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In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
We explain how to form a novel dataset of Calabi–Yau threefolds via the Gross–Siebert algorithm. We expect these to degenerate to Calabi–Yau toric hypersurfaces with certain Gorenstein (not necessarily isolated) singularities. In particular, we explain how to ‘smooth the boundary’ of a class of four-dimensional reflexive polytopes to obtain polarised tropical manifolds. We compute topological invariants of a compactified torus fibration over each such tropical manifold, expected to be homeomorphic to the general fibre of the Gross–Siebert smoothing. We consider a family of examples related to products of reflexive polygons. Among these we find $14$ topological types with $b_2=1$ that do not appear in existing lists of known rank-one Calabi–Yau threefolds.
We introduce a concept of minimality for Fano polygons. We show that, up to mutation, there are only finitely many Fano polygons with given singularity content, and give an algorithm to determine representatives for all mutation-equivalence classes of such polygons. This is a key step in a program to classify orbifold del Pezzo surfaces using mirror symmetry. As an application, we classify all Fano polygons such that the corresponding toric surface is qG-deformation-equivalent to either (i) a smooth surface; or (ii) a surface with only singularities of type $1/3(1,1)$.
An alternative version of the necessary and sufficient condition for almost sure fixation in the conditional branching process model is derived. This formulation provides an insight into why the examples considered in Buckley and Seneta (1983) all have the same condition for fixation.
Montage is a portable, scaleable toolkit that runs on end-users desktops, clusters, and computing grids. It generates astronomical image mosaics that preserve the calibration and photometry in the input FITS files. The code is available for download at the project website at <http://montage.ipac.caltech.edu>, and includes independent modules for image discovery (including support for VO image access protocols), image reprojection, rectification of the sky background to a common level and image co-addition.
Variable magnetic field Hall effect, photoluminescence (PL) and capacitance-voltage (CV) analysis have been used to study InN layers grown by plasma assisted molecular beam epitaxy. All three techniques reveal evidence of a buried p-type layer beneath a surface electron accumulation layer in heavily Mg-doped samples. The use of lattice-matched Yttria-stablized Zirconia substrates also provides evidence of a p-type layer.
A manifestation from Lieutenant-Colonel John Lilburne, Mr William Walwyn, Mr Thomas Prince, and Mr Richard Overton (now prisoners in the Tower of London), and others, commonly (though unjustly) styled Levellers
Since no man is born for himself only, but obliged by the laws of nature (which reaches all), of Christianity (which engages us as Christians), and of public society and government, to employ our endeavours for the advancement of a communitive happiness of equal concernment to others as ourselves, here have we (according to that measure of understanding God has dispensed unto us) laboured, with much weakness indeed but with integrity of heart, to produce out of the common calamities such a proportion of freedom and good to the nation as might somewhat compensate its many grievances and lasting sufferings. And although in doing thereof we have hitherto reaped only reproach and hatred for our good-will, and been fain to wrestle with the violent passions of powers and principalities, yet since it is nothing so much as our blessed Master and his followers suffered before us and but what at first we reckoned upon, we cannot be thereby any whit dismayed in the performance of our duties, supported inwardly by the innocency and evenness of our consciences.
'Tis a very great unhappiness – we well know – to be always struggling and striving in the world, and does wholly keep us from the enjoyment of those contentments our several conditions reach unto.
If afflictions make men wise and wisdom direct to happiness, then certainly this nation is not far from such a degree thereof as may compare, if not far exceed, any part of the world, having for some years by-past drunk deep of the cup of misery and sorrow. We bless God our consciences are clear from adding affliction to affliction, having ever laboured from the beginning of our public distractions to compose and reconcile them, and should esteem it the crown of all our temporal felicity that yet we might be instrumental in procuring the peace and prosperity of this commonwealth, the land of our nativity. And therefore according to our promise in our late Manifestation of 14 April 1649, being persuaded of the necessity and justness thereof as a peace-offering to the free people of this nation, we tender this ensuing Agreement, not knowing any more effectual means to put a final period to all our fears and troubles.
It is a way of settlement, though at first much startled at by some in high authority, yet, according to the nature of truth, it hath made its own way into the understanding and taken root in most men's hearts and affections, so that we have real ground to hope – whatever shall become of us – that our earnest desires and endeavours for good to the people will not altogether be null and frustrate.
Background. Population-based studies suggest substantial
co-morbidity between physical illness
and depression in late-life. However, a causal relationship has not
been established. If a relationship
exists, it is important to establish which aspects of poor health determine
risk for depression, and
which factors confer vulnerability or resilience in the face of poor health.
We investigate the role of disablement, measured as impairment, disability
Methods. A prospective population-based cohort study, comprising
an index assessment and 1 year
follow-up, of all residents aged 65 years or over, of an electoral ward
in London, UK (N=889).
Results. The prevalence of SHORT-CARE pervasive depression
17·7% at index assessment.
The 1 year onset rate for pervasive depression was 12·0%, and the
1 year maintenance rate 63·2%.
There was a high mortality rate among the depressed. Disablement, particularly
handicap was the
most important predictor of the onset of depression (population attributable
fraction, 0·69). Lack
of contact with friends was a direct risk factor but also modified the
association between handicap
and depression. Marriage was protective for men, but a risk factor for
women. Maintenance of
depression was predicted by low levels of social support and social
participation, rather than by disablement.
Conclusions. It seems likely that disablement, specifically
is the chief cause of onsets of
depression in late-life. Genetic predisposition, early adversity and
serious life events may play a less
prominent role than in earlier life. Effective prevention of late-life
depression requires attention at
the structural level to the sources of handicap within communities.
Background. A companion paper reported a very strong
cross-sectional association between handicap and late-life depression.
Adjusting for handicap weakened associations between sociodemographic
variables and depression. It was unclear whether handicap was a
confounder, or a useful summary variable, mediating the effect of a
range of sociodemographic disadvantages. This paper focusses on the
cross-sectional relationship between depression and demographic
variables, social support, and life events.
Method. A community survey of all residents over the age
of 65 years of an electoral district in London, UK.
Results. There was a moderate association between
SHORT-CARE pervasive depression and the number of life events
experienced over the previous year. Personal illness, bereavement and
theft were the most salient events. There was a stronger, graded,
relationship between the number of social support deficits (SSDs) and
depression. Number of SSDs also related to age, handicap, loneliness
and use of homecare services. Loneliness was itself strongly
associated with depression; odds ratio 12·4
Conclusions. Problems of collinearity, and the
cross-sectional design of the study limited interpretation of the
exact nature of the relationship between social support, loneliness,
handicap and depression. However, the clustering of these four factors
can be used to define a large part of the elderly population with a
poor quality of life. An important avenue for future research will be
the development and implementation of population intervention
strategies designed to address some or all of these problems among
older people in general.
Background. An association between disablement and
late-life depression is often reported in cross-sectional studies.
However, many lack effect sizes, and do not control for confounding.
Therefore, it is difficult both to quantify the overall impact of poor
health on depression and to understand which aspects are most
Methods. A catchment area survey of all over 65-year-old
residents of an electoral district in London, UK, using a population
register derived from a door-to-door census was undertaken. Depression
was measured using SHORT-CARE, and the consequences of disease
classified according to the WHO International Classification of
Impairments, Disabilities and Handicaps.
Results. Six hundred and fifty-four subjects were
interviewed out of an older population of 889. The prevalence of
SHORT-CARE pervasive depression was 17%. Impairment, disability and,
particularly, handicap were strongly associated with depression. The
adjusted odds ratio for depression in the most handicapped quartile
compared with the least was 24·2
(8·8–66·6). The population attributable fraction
(PAF) for depression attributable to handicap was 0·78. The
PAFs for recent life events and female gender were much lower.
Handicap explained most of the depression associated with individual
impairments and disabilities. Adjusting for handicap abolished or
weakened the associations between depression and social support,
income, older age, female gender and living alone.
Conclusions. Even given some uncertainty in distinguishing
handicap and depression as constructs, and the impossibility of
deciding direction of causality, it seems likely that handicap is of
central significance to late-life depression. Handicap may be more
amenable to intervention than either impairment or
X-ray pulsars are the only accreting magnetic stars where rotation torques induced by accretion are large enough to be measured on short timescales ~ days. They are thus unique laboratories for studying the interaction between an accretion disk and a stellar magnetosphere. We describe 5 years of continuous pulsar timing observations by the BATSE instrument on GRO which paint a strikingly different picture of pulsar spin behavior than understood from the previous 20 years of sparse observations. In particular, we find that more than half of the persistent pulsars we observe undergo dramatic torque reversals, switching suddenly between extended periods of steady spin-up and steady spin-down. Moreover, variations in pulsed flux are anticorrelated with torque in at least one system undergoing secular spin-down, GX1+4. This behavior contradicts standard accretion torque theory (Ghosh and Lamb 1979). A simple – albeit unconventional – hypothesis which naturally explains these observations is that the disks in these systems somehow alternate between epochs of prograde and retrograde rotation.
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