is irrespective of pre- or post- approval status.                                 These findings highlight the importance of postoperative monitoring in evaluation of overall outcomes. The reason by which there was more frequent negative outcomes in the WATCHMAN than LARIATs need to be considered. Obviously there's several limitations in the MAUDE database, similar with all large databases. However, it does highlight the importance of considering the mechanisms or sure decision making necessary, not just amongst patients and their providers but amongst operators of the staff or amongst physicians and industry executives. To determine how to optimize devices going forward.                                 Speak of left atrial appendage occlusion devices and the potential future of these, we next review an article by Robinson et al, entitled "Patient-specific design of a soft occluder for the left atrial appendage" published in nature biomedical engineering, in volume two in the year 2018. Robinson et al used 3D printing to create a soft, immunocompatible, biocompatible, endocardial implant to occlude the left atrial appendage. They use the individual CT of an in vivo pig to three D print using a specialized material, a left atrial appendage occlusion device, and demonstrated feasibility of achieving adequate occlusion. This paper is important and is one of the initial [inaudible 00:22:03] to how three D printing may be used to optimize patient care. In fact, three D printing has the potential to overturn medical manufacturing and device development.                                 Anatomy tends to be more often patient-specific than not. That's one size fits all implant designs may not be optimal, and resulting exclusion or inadequate occlusion amongst many patients. Decide of three D printable patient specific rapidly prototype soft devices that are biocompatible and hemocompatible, holds the potential to revolutionize the occlusion.                                 Staying in the field of left atrial appendage occlusion, we next review an article by Lakkireddy et al entitled "left atrial appendage closure and systemic homeostasis: The LAA homeostasis study" published in JACC. The authors sought to evaluate the effect of epicardial-versus endocardial left atrial appendage occlusion on systemic homeostasis, including effects on neuro-hormonal profiles of patients. They performed a prospective, single center, observational study, including 77 patients, about half of whom received endocardial versus epicardial device. Interestingly, they noted that the epicardial left atrial appendage occlusion cohort exhibited significant decrease in blood adrenaline, noradrenaline and aldosterone levels. Those are not seen with endocardial devices. Internal epicardial devices are associated with increases in adiponectin and insulin levels as well as a decrease in free fatty acids and consistently lower systemic blood pressure.                                 These data suggest a significant difference in the effect of epicardial versus endocardial closure left atrial appendage on neurohormonal profile. The authors propose several mechanisms for these findings but not the exact mechanisms as yet unclear. Several factors potentially could lead to these findings. One is that epicardial ligation may result in more total ischemia of the left atrial appendage than endocardial closure. Another potential mechanism maybe that the presence for material in the pericardial space versus in the bloodstream may have different effects on neuro-hormonal profile. However, these significant differences in outcomes highlight the importance of considering whether all approaches of left atrial appendage occlusion are considered equal. Many flaws of this study is that it's observational and not randomized. Does it possible those receiving epicardial closure may have been perceived to be lower risk for epicardial puncture, in this, as result, had better long-term outcomes.                                 Changing gears now but staying within the realm of atrial fibrillation, we next review elements for cardiac mapping and ablation. The first article we review is one that has received significant press, published by Marrouche et al entitled "Catheter ablation for atrial fibrillation with heart failure" in the New England Journal of Medicine, volume 378. It is well recognized that morbidity and mortality are higher in heart failure patients who also have atrial fibrillation. Marrouche et al published the results of the CASTLE-AF trial, which attempted to determine if catheter ablation [inaudible 00:24:46] better outcomes among patients with heart failure and atrial fibrillation. They randomized 179 patients to ablation and 184 to medical therapy, which consisted of either rate or rhythm control. Inclusion criteria were those with NYHA class II to IV heart failure, LVEF of 35% or less, and an ICD.                                 The primary endpoint was a composite where the death from many causes or hospitalizations for worsening heart failure. They noted over a median of three as a follow up, the end-point was reached in 28.5% of the ablation group and 44.6% of the medical therapy group, accounting for a significant hazard ratio of 0.62. Furthermore, fewer patients that in the ablation group died from any cause, were hospitalized for worsening heart failure, or died from cardiac causes. These data made a big splash because they're highly supportive of the premise that catheter ablation may be beneficial in some patients with atrial fibrillation and heart failure, often beyond that of medical therapy alone.                                 One major strength of this paper is that the actual AF burden was tracked by the ICD, so we know for sure whether or not the procedure was successful and how controlled the atrial fibrillation was. One thing to note however, is that subgroup analysis suggest that those with more symptomatic heart failure, namely NYHA class III to IV, not benefit as much from ablation. Furthermore, it's also important to note that the five years expected mortality in patients was higher than predicted in the CASTLE-AF trial, however overall these trials highly suggest that the potential benefit that ablation may hold over conventional medical therapy. Extrapolation to comparison with the utility of interventions such as biventricular pace with AV node ablation, however, remains to be considered.                                 Next, we review an article by Chugh et al entitled "Spectrum of atrial arrhythmias using ligament of Marshall in patients with atrial fibrillation" published in Heart Rhythm volume 15, issue 1. They reviewed the spectrum of presentations associated with arrhythmogenesis attributed to the ligament of Marshall, amongst patients with atrial fibrillation. They demonstrate that nearly a third of those patients, ligament of Marshall associated arrhythmias had a pulmonary vein ligament connection, that variously required ablation, the left lateral ridge, the mitral annulus, or alcohol ablation. In addition, they noted about a quarter of patients had atrial tachycardia attributable to the ligament, and the remaining had periatrial reentry requiring either ablation or alcohol injection of the ligament to attain a conduction block.                                 The relevance of this publication, albeit it is of a small number of patients and a small center, lies in highlighting on the right mechanisms by which the ligament of Marshall may contribute to arrhythmogenesis. Namely, can include direct venous connections, inhibition to inaudibility to attain mitral block, and directly attributed atrial arrhythmias. Recognition of the various ways and situations under which the ligament of Marshall may play a role in arrhythmogenesis in atrial fibrillation patients, may optimize physician decisions to look for identify and target the ligaments. What is not as well understood however is the frequency with which ligament of Marshall plays a significant role in arrhythmogenesis in atrial fibrillation.                                 Moving gears, we next review an article by Pathik et al entitled "Transient rotor activity during prolonged three-dimensional phase mapping in human persistent atrial fibrillation" published in a special issue of JACC Clinical Electrophysiology, that focus on atrial fibrillation specifically, in volume 4 issue 1. Pathik et al sought to validate three-dimensional phase mapping system for persistent atrial fibrillation. Commercially available rotor mapping systems project the heart into two dimensions based on a three-dimensional catheter. Instead, Pathik et al used a combination of basket catheters along with the non-left atrial surface geometry to construct three D representations of phase progression. Amongst 9 out of 14 patients, they identified 34 rotors, with all these rotors being transients. Of particular interest, the rotors were only seen in areas of high electric density, where internal electric distances were shorter. They also noted the single wave front is also the most common propagation pattern. The importance of this publication lies in considering two things. First is the three dimensional representation of rotor position and the feasibility of this, and the second is really the high electro-density necessary to observe for others.                                 This has been one of the main problems in rotor analysis, namely what the spacial and temporal density is, that is required to identify rotors, especially given how transient they often are. The presence of rotors does not necessarily mean they're ablation targets in all patients. However, the question still remains regarding the optimal approach to mapping rotors, it needs to be remembered that rotors actually are meant to represent three dimensional scrollway phenomena, that cannot necessarily always be reflected in traditional two D mapping schema. Furthermore, to be remembered that when we claim three-dimensional mapping, this just reflects a two-dimensional surface being wrapped in three dimensions to reflect overall internal surface geometry but it does not take into account transmural activation.                                 Thus, taking into account all these elements it should be remembered as sometimes, it is possible that a rotor might exist but it's just not evident based on the two-dimensional representation or a two-dimensional representation that looks like a rotor may in fact not be a rotor when you consider it in a three-dimensional media.                                 Our last article within the realm of cardiac mapping and ablation we will consider is by Zghaib et al, entitled "Multimodal examination of atrial fibrillation substrate: Correlation of left atrial bipolar voltage using multielectrode fast automated mapping, point by point mapping, and magnetic resonance imaging intensity ratio", published in JACC Clinical Electrophysiology, in the same volume as the previous article. The authors sought to compare fast automated mapping with multiple electrodes versus point by point mapping and correlate with weighed gadolinium enhancement as seen by MRI, termed the image intensity ratio.                                 We all recognize that bipolar voltage is critical to recognizing and evaluating substrate. It's traditionally used in decay regions of substrate in both the atrium and ventricles. However, whether a newer automated approach used to characterize substrate perform equally well in comparison with traditional point to point mapping is still unknown. Thus, the authors in 26 patients perform cardiac MRI and mapping endocardial using both voltage mapping techniques. They noted that for each unit increase in image intensity ratio on MRI, in other words, increasing late enhancement, there was 57% reduction of bipolar voltage. They also noted that the bipolar voltage using other fast elevating mapping or point by point was significantly related with actual differences in calculated voltage, becoming more dissimilar in the extreme of high and low voltage areas.                                 The relevance of this publication is highlight in the potential utility of fast automated mapping in creating accurate voltage maps. The correlation of voltage values with image-intensity ratios suggest the utility of either approach. In turn, correlation with MRI suggest a pathologic correlate for all of these findings. However, whether substrate characterization guide ablation carries incremental benefit remains to be seen.                                 Changing gears but staying in the realm of atrial fibrillation, we next review elements of risk stratification and management. The first article we review is by Friedman et al, entitled "Association of left atrial appendage occlusion and readmission for thromboembolism amongst patients with atrial fibrillation undergoing concomitant cardiac surgery", published in JAMA, volume 319, issue four. Friedman et al sought to evaluate whether surgical left atrial appendage occlusion let to a reduction in long-term thromboembolic risk in a large database of Medicare recipients. They included the primary outcome as readmission for thromboembolism, including stroke, TIA, or systemic embolism, in up to three years of follow-up. With secondary end-points including hemorrhagic stroke, all-cause mortality, and a composite end-point of all outcomes.                                 Amongst more than 10,000 patients, there were almost 4,000 patients receiving surgical occlusion of left atrial appendage. Surgical occlusion was associated with a reduction in thromboembolic risk, OR of 6%, all cause mortality, 17 versus 24%, and the composite end-point, 21 versus 29%. However, interestingly, surgical occlusion was only associated with reduction in thromboembolic risk compared with no occlusion amongst those discharged without anticoagulation and those discharge with it. Namely, the thromboembolic risk reduction was primarily seen in those where the surgical occlusion, those who were sent home without any sort of anticoagulation. These data suggest that surgical occlusion leads to reduction of thromboembolic risk overall. As any large database based study, there are massive flaws in the database itself. Namely, we're relying on the coding of hospitals and operators. To know exactly what was done and what happens latter.                                 However, these data are hypothesis generating. One key element is the fact that surgical left atrial appendage occlusion was only superior in reducing thromboembolic risk amongst those discharged without anticoagulation. This raises the question as why. Was left atrial appendage completely closed in these patients? In which case, they may be at further increased risk or that the operators felt that there is a high risk for other reasons that cannot be cleaned from an administrative datasets? While the data support consideration of the benefit of left atrial appendage occlusion in a surgical manner, a kin to what has been seen in papers on WATCHMEN and other approaches, and how is the critical nature of randomized trials in this regard.                                 We next review an article published in JAMA Cardiology, volume three issue one by Inohara et al, entitled "Association of atrial fibrillation clinical phenotypes with treatment patterns and outcomes: A multicenter registry study." Traditionally classification of AF has depended largely on factors such as the nature of AF, paroxysmal versus persistent, LA size, and other factors such as extend of the late enhancement. Inohara et al sought to evaluate whether cluster analysis could better define heterogeneity of AF in the population. They included an observational cohort of almost 10,000 patients admitted to 124 sites in the United States in the ORBIT-AF registry.                                 Outcome was a composite major address cardiovascular and neurological events or major bleeding. Amongst these patients, they identified four clusters, including one those with lower rates of risk factors and comorbidities than other clusters, two, those with AF at younger ages and with comorbid behavior disorders. Three, those with AF with tachycardia-bradycardia type syndromes and had devices for sinus node dysfunction, and four, those with AF with other risk factors such as a coronary disease. Those in the first cluster had significantly lower risks of major events. All clusters were noted to have symptom dissociation to specific clinical outcomes.                                 These data are interesting and highlight the highly heterogeneous nature of classifying risk attributable to atrial fibrillation. When broad datasets associated atrial fibrillation with specific outcomes. Maybe suggest an attribution to all patients with atrial fibrillation. However, this single relationship was specific to the outcomes suggest the limitation of applying outcome as approach to understand atrial fibrillation impacts and outcomes, namely depending on clusters that may take into account patient age or comorbidities, it may be irrelevant in discriminating patient outcomes than the traditional paradigm in the same paroxysmal versus persistent or depending on the left atrial size.                                 These data also highlight the importance of considering the inclusion criteria in randomized trials of atrial fibrillation before stripling real world outcomes to patients who don't fit within that trial.                                 Next, we will be reviewing an article by Chou et al entitled "Relationship of aging and incident comorbidities to stroke risk in patients with atrial fibrillation," published in JACC, volume 71 issue two. Chou et al sought to evaluate the effect of aging and evolving instant comorbidities to stroke risk in patients with atrial fibrillation. Many large database studies or trials where added baseline CHADSVASC score and the then ensuing follow up period to define risk over time of ischemic stroke.                                 The authors hypothesized that as patients age, develop new comorbidities that would change the score, may be more predictable of long-term outcomes than the score itself. They included over 31,000 patients who do not have comorbidities to CHADSVASC aside from age and sex but had atrial fibrillation. They didn't calculate a delta score defined as the difference between the baseline and follow up scores. The mean baseline score was 1.29 with an increase in 2.3 during follow up, with an average delta of one. The score may not change over follow up in 41% of patients. Interestingly, significantly more patients had a delta CHADSVASC of one or more and develop ischemic stroke than non-ischemic stroke. The delta CHADSVASC was shown to better predictor of ischemic stroke than either baseline or follow up CHADSVASC score. This data suggest that additive shifts in the CHADSVASC score over time may be more predictive of stroke risk than the actual score itself.                                 These findings are thoughtful and logical. They indicate the potential impact of continued aging or acquisition identification of new comorbidities. In some patients, potential discovery or new comorbidities or follow-up; for example, hypertension and coronary artery disease may lead to reclassification of stroke risk. That is important to maintain close follow up of atrial fibrillation patients, and not to show a continued need or lack of need of anticoagulation on the basis of a baseline evaluation. This also holds relevance single center long-term outcomes in patients specific scores. Whether is acquisition of new comorbidities or presence of baseline comorbidities or predict a long-term score, should we consider when assessing the need for anticoagulation, particularly in perceived initially low risk cohorts who go on to develop ischemic stroke.                                 Lastly, within the realm of atrial fibrillation, we review an article by Hussain et al, entitled "Impact of cardiorespiratory fitness on frequency of atrial fibrillation, stroke, and all-cause mortality" published in the American Journal of Cardiology, volume 121 issue one. Hussain et al review the effect of cardiorespiratory fitness on overall outcomes and incidence of atrial fibrillation and outcomes amongst patients with atrial fibrillation. Amongst over 12,000 individuals prospectively followed up after treadmill exercise test, they noted 1,222 had a incidence of AF, 1,128 developed stroke, and 1,580 died. For every 10% increase in functional layover capacity, there was a 7% decrease in risk of incident AF, stroke, or death.                                 Similarly, in those who developed AF, stroke was lower in those with higher functional aerobic capacity. These findings support the notion known to other areas of cardiovascular disease that better cardiorespiratory fitness is associated with better outcomes, in this case to stroke, incident AF, or mortality. Furthermore, even on the presence of AF, those with better functional capacity had a lower risk of stroke. These data highlight the continued importance of counseling patients on the benefits of physical fitness even in the setting of already present AF.                                 Moving on to a different area of electrophysiology, we review the realm of ICD pacemakers and the CRT.                                 The first article review is by Sze et al entitled "Impaired recovery of left ventricular function in patients with cardiomyopathy and left bundle branch block" published in JACC volume 71 issue 3. Patients with left bundle branch block and cardiomyopathy are known to respond to CRT therapy. Thus the investigators sought to evaluate whether guideline medical therapy in patients with reduced LVEF and left bundle branch block, afford a beneficial first line approach therapy. The reason for this currently guidelines suggest waiting at least three months before consideration of CRT has had as some patients may recover on guideline directed medical therapy without the need for device implantation.                                 They review patients with a LVEF of less or equal than 35% and baseline ECG showing left bundle branch block. In evaluating left ventricular ejection fraction at follow up of three to six months. They excluded patients with severe valvular disease, and already present cardiac device, an LVAD, or heart transplant. Among 659 patients meeting criteria, they notice 74% had a narrow QRS duration of less than 120 whereas 17% had QRS duration greater than 120, and the remainder had a QRS duration greater 120 but was not left bundle branch block. The mean increase in the left ventricular ejection fraction on guideline directed medical therapy was in those with a narrow QRS duration and least in those with left bundle branch block, 8.2%.                                 Furthermore, when comparing mean LVEF improvement, those with on versus non-on guideline directed medical therapy, there was virtually no difference in rates of recovery. Furthermore, composite end-point of heart failure hospitalization mortality was highest in those with left bundle branch block. These data suggest that those with bundle branch block and cardiomyopathy received less overall benefit from guideline directed medical therapy over the three to six months follow up period. Whether this is due to already more severe myopathic process to start with or due to the CRT is unclear. However, it may suggest that in some patients, left bundle branch block may benefit from inclusion of CRT early in their disease course as known the significant number of patients up to three to six months guideline directed medical therapy with insufficient DF recovery may then benefit from CRT. As well as intervening earlier may result in better outcomes, especially knowing the high and term raise mortality in heart failure hospitalization remains to be seen.                                 A trial studying early implantation of CRT on these patients may be relevant.                                 The next article review is by Gierula et al entitle "Rate-response programming tailored to the force-frequency relationship improves exercise tolerance in chronic heart failure" published in JACC Heart Failure, in volume six, issue two. The authors sought to evaluate whether tailored rate-response programming improved exercise tolerance in chronic heart failure. The double blinded, randomized, control, crossover study, they compared the effects of tailored programming on the basis of calculated force-frequency relationship, defined as including critical heart rate, peak contractility, and the slope, multidimensional programming and exercise time and maximal oxygen consumption. They demonstrate amongst 98 enrolled patients that rate-response settings limiting heart rate raise to below the critical heart rate led to create exercise timing and higher peak oxygen consumption.                                 These data suggest that personalizing rate-response therapies may improve exercise time and oxygen consumption values in patients with heart failure and pacing devices. The main limitation of the study is that the number of patients was small, 90, and then the number of patients crossing over was even smaller, 52. However, highlights the potential of working closely between device programmers and consideration of individual's characteristics and their exercise needs in determining optimal programming strategy.                                 Finally, within the realm of devices, we review an article by Hawkins et al, entitled "Long-term complications, reoperations, and survival following cardioverter defibrillator implant" published in Heart, volume 104 issue three. Hawkins et al sought to evaluate the long-term complications and risk of reoperation associated with defibrillator implantations in a large [inaudible 00:41:56] population of 300,410 patients, they noted over a 30-month follow up period there was a 12% reoperation rate within the year of implant. This is most prominent for CRT devices, with a risk of 18% in one year post-implant. Furthermore, CRT had the highest rate of early complications, with device complexity, age, or the presence of atrial fibrillation being significantly associated with complication risk.                                 Mortality also increased over time from 5% within the first year to nearly a third after five years. However, younger patients exhibited five years survival similar to the general population with a progressive decline of this as older patients were considered. These findings highlight several critical issues. First, they report a high one year reoperation rate for a variety of reasons. This finding highlights the importance of considering protocols to minimize the need for reoperation. Furthermore, they note the higher rate amongst CRT patients, with seems logical given the likely longer associated procedural risk and need for more leads. Finally, the impact of age on expectant survival are to be taken into consideration with the device and the life-saving potential of the defibrillator.                                 Moving on to cellular electrophysiology, review one article by Zhang et al, entitled "Reduced N-type calcium channels in atrioventricular ganglion neuron are involved in ventricular arrhythmogenesis" published at the journal of the American Heart Association, in volume seven issue two. Zhang et al reported a rat model of ventricular arrhythmogenesis and characterized the role of atrioventricular ganglion neurons in risk of arrhythmogenesis as well as the mechanism for this risk this model relates in humans to the attenuated cardiac vagal activity in heart failure patients, which is known to relate to their arrhythmic risk. The demonstrated reduced N-type calcium channel in these AV ganglion neurons, which project innervating systems to the myocardium, resulting in increased risk of PVCs, and increased susceptibility to induction of ventricular arrhythmias with programmed stimulation.                                 The relevance of the intrinsic cardiac nervous system arrhythmogenesis has become increasingly prominent as methods to study it have improved. Understanding the direct and most relevant inputs may facilitate better understanding of risk of arrhythmias in patients. In the case of this study by Zhang et al, the critical finding is that disorder of the atrioventricular ganglion neurons may lead to increased susceptibility for ventricular arrhythmogenesis. Clinical relevance includes consideration of effects on this specific ganglion when performing ablation on for other conditions, and potential long-term effect on arrhythmogenic risk, as well as potentially relevant functional explanations for arrhythmogenesis.                                 Moving on to the genetic channelop, these are considered two separate articles. The first one by Bilmayer et al, entitled "ExomeChip-Wide analysis of 95,626 individuals identified ten novel loci associated QT and JT intervals" published in Circulation: Genomic and Precision Medicine, in volume 11 issue 1. This whole exome study reviewed several novel loci that modified the QT and JT intervals. They include over 100,000 individuals and identified ten novel loci not previously reported in the literature. This increases the number of known loci that impact from ventricular portal adjacent by nearly one third. These loci appear to be responsible for myocyte and channel structure and interconnections that internally impact the ventricular repolarization.                                 While long QT syndrome be characterized amongst the known genes in 75% of affected individuals, that also means one fourth long QT syndrome cannot be characterized based on known genes impacting ventricular repolarization. The identification of novel loci or novel that may be affect repolarization kinetics to unique means are critical to define novel therapies as well as in genetic counseling the patients in potential effects on family members when screening them for potential disease risk. These findings should assess an opportunity for further studying the mechanisms by which these loci modulate QT and JT intervals and the potential contribution to phenotypic risk.                                 The second paper within this realm we review is by Zumhagen et al, entitled "Impact of presynaptic sympathetic imbalance on long QT syndrome by positron emission tomography" published in Heart, volume 104. The authors sought to evaluate by a PET scan the impact of sympathetic heterogeneity on long-QT syndrome risk. Amongst 25 patients with long-QT syndrome, including long-QT type I and II, and 20 ostensibly healthy controls, they noted that regional retention in disease were similar between affected patients and controls. However, regional washout rates were higher in the lateral left ventricles in patients with long-QT syndrome. Internal global washout rates were associated with greater frequency of clinical symptoms. That's there seem to be some relationship between regional and global sympathetic heterogeneity, particularly during washout, with overall risk in long-QT syndrome patients.                                 These findings report the notion for sympathetic imbalance, partly mediating the risk attributable to long-QT syndrome. The findings on PET suggest regional imbalance of presynaptic cathecholamine and reuptake and release, being one mechanisms. This was most prominent in long-QT I patients who also often drive most benefit from left sided sympathectomy. The novelty of these findings is in the potential role of imaging to determine basic contributors to congenital long-QT syndrome in given patients. The larger prospect of size would really need to be evaluated this further.                                 Moving on to the realm of ventricular arrhythmias, we review three different articles. The first one, by Hamon et al, entitled "Circadian variability patterns predict and guide premature ventricular contraction ablation, procedural disability, and outcomes" published in Heart Rhythm, volume 15 issue one. Hamon et al sought to evaluate whether circadian variability of PVC frequency can predict optimal drug response intraprocedurally during PVC ablation. One of the main problems of PVC ablation is when PVC are infrequent and tend to disappear during the procedure, achieving procedural success or attaining sufficient frequencies of PVCs to map becomes very difficult. Next, they use Holter monitoring in the ambulatory stripe to define three groups. Those of higher PVC burden during faster heart rates, those with higher PVC burden during slower heart rates, and those with no correlation between their PVCs burden and their heart rate.                                 More than half the one hundred and one patients included a high burden of PVCs at fast rate while 40% had no correlation between the two and 10% had higher burden in slower heart rates. Almost one third of patients taken for ablation have infrequent PVCs during a procedure, while the best predictor of this being a low ambulatory PVC burden of less than 120 per hour. Isoproterenol infusion was only useful in lessening PVCs in those with PVCs associated with fast heart rates. The isoproterenol washout or phenylephrine where used with those associated with slower heart rates.                                 Interestingly, not a single drug was effective in inducing PVCs in those with infrequent PVCs that have not heart rate correlation in the ambulatory stages. They noted that outcomes ablates were similar amongst those with higher heart rate associated PVCs and non-heart rate correlated PVCs previously responded to a drug. But, [inaudible 00:48:08] noted only a 15% success rate from ablation in infrequent PVCs in patients who lacked correlation between PVC burden and heart rate and who were unresponsive to drug previously. These data are important highlighting the potential for further defining idiopathic PVC ablation needs and likelihood of success based on ambulatory data, by correlating PVC burden with heart rate and their circadian variability, it's possible to predict likelihood specific intraoperative drugs working when dealing with infrequent intraprocedural PVCs.                                 Furthermore, the finding of lack of correlation with slower or fast heart rate in terms of PVC burden is associated with the poor success rate unless those PVCs are drug responsive. Highlights the potential benefit of performing preoperative antiarrhythmic drug testing to get likelihood of ablation success in this patients.                                 The next article we review is by Lee et al, entitled "Incidence and significance of the lesions encountered during epicardial mapping and ablation of ventricular tachycardia in patients with no history of prior cardiac surgery or pericarditis" published in Heart Rhythm, volume 15 issue one. Lee et al sought to determine the frequency of pericardial lesions, impeding mapping in patients without prior surgery, operative procedure, or pericarditis, in other words virgin hearts. Amongst 155 first time attempts of access, 8% had pericardial lesions. The only clinical predictor was the presence of severe renal impairment.                                 In addition, no patients with supposedly normal hearts had a lesions. Notably, those with a lesion had more frequent impairment in mapping and lower overall success rates; there were similar complication rates as those without the lesions. These data are relevant in highlighting the ease of mapping of pericardial access may not always be present, even when dealing with inversion of pericardial space. A lesion may be present in patients, particularly with severe renal disease. Advising patients of this possibility prior to the procedure and considering that epicardial access may be impaired in a fair number of patients, even the absence of prior history of surgery, epicardial access or pericarditis isn't important.                                 The final article we'll review within the realm of ventricular arrhythmias is by Kumar et al, published in Journal of Cardiovascular Electrophysiology, volume 29 issue one, entitled "Right ventricular scar-related ventricular tachycardia in nonischemic cardiomyopathy: Electrophysiological characteristics, mapping, and ablation underlying heart disease." Kumar et al sought to evaluate the substrate and outcomes associated with right ventricle scar related ventricular tachycardia ablation in nonischemic patients at large, but particularly in those with neither stroke or coronary artery disease as potential explanations for this scar. They reviewed 100 patients consecutively over half of whom had ARVC and the remainder was sarcoid or RV scar of unclear origin. Those with RV scar of unknown origin tend to be older compared to the ARVC patients, and had more severe LV dysfunction compared with saroid patients.                                 However, the scar distribution extend was similar within all these groups. Furthermore VT/VF survival was higher in those with RV scar of unknown origin. The velocity of survival free or death or cardiac transplant and VT/VF survival seen in sarcoid patients. These data suggest that close to one third of patients, RV scar related VT may have VT of unknown cause. Total outcome was superior overall to those with defined myopathic processes. What's most interesting is, over follow up, none of those with RV scar of unknown origin develop any further findings to reclassify them as sarcoid or ARVC. It is possible this group reflects some mild form of either disease however. Again, the exact pathophysiologic process remains unclear. These findings may help in counseling patients who are in long-term expected outcomes from ablation intervention.                                 The final article we'll review this month is within the realm of other EP concepts that may be broadly applicable, published by van Es et al, entitled "Novel methods for electrotissue contact measurement with multielectrode catheters", published in Europace, volume 20 issue one. In this publication, the authors sought to evaluate the potential utility of a novel measure on evaluating electro tissue contact. With multielectrode catheters it is known that one of the problems with assessing contact is a contact force that cannot be used. Electro with coupling index is often used but even this has fragile problems, especially when you get into high impedance areas, that can be affected by surrounding ion impedance structures. Due to the fact that measuring contacts forces challenging in such multielectrode catheters, the authors measure electric interface resistance by applying a low level electrical field, pushing neighboring electrodes. They compared the effectiveness of assessing contact by this approach without using contact force in a poor side model.                                 They know that this measure was directly correlated with contact force in measuring tissue contacts. These findings support a role for aversion of an active electrode location and determining tissue proximity and contact-based on the coupling between the electrodes on multipolar catheters in the tissue. These findings may be highly useful when there is a variety of catheters where contact force cannot be implemented. Further studies on the methods and cutoff to establish tissue proximity on the end of contact will be also needed.                                 To summarize, however, as a term was brilliant here that was not well explained, active electrical location is actually a phenomenon that occurs in nature. This is seen in deep sea fish, which actually have multiple electrodes oriented around its body. They emit a small electrical field that results in a general impedance field surrounding the fish. This essentially is the way of visualizing the world around them. Perturbations based on proximity to different structures, whether they are live or death, and based on whether they are live or death, results in changes in the perturbations of this resistive fields, resulting in proximity determination by the fish. Several individuals are looking into potential applications of this to understanding tissue proximity when using catheters in the body. This consideration of impedance is fundamentally different than the traditional measure impedance were used by traditional generator.                                 I appreciate everyone's attention to this key and hardening articles that we've just focus on or this past month of cardiac electrophysiology across literature. Thanks for listening. Now back to Paul. Dr Wong:             Thanks Suraj, you did a terrific job surveying all journals for the latest articles on topics of interesting in our field. There's not an easier way of staying in touch with the latest advances. These summaries and the list of all major articles in our field for month can be downloaded from the Circulation: Arrhythmia and Electrophysiology website. We hope that you find the journal to be the go to place for everyone interested in the field.                                 See you next month.  

Czwarty odcinek podkastu gotowy, by zabrzmieć w Waszych uszach! Korzystając z okazji, bo dziś Halloween – wskrzesimy wspomnienia oraz pamięć o zapomnianych platformach i technologiach. Do tego święta podchodzimy z przymrużeniem oka i mamy nadzieję, że udało się nam również utrzymać luźny charakter samego nagrania. Jeśli zbytnio "przytetryczyliśmy" – wybaczcie, wiecie gdzie kierować zażalenia, skargi i wnioski. Co by nie padł zarzut, że nic o jabłkach, przypominamy o halloweenowej zabawie zwanej apple bobbingiem. Poniżej kilka wybranych odsyłaczy do stron z rzeczami, o których wspomnieliśmy w kompocie: prezentacja Douglasa Engelbarta – Mother of all Demos moduł Jogeira Liljedahla – Guitar Slinger (YouTube) (MOD) moduł Walkmana (Tora Bernharda Gausena) – Klisje Paa Klisje (YouTube) (MOD) moduł Emaksa (Benniego Pedersena) – Defloration (YouTube) (MOD) moduł Scorpika (Adama Skorupy) – Próba mikrofonu (MOD) moduł Vulture – Anti-Atari song (MOD) Archiwum MODów amigowych klon Protrackera Audio Overload Richarda Bannistera – odtwarzacz muzyczny wspierający MODy (oraz inne formaty "z epoki") Archiwum dem amigowych kanał RetroDemoScene na YouTube z najpopularniejszymi produkcjami na Commodore 64 i Amigę wiki n/t grupy scenowej Slight, w której (między innymi) działał Remek (Rzóg) pierwsze demo grupy Slight Bitter Reality (YouTube) Opus Magnum grupy Slight - Overmind (YouTube) (nie)sławny joystick Atari (wiki) gra Jetpac (wiki) (JavaScript) gra Jet Set Willy (wiki) (JavaScript) gra Lode Runner (wiki) (HTML5) gra H.E.R.O. (wiki) (JavaScript) gra River Raid (wiki) gra Raid over Moscow (wiki) gra Crystal Castles (wiki) gra Pengo (wiki) gra Draconus (wiki) gra Zybex (wiki) gra The Goonies (remake) gra Boulder Dash (wiki) (JavaScript) gra Gyrrus (wiki) (JavaScript) gra Robbo (wiki) gra Wings (wiki) (GOG) gra Cannon Fodder (wiki) (GOG) gra Lemmings (wiki) (DHTML) gra SlamTilt (wiki) gra Moonstone (wiki) język programowania Logo (wiki) (JavaScript) język programowania BASIC (wiki) (JavaScript) edytor tekstu TAG (wiki) archiwum polskich amigowych magazynów dyskowych Fat Magnus archiwum zasobów Atari zbiór archiwalnych numerów czasopisma IKS zbiór archiwalnych numerów magazynu Bajtek jedna z publikacji Marka w serwisie PPA czasopismo Total Amiga, w których wybrane teksty (n-ry 22 i 23) tłumaczył Marek magazyn Świat Gier Komputerowych, w którym pojawiło się kilka recenzji Marka (kwiecień - sierpień 1993) mikrokomputer ZX Spectrum mikrokomputer Bosman 8 mikrokomputer Amstrad-Schneider CPC mikrokomputer Unipolbrit mikrokomputer Atari 800XL mikrokomputer Amiga 500 Po nagraniu wyszło na jaw, że pamięć bywa zawodna i kilka błędów popełniliśmy. Za to powyższa lista jest w 100% wolna od chochlików. Nasz podcast znajdziecie w iTunes (link), możecie też dodać do swojego ulubionego czytnika RSS (link) lub przesłuchać bezpośrednio w przeglądarce (link). Zapraszamy do kontaktu na Twitterze: Remek Rychlewski @RZoG. Marek Telecki @mantis30. Natomiast całe przedsięwzięcie firmuje konto @ApplejuicePl. Jesteśmy również dostępni dla Was pod adresem e-mail kompot[at]applejuice.pl

In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews Dr. Par Bolina, Chief Innovation Officer at IKS.  Par is a physician & expert in Healthcare Informatics, Electronic ...

In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews Dr. Par Bolina, Chief Innovation Officer at IKS.  Par is a physician & expert in Healthcare Informatics, Electronic Medical Records & Exam Room Ambulatory Workflow.  This episode focuses on one of the most critical and under-examined parts of healthcare delivery - the so-called “last mile” - the patient/provider encounter - where the rubber meets the road, and where healthcare value is directly created.  To be quite honest - this podcast episode is lengthy; but you won’t want to miss what’s revealed.   Dr. Bolina points out that our lack of investigation into and superficial understanding of the provider/patient encounter is what is leading to avoidable care gaps, suboptimal outcomes, inefficiencies, high costs, provider burnout, and less than optimal patient experience. Similar to a Jacque Cousteau, Bolina takes us on a deep dive into this largely unexplored domain, and opens our eyes to the ‘ecosystem of the encounter’ - what might be considered ‘the final frontier’ of healthcare delivery.  What Bolina reveals to us is that the provider/patient encounter is filled with real-time data that we could measure and use, to dramatically improve upon healthcare outcomes.  Dr. Bolina discusses ‘Scribbles’ - a ‘scribe on steroids’ redesign that he’s developed at IKS.  Scribbles is an asynchronous, virtual, off-site physician-scribe/coach who listens to the audio recorded encounters during off-hours, and provides the provider with daily, real-time feedback and recommendations to improve clinical care, documentation & coding.  

Ventrikuläre Tachyarrhythmien sind die Hauptursachen für den plötzlichen Herztod, der eine bedeutende Todesursache in der westlichen Welt darstellt. Dabei sind, neben strukturellen Veränderungen im Myokard wie Narben, Hypertrophie oder Ventrikeldilatation, elektrophysiologische Veränderungen der Repolarisationsphase ursächlich. Für die Repolarisation essentielle Kanäle sind die delayed rectifier Kaliumkanäle IKr und IKs; Mutationen in diesen Kanälen sind ursächlich für das angeborene Long QT-Syndrom, das mit lebensbedrohlichen Herzrhythmusstörungen assoziiert ist. Pharmakologische Wirkungen und Nebenwirkungen auf die repolarisierenden Kaliumkanäle können ebenfalls Herzrhythmusstörungen auslösen; man spricht dabei vom erworbenen oder Medikamenten-induzierten Long QT-Syndrom. Auch bei Herzinsuffizienz zum Beispiel aufgrund einer dilatativen Kardiomyopathie wird oft eine QT-Zeit Verlängerung und Rhythmusstörungen beobachtet. Dabei ist die Herunterregulation von Kaliumkanälen wie Ito ein oft beobachtetes Phänomen; in tierexperimentellen Untersuchungen wird teilweise auch eine Reduktion von IKr und IKs beschrieben. Für viele Ionenkanäle sind Unterschiede in der transmuralen Verteilung bekannt, so dass die Messung der delayed rectifier Kaliumkanäle in vorliegender Untersuchung getrennt nach subepikardialen, mittleren und subendokardialen Arealen des linksventrikulären Myokards durchgeführt wurde. Ein weiterer Aspekt der Arbeit ist der Vergleich der Repolarisation in verschiedenen Spezies, was bei der Interpretation von tierexperimentell gewonnenen Ergebnissen von großer Bedeutung ist. Dazu wurden IKr und IKs in verschiedenen Tiermodellen (Meerschweinchen, Schwein und Hund) unter Berücksichtigung der transmuralen Verteilung gemessen und mit den aus humanem Myokard gewonnenen Ergebnissen verglichen. Die porenbildenden alpha-Untereinheiten von IKr und IKs, KCNH2 und KCNQ1, wurden im heterologen Zellsystem exprimiert und deren Sensitivität auf IKr bzw. IKs spezifische Kanalblocker überprüft. Methodisch wurde für oben genannte Fragestellungen die patch clamp Technik in Ganzzellkonfiguration verwendet; zur Aufzeichnung von Aktionspotentialen und zum Nachweis von IKs in humanem Myokard wurde die perforated patch Methode verwendet, um eine Veränderung des intrazellulären Milieus mit Dialyse von Botenstoffen zu vermeiden. Auf molekularbiologischer Ebene wurde die mRNA-Menge der IKr und IKs alpha-Untereinheiten KCNH2 und KCNQ1, sowie deren (potentielle) beta-Untereinheiten KCNE1 und KCNE2 mit Hilfe der quantitativen real-time PCR bestimmt. Dabei konnten folgende Ergebnisse erzielt werden: IKr ließ sich im Menschen in allen Zellen in relevanter Größe nachweisen; der Strom ließ sich sowohl durch den spezifischen IKr-Blocker Dofetilide, aber auch durch Pharmaka aus nicht-kardiologischen Anwendungsgebieten wie das Neuroleptikum Haloperidol inhibieren. Dabei wies der Kanal eine Abhängigkeit von der extrazellulären Kaliumkonzentration auf, die sich umgekehrt zum elektrochemischen Gradienten verhielt: höhere extrazelluläre Kaliumkonzentrationen bewirkten eine Steigerung von IKr. IKs (definiert als HMR 1556 sensitiver Strom) ließ sich in humanem Myokard nur unter speziell optimierten Bedingungen (perforated patch Technik, adrenerge Stimulation mit Isoproterenol) nachweisen. Er hatte dann eine sehr kleine Stromdichte, die eine weitere elektrophysiologische und pharmakologische Charakterisierung nicht erlaubte. In Meerschwein, Schwein und Hund war IKr und IKs nachweisbar; dabei hatte das Meerschweinchen die höchsten Stromdichten von delayed rectifier Kaliumkanälen, das Schwein kleinere, aber robuste IKr und IKs-Ströme. Beim Hund fanden sich deutlich geringere Stromdichten für IKr und IKs; IKs war nicht in allen Zellen nachweisbar. IKr wies in allen Spezies epikardial eine kleinere Stromdichte auf als in mittleren und endokardialen Arealen. Dieser transmurale Gradient mit geringerer Stromdichte in epikardialen Arealen war nur in nicht-insuffizienten humanen Herzen nachweisbar; bei Herzinsuffizienz kam es zur Angleichung der Stromdichten in allen drei untersuchten Schichten. KCNH2 und KCNQ1 generierten im heterologen Zellsystem IKr bzw. IKs ähnliche Ströme, die jeweils typische Sensitivität für IKr bzw. IKs Blocker aufwiesen. Für KCNH2 und KCNQ1 mRNA waren keine transmuralen Gradienten und keine Regulation bei Herzinsuffizienz nachweisbar; KCNE1 und KCNE2 zeigten bei Herzinsuffizienz höhere Expressionslevel. Somit ließ sich das Vorhandensein und die Bedeutung von IKr und IKs in humanem Myokard belegen, wobei IKs nur in sehr geringer – in Ruhe gerade noch nachweisbarer – Stromdichte vorkommt. Dennoch lässt sich seine Bedeutung am Vorhandensein von Mutationen in KCNQ1, die lebensbedrohliche Rhythmusstörungen verursachen können, ablesen. Auch für KCNH2, das für die alpha-Untereinheit von IKr kodiert, sowie für die (potentiellen) beta-Untereinheiten KCNE1 und KCNE2 sind Mutationen beschrieben, die ursächlich für das angeborene Long QT-Syndrom sind. Damit scheinen IKr und IKs für die Repolarisation des humanen Aktionspotentials essentiell zu sein, wobei IKr aufgrund der relativ großen Stromdichte die wesentliche Rolle bei der Repolarisation des Aktionspotenials in humanem Myokard zukommt. IKs hat große Bedeutung als „Repolarisationsreserve“ zur Stabilisierung der Repolarisation unter Bedingungen erhöhter Katecholaminspiegel, bei tachykarden Herzfrequenzen und bei verzögerter Repolarisation wie durch Hypokaliämie, IKr-Blocker oder IKr-Mutationen und Polymorphismen. Mutationen in Proteinuntereinheiten von IKs können zur Störung dieser Repolarisationsreserve führen und somit Rhythmusstörungen auslösen, die charakteristischerweise in Situationen erhöhter sympathischer Aktivierung auftreten. Die Ausstattung der unterschiedlichen Spezies mit repolarisierenden Kaliumströmen wies erhebliche Unterscheide auf, was bei der Interpretation tierexperimentell gewonnener Daten zu berücksichtigen ist. Insbesondere korreliert eine Abnahme der Ruheherzfrequenz der Spezies mit einer deutlichen Reduktion der repolarisierenden Ströme entsprechend dem Konzept der speziesabhängigen Variabilität der repolarisierenden bei Konstanz der depolarisierenden Ströme (INa und ICa). Transmurale Unterschiede in der Expression von Ionenkanälen scheinen notwendig für den Ablauf der Erregungsbildung und Erregungsrückbildung zu sein. Die epikardial geringeren Stromdichten für IKr waren in allen untersuchten Spezies nachweisbar. Die Beobachtung einer geringeren Stromdichte der repolarisierenden Kaliumströme epikardial bedeutet, dass andere Ionenkanäle als IKr und IKs für die dort kürzere Aktionspotentialdauer verantwortlich sein müsssen. Eine Reduktion der Stromdichte bei Herzinsuffizienz, wie sie beispielsweise für Ito beschrieben ist, konnte für IKr nicht nachgewiesen werden. Jedoch fand sich eine Nivellierung des physiologischerweise Vorhandenen transmuralen Gradienten, was grundsätzlich zu einer Störung des physiologischen Erregungsablaufes mit Begünstigung von Rhythmusstörungen in insuffizienten Herzen beitragen könnte. Aus dem dualen Repolarisationsmechanismus im menschlichen Ventikelmyokard werden klinische Konstellationen mit Rhythmusstörungen verständlich, insbesondere in Hinblick auf die Variabilität der Empfindlichkeit gegenüber Medikamenten mit blockierender Wirkung auf IKr. Dabei stellt IKs in unterschiedlichem Maße eine Kompensation im Sinne einer Repolarisationsreserve bereit.