DISCLOSURES: No funding was received for this commentary. The author has nothing to disclose.

Background Nonvitamin K antagonist oral anticoagulants (NOACs) are increasingly used in patients with atrial fibrillation (AF) undergoing elective cardioversion (ECV). The aim was to investigate the use of NOACs and warfarin in ECV in a real-life setting and to assess how the chosen regimen affected the delay to ECV and rate of complications. Methods Consecutive AF patients undergoing ECVs in the city hospitals of Helsinki between January 2015 and December 2016 were studied. Data on patient characteristics, delays to cardioversion, anticoagulation treatment, acute (<30 days) complications, and regimen changes within one year were evaluated. Results Nine hundred patients (59.2% men; mean age, 68.0 ± 10.0) underwent 992 ECVs, of which 596 (60.0%) were performed using NOACs and 396 (40.0%) using warfarin. The mean CHA 2 DS 2 -VASc score was 2.5 (±1.6). In patients without previous anticoagulation treatment, NOACs were associated with a shorter mean time to cardioversion than warfarin (51 versus. 68 days, respectively; p  < .001). Six thromboembolic events (0.6%) occurred: 4 (0.7%) in NOAC-treated patients and 2 (0.5%) in warfarin-treated patients. Clinically relevant bleeding events occurred in seven patients (1.8%) receiving warfarin and three patients (0.5%) receiving NOACs. Anticoagulation treatment was altered for 99 patients (11.0%) during the study period, with the majority (88.2%) of changes from warfarin to NOACs. Conclusions In this real-life study, the rates of thromboembolic and bleeding complications were low in AF patients undergoing ECV. Patients receiving NOAC therapy had a shorter time to cardioversion and continued their anticoagulation therapy more often than patients on warfarin.

Since more than a decade, all kinds of businesses and organisations are intensively exploring enterprise-level information systems to better integrate their business processes, information flows and people. Consequently, the industry demands for technically skilled, but also “business-savvy” IT professionals are permanently growing. To meet this need, more and more computing education programs try to incorporate enterprise-level information systems into their curricula. While there is some computing education research done to investigate the need for this new type of IT-business professional and to analyse general implications for higher education, only very few research works or practice papers exist which report on concrete attempts to design and deliver higher education computing courses which intensively use enterprise-level systems. In this paper, the author reports on a series of experiences made within the Bachelor of Science (Information Systems Management) degree program offered by the School of Information Systems (SIS) at the Singapore Management University (SMU). The primary focus of this paper is put on establishing a working set of best practices for the design of an effective structure of the face-to-face teaching sessions for courses which use enterprise-level systems and applications in their curricula. While this paper is principally based on education experiences made within the frame of an Information Systems program, the best practices presented in this paper are equally applicable to any other computing education field or even to the engineering education in general.

Mining engineering involves the design, planning and management of operations for the development, production and eventual rehabilitation of resource extraction. These activities draw on a diverse set of skills. University of British Columbia mining engineers have traditionally been highly regarded for their strengths in the technical aspects of mining and mineral process but also for their understanding of the application of principles of sustainability and social responsibility. The current view of the UBC Mining curriculum demands the integration of aspects of environmental and social sciences shaping the future of tertiary engineering education. The solution is developing a curriculum that is focused on key learning objectives that are a reflection of all these external pressures. This paper examines the challenge of curriculum reform and the emergence of learning communities at the Norman B. Keevil Institute of Mining Engineering at the University of British Columbia, Canada.

Despite the recent interest in diversifying engineering education there has been very little analysis regarding the nature of interventions needed to refashion engineering education. This article proposes a preliminary framework referred to here as the Public Leadership Framework (PLF) to examine efforts to diversify engineering education. By comparing three highly regarded programs, the PLF is used here to reveals not just their topical differences but also the differences in their orientations and the nature of engagement with society.

Background Noninvasive risk stratification aims to detect abnormalities in the pathophysiological mechanisms underlying ventricular arrhythmias. We studied the predictive value of repeating risk stratification in patients with an implantable cardioverter-defibrillator (ICD). Methods The EUTrigTreat clinical study was a prospective multicenter trial including ischemic and nonischemic cardiomyopathies and arrhythmogenic heart disease. Left ventricular ejection fraction ≤40% (LVEF), premature ventricular complexes >400/24 hr (PVC), non-negative microvolt T-wave alternans (MTWA), and abnormal heart rate turbulence (HRT) were considered high risk. Tests were repeated within 12 months after inclusion. Adjusted Cox regression analysis was performed for mortality and appropriate ICD shocks. Results In total, 635 patients had analyzable baseline data with a median follow-up of 4.4 years. Worsening of LVEF was associated with increased mortality (HR 3.59, 95% CI 1.17–11.04), as was consistent abnormal HRT (HR 8.34, 95%CI 1.06–65.54). HRT improvement was associated with improved survival when compared to consistent abnormal HRT (HR 0.10, 95%CI 0.01–0.82). For appropriate ICD shocks, a non-negative MTWA test or high PVC count at any moment was associated with increased arrhythmic risk independent of the evolution of test results (worsening: HR 3.76 (95%CI 1.43–9.88) and HR 2.50 (95%CI 1.15–5.46); improvement: HR 2.80 (95%CI 1.03–7.61) and HR 2.45 (95%CI 1.07–5.62); consistent: HR 2.47 (95%CI 0.95–6.45) and HR 2.40 (95%CI 1.33–4.33), respectively). LVEF improvement was associated with a lower arrhythmic risk (HR 0.34, 95%CI 0.12–0.94). Conclusions Repeating LVEF and HRT improved the prediction of mortality, whereas stratification of ventricular arrhythmias may be improved by repeating LVEF measurements, MTWA and ECG Holter monitoring.