Category Archives: Anatomy

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Eur Heart J Cardiovasc Imaging. 2022 Jan 25:jeac011. doi: 10.1093/ehjci/jeac011. Online ahead of print.

ABSTRACT

The right atrium (RA) is the cardiac chamber that has been least well studied. Due to recent advances in interventional cardiology, the need for greater understanding of the RA anatomy and physiology has garnered significant attention. In this article, we review how a comprehensive assessment of RA dimensions and function using either echocardiography, cardiac computed tomography, and magnetic resonance imaging may be used as a first step towards a better understanding of RA pathophysiology. The recently published normative data on RA size and function will likely shed light on RA atrial remodelling in atrial fibrillation (AF), which is a complex phenomenon that occurs in both atria but has only been studied in depth in the left atrium. Changes in RA structure and function have prognostic implications in pulmonary hypertension (PH), where the increased right ventricular (RV) afterload first induces RV remodelling, predominantly characterized by hypertrophy. As PH progresses, RV dysfunction and dilatation may begin and eventually lead to RV failure. Thereafter, RV overload and increased RV stiffness may lead to a proportional increase in RA pressure. This manuscript provides an in-depth review of RA anatomy, function, and haemodynamics with particular emphasis on the changes in structure and function that occur in AF, tricuspid regurgitation, and PH.

PMID:35079782 | DOI:10.1093/ehjci/jeac011

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Imaging assessment of the right atrium: anatomy and function - DocWire News

The National Finance Commission is locked in a stalemate. Constitutionally mandated to give an Award for distribution of federal tax revenues, it has succeeded only sporadically. The last successful NFC Award was arrived at vide the 7th NFC in 2010. The 8th NFC expired on account of inaction. The 9th NFC went into freeze after the federal government put a proposal on the table for the provinces to finance some of federal expenditures which the provinces unanimously opposed.

The fate of the 10th NFC is uncertain. However, there appears to be a move to revive the federal governments case and an op-ed in The News (Is the NFC Award sustainable? January 22, 2022) has made a case in that regard. It begins by laying out four considerations: fairness, equity and flexibility to ensure financial functionality of the federal system.

There can be no dispute with any of the considerations; the problem arises with the interpretation of the federal income-expenditure balance sheet. The fiscal case is presented as follows: Budget 2021-22 estimates FBR tax collection at Rs5.8 trillion, of which Rs3.3 trillion is the provincial share vide the NFC Award, leaving the federation with Rs2.5 trillion. Adding Rs2.0 trillion of non-tax revenues, net federal revenues amount to Rs4.5 trillion.

Out of this amount, the federation has to undertake expenditures of Rs4.4 trillion for debt servicing and defence, leaving a balance of Rs0.1 trillion to cover a gap of over Rs3.5 trillion of expenditures on civil government, pensions, subsidies, PSDP and grants all of which have to be covered from loans. The conclusion drawn is that the 7th NFC Award is neither fair nor sustainable and the 18th Amendment has rendered it inflexible, resulting in a financially non-functional federal system.

Thenceforth, the novel argument: the federation encompasses the provinces, which it is implied renders them liable for sharing federal expenditures. To quote, the Rs3 trillion in debt service payments are made on debt taken by the state of Pakistan, not just Islamabad the Rs1.4 trillion for defense is to defend the state of Pakistan, not just Islamabad ....

All the above arguments are problematic. The 18th Amendment and the 7th NFC were concluded almost simultaneously. The understanding in the NFC where the federal government is also represented and is the chair was that the abolition of the Concurrent List would reduce federal expenditures and increase that of the provinces. Consequently, the change in the vertical shares reduction of the federal share and the concomitant increase in the share of the provinces was made on that understanding. However, the federal government has not followed up on that constitutional requirement. Accordingly, it is itself responsible for its financial dysfunctionality.

Rather, there is no restraint in federal fiscal profligacy. The first half of the current year shows double-digit growth in revenues and slowdown in development spending and yet a 29 percent jump in the budget deficit due to growth in current expenditure. The provinces cannot be asked to bear the burden of irresponsible federal fiscal mismanagement.

The argument that federal expenditures are not just for Islamabad is facetious and dangerous. If provinces are to bear their part of federal development expenditures, then there has to be an accounting over the last 50 years of the inter-provincial distribution of development expenditures and the corresponding debt service burden created thereof. If provinces are to bear their part of defence expenditures, then there can be a call for an accounting of inter-provincial composition of personnel.

Rather, if provinces are to pay for federal outlays, they can ask for the right to audit federal accounts. And if provinces are to pay for their share of federal expenditures, then the rationale for federal collection of revenues disappears and the case emerges for provinces to collect all tax and non-tax revenues and pay a percentage to Islamabad for its upkeep. In the event, the state of Pakistan will, de facto, convert from a federation into a confederation.

Any attempt to roll back the 18th Amendment or the 7th NFC Award also can be dangerous. The Sindh case offers an insight, where there has existed a nationalist movement with elements of secessionism, largely rooted in anti-Punjab sentiment. The 2010 devolution served to demolish this aspect of Sindhs politics. Evidence for this change emerges from the fact that post-2010, almost all nationalist parties and groups in Sindh aligned themselves with the Punjab-based PML-N and one of them even merged with it. Any undermining of the 18th Amendment or the 7th NFC Award is likely to provide fresh oxygen to the nationalist politics of yore.

The writer was a member of the 7th NFC and is now a member of the 10th NFC.

He tweets @kaiserbengali

Continued here:
Anatomy of the Seventh NFC - The News International

Even though Isobel Izzie Stevens was fired from Seattle Grace Hospital in the fifth season of Greys Anatomy, she remains one of the most beloved characters in the series. Despite her questionable decisions (just to name one, cutting Dennys LVAD wire), fans had a tough time adjusting to a show where Izzie wasnt a part of it.

Portrayed by Katherine Heigl, Izzie made her on-screen debut with the original five surgical interns, which included Meredith Grey (Ellen Pompeo), Cristina Yang (Sandra Oh), George OMalley (T.R Knight) and Alex Karev (Justin Chambers). Though devoted fans probably can't picture anyone else playing the surgical oncologist, there was another actress who almost snagged the role instead of Heigl.

Before joining the cast of ABCs hit drama Lost, Yunjin Kim could have been sporting a set of hospital scrubs instead of fighting for survival on a mysterious island.

In an exclusive interview with Entertainment Weekly, Kim revealed that she originally auditioned for the role of Izzie. At the time, she was transitioning her acting career from Korea to America. A secured deal with ABC allowed her to audition for some roles in the networks show lineup.

Lost was one of my first auditions but Grey's Anatomy was my first. I did not audition for Sandra Ohs character [Cristina], it was for Izzie. And I got a callback, she explained.

During that time, Kim also auditioned to play Kate Austen on Lost. Although she didnt get the part, creator and executive producer J.J. Abrams wrote the character, Sun-Hwa Kwon, specifically for her. Yet, Kim still wanted to keep Greys Anatomy on the table. But, she eventually changed her mind after making plans to film the pilot for Lost.

My agents were like, Why? You got cast on an amazing show. You should pack up and try to find a place in Hawaii. I was like, 'I don't know, I might like Greys Anatomy more. she added. I didn't want to put all my eggs in one basket. What if this falls out, you know? I had no guarantee. But anyway, I ended up not going back to the callback.

Story continues

In the end, the role went to Heigl, who played the character for six seasons. In 2010, she made her final on-screen appearance as Izzie and left the show.

As the saying goes, everything happens for a reason.

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RELATED: The 30 Best Greys Anatomy Episodes of All Time

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This Lost Star Nearly Played Izzie Stevens on Greys Anatomy Instead of Katherine Heigl - Yahoo Lifestyle

No show does aristocratic escapism quite like The Great. Tatler cover star, Elle Fanning, and Nicholas Hoult, star as Empress Catherine the Great and Emperor Peter III, in this flamboyant and wild rendition of their lives. Superb comic timing and fiercely witty comebacks make for an energetic and hilarious retelling of the escapades (and weren't they just) of the imperial Russian couple. It is advised that you do not, however, watch this in the hope of educating yourself on the countrys colourful history as the show describes itself as an occasionally true story. The 10-part-series is an aesthetic feast of extravagance, and the costumes, setting and makeup provide a cocktail of over-the-top indulgence, so much so, that one begins to understand the incitement of a revolution, caused by the country's monumentous disparity of wealth, in the coming century

Season three of The Great will air in late 2022 on Hulu

The rest is here:
These are the must-watch television shows of 2022: from Bridgerton to Anatomy of a Scandal - Tatler

Targeting youthful dollars has been a sound strategy for dozens of industries, with the marketing creation of the American teenager in the 1950s giving birth to a kaleidoscope of entertainment, fashion, food and lifestyle brands catering exclusively to the countrys newest consumers.

In the automotive world, things have always been a little different. New cars are expensive, often well beyond the budgets of even the hardest working high schooler or college student, which means advertising campaigns that skewed towards entry-level buyers traditionally took into account a wider demographic. It was easier, and more profitable, to make older folks feel young by feeding them a line or two about the rejuvenating effects of a vehicle than it was to build something exclusively for the sub-25 set.

In the early 2000s, Toyota turned this conventional wisdom on its ear by launching not just a sales campaign, but an entire brand built on a perceived gap in youth-oriented automobiles. Dubbed Scion, it was intended to sop up dollars from teens and twenty-somethings, who had given the Japanese manufacturer the cold shoulder due to its apparent frumpiness, by importing quirkier fare from the motherland. The effort even went so far as to target preteens before they had a chance to form their auto-brand affiliations.

Miraculously, for a very short period of time, the gambit worked. A few years after its debut, however, it became clear that Toyota had seriously miscalculated Scions appeal.

Once the initial surge of youth energy had been absorbed, a new demographic infiltrated showrooms, intent on rewarding themselves with a funky-looking, affordable automobile that would counter some of the salt-and-pepper streaking their once-full heads of hair.

Toyota was completely unprepared for the invasion of elders who suddenly appeared at dealerships, AARP membership cards in hand, eager to cash in on Scions no-haggle pricing model. Always wary of being told what they should find cool in the first place, and detecting the distinct odor of Werthers Originals wafting from the lot, the younger generations Toyota had once courted with Scion evaporated quickly, leaving behind leadership too stunned to steer into the skid.

The coolest toaster youve ever seen.

Toyota

At the outset, it appeared as though Toyota was making all the right moves with Scions market position. The quirky, toaster-shaped xB hatchback was an immediate success, followed closely by the flat-roofed tC coupe. After a soft launch in limited U.S. markets, by 2004 the company was selling 100,000 units total, a number that crested 173,000 sales by 2006.

So what if Scions full lineup numbers didnt match half a good year for the Toyota Camry? And pay no attention to the fact that the utilitarian xA subcompact trailed its more attractive siblings by as much as 75% on the sales sheet. There was plenty of time to convince Scions fresh-blooded customers to merge into Toyotas lane down the road and upgrade to something a little more adult (and more profitable). Until that day, Scions momentum seemed to be trending ever upward.

Then, the unthinkable. The brands sales began to plummet. In 2007, the company bled a quarter of its customers, and the following years global recession took most of the rest. By 2010, the company was down nearly 70% from where its tumble began, with a mere 45,678 units heading out the door.

What teen wouldnt want individual DVD players in the headrests?

Toyota

What happened? On the outside, it appeared as though the combination of an unpopular redesign of the standard-bearing xB (puffing it out past its previously cute proportions) plus the financial chaos of 2008-2009 were the primary culprits for Scions tumble. A closer look reveals a company that was unwilling to confront an uncomfortable truth about who its buyers actually were.

While it was accurate that back in 2004, the average age of its customer was roughly 35 years old (considerably younger than both Toyota and industry averages at the time), the crossover appeal of both the xB and the tC were already starting to dilute that figure. Media reports at the time were happy to turn the lens towards the drivers in their 40s, 50s, and 60s who were drawn in by Scion, a process that created a feedback loop that attracted the curiosity of an increasingly middle-aged clientele. In the space of just three years, Scions average customer was pushing 43, with some models skewing closer to 50.

At the same time as Scion was attracting a more experienced crowd, the initial groundswell of support from the younger set was fading as its occasionally bare-bones sales model failed to catch on. Instead of options, Toyota had counted on its extensive accessory program to fill coffers, figuring that a more energetic and engaged buyer base would want to soup up or otherwise customize their vehicles to reflect their individual tastes.

This revenue stream failed to materialize, as Toyota didnt understand that its original batch of Scion customers were attracted to bargain basement pricing and didnt necessarily have the means to explore fancy exhaust kits or decal sets. That went double for the increasingly silver-haired clientele elbowing out Scions disenchanted youth.

The compact Scion tC started off hot but sales numbers started to dip in 2007 and never fully recovered.

Toyota

By 2007, it should have been clear that Scions initial pitch to the under-30 crowd had failed in two crucial aspects.

Rather than seeing these vehicles as a blank canvas for self-expression via accessorizing, college grads and minimum-wage workers alike perceived the Scion badge as the mark of basic transportation, a budget-conscious sub-brand of Toyota rather than anything new or exciting. Toyota conflated youth spending on CDs and clothes in malls across America as an indication that maybe there was enough left under their mattresses for anything other than a reliable ride to work in the morning.

At the same time, Scions appeal to more experienced drivers should have made it abundantly clear that it was time to shift gears and start outfitting its automobiles with the kind of features that could keep this momentum going. The older crowd appreciated the easy-to-get-into xBs ride height and practicality, as well as the tCs comfortable ride matched with sporty looks that recalled their glory days without requiring them to open their wallets too wide. Packing more features into these models, including modern infotainment, and eliminating the accessory catalog in favor of a traditional options sheet could have helped squeeze lemonade from the increasingly sour sales reports.

Maybe Scion should have stuck with the original xB.

Toyota

As history has shown, Toyota made almost no effort to deviate from its youthful focus/senior results dichotomy. As late as 2011 it was introducing a (legitimately fun to drive) sports coupe in the form of the FR-S, followed by the curious iQ hatchback (a pint-size vehicle outshone by the more capable, and cheaper, Toyota Yaris), two vehicles that couldnt have been more different. The former was designed to tackle Japans mountain roads, while the latter seemed destined to be towed behind an RV being driven by a retired couple discovering America on a fixed income.

The message inside Scion showrooms was likewise confusing at best, as also-rans like the iA were sourced from Mazdas entry-level dregs and the iM did its best Corolla impression in the companys final years. The tC and the xB languished, each receiving only a single redesign during nearly a decade of existence. Young buyers had by that point defected almost entirely to Toyota, which had rehabbed its image and the lower limits of its lineup to compete harder for first-timers. Scion was dragged down-market in the eyes of potential shoppers even as the mothership accrued greater respect, with the net effect of Toyota stealing sales from itself.

Golden-agers continued to power Scions sales throughout this period, but the returns were clearly diminishing; sales climbed briefly to 73,000 for 2012, yet as of the 2016 date of execution they had once again tumbled to just over 56,000 units. By the time younger buyers began to circle back to Scions rock-bottom pricing and claw the average customer age down from its mid-century crisis, it was too little, too late. With little money to be made from its unusual combination of skinflint Boomer devotees and blood-from-a-stone entry-level kids, Toyota shuttered Scion at the end of that year.

Not even the tantalizing FR-S could revive Scion.

Toyota

Corporate inertia is a powerful force, none more so than when its backed up by an unrealistic appraisal of how a market perceives a product. Unlike Amazons same-era Kindle, which wholeheartedly embraced the unexpected boon of elderly readers drawn by the devices promise of easy access to endless Danielle Steel ebooks, Toyota was unwilling to concede that it had missed the boat on who was really buying Scions.

How much did this single-minded focus hurt Toyota? In the long run, the effects were likely minimal. Scions portfolio was either based on JDM models or farmed out to corporate partners, which kept production costs minimal especially considering that only a million or so models were sold over the course of its entire existence. What few popular models were left after the shutdown were shunted off to other areas of the Toyota lineup, and with dealers sharing space on the Toyota lot the American investment was also far from onerous, making this an embarrassing, but not altogether financially painful experience for the automaker overall.

The true impact of Scions legacy is likely to be a kibosh on any future attempts to harness the alleged spending power of Millennials/Gen Z/whoevers next in line to bear the brunt of the generational hype. A sticker package here, an outdoorsy trim level there why not? An entire brand dedicated to scooping up dollars that simply dont exist?

Can we instead interest you in this fine, uh, Toyota?

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Anatomy of a Failure: The Demographic Mistargeting That Doomed Scion - InsideHook

From 2010 to July 2021, ClinicalTrials.gov reports that the number of registered clinical trials more than tripled, growing from 100,208 to 384,288 and counting.1

The race for a COVID-19 vaccine made clinical trials headline news in 2020 and 2021, with thousands of people worldwide volunteering to take part in vaccine studies. Still, for some, the details of what clinical trials do and how they work may not be clear.

Judy Sewards, Head of Clinical Trial Experience at Pfizer, offers some insight into the purpose, people, and phases of clinical trials.

Clinical trials study whether potential new therapies are safe for humans and that they work as intended.

Some clinical trials study whether investigational therapies may help prevent disease, and others help scientists understand whether these therapies may treat disease. No matter the type of trial, Sewards says they all have one thing in common.

Clinical trials are designed to prioritize protecting the participants, she says. Trials are examined by entities that provide oversight of the research study, such as institutional review boards, data and safety monitoring committees, and regulatory agencies or health authorities, to ensure it stays that way throughout the trial.

Establishing and maintaining participants' trust is important to successfully conducting clinical trial studies, but it's just one piece of a much bigger commitment to upholding the highest ethical standards and principles in the exploration of safe and effective ways to prevent or treat diseases..

Clinical trials operate from an infrastructure of ethics, Sewards says. You don't want to design a clinical trial that disadvantages somebody from getting standard of care treatment theyd otherwise get if they werent in the trial. For example, in cancer we know that patients are unlikely to benefit from a placebo so this wouldnt generally be an option. Cancer trials typically compare the potential treatment with the existing treatment or add something new onto the existing treatment to see if the potential treatment an improve outcomesover what is available outside of the trial.

Behind every clinical trial is a team of people who keep research on track:

As a participant, your primary relationship is with the study doctor, the stucy coordinator, and the staff who work at the site where you go to participate in the trial, Sewards says.

Clinical trials take place in several phases. Phase 1 helps scientists understand the safety of a particular medicine or vaccine. Phase 2 begins to understand early efficacy. Phase 3 focuses on broader efficacy and dosing in preparation for health authority approval. And Phase 4 continues to monitor and collect data after a drug has been approved.

Your experience in the trial can vary by phase, Sewards says, adding that while early-phase drug trials often include healthy volunteers, late-stage research typically involves study activities for a specific health problem. In later phases, and depending on the type of study or disease, youre the patientbut instead of getting the current standard of care, you might receive a potential new solution.

No matter the phase, participants can expect to be monitored throughout their participation in the study. Monitoring can take place through checkups at the research site or remotely.

Ultimately, Sewards says participating in clinical research supports the greater good. Participants can help to bring progress to science, medicine, and, in some cases, to the world at large.

When you volunteer for a clinical trial, its a wonderful gift to society and something were all grateful for, including people that are patiently waiting for breakthroughs, she says.

And as more people take an interest in participating in clinical trials, it also stands to make research more diverse.

Representation across different ages, genders, races, and ethnicities in clinical trials makes a difference, Sewards says. The more diverse a group of clinical trial participants, the more we can learn about how a potential medicine or vaccine works within those populations. Participation in clinical trials by people of all backgrounds can make a difference by reducing health disparities among underrepresented populations and improving the development of medicines and vaccines for everyone.

When you participate," she says, "youre representing people like you.

References:

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Anatomy of a Clinical Trial: The Purpose, People, and Phases of Clinical Research - Pfizer