Podcasts about international registry

This week please join author Eric Rosenthal and Associate Editor Gerald Greil as they discuss the article "Covered Stent Correction for Sinus Venosus Atrial Septal Defects, an Emerging Alternative to Surgical Repair: Results of an International Registry." For the episode transcript, visit:  https://www.ahajournals.org/do/10.1161/podcast.20250317.309077

CONFIRM-2: Artificial Intelligence Enabled Quantitative CT Assessment of Atherosclerosis and Major Adverse Events: A Multi-Center International Registry

In this episode of CTSNet's flagship podcast, editor in chief Joel Dunning runs through the latest, most popular content on ctsnet.org—the largest online community of CT surgeons and source of CT surgery information—and breaking cardiothoracic surgery news and research from around the world. Joel discusses a new analysis of the ISCHEMIA trial, a report on trends in management and outcomes of type B aortic dissection, and Bayesian interpretation of non-inferiority in TAVI vs. SAVR trials. He also talks about clinical videos demonstrating trileaflet expanded polytetrafluoroethylene valved conduit creation, the Ross procedure, and a novel warm arch repair strategy. After discussing upcoming events in the CT surgery world, he closes with the announcement that this is the last episode of the year. The Beat will be back with a new episode on January 11, 2024. JANS Items Mentioned The ISCHEMIA Trial Revisited: Setting the Record Straight on the Benefits of CABG and the Misinterpretation of a Landmark Trial  Editor's Choice—Trends in Management and Outcomes of Type B Aortic Dissection: A Report from the International Registry of Aortic Dissection  Bayesian Interpretation of Non-Inferiority in TAVI Versus SAVR Trials: A Systematic Review and Meta-Analysis  CTSNet Content Mentioned Technique For Trileaflet Expanded Polytetrafluoroethylene Valved Conduit Creation   Pioneering Precision: The Ross Procedure Unveiled  Introduction of the Novel Warm Arch Repair Strategy  Other Items Mentioned CTSNet Events Calendar Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

Antariksh Matters #1: Fishing out illegal fishing vessels— Pranav R SatyanathDuring the Quad Summit held in Tokyo on May 23, the leaders of Australia, India, Japan and the United States agreed to establish the Indo-Pacific Partnership for Maritime Domain Awareness (IPMDA). This initiative hopes to extend the existing mechanisms for maritime cooperation among the four countries and harness commercially-available data to put together a more accurate picture of the maritime domain.The Quad countries also plan to use greater cooperation to tackle the issue of illegal fishing by Chinese vessels, as reported by Demetri Sevastopulo in the Financial Times. The report states that the partner countries will use space-based capabilities and existing maritime fusion centres to combat illegal, unreported and unregulated (IUU) fishing carried out by Chinese vessels in the Indian Ocean. The problem of IUU fishing by Chinese vessels is not new, with the IUU Fishing Index 2021 giving China an overall score of 3.86 (a score closer to 1 being the best) – making China the worst performing among 152 countries.Space-based capabilities to track maritime activities are not new and remain crucial marine safety and sustainability pillars. However, the Quad initiative to enhance maritime awareness through data exchanges is novel, as it brings together state-capacity, commercial capabilities of the partnering countries and publicly-available data to better monitor the maritime domain. There are three main ways to monitor and track maritime activities, which are likely to be used in tandem by the Quad countries. Each of these methods is described below:Transponder signatures: Any vessel that ventures into the seas is required to have onboard the Automatic Identification System (AIS), a transponder which transmits data about a vessel’s set course, speed and manoeuvres carried out. Further, it also provides details of the vessel’s registry under the International Maritime Organisation (IMO), the vessel’s dimensions and its call sign. Although AIS transponders are not registered, they can be identified by a vessel’s unique 9-digit Maritime Mobile Service Identity (MMSI), which is included in all transmissions.The IMO requires all international vessels weighing 300 gross tons or more to carry onboard AIS transponders. This requirement initially served the purpose of avoiding accidents and collisions at sea. Today, the AIS data, which anyone with a correctly configured receiver can access, has become an essential pillar of coastal security, monitoring IIUU fishing, tackling anti-piracy, and enforcing international sanctions.International Registry: The registry of a vessel under the IMO is an authoritative and legitimate identification of a vessel. IHS Markit assigns each registered vessel a unique 7-digit identification number on behalf of the IMO, which can be publicly accessed free of charge. This number remains permanent, even after a vessel changes its flag (the country where the ship is registered). The IMO registry provides details such as the vessel’s ownership, physical features, and registered flag. It remains the most authoritative form of maritime identification.Physical identification: The final way of identification is by a vessel’s physical features. Since the details of a vessel’s dimensions are already available in the public domain, it can be verified either by coastal surveillance or through satellite imagery. The use of satellite images has become commonplace in the shipping industry. Besides using optical images, new commercially-available technologies such as synthetic aperture radar (SAR) satellites have made it possible for private entities and NGOs to verify several aspects of illegal maritime activities. Furthermore, the use of machine learning to identify vessels at sea is also an upcoming technology used in the maritime domain.International cooperation has always been an important initiative in combating illegal maritime activities. The United States, for example, has forged several multilateral partnerships to curtail IUU fishing across the world. Based on the available details about the Quad’s IPMDA initiative, we can speculate that the fusion centres in India, Singapore, Solomon Islands, and Vanuatu will use the methods mentioned above to monitor and track IUU fishing activities. In addition, data gathered by coastal radars, patrol boats, drones and manned patrol aircraft could act as a force multiplier in their effort to mitigate illegal maritime activities.Matsyanyaaya: A Roadmap for the Quad’s Emerging Technology Working Group— Arjun GargeyasThe official statement released by the White House following the first-ever in-person Quad summit in September, outlined the broad areas that the partners were looking at. From 5G and semiconductors to biotechnology, critical areas were identified for the alliance to develop a strategic advantage in. With the launch of the ‘Quad Semiconductor Supply Chain Initiative’, the group signaled its intent to establish itself in the technology domain.Notwithstanding this pledge, there still exists uncertainties regarding the commitments made on the technology front. There is also the question of how much progress has been made by the member states regarding critical and emerging technologies. With the remnants of the COVID-19 pandemic and new geopolitical events such as the Russia-Ukraine war still affecting several technology supply chains, the Quad has to focus on three main areas to create an immediate impact in the technology domain.Bubbles of TradeExtending the concept of the ‘bubbles of trust’ approach that envisages better diplomatic relations between like-minded states, the Quad should set up a mechanism for the free flow of goods, labour, and capital-related to strategic technologies. Taking the example of the semiconductor industry, it is clear that key technology sectors have burgeoned globally and have relied on international cooperation for their growth and sustainability. This ensures that they cannot be restructured in such a short period of time. Robust infrastructure and an efficient value chain have been developed in high-tech sectors due to free trade.But the current situation has thrown up several key challenges for the Quad to navigate. This includes protectionist measures resulting in high import tariffs and export control regulations preventing access to critical components for building key technology ecosystems. The military applications of these technologies have also raised the fears of weaponisation resulting in lesser collaboration efforts. The Quad should aim for creating a more liberalised and open market policy that helps the four countries indulge in a greater exchange of goods, labour and capital related to strategic technology sectors. Favourable trade policies encouraging the exchange of technology sector-centric trade must be a priority. The governments of the Quad should focus on developing a comprehensive trade policy suited or catered to building strategic technology ecosystems across all the states.A Robust IP Protection RegimeWith the technological rise of China and the fears of economic espionage, there has been a restriction on the transfer of critical technology between states, thereby hampering the level of growth and innovation in certain fields. This can be addressed by the Quad coming together to build a strong intellectual property (IP) protection framework. It can help in formulating transfer of technology agreements in critical technologies between the states without fears of IP theft. Securing technology supply chains have become a challenge due to the intrinsic dependencies that have been created in several areas. Technology transfers remain a solid solution to build resiliency in these value chains themselves. However, the qualms of the IP-owning countries have been the fear of these critical technologies leaking out and reaching adversaries.A starting point for the Quad would be to introduce and ensure the enforcement of strict IP theft rules and regulations to facilitate technology transfer agreements. Prevention of exports, restrictions on domestic operations, and levying fines or penalties for specific firms violating IP theft guidelines will ensure innovation-based competition and create a favorable environment for multilateral collaboration. It must be noted that almost all modern-day technological powers have benefited from the transfer of technology from more advanced states. Hence, it remains in the interest of the Quad to share critical technologies between its alliance members. Joint Standards DevelopmentThe race for technological superiority has moved from the domination of market share to the establishment of governance mechanisms for certain critical technologies. This is where technology or technical standards come into play. Setting standards in crucial technologies have allowed states and companies to reap economic and geopolitical benefits. The Quad has the collective technical expertise to formulate and set technical standards in various emerging technologies. In recent times, there has been a steady increase in governments’ participation in the process of standards-setting. States are now openly advocating for certain technical standards to be adopted as the global ones which would eventually benefit the state and its domestic private sector. The Quad, as a group, must prioritise pre standardisation research as well as advocate and push for jointly developed technical standards at international standard-setting bodies. An increase in Chinese influence in these global standard-setting bodies has set alarm bells ringing in the West. The Quad can take over the mantle and establish committees to spearhead standard development activities in technologies like advanced communications, quantum technology, and artificial intelligence. This would put the alliance in the driver’s seat to set and formulate standards that will end up shaping the way future technologies might work.Antariksh Matters #2: Can you ban space weapons?— Aditya RamanathanDoes it make sense for India to pursue arms control in space? The recently concluded session of the Open Ended Working Group (OEWG) meeting in Geneva has infused urgency into this question. The OEWG focused on how space threats could be reduced through norms, principles, and guidelines My colleague Pranav R. Satyanath covered the OEWG in the previous edition of this newsletter.For our purposes, the OEWG meeting was notable for both the absence of any substantial efforts to ban space weaponry and for the lack of active Indian participation. This Indian reticence will keep it from shaping the future of space security. But to actively intervene in future discussions, Indians will need to agree on a few basics. As Pranav pointed out, states are debating about:“whether to regulate space capabilities or to regulate space activities; and second, whether to negotiate legally-binding treaties or whether to agree on non legally binding transparency and confidence-building measures.”This week, I’ll stick to considering the first of these themes: space capabilities. There’s been widespread scepticism about the prospects for arms control in space. One reason for this, as we previously argued, is that space warfare is essentially primitive in its current state – at least when you compared to the highly evolved systems of warfare on Earth that incorporate speciated weapons and platforms fulfilling niche roles on battlefields.As two scholars with the United Nations Institute of Disarmament Research (UNIDIR) pointed out, potential space weapons are often ‘dual-capable’ systems such as repair satellites that can be used for more hostile purposes. In addition to these dual-capable systems, there exist multi-use capabilities such as direct ascent ASAT missiles, which are largely derived from existing ballistic missile defence (BMD) systems.If potentially offensive space capabilities are either dual-capable or multi-use, can they really be curbed? To consider this issue, it’s best to look at key factors that usually help decide success in arms control. Paul Scharre suggests three factors that influence the feasibility of a workable deal: “the perceived horribleness of the weapon; its perceived military utility; and the number of actors who need to cooperate for a ban to work.”We can add two more criteria to this list. One, whether the capability is dual-capable or multi-use. Two, whether verification of compliance with an agreement is feasible.How do these criteria fare against the implements of space warfare? Since space warfare can be waged on both Earth and in space we must consider each category of weapons. On Earth, space warfare is waged with well-established arms and modes of fighting. The combat aircraft, long-range missiles, or elite infantry forces used to attack Earth-based space assets will not be subject to bans for obvious reasons.This leaves us with those capabilities that directly target space-based assets. Specifically, these are:Electronic warfare and cyber attack capabilitiesKinetic ASAT missiles (whether direct ascent or co-orbital)RPO satellites (such as the aforementioned repair satellites or debris- clearing craft)Directed energy weapons (such as lasers and high-powered microwaves)Any future space-to-Earth kinetic weapons such as the once-proposed ‘Rods from God’The proscribing of offensive space capabilities would work best when:the perceived horribleness is highthe perceived military utility is lowthe number of actors that need to agree is lowthe capability in question in not dual-capable or multi-useverification is feasibleThe table below maps how five types of offensive space capabilities fare against these conditions:Naturally, there is much that is subjective about arms control. In particular, ‘horribleness’ is a slippery concept. For instance, anti-personnel laser weapons that can blind people are proscribed while lasers that target weapons platforms are allowed along with all manner of other conventional and nuclear weaponry that shred or incinerate human beings. As a rule of thumb, weapons that specifically target humans are subject to much greater scrutiny than those that target things – even if attacks on those things leads directly to human suffering. Therefore, electronic warfare and cyber attacks, RPO satellites, and lasers that attack orbital craft are unlikely to elicit the visceral opposition as blinding lasers. The one exception to this rule is the kinetic destruction of satellites. While kinetic collisions in space may not directly kill anyone (though the resultant debris could notionally endanger spacefaring humans), they create serious practical problems and impose high reputational costs, which could, in turn, have serious diplomatic consequences during a conflict.Candidates for Arms ControlThe table makes clear that only one type of system meets all the ideal conditions for arms control: orbital space weapons meant to attack Earth-based targets, such as the so-called ‘Rods from God’ fanciful proposals for orbital craft that will unleash 20-foot-long tungsten rods that act like artificial meteorites, striking hardened targets such as bunkers or ICBM silos.Despite their evident horribleness, such weapons would have low military utility simply by virtue of being highly vulnerable. To be able to get weapons on target quickly, the orbiting platforms would have to be in low earth orbit, making them easy targets for Earth-based countermeasures such as ASAT missiles. Any user would also need to maintain a sizeable a constellation of these platforms to ensure adequate coverage.Besides this, no state has invested serious resources into developing ‘Rods from God’, meaning the number of actors is presently zero. Furthermore, any such platform is not dual-capable/ multi-use and their existence can be easily verified, since these large orbital platforms will resemble nothing else circling the Earth.The other candidate for some manner of arms control is Earth and space-based kinetic ASAT weapons. On the one hand, these weapons possess some clear utility: destroying a satellite puts it out of action permanently and signals serious intent to an adversary. However, a closer examination reveals these weapons score low on military utility and high on horribleness.Consider utility: the violence of kinetic collisions narrows down its potential use to the sole circumstance of high intensity conventional conflict. If used first by a spacefaring state, it opens itself up to retaliation in kind. Furthermore, to substantially degrade an adversary’s use of space, several satellites will need to be targeted. While non-kinetic capabilities theoretically offer the ability to disrupt multiple satellites for specific periods of time or over specific ground tracks, attempting something similar with kinetic collision could create enough debris to risk India’s own celestial lines of communication.With high horribleness, low military utility and a relatively small number of actors (only five states including India have proven ASAT capabilities), kinetic kill ASATs seem like good candidates for a ban. However, the multi-use nature of direct-ascent ASAT missiles and the makes any effective ban impractical. What is possible is a ban on destructive ASAT tests. Back in March, we had advocated India unambiguously back such a ban. The following month, US Vice-President Kamala Harris committed the US to a self-imposed ban on such tests and establishing such a moratorium “as a new international norm for responsible behavior in space.”Having already conducted a successful destructive test in 2019, India is in a good position to support an international moratorium on destructive tests with direct-ascent ASAT missiles.Working out a Negotiating PositionIndia’s stance on space security is likely to evolve in the coming years. While traditional arms control is unlikely to serve as a foundation for its strategy, India may do well to propose outright bans on space-to-Earth kinetic weapons, and back a global ban on destructive DA-ASAT tests.In the coming weeks and months, Pranav and I will examine the effects of the OEWG on space threats, consider ways in which India can best secure its interests.[Book] The Shock of the Old: Technology and Global History Since 1900 by David Edgerton.[Article] “Operational Monitoring of Illegal Fishing in Ghana through Exploitation of Satellite Earth Observation and AIS Data by Andrey A. Kurekin et. al.[Blog] Artifice and Intelligence by the Center on Privacy & Technology This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit hightechir.substack.com

This week I'm speaking with Felipe Engineer, a registered Scrum master and trainer. Felipe also leads the Lean construction program at McCarthy Building Companies and is the CEO and podcast host of the EBFC Show, which is dedicated to Lean construction. In this episode, Felipe and I go into detail about integrating Lean into construction. We also talk about Scrum, what it is and how Scrum can be used when you're in the construction industry. What You'll Learn This Episode: The importance of Lean in construction Felipe's podcast, The EBFC show What is Scrum How you can use Scrum in design and construction Lean tools and techniques that are used on a construction site The argument that Lean is too academic How you can start improving your work today About the Guest: Felipe leads the Lean Construction program for McCarthy Building Companies, Inc. Engineer-Manriquez is also the CEO and Host of The EBFC Show. The Easier, Better, for Construction Show allows people to make building easier and better share how. As a Registered Scrum Trainer™ (RST) endorsed by Dr. Jeff Sutherland, Felipe also co-created the Design and Construction Registered Scrum Master™ (RSM) curriculum with the Agile Education Program team. It enables RSM graduates to deliver construction project value and earn recognition in the International Registry of Agile Professionals™. Engineer-Manriquez is an active contributing member of the Lean Construction Institute (LCI) and is an approved instructor/facilitator and 2019 LCI Chairman's Award recipient for contributions to the Institute and the design and construction industry as a whole. Important Links: https://www.theebfcshow.com/ https://www.linkedin.com/in/engineerfelipe/ https://constructionscrum.com/ --- Support this podcast: https://anchor.fm/leansolutions/support

In this episode, guest host Dr. Sarah Wise speaks with Dr. Zara Patel.  They will discuss the article: International Registry of Otolaryngologist ‐ Head and Neck Surgeons with COVID‐19. Read the article in International Forum of Allergy and Rhinology Listen and subscribe for free on Apple Podcasts , Google Play Music and Subscribe on Android.

When the COVID-19 pandemic hit the US, a researcher who focuses on sickle cell disease (SCD) was concerned. So, she assembled a team to create a registry of SCD patients who’ve contracted COVID-19. Learn about a SCD/COVID-19 registry that’s now international in scope and hope of providing better outcomes, inside this edition of CTSI Discovery Radio!

David Mayer, a Partner with the law firm of Shackelford, Bowen, McKinley & Norton, LLP, discusses some of the business and legal issues one should consider when acquiring a new or pre-owned aircraft. Topics covered include: The kinds of business professionals a buyer should engage for an aircraft purchase. The terms a Letter of Intent (LOI) should include when it comes to the acquisition process. Why use an LOI rather than enter into an Aircraft Purchase Agreement immediately? Should the LOI state the purchase be contingent on securing financing? Drafting the Aircraft Purchase Agreement. Issues that are important to address in the Aircraft Purchase Agreement. How Federal Air Regulations can affect aircraft purchases and structuring. The benefit of establishing a Limited Liability Company (LLC) or Trust to own an aircraft. Tax planning and bonus depreciation. The “fly-away” sales tax exemption. How aviation insurance protects an owner or lessee. The importance of Uniform Commercial Code (UCC), FAA and International Registry filings.

While missing aortic dissection was considered "the standard" in the late 20th century, our understanding of the clinical diagnoses has improved considerably since the landmark International Registry of Aortic Dissection (IRAD) study in 2000. Nonetheless, aortic dissection remains difficult to diagnosis with 1 in 6 being missed at the initial ED visit. With the help of Dr. David Carr we’ll discuss how to pick up atypical presentations of aortic dissection without over-imaging as well as manage them like pros by reviewing: 1. The 5 Pain Pearls, 2. The concepts of CP +1 and 1+ CP, 3. Physical exam pearls, 4. CXR pearls and blood test pitfalls, and 5. The importance of the correct order and aggressive use of IV medications. So with these objectives in mind… The post Episode 92 – Aortic Dissection Live from The EM Cases Course appeared first on Emergency Medicine Cases.

David Pearce created the Coordination of Rare Diseases at Sanford or CoRDS registry as a national resource that could help accelerate research into rare diseases. We spoke to Pearce, president of Sanford Research, director of Sanford Children’s Health Research Center, and the Global Genes 2012 Champions of Hope honoree for Research & Science, about his own research into the neurodegenerative disorder Batten Disease, how that led to the development of CoRDS, and the role patient registries can play in accelerating rare disease research and the development of new therapies. This is an encore presentation of an interview with Pearce that originally aired April 2015.

Carolyn: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr. Carolyn Lam, Associate Editor from the National Heart Center and Duke National University of Singapore.     Today, we will be discussing an interesting Danish nationwide cohort study on the return to the workforce following first hospitalization for heart failure, but first here's your summary of this week's journal.     The first paper addresses a common question asked by patients who have survived an aortic dissection. Will this happen to me again? First author, Dr. Isselbacher, and corresponding author, Dr. Lindsay, and investigators of the International Registry of Aortic Dissection investigated this in the largest systematic analysis to date of patients presenting to hospital with a recurrent aortic dissection.     In this large registry, the authors identified 204 patients with recurrent aortic dissection and compared these to 3624 patients in the registry with an initial aortic dissection. They found that patients with recurrent dissection were more likely to have Marfan syndrome, but not bicuspid aortic valve. Descending aortic dimensions were greater in those with recurrent dissections than those with only an initial dissection, and this was independent of the sentinel dissection type. In multivariable analysis, the diagnosis of Marfan syndrome was independently predictive of a recurrent aortic dissection with a hazards ratio of 8.6.     Furthermore, they found that the patient's age at the time of first dissection correlated with the anatomic pattern of aortic involvement. In younger patients, dissection of the proximal aorta tended to be followed by dissection of the distal aorta, whereas the reverse was true among older patients suggesting divergent mechanisms of disease.     In summary, therefore, this study shows that recurrent aortic dissection while in common does occur and in fact affected 5% of those in this registry. The data really illustrate the importance of syndromic forms of aortic dissection and suggest that occurrence of a recurrent dissection should raise suspicion of a genetic etiology of aortic disease.     The next study provides pre-clinical data suggesting that counteracting increased hepcidin may be a therapeutic target for treatment of intracerebral hemorrhage. In this study from first author, Dr. Xiong, corresponding author, Dr. Yang, and colleagues from Xinqiao Hospital, the Third Military Medical University in China, parabiosis and intracerebral hemorrhage mouse models were combined with in vitro and in vivo experiments to investigate the roles of hepcidin in brain iron metabolism after intracerebral hemorrhage. Hepcidin in an important iron regulatory peptide hormone that controls cellular iron efflux.     The authors found that increased hepcidin-25 was found in the serum and astrocytes after intracerebral hemorrhage. In hepcidin-deficient mice with intracerebral hemorrhage, there was improvement in brain iron efflux and protection from oxydative brain injury and cognitive impairment, whereas, the administration of human hepcidin-25 peptide in these mice aggravated the brain injury and cognitive impairment.     In vitro studies showed that increased hepcidin inhibited intracellular iron efflux in  brain microvascular endothelial cells, but this phenomenon was rescued by a hepcidin antagonist. Additionally, toll-like receptor 4 signally pathway increased hepcidin expression, whereas, a toll-like receptor 4 antagonist decrease brain iron levels and improve cognition following intracerebral hemorrhage.     In summary, the study showed that increased hepcidin expression caused by inflammation prevented brain iron efflux and aggravated oxidative brain injury and cognitive impairment, thus, counteracting increased hepcidin maybe a mechanistic target to promote brain iron efflux and attenuate oxidative brain injury following intracerebral hemorrhage.     The next basic science paper provides fascinating insights into the similarities between advanced atherosclerotic lesions and tuberculous granulomas, both of which are characterized by a necrotic lipid core and a fibrous cap. First author Dr. Clement, corresponding author Dr. Mallat, and colleagues from the University of Cambridge Addenbrooke's Hospital in United Kingdom looked at the C-type lectin receptor 4E which has been implicated in the events leading to granuloma formation in tuberculosis.     The authors hypothesized that the same C-type lectin receptor 4E may be involved in the formation of atherosclerotic lesions as well. They addressed this hypothesis by examining the impact of receptor activation on macrophage functions in vitro and on the development of atherosclerosis in mice. They showed that C-type lectin receptor 4E was expressed within human and mouse atherosclerotic lesions and was activated by necrotic lesion extracts. The receptor signaling in macrophages inhibited cholesterol efflux and induced endoplasmic reticulum stress responses leading to the induction of proinflammatory mediators and growth factors.     Furthermore, repopulation of LDL receptor-deficient mice with C-type lectin 4E receptor-deficient bone marrow reduced lipid accumulation, endoplasmic reticulum stress, macrophage inflammation, and proliferation within developing arterial lesions that's significantly limiting atherosclerosis.     In summary, this paper shows that C-type lectin receptor 4E orchestrates major pathophysiologic events during pluck development and progression, and thus, provides a mechanistic explanation for the close association between necrotic lipid core formation and the development of inflammatory advanced atherosclerotic lesions.     The last paper examined the impact of optimal medical therapy in the dual antiplatelet therapy or DAPT study. In this paper from first author, Dr. Resor, corresponding author, Dr. Mauri, from the Brigham and Women's Hospital in Boston and colleagues, authors sought to assess the impact of optimal medical therapy use on long term patient outcomes and on the treatment benefit and risk of continued dual antiplatelet therapy, and they did this using data from the DAPT study which was a randomized placebo control trial comparing 30 versus 12 months of final prudent therapy on the background of aspirin after coronary stenting.     Optimal medical therapy was defined as a combination of statin, beta blocker, and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker used in patients with an ACC/AHA class 1 indication for each medication. Endpoints included myocardial infarction, major adverse cardiovascular and cerebral vascular events or MACE, and GUSTO moderate or severe bleeding events.     Of 11,643 randomized patients with complete medication data, 63% were on optimal medical therapy. Between 12 and 30 months, continued final prudent therapy reduced myocardial infarction compared to placebo in both groups and had consistent effects on the reduction in MACE, and an increased bleeding regardless of the optimal medical therapy status. In other words, the P for interaction was nonsignificant for these comparisons.     Importantly, patients on optimal medical therapy had lower rates of myocardial infarction, MACE, and bleeding compared to patients not on optimal medical therapy. Rates of stent thrombosis in death did not differ. The take home message is therefore, that more emphasis on the use of optimal medical therapy after coronary stenting is needed, but the decision to continue dual antiplatelet therapy beyond 12 months should be made irrespective of the optical medical therapy status.     Those were your summaries. Now, for our feature paper.     Our feature paper today discusses a really important, but frankly, often neglected outcome in heart failure, and that is return to the workforce following first hospitalization for heart failure, and I'm really pleased to have the first and last author of this really special Danish paper, Dr. Rasmus Rorth and Dr. Soren Kristensen, both from the University of Copenhagen, here to join me today. Hello, gentlemen.   Soren: Hello and thank you for having us, Carolyn.   Rasmus: Hello.   Carolyn: As a very special third guest, we actually have editorialist, Dr. Martin Cowie from Imperial College London as well. Hi, Martin.   Martin: Hi, Carolyn. Nice to be part of the conversation.   Carolyn: This is going to be so fun. Let's get straight into this. Rasmus, maybe you could start by telling us. This return to work concept is hardly addressed in guidelines, it's so important, and yet, you are one of the first if not the first to take a look at it. What inspired you to do this?   Rasmus: First of all, we are very inspired to work with heart failure because heart failure is a common costly, disabling, and deadly disease, and furthermore, information on young patients with heart failure is vast.  We know that they have a high hospitalization rate and a low mortality rate compared to all the patients. We also know from some of the big trials that young heart failure patients report low quality of life. Therefore, we wanted in this study to examine return to work for a number of reasons.     First of all, it gives off some information of the patient's performance basis and we get some information of their quality of life and mental status, and one more reason that is not that common for us as clinicians to think about is also for society, the economic burden these patients play in the society, and all of these reasons inspired us to get into this exciting field.   Carolyn: I really appreciated that you did this because the patients that I see here in Asia are on average 10 years younger than the heart failure patients that have been seen in other European registries and so on, so it is a very, very important aspect because my heart failure patients are often the sole breadwinners of families here. Could you, maybe, Soren, share with us what are those unique resources that you manage to look at this in such detail in the Danish registries?   Soren: The unique quality in Denmark is that you have the unique identifying numbers for all the citizens of Denmark and these numbers are not only used in the health systems. They're also used for administrative registries for tax paying and for state funds and pensions. We were able to link information from the hospital discharge registries with information on tax paying and whether or not people are getting pensions. In that way, we could follow all patients who stayed in Denmark at least to see whether or not they were receiving any funds, any pension, or sick leave money, or things like this from the state, or whether they upheld a position. That's what makes the Danish system a bit unique, that we have this ability to track the patients across all the fields of society and also that we have a public health system which all patients are included in, and the private sector is negligible in Denmark.   Carolyn: Wow. Listening to that is making all epidemiologist everywhere really drool. That is such a precious system to look at this. What were your main findings, Rasmus?   Rasmus: Maybe I should explain a bit about the setting. This is a nationwide-based study starting where we identify the patient with the first heart failure hospitalization, 18 to 60 years in the period from 1997 to 2012, and we followed them onwards. In our primary analysis, we only included patients in the workforce, that means either employed or available for the labor market at time hospitalization. That is the setting of the study.   Carolyn: Could you share your main findings and your take home messages?   Rasmus: Our primary outcome of this study is that after one year, 25% of the patients did not return to the workforce and we had a low mortality, only 7% died.   Carolyn: Twenty-five percent didn't return to the workforce?   Rasmus: Yeah, and keeping in mind, Carolyn, these are patients in the workforce at their first hospitalization and also young patients. Our take home patient from this paper is that patient in the workforce at heart failure hospitalization had a low mortality for the high risk of [inaudible 00:13:41] from the workforce at one year of followup. Furthermore, we look at some association effect associated with returning to work, and we found that young age, male sex, and high level of education were associated with high likelihood of returning to work.   Carolyn: Martin, you wrote just a beautiful editorial. I have to say I was chuckling and enjoying it as I read it. I could hear your voice in it. What do you make of these results in the interpretation?   Martin: I was really pleased to see something published by this really important topic that is largely ignored, and as you said in your introduction, the guidelines, if you read them you'll think that nobody of working age ever develops heart failure. There's no mention at all about return to work. There's no mention of the kind of urgent need to be able to provide people with the counseling about the heart failure and how it might impact their work, and also, no interaction, no mention of interaction with employers to tell them, "Yes, this person have this condition, but actually, could do their job or stay in the same job," or "How we can help support them?"     I think this article which is so good to see graded publish in Circulation and I think we have to see it in the context of other occupational rehabilitation work which shows that if you don't get people back to work quite quickly after a major event in their lives, then you'll never get them back, and that's got huge consequences for them in their mental health, their economic, social, family, and never mind the healthcare system. It's really nice to see this work and I hope many people read it and quote it.   Carolyn: Martin, you've been to Asia. You know that our patients are strikingly young, but I wonder, do you think these results are extrapolatable outside of Denmark?   Martin: I think this comment and not an editorial, Denmark, of course, is a relatively small country. It's wealthy. It's different from the states, but it's very different from Asia as you say, so lots of heart failure patients in Asia are young, of working age, and quite often, their families depend on them.     I think the tactics may have to be different to different countries, but the general principles are the same that we, as a heart failure team, as heart failure doctors, have to think about the person not just in terms of the left atrium and left ventricle, or even of the whole body function, but actually, what is their role in their family, what are they trying to achieve in life, how can we support them about way, because otherwise, we're really failing our patient.     I think, in Asia even more than in some wealthy, rich countries where there's a lot of safety nets, it's really important. I'd be interested in your comment, Carolyn, on what you think we can do to improve right across the world in terms of occupational rehab.   Carolyn: First, I think it begins with awareness and that's why I just wanted to tell Soren and Rasmus how much I enjoyed this paper and I will be citing it because I think it's so important especially in the younger heart for the community, but can I ask you, Soren or Rasmus, have these findings changed your practice in any way or to be even more provocative, do you think that maybe return to work should be a benchmark to evaluate heart failure programs?   Rasmus: Martin also points out that, first of all, we need to shed light on this hidden fact of heart failure, and afterwards, I think it's also a very good policy metrics to use in the future to see how our patients do.   Carolyn: Are there efforts in Denmark to improve this as a yardstick?   Soren: I'm quite sure that, by large, it's not really registered who is working, who is not working there. There's not much attention to it. We're all focusing very much on the performance of the patient of the NYHA class and so on, so I think we should put more emphasis on this issue and we should, as Martin also added, that we should discuss with the patients if they could change their job or their positions in some ways to better cope if they lost some of their performance, because we're both think and we both agree with Martin that it's a huge quality of life to be able to maintain your job in one way or the other, and we should definitely put more focus on that, but I'm afraid to say that I don't think we put much focus on it in Denmark at this time, but hopefully, we will.   Martin: I think you're right, the attitude have to change across the world, don't they, and they start with the heart failure team and the patients because I think most doctors and nurses and patients assume diagnosis of heart failure, that means really nothing can be the same again, but we really should be trying to return people to their optimal function, and I'm sure we can do a lot more, but perhaps, we need to upscale the workforce and knowing about the key things about occupational counseling, and maybe also [inaudible 00:18:30] interact with employers a little bit more without patient's permission to give them the confidence to have this person re-enter the workforce in a supported way because I'm sure the employers value many of these people and would be pleased to see them still in the workforce.   Rasmus: Exactly. I even think that could be like a fair way of trying to help the patient by relieving them from their job, which is actually will be a big mistake for some patients [inaudible 00:18:54] as a physician to help them with making sure they don't have to return to their job and fill out the statements and everything, but this may not be the best for the patient.   Martin: Exactly.   Carolyn: Gentlemen, I have enjoyed this conversation so much. Thank you for taking the time to discuss this very important paper.     You've been listening to Circulation on the Run. Tune in next week for more.  

ITUNES OR LISTEN HERE We cover pearls from smaccDUB (Social Media and Critical Care Conference in Dublin, Ireland), Day 3. We are here thanks to the Rosh Review. Dr. Scott Weingart - "Post-Intubation Sedation" Analgesia first. Try a hydromorphone 1mg push while you're waiting for the fentanyl drip. The endotracheal tube is uncomfortable. Minimize sedation. There's this principle: eCASH: early Comfort using Analgesia, minimal Sedatives and maximal Humane care [1].  Sedation: go for dexmedetomidine if you have it (but it's expensive) or propofol. This is supported by the Society of Critical Care Medicine (SCCM) Pain, Agitation, and Delirium guidelines [2]. Be careful with rocuronium.  The long duration of rocuronium means that you can't assess for pain or discomfort so you must be responsible and get these Dr. David Carr - "The Aorta Will #!&?% You Up" Dr. Kathleen Thomas - "Oh Sh**! They’re bombing the hospital!" We should not need a website entitled STOPBOMBINGHOSPITALS.ORG but, unfortunately, over the past 4 years, 400 hospitals have been bombed. This passionate, wrenching talk is a "must see" and "must listen" when the free talks are released on the SMACC podcast over the course of the next year. ive use in the emergency department. Emergency medicine journal : EMJ. 30(11):893-5. 2013. [pubmed] Imamura H, Sekiguchi Y, Iwashita T et al. Painless Acute Aortic Dissection. Circ J. 75(1):59-66. 2011. [article] Diercks DB, et al. Clinical policy: critical issues in the evaluation and management of adult patients with suspected acute nontraumatic thoracic aortic dissection. Ann Emerg Med. 2015 Jan;65(1):32-42.e12. PMID: 25529153. Hagan PG, Nienaber CA, Isselbacher EM. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 283(7):897-903. 2000. [pubmed]

Background: Tuberous sclerosis complex (TSC) is a rare, multisystem, genetic disorder with an estimated prevalence between 1/6800 and 1/15000. Although recent years have seen huge progress in understanding the pathophysiology and in the management of TSC, several questions remain unanswered. A disease registry could be an effective tool to gain more insights into TSC and thus help in the development of improved management strategies. Methods: TuberOus SClerosis registry to increase disease Awareness (TOSCA) is a multicentre, international disease registry to assess manifestations, interventions, and outcomes in patients with TSC. Patients of any age diagnosed with TSC, having a documented visit for TSC within the preceding 12 months, or newly diagnosed individuals are eligible. Objectives include mapping the course of TSC manifestations and their effects on prognosis, identifying patients with rare symptoms and co-morbidities, recording interventions and their outcomes, contributing to creation of an evidence-base for disease assessment and therapy, informing further research on TSC, and evaluating the quality of life of patients with TSC. The registry includes a `core' section and subsections or `petals'. The `core' section is designed to record general information on patients' background collected at baseline and updated annually. Subsections will be developed over time to record additional data related to specific disease manifestations and will be updated annually. The registry aimed to enrol approximately 2000 patients from about 250 sites in 31 countries. The initial enrolment period was of 24 months. A follow-up observation period of up to 5 years is planned. Results: A pre-planned administrative analysis of `core' data from the first 100 patients was performed to evaluate the feasibility of the registry. Results showed a high degree of accuracy of the data collection procedure. Annual interim analyses are scheduled. Results of first interim analysis will be presented subsequent to data availability in 2014. Implications: The results of TOSCA will assist in filling the gaps in understanding the natural history of TSC and help in planning better management and surveillance strategies. This large-scale international registry to study TSC could serve as a model to encourage planning of similar registries for other rare diseases.

To report on the demographic data from the first 18 months of enrollment to an international registry on autoinflammatory diseases in the context of the Eurofever project.

We report the development of an international registry for Neurodegeneration with Brain Iron Accumulation (NBIA), in the context of TIRCON (Treat Iron-Related Childhood-Onset Neurodegeneration), an EU-FP7-funded project. This registry aims to combine scattered resources, integrate clinical and scientific knowledge, and generate a rich source for future research studies. This paper describes the content, architecture and future utility of the registry with the intent to capture as many NBIA patients as possible and to offer comprehensive information to the international scientific community.

Acute Aortic Intramural Hematoma: an analysis from the International Registry of Acute Aortic Dissection - Presented by Dr. Kevin M. HarrisCircadian Dependence of Infarct Size and Left-Ventricular Function Following ST-Elevation Myocardial Infarction - Presented by Dr. Ronald ReiterCardiogenic Shock in Cardiac Arrest No Longer a Contraindication for Therapeutic Hypothermia - Presented by Fourth-Year Medical Student, Kalie Y. KebedPrevalence of Premature Coronary Heart Disease and Female Gender in Patients Presenting with ST-Elevation Myocardial Infarction - Presented by Dr. Michael D. Miedema