text:
Cardiac Magnetic Resonance Imaging Guided Left Ventricular Lead Placement
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
|ClinicalTrials.gov Identifier: NCT01417624
Recruitment Status : Unknown
Verified August 2011 by Royal Brompton & Harefield NHS Foundation Trust.
Recruitment status was: Recruiting
First Posted : August 16, 2011
Last Update Posted : August 16, 2011
|Tracking Information
|First Submitted Date ICMJE
|August 11, 2011
|First Posted Date ICMJE
|August 16, 2011
|Last Update Posted Date
|August 16, 2011
|Study Start Date ICMJE
|August 2011
|Estimated Primary Completion Date
|December 2012 (Final data collection date for primary outcome measure)
|Current Primary Outcome Measures ICMJE
|6 Minute Walk Test Distance [ Time Frame: 12 months ]
CMR guided LV lead placement during CRT implantation results in improved exercise tolerance at 12 months in patients with heart failure.
|Original Primary Outcome Measures ICMJE
|Same as current
|Change History
|No Changes Posted
|Current Secondary Outcome Measures ICMJE
|Original Secondary Outcome Measures ICMJE
|Same as current
|Current Other Outcome Measures ICMJE
|Not Provided
|Original Other Outcome Measures ICMJE
|Not Provided
|Descriptive Information
|Brief Title ICMJE
|Cardiac Magnetic Resonance Imaging Guided Left Ventricular Lead Placement
|Official Title ICMJE
|The Assessment of Cardiac Magnetic Resonance Imaging Guided Left Ventricular Lead Placement During the Implantation of Cardiac Resynchronisation Therapy on Clinical Outcomes in Patients With Chronic Heart Failure
|Brief Summary
Heart failure is a common, costly, disabling and potentially lethal condition. Despite well recognised and proven drug therapies, many patients remain breathless on exertion. A special pacemaker (cardiac resynchronisation therapy) may help improve symptoms of breathlessness and survival by restoring coordinated beating of the heart. However, despite careful planning and the knowledge of the most appropriate selection criteria, up to a third of patients do not get the desired beneficial effects after the pacemaker has been implanted.
The implantation of the special pacemaker requires three leads (wires) to be inserted within the heart. Currently this is undertaken under X-ray guidance. Some patients may have scarring of the heart muscle due to previous heart attacks or their underlying condition. The X-ray technique cannot see this and therefore the doctor may implant the lead in such an area of scar tissue. Cardiac magnetic resonance imaging (CMR) can demonstrate these areas of scar. The study aims to investigate whether CMR can better predict where the wires should be placed. The CMR pictures will be taken before the patient has the special pacemaker implanted.
|Detailed Description
Cardiac Resynchronisation Therapy (CRT) is currently recommended for patients with heart failure who have symptomatic left ventricular (LV) systolic impairment and a prolonged QRS duration.1, 2 Up to a third of patients post CRT implantation do not derive the anticipated clinical benefit. The reasons for this are multifactorial, with patient selection and successful LV lead implantation likely to be key factors.
The mechanism by which CRT exerts its clinical benefits is fundamentally through the correction of mechanical dyssynchrony. However, despite much research in this area the optimal measures of dyssynchrony for the selection of suitable candidates for CRT have not been established. The current guidelines were revised in light of the PROSPECT trial which failed to prove validity and reproducibility in complex echocardiographic variables of dyssynchrony.3 The 12 lead electrocardiogram (ECG) remains the most widely used criterion for the assessment of dyssynchrony in patients being considered for CRT, with patients with a broad QRS complex (>150ms) appearing to benefit the most.4, 5
Although the definition of left bundle branch block (LBBB) is well established, the precise electrophysiological characteristics remain poorly understood. An arbitrary 'cut off' of 120 milliseconds was recommended by the New York Heart Association (NYHA) in 1948 for its definition.6 This has subsequently become enshrined in the literature. The presence of LBBB, a heterogeneous entity, is associated with both electrical and mechanical abnormalities within the left ventricle.7 Septal and lateral wall delay frequently occur in this setting, with delayed activation of the lateral LV wall forming the basis for bi-ventricular pacing. It is well documented within populations with left ventricular impairment that there is prolongation of the QRS complex which is associated with an adverse prognosis.8
The success of CRT is reliant upon achieving an acceptable position of the left ventricular lead during implantation. The LV lead position needs to be anatomically stable to minimise the risk of lead displacement and also to avoid diaphragmatic capture. Furthermore, patients with myocardial scar tissue in the lateral LV segments as detected on CMR are known to have a worse outcome following CRT 9 and pacing such sites may potentially be pro-arrhythmic.10 It is not known whether CMR guided placement of the LV lead in order to avoid sites of myocardial scar and fibrosis can result in an improved clinical outcome in these patients.
A recently published study corroborates that myocardial scar in the region of activation of the LV lead may have a detrimental effect on the delivery of CRT. A consecutive series of 397 patients with ischaemic cardiomyopathy were imaged prior to the implantation of CRT. Using the complex echocardiographic technique of 'speckle tracking', myocardial scar was demonstrated to have an adverse effect on patients' outcomes. It remained an independent predictor of adverse clinical outcome. Notably due to the complexity of the technique, the presence of myocardial scar was validated using CMR.11
CRT response is a contentious subject. It is well recognised within the literature that approximately 30-40% of patients do not appear to improve clinically following CRT implantation.12 However, the inter-study variability of what has been considered as a marker of response has been wide and several different variables have been utilised.13 Several of the studies have also been small, single centre, and non-randomised. There is currently a lack of consensus in what constitutes 'response' vs 'non-response' following CRT, which may be either defined in terms of markers of LV reverse remodelling or changes in the clinical indices of heart failure or a combination of them both. In an effort to rationalise the endpoints of CRT trials, clinical composite scores have been devised inclusive of both imaging based and clinical endpoints. However, the correlation between both LV remodelling and clinical endpoints when compared using correlation coefficients is marginally better than chance. The realisation that clinical improvement post CRT implantation does not necessarily accompany mechanical remodelling has also confused the issue.
Rationale for Study The aim of the present study is to provide pilot data, the results of which should increase our understanding of the mechanisms by which CRT improves clinical outcomes in patients with heart failure.
|Study Type ICMJE
|Study Phase
|Phase 3
|Study Design ICMJE
|Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
|Condition ICMJE
|Heart Failure
|Intervention ICMJE
|Other: CMR Guidance in terms of guiding LV lead implantation
Following randomisation, the optimal position of the LV lead will be determined either according to current standard criteria (as proposed by the primary operator) or with CMR guidance.
The CRT device will be implanted using established conventional techniques. The CMR study will be performed pre-implantation only. The distribution of myocardial scar and fibrosis will be derived from this study. A CMR venogram will also be generated and the suggested optimal venous tributaries of the great cardiac vein will be identified from discussion between the principal investigator and senior CMR physician. This information will be used for those in the active arm only.
Other Name: A cardiac Magnetic resonance Scan using Gadolinium Contrast
|Study Arms
|Publications *
|Not Provided
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
|Recruitment Information
|Recruitment Status ICMJE
|Unknown status
|Estimated Enrollment ICMJE
|Original Estimated Enrollment ICMJE
|Same as current
|Estimated Study Completion Date
|June 2013
|Estimated Primary Completion Date
|December 2012 (Final data collection date for primary outcome measure)
|Eligibility Criteria ICMJE
Inclusion Criteria:
Exclusion Criteria:
|18 Years to 90 Years (Adult, Older Adult)
|Accepts Healthy Volunteers
|Contacts ICMJE
|Contact information is only displayed when the study is recruiting subjects
|Listed Location Countries ICMJE
|United Kingdom
|Removed Location Countries
|Administrative Information
|NCT Number ICMJE
|Other Study ID Numbers ICMJE
|Has Data Monitoring Committee
|U.S. FDA-regulated Product
|Not Provided
|IPD Sharing Statement
|Not Provided
|Responsible Party
|Dr Rakesh Sharma, Consulant Cardiologist, Royal Brompton Hospital, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
|Study Sponsor ICMJE
|Royal Brompton & Harefield NHS Foundation Trust
|Collaborators ICMJE
|Not Provided
|Investigators ICMJE
|PRS Account
|Royal Brompton & Harefield NHS Foundation Trust
|Verification Date
|August 2011
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP


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Temenos T24 Business Senior Consultant/Manager (m/f)Job Description
Our Strategy & Operations Team provides major financial institutions and global organizations with customised solutions around their strategy, processes and operations, leveraging on the different strengths of our firm. Our EMEA TEMENOS Solution Center focuses on our T24 expertise to provide advisory services to our clients.
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As a TEMENOS T24 Business Senior Consultant/Manager, you will:
Analyse client business requirements and relate them to TEMENOS products capabilityIdentify and validate any gaps together with proposals for their resolution (e.g. work arounds or changes in processes) and ensure any solutions proposed are realistic and within the agreed scope of the projectDefine and validate customization needs for TEMENOS products as per agreed business definitionsPrepare and perform the configuration of TEMENOS products through the definition of static and semi-static data for the installation of the core systemPrepare and perform the functional testing to support User Acceptance Testing (UAT)Review client organization, processes and workflows to propose a 'post-picture' to maximize the benefit from T24 as well as make recommendations on best banking practices or alert on practices that might damage the client's business or contradict legal requirementsWho are you?
To be the right fit for this position, you have to:
Hold a Master degree in Business Administration, Finance or ITHave at least 5 years of experience in Finance and banking software consultancyShow in depth knowledge of standard banking processes and T24 modules like accounting, AA, securities…Show full understanding and ability to leverage the TEMENOS Implementation MethodologyDemonstrate excellent communication skills (both written and spoken)Be fluent in English; German or French are considered as strong assetsHave knowledge of other Temenos solutions such as Triple'A, Insight or T-Connect or ancillary solutions such as Assentis, EFS or FRS will be considered as an assetWhat do we offer?
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subset: commoncrawl


text:
A few days ago Michael Moore's open letter endorsing General Wesley Clark hit an email list I'm on. Today a member of that list forwarded a response to Moore's letter, written by someone on a different mailing list. The response was in the form of a Word document attachment. Since sending a Word attachment is a bad idea for people in Microsoft environments as they can contain malicious code, I took the liberty of converting it to HTML and posting it here in all its breathless misspelled ranting glory.
Here's an excerpt. The response comments are in bold interspersed with Moore's original text:
7. He will cut the Pentagon budget,HMMMM Didnt Slick Willie do this every year during the 90s and claim that he cut the size of government? Are we sure we want any more of these DRAKONIAN CUTS? use the money thus saved for education and health care, SO $540 BILLION is not enough? What exactly would be? If there is a figure that would qualify as enough please specify. One would think that one third of the budget would be enough but perhaps Im mistaken. and he will STILL make us safer than we are now. Only the former commander of NATO could get away with such a statement.The man who single handedly murdered over 2000 Serb civillians from the air!
I'd really love to take the time to go over this rant and annotate it with links to the various logical fallacies employed and factual errors , but really what's the point.


text:
May 10, 2009
This post will not be about graphic design or about design in general.
It is about a situation -or to put it better- "a state of mind" that we are extremely frustrated of. That state of mind which has created a notion of "restriction of the internet" -something we had not heard of before- someone controlling and deciding which sites we can access and which we can't.
I shall post the manifesto of this movement tomorrow. Have a glimpse at the video below for the time being.
Subscribe to The Wonderland by Email


text:
MS SQL Code Factory is a premier SQL Server GUI tool aimed at the SQL queries and scripts development.
Key features include:
Visual Query Builder;
handy SQL editor with code folding and syntax highlighting, simultaneous executing of several queries with multi-threading;
data management features as viewing, editing, grouping, sorting and filtering to analyze the queries data in the most convenient way;
data export/import to/from the most popular formats including Excel, HTML, XML, and more;
powerful BLOB Viewer and Editor.
COPYRIGHT (C) 2005 - 2015 , Gdosoft Associates . ALL RIGHT RESERVED


text:
At my day job, we listen to Pandora all day. Because there are at least four people hitting the "thumbs-up" and "thumbs-down" buttons on our station, Pandora tends to get confused about our preferences. Today, it played a song from the Amelie soundtrack (entirely instrumental and featuring an accordion) followed immediately by The Police.
Sometimes, this is annoying. Like when I'm really in the mood for classic 80s rock and get hit with the theme song from Lord of the Rings instead. But the benefit of this schizophrenia is that I discover music I wouldn't normally seek out on my own personal Pandora stations. Today, along with the aforementioned songs, I heard one that the main character of my work-in-progress would *love.* By the time the chorus rolled around, I said to myself, "Now THAT's what she'd have on her iPod." I created my own Pandora station from the artist, and I spent all evening listening to my character's music, getting deeper into her head.
The whole experience has me thinking about the things we seek out versus the things we discover, and how being too focused about our goals can make us miss really fascinating side trips. If not for the randomness of my workplace Pandora station, I never would have heard this song, because my characters don't always listen to the same music I do. It's a trivial example of a more important point: In any creative field, it's important to have "wandering time," periods when you don't have a specific goal—or even the hope of a goal—to distract you. Seeking out information is important, but it's just as important to let your mind wander, trusting instinct and luck to bring you somewhere interesting.
I try to build "wandering time" into my life by getting semi-lost on long walks, cruising through bookstore sections I don't normally visit, and, yes, listening to radio stations I typically don't like.
How do you wander?


text: Hey guys (and any girls who may or may not read this). I've been reading these forums for a little while now, and based on that picked up a 7in Coby Tablet. If anyone is interested I work for a slightly 'Random' Australian/New Zealand retail electronics company, which means I get some rather fun toys to play with (including an NZ charger for my tablet). I'm a reformed overclocker (started getting WAY too expensive) so I'm looking forward to getting under the hood of my tablet and 'tweaking', rooting and generally messing around with the settings on it. I do have some questions about things, but I felt it would be polite to introduce myself first.


text:
Photo by Babies Bellies.
The founder decided to set up Babies Bellies Javanese Massage and Spa after her positive experience of Jamu pre and post natal massage. The treatment not only helped her maintained her figure and also achieved weight reduction after pregnancy. She hired certified masseurs with many years of experience to help mothers experience overall body wellness. Though the spa focuses on pre-natal and post-natal massage, they also provide tummy trimming treatment, wraps, facials, manicure & pedicure.
Additionally, they are affiliated to certified and licensed Chinese nannies and Chinese confinement meals. If you are a mother looking to satisfy pre-natal and post-natal pregnancy needs, Babies Bellies will definitely to be your one stop choice of health and wellness.
Babies Bellies services include body firming and tummy trimming treatment, pre and post natal massage and a variety of other massage services, which are available for men too! It seems like an ideal place to be at for couples, where the wives can keep in shape while the hubbies can enjoy some relaxation as well!
Babies Bellies' website is both informational and welcoming, and it certainly provides a pretty good first impression of its massage and spa. It would be most interesting to hear from you if you have tried their Javanese massage, especially those who have tried a pre or post natal massage. So do feel free to leave comments or post a review for us to share your personal experience!
No. 390 Golden Landmark, Victoria St, #01-48
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Tel: +65 6296 7198,
Mobile: +65 9228 6372 / +65 9222 1544
Operating Hours: Mon to Sat – 10am to 8pm (Including PH except Hari Raya), Sun: Closed
Babies Bellies at United Square
110 United Square, #01-55, Thomson Road, Singapore 307591
Tel: +65 6356 6623
Mobile: +65 9228 6372 / +65 9222 1544
Operating Hours: Mon to Sat – 10am to 8pm (Include PH except Hari Raya), Sun: 10am to 5pm


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text:
As a best practice, we create lists that have substantial number of columns using powershell.
What I like about using powershell is – repetitive and controlled deployment in dev, test and prod are predictable.
Not just that, you can control the internal field names much better.
The Aggregations (or Count of rows) is done to the View – not to the List. So you need to get reference to the View (and not to the List).
$web = "http://dev/sites/yoursitename/"
$spsite = [Microsoft.SharePoint.SPSite]($web)
$web = $spsite.OpenWeb()
$view = $web.GetViewFromURL("Lists/YourList/AllItems.aspx)
$aggregations = "<FieldRef Name='LinkTitle' Type='COUNT'/>"
$view.Aggregations. = $aggregations
$view.AggregationsStatus = "On"
That's it.
Other Aggregations Types are 'MAX' for Maximum, 'SUM' for Sum's, above example has 'COUNT' for Total's.
Now that looks very simple, but in your real life scenario you are probably building up a more complex query and aggregations.
So how do I actually build the CAML query. Using spcamlqueryhelper.codeplex.com
Create a list first (using powershell or IE) – and understand the CAML by actually creating a view using UI (internet explorer) if you are uncomfortable with powershell.
When the view is available, use the SPCAML Query Helper to figure out what the CAML was for your view. I found this to be very handy.


text:
thick-knee, common name for terrestrial, Old World birds in the family Burhinidae. The name derives from the bird's thickened tarsal joints. Thick-knees are shy, solitary birds. They are rapid runners with long legs and partially webbed feet, which lack a hind toe. The wings may be long and pointed, or short and rounded, according to species. Generally they fly fast and low but only for short distances. In body length, thick-knees range from 14 to 20 in. (36–51 cm). Members of the genus Burhinus are among the smaller species. Their straight, stout bills are shorter than their heads. Thick-knees of the genus Orthorhamphus have massive bills considerably larger than their heads, while those of the genus Esacus are compressed and slightly upturned. Thick-knees are widely distributed throughout a range of temperate and tropical habitats including shore, scrub, desert, and savanna, but typically in somewhat open country. Their colorations vary with their backgrounds, usually dull gray-brown with darker streaks. They are nocturnal birds, with large, owllike eyes. Their diet consists of a wide range of animals and plants, including insects, small mammals, seeds, and, occasionally, other birds. Their alternate name of stone curlew probably derives from their habit of laying their large eggs directly on bare, stony ground. The eggs range in color from cream to brown, with various darker markings according to local soil colors. Both sexes participate in incubation, and the highly precocious chicks are able to leave the nest almost immediately upon hatching. Thick-knees are classified in the phylum Chordata , subphylum Vertebrata, class Aves, order Charadriiformes, family Burhinidae.
The Columbia Electronic Encyclopedia, 6th ed. Copyright © 2012, Columbia University Press. All rights reserved.
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text:
Canon USA, Inc. announced Tuesday two new models of its Digital ELPH cameras line. The main difference between the two is essentially the image sensor resolution and price.
Available in October for US$299.99 the compact, 3.2 megapixel PowerShot SD200 Digital ELPH features a 35-105mm 3x optical/3.2x Digital/10x combined zoom lens. The 4.0 megapixel PowerShot SD300 Digital ELPH camera (photo below) features a 35 - 105mm 3x optical/3.6x digital/11x combined zoom lens and will be available in November for US$399.99.
The new cameras replace the current PowerShot SD110 model. Aside from smaller sizes and better resolution, they both offer faster startup at 1.3 seconds versus 2.6 for the SD110.
Both models have 2.0-inch optical LCD screens, 13 shooting modes, through the lens (TTL) 9-point AiAF autofocus and an Intelligent Orientation Sensor that provides the user with a horizontal image during playback, even if the picture was taken vertically.
Both cameras have Canonis new Fast Frame Rate Movie Mode, which records movies at 60 frames-per-second (fps). At 320 x 240 pixels, users can record up to one minute of fast action or sports clips, allowing consumers to analyze their golf or tennis swing in slow motion, as an example. The cameras also feature additional movie modes, including 640 x 480 or 320 x 240 pixels at either 30 or 15 fps for the full capacity of the memory card and a compact movie setting of 160 x 120 pixels at 15 fps for a maximum of three minutes recording.
The other noticeable difference between the two is their appearance. The PowerShot SD200 has an aluminum body, while the SD300 features a stainless steel body.


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One thing I failed to record when I went on retreat recently is that the retreat house had a poster advertising 'Christian massage'. I booked one, but I was at a loss to know what was particularly Christian about it – it seemed pretty much the same as any other massage. Maybe the background music was actually instrumental Christian choruses – I am very out of date with what the up to date charismatic is currently singing so I wouldn't have known.
Some weeks prior to this I had noticed on my Facebook profile an advertisement for 'Christian holiday cottages'. I was equally perplexed. Can a holiday cottage, or a massage, believe in and follow Jesus? I thought it was only people who could do that.


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Canada's Shaw Communications Cuts 400 Jobs
The cable and media giant is reorganizing to fend off stiff competition in western Canada from phone giant Telus Corp.
TORONTO — Canadian cable and media giant Shaw Communications is cutting 400 management and backroom jobs for greater efficiency as it faces a continuing dog-fight in western Canada for customers with phone giant Telus Corp.
Calgary-based Shaw said Monday in a press release it will hire another 100 people to offset the 400 lost jobs, or around 3 percent of its overall workforce.
Shaw said it will consolidate its residential cable, satellite, Internet and home phone services into one business unit.
Shaw Media, the TV unit that includes the Global Television network and a string of cable channels, will continue to operate independently of the group's cable, telephony and satellite TV businesses.
The restructuring will also see Shaw's engineering and IT department combined into a single unit.
Shaw serves 3.2 million overall subscribers.