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BACKGROUND: His bundle pacing (HBP) is a relatively new treatment modality for patients experiencing issues with the cardiac conduction system. The treatment is thought to be an advantageous therapy compared with the standard treatment because it uses the native conduction pathway instead of introducing a non-physiological correction pathway which has been documented to increase the risk of heart failure. First carried out in humans in 2000 (Deshmukh, Casavant, Romanyshyn, & Anderson, 2000), HBP has been shown to be superior to right ventricular pacing and equivalent to cardiac resynchronization therapy. Because of the relative recency of the application of this technique in humans, there is a need for more studies to understand the long-term effectiveness and to guide training for new clinicians. 
OBJECTIVES: The objectives of this study were to (1) define the utility of three-dimensional mapping as a guiding tool for lead placement in HBP, (2) investigate the electroanatomical imaging of the atrioventricular (AV) septum, bundle of His, and other areas of the conduction system, (3) apply these observations to guide optimal pacing lead placement in the clinical setting, and (4) describe the correction of right and left bundle branch blocks by HBP. METHODS: Patients with pacemaker indication due to diseased conduction system were identified and recommended to undergo His bundle lead implantation. The lead was navigated into the heart by fluoroscopy and progressing the catheter through the axillary, subclavian, and cephalic veins. During the procedure, electroanatomical mapping was conducted by a quadripolar catheter to guide lead placement. His cloud, non-selective capture, and selective capture areas were marked and used to generate a 3D model layering the patient conduction system onto the physical anatomy. Pacemapping was then utilized to identify the most suitable area for disease correction.
Results: HBP mapping data were available in 24 patients. Several different responses to pacemapping were observed in the area of the AV septum including selective HBP (S-HBP), non-selective HBP (NS-HBP) (with upper, lower, and common variants), and right bundle branch (RBB) capture. Capture areas were superimposed onto the 3D model in real time and used to guide lead implantation for purposes of correcting various forms of conduction disease. The use of electroanatomical mapping (EAM) reduced the need for fluoroscopic guidance compared with the non-EAM-assisted procedure. Four common patterns were observed while mapping: (1) pattern 1, selective capture surrounded by upper and lower non-selective regions of capture; (2) pattern 2, selective capture surrounded by a common non-selective region of capture; (3) pattern 3, two separate non-selective capture areas with no selective capture; (4) pattern 4, common non-selective capture area with no selective capture. There was no correlation between capture threshold voltage and location of non-selective capture. Also, no correlation was found between capture threshold voltage and presence of common non-selective versus upper and lower non-selective capture areas. Patients with left bundle branch block (LBBB) and RBBB had similar His capture anatomy and were correctable by NS-HBP. CONCLUSIONS: HBP guided by electroanatomical mapping should be considered as a standard approach during pacemaker implantation. Because the underlying conduction anatomy is variable among patients, the use of EAM can direct lead positioning at a more physiologic location. In addition, EAM-guided implantation can reduce the need for fluoroscopy.

Buffalo Boys 100 years of wearing his heart on his sleeve is the sum of my experience at the University of Saskatchewan. It is an exploration of or coming to know my worldview. I have come to know that history is a construction, fragments of memory told through the bias of time, place and privilege. <p>Bison in the Bowl: This is Indian Land is a site of resistance. A layering of energy over matter through image projection over a colonizing space, the college building. I will place my family tipi in the bowl to honour the bison; the projected images will be of bison, buffalo boy and other contemporary aboriginal experiences. Through projection, I enlighten matter, a union of disparate histories that can be healed through the presence of an aboriginal healing device, the tipi. Happenings dependent on weather will occur September 21, 22 and 23. <p>Crow Chief Plenty Coups refused to speak of the years after the last wild bison herds were gone, saying, when the buffalo went away the hearts of my people fell to the ground, and they could not lift them again. After this nothing happened. <p>Nothing Happened: Old Sun represents the reconstruction of cultural icons through bison fragments, manufactured steel and a light from the Old Sun Residential School on the Blackfoot Reserve. Shadows of the past interrogate traditional and contemporary ideas. I believe that objects hold energy; this light that once shone above the heads of many children within the school is a witness to cultural genocide. Illumination of our histories can bring us out of the shadows and enlighten our being. Time is the Western paradox; it is to be played with. It is a container, a crypt that fragments real time image. It is a space of introspection and the cosmic dance. Bison Heart connects me to the heart of my art practice. In the context of my aboriginal experience, this painting can be romantic, iconic and political. I invite the viewer to move between the values to uncover their own meaning and relationship with the subject and self. <p>Gambling the Prairie Winnings is the construction of time through narrative, image and artifact. It is a serious and humorous view of how the west was dumb, it parodies the Western Development Museums centennial theme Winning the Prairie Gamble. The reinforcement of the colonial project occurs primarily through media, my intent is to subvert this medium. <p>Mission Impossible: Buffalo Boys Wild West Peep Show is an altar and a stage based on the first Blackfoot Mission church. It is a video projection where Buffalo Boy can dream of missions past, play in the present and vision the future. <p>This exhibition includes but is not limited to ideas within indigenous knowledge, meta/ quantum physics role in creating unity, the re-immergence of two-spirit peoples history, colonial or post -colonial critique, ecology, spirituality and healing modalities within the creative process. Through my art making I transcend the constructions of history, I heal myself for others to see, it is a new place from which to view the world.

Buffalo Boys 100 years of wearing his heart on his sleeve is the sum of my experience at the University of Saskatchewan. It is an exploration of or coming to know my worldview. I have come to know that history is a construction, fragments of memory told through the bias of time, place and privilege. <p>Bison in the Bowl: This is Indian Land is a site of resistance. A layering of energy over matter through image projection over a colonizing space, the college building. I will place my family tipi in the bowl to honour the bison; the projected images will be of bison, buffalo boy and other contemporary aboriginal experiences. Through projection, I enlighten matter, a union of disparate histories that can be healed through the presence of an aboriginal healing device, the tipi. Happenings dependent on weather will occur September 21, 22 and 23. <p>Crow Chief Plenty Coups refused to speak of the years after the last wild bison herds were gone, saying, when the buffalo went away the hearts of my people fell to the ground, and they could not lift them again. After this nothing happened. <p>Nothing Happened: Old Sun represents the reconstruction of cultural icons through bison fragments, manufactured steel and a light from the Old Sun Residential School on the Blackfoot Reserve. Shadows of the past interrogate traditional and contemporary ideas. I believe that objects hold energy; this light that once shone above the heads of many children within the school is a witness to cultural genocide. Illumination of our histories can bring us out of the shadows and enlighten our being. Time is the Western paradox; it is to be played with. It is a container, a crypt that fragments real time image. It is a space of introspection and the cosmic dance. Bison Heart connects me to the heart of my art practice. In the context of my aboriginal experience, this painting can be romantic, iconic and political. I invite the viewer to move between the values to uncover their own meaning and relationship with the subject and self. <p>Gambling the Prairie Winnings is the construction of time through narrative, image and artifact. It is a serious and humorous view of how the west was dumb, it parodies the Western Development Museums centennial theme Winning the Prairie Gamble. The reinforcement of the colonial project occurs primarily through media, my intent is to subvert this medium. <p>Mission Impossible: Buffalo Boys Wild West Peep Show is an altar and a stage based on the first Blackfoot Mission church. It is a video projection where Buffalo Boy can dream of missions past, play in the present and vision the future. <p>This exhibition includes but is not limited to ideas within indigenous knowledge, meta/ quantum physics role in creating unity, the re-immergence of two-spirit peoples history, colonial or post -colonial critique, ecology, spirituality and healing modalities within the creative process. Through my art making I transcend the constructions of history, I heal myself for others to see, it is a new place from which to view the world.

In this thesis, I explore the uses to which children’s authors C.S. Lewis and Philip Pullman put the major biblical theme of the Fall (with passing commentary on Temptation, the precursor to the Fall) in their seminal children’s series The Chronicles of Narnia and the His Dark Materials trilogy. I argue that each author uses the subject of the Fall as a central theme in his series in order to inflect the dominant message of this biblical story (that humanity has fallen from perfection into sin) with their personal opinions on fundamental human questions concerning the nature of God, the difference between good and evil, and the metaphysical ‘rules’ that structure the universe and mankind’s place in it.1 In exploring these issues, I point out the ways in which Pullman and Lewis, in their drastically differing opinions as to the legitimacy of the worldview implicit in the original Bible story, are nevertheless both heavily dependant on the overwhelming influence that the Fall narrative has had on Western culture.

This study examines intensively Edward Taylor's Gods Determinations touching his Elect: and The Elects Combat in their Conversion, and Coming up to God in Christ together with the Comfortable Effects thereof. This poetic history was probably written immediately prior to one of Taylor's spiritual unions with God, which he described in his Preparatory Meditations. It is the work of a man sure of himself and of his salvation. For Taylor the task was clear: he must explain and justify to his parishioners the revelations from God which he had so regularly and recently experienced during the sacrament of communion.Gods Determinations is not the personal and enigmatic notations of a secretive Puritan minister. In the poem Taylor did not doubt his ideas or his purpose; however, if he was certain of his religious standing, the characters in the poem are not. What makes the poem more than mere Calvinistic propaganda is the fact that in the context of the poem the human characters are not static and unchanging. They choose to act. Gods Determinations is poetically complex, lacking neither tension nor paradox. The characters are not emotionless puppets; their hopes and fears evolve as the poem progresses. Tension arises from their ability to choose, to act.Taylor's poem is best viewed as a soul-search, the culmination of which will be the joyful exclamation of found assurance and of enlightened purpose. What Taylor had experienced in his soul's quest for truth in Gods Determinations enabled him to proceed confidently with his task in Preparatory Meditations, his life task, one might note, for these meditations covered a span of 43 years, from 1682-1725. The rational struggle for assurance is fought in Gods Determinations; the sensual and emotional expression of his complete joy and obedience is found in Preparatory Meditations. Taylor found strength in Gods Determinations to proceed on his poetic course of action. His Preparatory, Meditations were the poetic fruit of victory found in Gods Determinations,.Initially this study reviews and analyzes those scholarly studies which were concerned with Taylor's theology and his poetic devices, at first as they are found in all of Taylor's writings but more specifically as they are found in Gods Determinations. Often these studies were found to be critically inaccurate, unfair to Taylor the Puritan minister or to Taylor the poet.The heart of this study is that Edward Taylor the faithful Puritan minister was a serious poet who revised and edited his poems, as witness the first drafts and revisions of the Poetical Works. He controlled his material. Yet his poetic devices were always harnessed to theological ideas. Thus Taylor's poetic style is best viewed as religioaesthetic, a combination of spiritual and sensual realms.Granting Taylor's poetic ability, this study proceeds to explicate Gods Determinations, dividing the long poem into four significant eras of man's spiritual consciousness. The poem's thirty-six lyrics are not primarily a play, or a sermon, or a meditation; they are a history, a spiritual history of God's people. Taylor viewed this history in terms of four dispensations of God's Grace, four historical eras of significant religious awareness.Taylor's Gods Determinations progresses historically (in Judeo-Christian terms) from the beginning of time to a particular place in time, seventeenth-century Puritan New England. Ultimately, however, the poem is best viewed cyclically, spiritually and physically having no beginning or end. The essential concept, the unifying theme, of the entire poem is renewal. The poem does not end physically, because Taylor led into the Preparatory Meditations with it; it does not end spiritually because God is eternal and manis eternal. Taylor's fundamental aesthetic value must depend upon the complexity of the experiences of his characters during his four spiritual dispensations of God's Grace. In the end, the universal emotions and feelings of these struggling men were particularized by Puritan tenets that Taylor felt satisfied these emotions and yearnings.

HydroShare is a collaborative online system being developed by the Consortium of Universities for the Advancement of Hydrologic Science Inc. (CUAHSI) with the goal of facilitating the dissemination, visualization, and publishing of hydrologic data and models. External web applications serve a key role in extending HydroShare's capabilities, so robust application programming interfaces (APIs) are a vital component of HydroShare's architecture. Hydrologic data stored on HydroShare are defined by a data type, and much of these data are either geospatial or time series data. Although HydroShare's API provides ways to upload and download files, as well as access certain metadata, it does not currently provide GIS services defined by the Open Geospatial Consortium, or Hydrologic Information System (HIS) services developed by CUAHSI. The absence of these services severely limits the capabilities of HydroShare apps while also increasing the development time and complexity of apps that are developed.To help alleviate this disconnect between HydroShare and HydroShare apps, I have developed a system which helps extend HydroShare's data service capabilities using GeoServer and a Water Data Server to expose GIS and HIS data services for HydroShare content. With this system in place, HydroShare apps have much better access to HydroShare content, allowing them to be developed in less time, and provide much more powerful visualization, access, and analysis services to HydroShare users.

The 2-His-1-carboxylate facial triad is a common metal binding motif among nonheme iron(II) enzymes. Made up of two histidine side chain residues, and one carboxylate side chain of either a glutamate or aspartate residue occupying one face of the iron(II) octahedral coordinating sphere, the 2-His-1-carboxylate motif provides proximity of substrate(s) and molecular oxygen for important oxidation reactions in biological chemistry. Computational, structural, and kinetic analyses have afforded mechanistic details on how these enzymes control the oxidation reactions they catalyze; from the oxidation state of the metal center to the supporting interactions from secondary sphere amino acid residues. However, the extensive literature on the 2-His-1-carboxylate facial triad enzymes currently contains deficiencies in the area of fundamental, experimental thermodynamic analyses of metal and substrate binding in these systems. The focus of this study is to determine the energetics of substrate and metal binding to two representative enzymes of the 2-His-1-carboxylate facial triad-containing family. More specifically, we examine iron(II) binding to the alpha-ketoglutarate- dependent model system alpha-ketoglutarate/taurine dioxygenase, and substrate binding to a well-known extradiol dioxygenase, homoprotocatechuate 2,3-dioxygenase. Using isothermal titration calorimetry, we are able to determine equilibrium constants, enthalpies, entropies and Gibbs free energies for the binding reactions, affording new insight into what drives the reactions forward at the 2-His-1-carboxylate facial triad active site center.

Este trabalho apresenta o estudo e implementação de um sistema para vinculação e visualização de imagens de ressonância magnética nuclear e tomografia computadorizada a partir de um sistema de informação em radiologia (RIS), possibilitando a recuperação e disponibilização dos exames (laudos e imagens), através de rede \"ethernet\", para visualização a partir de uma interface desenvolvida para \"browser\". Os exames podem ser recuperados através do número de registro (RGHC) ou do nome do paciente. As imagens utilizadas no trabalho estão nos padrões DICOM 3.0 (Digital Imaging and Communications in Medicine) e JPEG (Joint Photographic Experts Group). Para a vinculação dos exames que possuem suas imagens em JPEG foi desenvolvida uma interface para inclusão das informações necessárias que garantem a consistência deste processo. Para os exames que possuem suas imagens em formato DICOM 3.0 as informações foram extraídas automaticamente dos cabeçalhos e armazenadas no banco de dados. O sistema possui uma interface amigável ao usuário, podendo ser rapidamente incorporada ao projeto de um PACS (Picture Archiving and Communication System). A implementação foi idealizada para servir ao Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP/USP), com base no seu sistema de informação em radiologia. Os resultados demonstram que o tempo de retorno das imagens é clinicamente satisfatório e considerado bom pela avaliação qualitativa dos médicos. / This work presents the study and implementation of a system aiming the indexing and visualization of the images of nuclear magnetic resonance and computerized tomography from a radiology information system (RIS), allowing the retrieval and availability of the exams (results and images), through an ethernet net for visualization beginning with an interface developed to a browser. The exams may be recovered either through their register number (RGHC) or the patient\'s name. The images employed in the work follow the DICOM 3.0 (Digital Imaging and Communications in Medicine) and JPEG (Joint Photographic Experts Group) patterns. For the indexing of the exams that present images in JPEG, an interface was developed to include the information required to guarantee the consistency of the process. For the exams presenting the DICOM 3.0 format, information was extracted automatically from the heading and filed in the database. The system has a friendly interface for the user, it may be rapidly incorporated to the project of an PACS (Picture Archiving and Communication System). The implementation was idealized to serve the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, of the Universidade de São Paulo (HCFMRP/USP), based on its radiology information system (RIS). The results demonstrated that the time of retrieval of the images is satisfactory and considered good by evaluation qualified of the doctors.

Modern surgery of the 21st century relies in many aspects on computers or, in a wider sense, digital data processing. Department administration, OR scheduling, billing, and - with increasing pervasion - patient data management are performed with the aid of so called Surgical Information Systems (SIS) or, more general, Hospital Information Systems (HIS). Computer Assisted Surgery (CAS) summarizes techniques which assist a surgeon in the preparation and conduction of surgical interventions. Today still predominantly based on radiology images, these techniques include the preoperative determination of an optimal surgical strategy and intraoperative systems which aim at increasing the accuracy of surgical manipulations. CAS is a relatively young field of computer science. One of the unsolved "teething troubles" of CAS is the absence of technical standards for the interconnectivity of CAS system. Current CAS systems are usually "islands of information" with no connection to other devices within the operating room or hospital-wide information systems. Several workshop reports and individual publications point out that this situation leads to ergonomic, logistic, and economic limitations in hospital work. Perioperative processes are prolonged by the manual installation and configuration of an increasing amount of technical devices. Intraoperatively, a large amount of the surgeons' attention is absorbed by the requirement to monitor and operate systems. The need for open infrastructures which enable the integration of CAS devices from different vendors in order to exchange information as well as commands among these devices through a network has been identified by numerous experts with backgrounds in medicine as well as engineering. This thesis contains two approaches to the integration of CAS systems: - For perioperative data exchange, the specification of new data structures as an amendment to the existing DICOM standard for radiology image management is presented. The extension of DICOM towards surgical application allows for the seamless integration of surgical planning and reporting systems into DICOM-based Picture Archiving and Communication Systems (PACS) as they are installed in most hospitals for the exchange and long-term archival of patient images and image-related patient data. - For the integration of intraoperatively used CAS devices, such as, e.g., navigation systems, video image sources, or biosensors, the concept of a surgical middleware is presented. A c++ class library, the TiCoLi, is presented which facilitates the configuration of ad-hoc networks among the modules of a distributed CAS system as well as the exchange of data streams, singular data objects, and commands between these modules. The TiCoLi is the first software library for a surgical field of application to implement all of these services. To demonstrate the suitability of the presented specifications and their implementation, two modular CAS applications are presented which utilize the proposed DICOM extensions for perioperative exchange of surgical planning data as well as the TiCoLi for establishing an intraoperative network of autonomous, yet not independent, CAS modules. / Die moderne Hochleistungschirurgie des 21. Jahrhunderts ist auf vielerlei Weise abhängig von Computern oder, im weiteren Sinne, der digitalen Datenverarbeitung. Administrative Abläufe, wie die Erstellung von Nutzungsplänen für die verfügbaren technischen, räumlichen und personellen Ressourcen, die Rechnungsstellung und - in zunehmendem Maße - die Verwaltung und Archivierung von Patientendaten werden mit Hilfe von digitalen Informationssystemen rationell und effizient durchgeführt. Innerhalb der Krankenhausinformationssysteme (KIS, oder englisch HIS) stehen für die speziellen Bedürfnisse der einzelnen Fachabteilungen oft spezifische Informationssysteme zur Verfügung. Chirurgieinformationssysteme (CIS, oder englisch SIS) decken hierbei vor allen Dingen die Bereiche Operationsplanung sowie Materialwirtschaft für spezifisch chirurgische Verbrauchsmaterialien ab. Während die genannten HIS und SIS vornehmlich der Optimierung administrativer Aufgaben dienen, stehen die Systeme der Computerassistierten Chirugie (CAS) wesentlich direkter im Dienste der eigentlichen chirugischen Behandlungsplanung und Therapie. Die CAS verwendet Methoden der Robotik, digitalen Bild- und Signalverarbeitung, künstlichen Intelligenz, numerischen Simulation, um nur einige zu nennen, zur patientenspezifischen Behandlungsplanung und zur intraoperativen Unterstützung des OP-Teams, allen voran des Chirurgen. Vor allen Dingen Fortschritte in der räumlichen Verfolgung von Werkzeugen und Patienten ("Tracking"), die Verfügbarkeit dreidimensionaler radiologischer Aufnahmen (CT, MRT, ...) und der Einsatz verschiedener Robotersysteme haben in den vergangenen Jahrzehnten den Einzug des Computers in den Operationssaal - medienwirksam - ermöglicht. Weniger prominent, jedoch keinesfalls von untergeordnetem praktischen Nutzen, sind Beispiele zur automatisierten Überwachung klinischer Messwerte, wie etwa Blutdruck oder Sauerstoffsättigung. Im Gegensatz zu den meist hochgradig verteilten und gut miteinander verwobenen Informationssystemen für die Krankenhausadministration und Patientendatenverwaltung, sind die Systeme der CAS heutzutage meist wenig oder überhaupt nicht miteinander und mit Hintergrundsdatenspeichern vernetzt. Eine Reihe wissenschaftlicher Publikationen und interdisziplinärer Workshops hat sich in den vergangen ein bis zwei Jahrzehnten mit den Problemen des Alltagseinsatzes von CAS Systemen befasst. Mit steigender Intensität wurde hierbei auf den Mangel an infrastrukturiellen Grundlagen für die Vernetzung intraoperativ eingesetzter CAS Systeme miteinander und mit den perioperativ eingesetzten Planungs-, Dokumentations- und Archivierungssystemen hingewiesen. Die sich daraus ergebenden negativen Einflüsse auf die Effizienz perioperativer Abläufe - jedes Gerät muss manuell in Betrieb genommen und mit den spezifischen Daten des nächsten Patienten gefüttert werden - sowie die zunehmende Aufmerksamkeit, welche der Operateur und sein Team auf die Überwachung und dem Betrieb der einzelnen Geräte verwenden muss, werden als eine der "Kinderkrankheiten" dieser relativ jungen Technologie betrachtet und stehen einer Verbreitung über die Grenzen einer engagierten technophilen Nutzergruppe hinaus im Wege. Die vorliegende Arbeit zeigt zwei parallel von einander (jedoch, im Sinne der Schnittstellenkompatibilität, nicht gänzlich unabhängig voneinander) zu betreibende Ansätze zur Integration von CAS Systemen. - Für den perioperativen Datenaustausch wird die Spezifikation zusätzlicher Datenstrukturen zum Transfer chirurgischer Planungsdaten im Rahmen des in radiologischen Bildverarbeitungssystemen weit verbreiteten DICOM Standards vorgeschlagen und an zwei Beispielen vorgeführt. Die Erweiterung des DICOM Standards für den perioperativen Einsatz ermöglicht hierbei die nahtlose Integration chirurgischer Planungssysteme in existierende "Picture Archiving and Communication Systems" (PACS), welche in den meisten Fällen auf dem DICOM Standard basieren oder zumindest damit kompatibel sind. Dadurch ist einerseits der Tatsache Rechnung getragen, dass die patientenspezifische OP-Planung in hohem Masse auf radiologischen Bildern basiert und andererseits sicher gestellt, dass die Planungsergebnisse entsprechend der geltenden Bestimmungen langfristig archiviert und gegen unbefugten Zugriff geschützt sind - PACS Server liefern hier bereits wohlerprobte Lösungen. - Für die integration intraoperativer CAS Systeme, wie etwa Navigationssysteme, Videobildquellen oder Sensoren zur Überwachung der Vitalparameter, wird das Konzept einer "chirurgischen Middleware" vorgestellt. Unter dem Namen TiCoLi wurde eine c++ Klassenbibliothek entwickelt, auf deren Grundlage die Konfiguration von ad-hoc Netzwerken während der OP-Vorbereitung mittels plug-and-play Mechanismen erleichtert wird. Nach erfolgter Konfiguration ermöglicht die TiCoLi den Austausch kontinuierlicher Datenströme sowie einzelner Datenpakete und Kommandos zwischen den Modulen einer verteilten CAS Anwendung durch ein Ethernet-basiertes Netzwerk. Die TiCoLi ist die erste frei verfügbare Klassenbibliothek welche diese Funktionalitäten dediziert für einen Einsatz im chirurgischen Umfeld vereinigt. Zum Nachweis der Tauglichkeit der gezeigten Spezifikationen und deren Implementierungen, werden zwei modulare CAS Anwendungen präsentiert, welche die vorgeschlagenen DICOM Erweiterungen zum perioperativen Austausch von Planungsergebnissen sowie die TiCoLi zum intraoperativen Datenaustausch von Messdaten unter echzeitnahen Anforderungen verwenden.