Generator Replacement Research Articles

P.099 Generator replacement with cardiac based VNS device in children with drug-resistant epilepsy

Background: We aimed to study the proportion of patients with DRE and pre-existing VNS device, who show improvement of at least one class in McHugh seizure outcome classification at last follow up after generator replacement with cardiac based VNS device. Methods: We retrospectively reviewed children with DRE with the older VNS model (102) who underwent battery replacement with the AspireSR®, model 106 since September 2016 at our institution. We assessed the seizure outcomes since the first VNS device insertion till the last follow up after AspireSR® (with cardiac-based seizure detection) using McHugh seizure outcome classification. Results: The study population was comprised of 15 patients. The mean age at seizure onset was 2.7 years old, with mean age of initial VNS1 placement being 10.1 years and mean age of replacement with VNS2 being 14.9 years of age. Three of the fifteen patients had reported status epilepticus prior to initial VNS insertion, and none reported episodes following insertion. Two patients showed at least one class improvement in McHugh seizure outcomes at last follow up after VNS2. Conclusions: Through our preliminary data at the present time, we note that the majority of our patients maintains their seizure control following replacement with VNS2 with a few showing improvement.

Social security of the elderly. Challenges of the post-pandemic reality

Progressive demographic transformations and their consequences including the increasing risk of the lack of replacement of generations, family and institutional deficits in fulfilling of the caring and protective functions – create an urgent need to resume the social discourse on creating the social security of the 60+ generation. The pandemic time brought many additional changes, both in social behaviour and in the catalogue of individual needs. It revealed new challenges and axiological priorities, requiring a broader understanding of the nature of social policy towards the third generation.

Magnetically Guided Catheters, Micro- and Nanorobots for Spinal Cord Stimulation.

Spinal cord stimulation (SCS) is an established treatment for refractory pain syndromes and has recently been applied to improve locomotion. Several technical challenges are faced by surgeons during SCS lead implantation, particularly in the confined dorsal epidural spaces in patients with spinal degenerative disease, scarring and while targeting challenging structures such as the dorsal root ganglion. Magnetic navigation systems (MNS) represent a novel technology that uses externally placed magnets to precisely steer tethered and untethered devices. This innovation offers several benefits for SCS electrode placement, including enhanced navigation control during tip placement, and the ability to position and reposition the lead in an outpatient setting. Here, we describe the challenges of SCS implant surgery and how MNS can be used to overcome these hurdles. In addition to tethered electrode steering, we discuss the navigation of untethered micro- and nanorobots for wireless and remote neuromodulation. The use of these small-scale devices can potentially change the current standard of practice by omitting the need for electrode and pulse generator implantation or replacement. Open questions include whether small-scale robots can generate an electrical field sufficient to activate neuronal tissue, as well as testing precise navigation, placement, anchoring, and biodegradation of micro- and nanorobots in the in vivo environment.

Research of metrological capabilities of digital (DDS- and Trueform-) generators

Abstract
 One of the fundamental improvements of the measurement standard of frequency deviation of frequency-modulated oscillations was the replacement of analog frequency-modulated generators used in DETU 09-03-95 with digital ones based on the principle of direct digital synthesis (DDS) and its next version of Trueform technology. These generators have wider ranges of frequency deviation and modulation frequencies than analog ones, but nonlinear distortion laws of the frequency modulation are not standardized.
 The subject of the article is the development of methods and research of these generators and frequency-modulated signals generated by them for nonlinear distortions, accompanying amplitude modulation, frequency noise. Three methods were used in the study: direct measurement; “combination frequencies” and “frequency shift”. The experiment was performed using several measurement methods, which allowed to estimate very small values of nonlinear distortion. Methods were developed and experimental estimations of concomitant amplitude modulation of DDS-generators (in frequency modulation mode), as well as their frequency noise level, were performed. An experimental evaluation of the capabilities of the analog-digital demodulator of the R&S FSL6 spectrum analyzer with the K7 option was performed, its high linearity was shown, its capabilities with respect to the frequency ranges of carrier oscillations and frequency deviation were evaluated. The research results provide a basis for the method of calibration of DDS-generators and demodulator of spectrum analyzers with the K7 option in those ranges where their parameters are not normalized (at direct current up to 8 MHz and F up to 500 kHz).

USE OF SKIN BARRIER TO REDUCE CARDIAC DEVICE INFECTION: A SINGLE CENTER EXPERIENCE

BACKGROUND Cardiovascular implantable electronic devices (CIED) infection is associated with significant morbidity and devastating sequelae for the patients. The use of incremental perioperative antibiotics, as well as use of an antibiotic impregnated pouch to reduce periprocedural device infections have recently been investigated. Trials investigating these additive interventions have shown only modest benefit, in addition these interventions carry a high cost to the system. Cost of antibiotic pouches can be greater than $1000 per use and use of additive antibiotics in all comers was shown to be neutral in Canadian centers. We sought to determine the effect of skin barrier use at reducing the risk of CIED infection as a simple, low cost intervention at time of device implantation. METHODS AND RESULTS We conducted an audit of all CIED implant procedures completed between Jan 2007 and April 2020 by 17 experienced operators in a shared procedure practice model. All device infections requiring reoperation or extraction were collected prospectively and diagnosis reconfirmed by an infectious disease specialist. A skin barrier was used as per physician preference and operations were retrospectively evaluated for use of skin barrier. Antibiotic use and periprocedural care were consistent in all procedures as per institutional protocol. Over a 13-year period 14,607 procedures were completed (mean age 72 +/- 14 years, female 35%). A total of 7816 pacemakers, 3292 ICDs, 1482 CRTs, and 1635 device upgrade or lead revision procedures were performed. 3913 procedures were completed with skin barrier and 10693 without. There were 90 infections in the no barrier group vs. 19 infections in the barrier group (0.84% vs. 0.48%, p=0.02). After a sensitivity analysis adjusting for the number of procedures, procedure type (ILR, PPM, ICD, CRT, de novo vs. upgrade vs. revision vs. generator replacement), the difference remained statistically significant. CONCLUSION Our data suggests that skin barrier use may be protective against infection. Considering low cost of skin barrier and catastrophic sequelae of device infection, the use of skin barrier during the procedure may be considered as an additional preventative measure to reduce device related infection. The low rates of infection in the barrier group are likely due to operator experience, use of standardized guideline directed perioperative care, and likely reduction of skin flora translocation during the procedure. Re-evaluation after transition to use of skin barrier for all cases will help further confirm these findings. Cardiovascular implantable electronic devices (CIED) infection is associated with significant morbidity and devastating sequelae for the patients. The use of incremental perioperative antibiotics, as well as use of an antibiotic impregnated pouch to reduce periprocedural device infections have recently been investigated. Trials investigating these additive interventions have shown only modest benefit, in addition these interventions carry a high cost to the system. Cost of antibiotic pouches can be greater than $1000 per use and use of additive antibiotics in all comers was shown to be neutral in Canadian centers. We sought to determine the effect of skin barrier use at reducing the risk of CIED infection as a simple, low cost intervention at time of device implantation. We conducted an audit of all CIED implant procedures completed between Jan 2007 and April 2020 by 17 experienced operators in a shared procedure practice model. All device infections requiring reoperation or extraction were collected prospectively and diagnosis reconfirmed by an infectious disease specialist. A skin barrier was used as per physician preference and operations were retrospectively evaluated for use of skin barrier. Antibiotic use and periprocedural care were consistent in all procedures as per institutional protocol. Over a 13-year period 14,607 procedures were completed (mean age 72 +/- 14 years, female 35%). A total of 7816 pacemakers, 3292 ICDs, 1482 CRTs, and 1635 device upgrade or lead revision procedures were performed. 3913 procedures were completed with skin barrier and 10693 without. There were 90 infections in the no barrier group vs. 19 infections in the barrier group (0.84% vs. 0.48%, p=0.02). After a sensitivity analysis adjusting for the number of procedures, procedure type (ILR, PPM, ICD, CRT, de novo vs. upgrade vs. revision vs. generator replacement), the difference remained statistically significant. Our data suggests that skin barrier use may be protective against infection. Considering low cost of skin barrier and catastrophic sequelae of device infection, the use of skin barrier during the procedure may be considered as an additional preventative measure to reduce device related infection. The low rates of infection in the barrier group are likely due to operator experience, use of standardized guideline directed perioperative care, and likely reduction of skin flora translocation during the procedure. Re-evaluation after transition to use of skin barrier for all cases will help further confirm these findings.

B-PO04-052 CARDIAC IMPLANTABLE ELECTRONIC DEVICE INFECTION: THE CUMULATIVE RISK OF SUCCESSIVE RE-INTERVENTIONS

Risk of infection is an important consideration for patients undergoing cardiac implantable electronic device (CIED) procedures. We examined the comparative incidence and associations of device infection for patients undergoing either de novo CIED implant or device re-intervention. Data were extracted from a high-volume UK centre from 2016-2019. Patient demographics, procedural parameters and outcomes were examined according to two groups: ‘De novo implants’ (all transvenous CIED implants) and ‘Re-interventions’ (generator replacement or revision, new lead insertion without extraction, and lead extraction). Patients undergoing re-intervention for device infection were excluded. During follow-up, a device infection was defined as a clinical diagnosis of pocket or systemic infection requiring intervention within 90 days of the index procedure. 7,384 procedures were included. There were 4,837 de novo implants (61.2% dual chamber, 22.5% single chamber, 16.1% biventricular devices) and 2,547 re-interventions (53.4% generator replacement, 27.9% new lead, 16.6% lead extraction). All patients received a pre-procedural bolus of two intravenous antibiotics. 43 device infections were recorded (0.58%). There was an exponential relationship between intervention number and infection incidence; de novo implant: 0.27%, 2nd intervention: 1.01%, 3rd (or greater) intervention: 3.3%. Adjusting for indication, type of re-intervention performed, device type, and patient co-morbidities (Age, Sex, LV function, ischaemic heart disease, cardiomyopathy, atrial fibrillation), intervention number was an independent predictor of device infection versus de novo implant (adjusted OR 4.6 (2.1-10), p<0.0001). The risk of infection from device re-intervention was significant, cumulative, and occurred independently of procedure type and patient parameters. This data should contribute to procedural decision-making, particularly for patients in whom the indication for re-intervention may be equivocal.

Network-secure bidding optimization of aggregators of multi-energy systems in electricity, gas, and carbon markets

The increasing replacement of conventional generators by variable renewable energy sources is reducing the flexibility of the power system, and consequently reducing its reliability indexes. To compensate for this reduction of flexibility, market participation of aggregators of multi-energy systems has been proposed in the literature. Under this scope, this paper presents a network-secure bidding optimization strategy to assist aggregators of multi-energy systems calculating electricity (energy and reserve), gas and carbon bids, considering multi-energy network constraints. This strategy is a distributed approach based on the alternating direction method of multipliers, where the aggregator collaborates with the operators of electricity, gas and heat networks to calculate network-secure bids. The proposed strategy is benchmarked against two other approaches. The results show that the newly developed strategy computes multi-energy and network-secure bids with execution times that suit the timelines of the electricity, gas, and carbon markets. The joint optimization of multi-energy systems reduced the aggregator’s costs by 89% compared to a single energy-vector approach. Furthermore, two sensibility studies were also performed. The first study revealed that in the presence of slow ramp-rate resources (e.g. combined heat and power systems), aggregator’s costs can decrease up to 87% when considering slower response times to the secondary reserve signal. In the second study, it was observed that the bidding behavior of the aggregator only starts changing significantly with carbon prices higher than 200€/tCO2.

B-PO03-070 USE OF SKIN BARRIER IN CARDIAC DEVICE IMPLANTATION TO REDUCE INFECTION

Infection of cardiovascular implantable electronic devices (CIED) are associated with significant morbidity and devastating sequelae for patients. Use of incremental perioperative antibiotics and an antibiotic impregnated pouch to reduce periprocedural infections have recently been investigated. Such additive interventions carry a high cost and have proven to be modestly beneficial at best. We sought to determine the effect of skin barrier use in reducing the risk of CIED infection. We conducted an audit of all CIED implant procedures completed between Jan 2007 and April 2020 by 17 experienced operators in a shared procedure practice model. All device infections requiring reoperation or extraction were collected prospectively and diagnosis reconfirmed by an infectious disease specialist. A skin barrier was used as per operator preference and its use was evaluated retrospectively. Antibiotic use and periprocedural care were consistent in all procedures as per institutional protocol. Over a 13-year period 14,607 procedures were completed (mean age 72 +/- 14 years, female 35%). A total of 7,816 pacemakers, 3292 ICDs, 1,482 CRTs, and 1635 device upgrade or lead revision procedures were performed. 3,913 procedures were completed with skin barrier and 10,693 without. There were 90 infections in the no barrier group vs. 19 infections in the barrier group (0.84% vs. 0.48%, p=0.02). After a sensitivity analysis adjusting for the number of procedures, procedure type (ILR, PPM, ICD, CRT, de novo vs. upgrade vs. revision vs. generator replacement), the difference remained statistically significant. Our data suggests that skin barrier use may be protective against infection. Considering low cost of skin barrier and catastrophic sequelae of device infection, its use during CIED procedures may be considered as an additional preventative measure to reduce device related infection. The low rates of infection in the barrier group are likely due to operator experience, use of standardized guideline directed perioperative care, and reduction of skin flora translocation during the procedure. Re-evaluation after transition to use of skin barrier for all cases will help further confirm these findings.

Deep Brain Stimulation of the Globus Pallidus Internus for Secondary Dystonia: Clinical Cases and Systematic Review of the Literature Regarding the Effectiveness of Globus Pallidus Internus versus Subthalamic Nucleus

Deep brain stimulation (DBS) is a frequently applied therapy in primary dystonia. For secondary dystonia, the effects can be less favorable. We share our long-term findings in 9 patients with severe secondary dystonia and discuss these findings in the light of the literature. Patients who had undergone globus pallidus internus (GPi)-DBS for secondary dystonia were included. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores, clinical improvement rates, follow-up periods, stimulation parameters and the need for internal pulse generator replacements were analyzed. The PubMed and Google Scholar databases were searched for articles describing GPi-DBS and subthalamic nucleus (STN)-DBS only for secondary dystonia cases. Keywords were "dystonia," "deep brain stimulation," "GPi," "dystonia," "deep brain stimulation," and "STN." A total of 9 secondary dystonia patients (5 male, 4 female) had undergone GPi-DBS with microelectrode recording in our units. The mean follow-up period was 29 months. The average BFMDRS score was 58.2 before thesurgery, whereas the mean value was 36.5 at the last follow-up of the patients (mean improvement, 39%; minimum, 9%; maximum, 63%). In the literature review, we identified 264 GPi-DBS cases (mean follow-up, 19 months) in 72 different articles about secondary dystonia. The mean BFMDRS improvement rate was 52%. In 146 secondary dystonia cases, reported in 19 articles, STN-DBS was performed. The average follow-up period was 20 months and the improvement in BFMDRS score was 66%. Although GPi-DBS has favorable long-term efficacy and safety in the treatment of patients with secondary dystonia, STN seems a promising target for stimulation in patients with secondary dystonia. Further studies including a large number of patients, longer follow-up periods, and more homogenous patients are necessary to establish the optimal target for DBS in the management of secondary dystonias.

Biomass direct gasification for electricity generation and natural gas replacement in the lime kilns of the pulp and paper industry: A techno-economic analysis

This study shows a comparative techno-economic analysis of the integration of biomass gasification for generation of producer gas to be used in electricity production and to replace natural gas in the lime kilns of the pulp and paper industry. Three study cases with alternative configurations of the energy system integrating biomass gasification were analysed, including or not the co-generation of electricity and thermal energy, namely: i) Case I, for generation of electricity from residual forest biomass (RFB) in an integrated gasification combined cycle system, ii) Case II, generation of producer gas by RFB gasification for replacement of natural gas in the burners of a lime kiln, and iii) Case III, as an integration of Cases I and II for combined production of electricity and heat. Residual forest biomass from eucalyptus logging activities for feedstock processing for the pulp and paper industry was considered as fuel for direct (air) gasification in bubbling fluidized bed. The analysis made is supported on review reports, namely, the evaluation of the existing literature on investment projects in biomass power plants, and on experimental investigation for determining the composition of the producer gas from gasification of the selected feedstock. An economic model was developed that combines the net present value, internal rate of return and payback period. The main results of the energy system analysis show that the net electricity generation is between 72 and 83 GWh/year, while the production of CaO in the lime kiln supported by combustion of producer gas, is 82.12 kt/year, and a global energy efficiency between 21.70 and 34.17 % is achieved for the analysed configurations of the energy system. The results of the economic analysis show a positive NPV, an IRR greater than the discount rate and a PBP less than the useful life of the plant. The sensitivity analysis shows quite favorable investment projections given the low probability that the NPV will reach negative values and compromise the economic viability of the project.

Clinical utility of sonication for diagnosing infection and colonization of cardiovascular implantable electronic devices.

Our study aimed to evaluate the sensitivity of the sonication tool for the microbiological diagnosis of cardiovascular implantable electronic device infections (CIEDIs). The extracted cardiac implants of 52 patients were assessed: 19 with CIEDI and 33 with elective generator replacement or revision without clinical infection. Sonication fluid culture of explanted CIEDs yielded higher numbers of microorganisms than pocket tissue or swab cultures. The sensitivity of sonication fluid culture was significantly higher than that of pocket swab and tissue culture for microbiological diagnosis of CIEDI. The microorganisms isolated most frequently via sonication of explanted CIEDs were Gram-positive cocci (70%), of which 50% was coagulase-negative Staphylococcus. Sonication fluid culture detected colonization in 36.4% of the non-infected patients. Sonication fluid culture represents a promising diagnostic strategy with increased sensitivity compared to conventional culture methods for microbiological diagnosis of cardiac devices associated with infection and colonization.

Values, Partisan Interest, and the Voting Age: Lessons from Australia

The decline in youth participation in elections has been an ongoing concern in Australia, in spite of the requirement for compulsory turnout. In 2018, and in response to these concerns, the Australian parliament debated an electoral amendment that would lower the national voting age to 16 years. The Bill, however, did not succeed even though two opposition parties—the Australian Labor Party and the Australian Greens—supported the reform and the Morrison Government accepted the premise that youth electoral disengagement was a troubling phenomenon. Drawing on veto player theory, this article examines how the legislative dynamics intersected with partisan self‐interest and party value priorities to undercut the case for lowering the voting age to 16. The Australian case highlights the ways in which latent ideological differences among parties can serve to divide them on the inclusiveness of franchise, and the democratic goals to be served by voting.Related ArticlesCormack, Lindsey. 2019. “Leveraging Peer‐to‐Peer Connections to Increase Voter Participation in Local Elections.” Politics &amp; Policy 47 (2): 248‐266. https://doi.org/10.1111/polp.12297Fisher, Patrick. 2020. “Generational Replacement and the Impending Transformation of the American Electorate.” Politics &amp; Policy 48 (1): 38‐68. https://doi.org/10.1111/polp.12340Ike, Vivian. 2020. “The Impact of Veto Players on Incremental and Drastic Policy Making: Australia's Carbon tax Policy and its Repeal.” Politics &amp; Policy 48 (2): 232‐264. https://doi.org/10.1111/polp.12346

STABILITY AND CHANGES IN PARTY IDENTIFICATION IN TAIWAN: AN EXAMINATION OF LIFE CYCLE, COHORT, AND PERIOD EFFECTS

AbstractThis article builds on the theoretical debate over age, period, and cohort effects (APC) and explores how these factors might affect Taiwan's partisan stability. We conducted a two-level multinomial logit random effects model using survey data from 1991 to 2020 to disentangle the APC effects. Our findings challenge Converse's core assumption that partisanship strengthens with age. As a new democracy, Taiwan's party affiliations remain fluid, and we do find evidence of period effects, particularly associated with cross-Strait crises that favor the DPP. However, generational replacement is the most significant factor driving party identity changes in Taiwan. With generational replacement, the Kuomintang is burdened by the image of a century-old party. The Democratic Progressive Party (DPP) had previously fared better among young cohorts but has recently lost its support from millennials. The youngest generation increasingly refuses to associate with the traditional political parties. It seems reasonable to expect that the new generational forces will restructure the Blue–Green cleavage and expand the ideological diversity of Taiwan's party system.

Banded Charnockite: The Result of Crustal Magma Generation, Piecemeal Emplacement, and Fluid-Driven Mineral Replacement in High-Grade Crust (Central Dronning Maud Land, Antarctica)

Our study of a banded charnockite complex of the Mühlig-Hofmannfjella in Dronning Maud Land, Antarctica, illustrates how the combination of high-temperature (re-)crystallization processes, melts, and volatile fluids leads to complex intrusive, metasomatic, and structural relationships. The igneous complex consists of gently dipping sets of charnockite interlayered with dolerite and leucogranite. The banded complex formed primarily by magmatic processes, but with superimposed modifications by metasomatism. The charnockite has a ferroan composition and contains both orthopyroxene (Fs80–84) and olivine (Fa94–96). Zircon U-Pb dates the emplacement of charnockite at 515 Ma, and inherited zircon cores and negative εNd values of −3 to −5 indicate that the age of the source of the magma was about 1100 Ma. Neodymium isotopes were not homogenized during the Cambrian magmatic event, which suggests that the generation and emplacement of the magma took place in separate batches during construction of the banded complex. By contrast, the Rb-Sr system in the charnockite was extensively homogenized, likely because of the superimposed late-magmatic fluid activity, which also produced the bands and networks of leucogranites. These events occurred during the late stages of the assembly of Gondwana, with postcollisional extension and mantle upwelling maintaining a high heat flow.

Using Online Social Networks to Acquire Political Information: the Politically Engaged Non-ideological Youth in Chile, 2017-2019.

This paper assesses the impact of age and ideological identification on the left–right scale on the use of online social networks to acquire political information. Socio-demographic indicators and ideological identification have been found to impact democratic engagement and the access and use of social networks. In countries where the digital divide (access to the internet) and digital inequality (use of the internet) coexist, the impact of socio-demographic indicators is stronger, as those with fewer tools and resources have less access and make less use of social networks for democratic engagement. We postulate three hypotheses on the effect of socio-demographic determinants and ideological identification and test them using 6 national polls conducted between 2017 and 2019 in Chile, a middle-income country with high levels of inequality. Though socio-demographic variables and ideological identification impact the use of social networks to acquire political information, young people who do not identify on the ideological scale are as likely to use social networks to obtain political information as older people who identify on the left–right scale. As generational replacement kicks in, online democratic engagement will become more intense. Even the non-ideological youth is more politically engaged than the ideologically identified older age cohorts.

Optimizing S-box generation based on the Adaptive Agent Heroes and Cowards Algorithm

This paper introduces a new variant of a metaheuristic algorithm based on Agent Heroes and Cowards Algorithm (AHC), called Adaptive Agent Heroes and Cowards Algorithm (AAHC). The main feature of AAHC is the fact that the algorithm allows adaptive assignment of its population agents into cowards and heroes based on the exponential controlling functions. Furthermore, unlike its predecessor, AAHC also permits systematic manipulation of candidate solutions around the global best agent via the swap operator to boost its search intensification process. Meanwhile, to further enhance the diversification its solution, AHC also exploit the Tent map as the pseudo random generator replacement during its initial population initialization. Experimental results based on the generation of 8 × 8 substitution-box demonstrate that the proposed AAHC outperforms other competing metaheuristic algorithms in two main S-box criteria namely nonlinearity and strict avalanche criteria whilst maintaining commendable performances on bits independence criteria, differential approximation probability, linear approximation probability and transparency order.

Red to Purple? Changing Demographics and Party Change in Texas

Objective Texas is regarded as a safe Republican state, yet in recent elections Democrats have gained electoral ground. This study investigates if generational replacement and demographic changes are leading to an increase in Democratic identification, with the potential to create an environment for increasingly competitive elections. A competitive Texas will have national political implications.Method Party identification and ideology are analyzed, with line graphs and linear regression, using public opinion surveys of Texans from 2009 to 2019. The impact of generation cohorts and demographics are the main independent variables of interest.Results The findings demonstrate that younger cohorts of white Texans are less likely to identify as Republican and older cohorts of white Texans are most likely. All cohorts of Texans of color are likely to identify as Democrats.Conclusions Generational and demographic changes are leading to an increase in Democratic party identification and a decline in Republican identification. The mobilization by parties of young Texans, who are trending toward Democrats, and people of color is critical to the future of Texas politics.

When the chickens come home to roost: The long‐term impact of party positions on religious voting

AbstractDespite the widespread secularisation of West European societies, research has only found mixed evidence of a decline in the influence of religion on people's electoral preferences. A relatively recent line of inquiry has adopted a ‘top‐down’ approach to this problem, arguing that the impact of religion not only depends on structural social changes, but also on parties’ convergence on moral issues. Drawing upon this ‘top‐down’ approach and the ‘impressionable years’ model, this article argues that parties’ political strategies aimed at (de‐)mobilising social cleavages have a lasting effect on voters’ party preferences. Using nine rounds of the European Social Survey for 19 West European countries, I find the impact of religiosity on voting for the centre‐right (Conservative and Christian Democratic parties) to be significantly smaller for voters who were exposed during emerging adulthood (aged 15–25) to a centre‐right party that adopted similar positions on moral issues to those of its main competitors. These findings have important implications because they highlight the role of generational replacement in bringing about electoral change, even when this is prompted by parties’ strategic choices.

Analysis of newborn thermal comfort in a textile incubator

Data published by European and World Health Organizations show that since 1990 the number of births has been steadily decreasing, which poses the risk of lack of generational replacement. According to WHO report, every year, 2.6 millions of newborns in the world die in the first month of their life. One million of them in the first 24 h so they require special care and medical supervision, so for the first days or even months of their lives they remain in incubators. The purpose of the research was to develop the construction and build a prototype of a textile incubator, whose most important function is to keep the baby warm, with the possibility of cooling it during therapeutic hypothermia. The incubator model was built in three variants of material packages, and each of them consisted of five material layers. An innovative solution is using for the external thermal insulation layer a composite connecting a knitted fabric with aerogel. The total thermal conductivity resistance for the developed material packages of the incubator was measured using a thermally insulated sweating hot plate known as the ‘skin model’. The obtained values of thermal resistance coefficient R ct are within 2.07–2.83 clo, and in case of the package with an additional insulation layer R ct = 3.68 clo. It turned out that when the infant was placed in a textile incubator without a functional heating and cooling mat its heat balance for the adopted ambient temperatures from −5 to 24 °C was negative and ranged from −0.04 up to −50.50 W. In cases of positive heat balance, especially for all ambient temperatures, which took place for the second package where ΔQ = 0.10 ÷ 6.51 W, there is a risk of overheating the baby. The analysis of the heat balance components shows that convection and radiation have the greatest impact on the total heat loss, as on average they constitute 85.6% of the heat lost by a baby in a textile incubator.

Defibrillation success after subcutaneous implantable cardioverter-defibrillator generator replacement is not affected by impedance increase

Abstract Funding Acknowledgements Type of funding sources: None. Background Routine defibrillation testing during implant and replacement of the subcutaneous implantable cardioverter-defibrillator (S-ICD) is recommended per current guidelines. Recently, concerns have been raised about an increase in shock impedance and consequent shock failure during defibrillation testing in S-ICD patients undergoing a generator replacement. Purpose We aim to describe the defibrillation success rate in relation to the shock impedance in patients undergoing S-ICD generator replacement in our large tertiary center. Methods In this retrospective analysis, data from replacement procedures were collected from all patients who underwent an S-ICD generator replacement in our center from June 2014 to December 2020. Defibrillation testing was performed with at least one shock of ≤65J, and a successful shock was defined as terminating the ventricular arrhythmia within 5 seconds after the shock. Results A total of 133 patients underwent an S-ICD generator replacement, 5.8 ± 0.9 years after initial implant. Reasons for replacement were: reaching of elective replacement indicator (n = 119), early battery depletion (n = 9), complaints of generator pocket (n = 3) and device malfunction (n = 2). Defibrillation testing was performed in 111 patients (86.5%) undergoing a replacement procedure. Shock impedance data from both the implant and replacement procedure were available in 101 patients. The median shock impedance of these patients during their replacement procedure was significantly higher than during their implant, 79Ω (IQR 66-94) and 66Ω (IQR 57.5-81) respectively (Z = -5.552, p &amp;lt; 0.001). Despite the higher shock impedance, first shock during defibrillation testing was successful in 105/111 patients (94.6%), with a success rate of 97.3% after two attempts. In the remaining three patients, the ventricular arrhythmia could only be terminated with a 80J shock. This was the case during both their initial implant and their replacement procedure. Shock impedance increase between implant and replacement was not significantly higher in patients with a successful first shock compared to patients with an unsuccessful first shock (Δ+11.1 ± 20.0Ω versus Δ+12.7 ± 27.6Ω, p = 0.86). Conclusion In this large retrospective analysis, we have shown a first shock success rate during S-ICD generator replacement of 94.6%, which is similar to the success rate of defibrillation testing after initial implant. After multiple attempts, defibrillation testing success rate was 100%. Even though the median shock impedance during replacement was significantly higher than during the initial implant, there was no difference in impedance increase in patients with a successful shock compared to patients with an unsuccessful shock. Abstract Figure. Defibrillation success