Sustaining Agility in IS Portfolios–A Critical Realist Study

ABSTRACT Research into adapting portfolio practices for large‐scale agile environments has not kept pace with the growing interest in extending agile practices to the enterprise level. Although several agile scaling frameworks offer portfolio practice recommendations, their longer‐term effectiveness is unclear, given the lack of rigorous theoretical foundations. Consequently, it is uncertain how these practices sustain agility and optimise value realisation from their Information Systems investments. This study adopts a systems‐theoretic approach to identify causal mechanisms that sustain agility within enterprise IS portfolios. Using a critical realist perspective, we analyse existing IS portfolio practices from three distinct enterprises to evolve an explanatory framework comprising two generative mechanisms and a structural arrangement of portfolio practices that help achieve sustained portfolio agility by sensing, assessing, learning from, and responding to changes in its internal and external environments while ensuring a sustained flow of business value. In addition to being a comprehensive tool for practitioners designing and diagnosing agile IS portfolio capabilities, our results extend existing theoretical approaches to understanding agility at the portfolio level and provide opportunities to refine existing models to address the dynamic complexities of IS portfolio agility.

Wound Management and Surgery for Calcific Uremic Arteriolopathy (Calciphylaxis): A Retrospective Observational Cohort Study

ABSTRACT Wound care in calciphylaxis remains poorly defined without evidence‐based consensus on timing and technique of surgical intervention. We demonstrate that surgical debridement and subsequent wound closure are safe and effective in calciphylaxis and describe a systematic multidisciplinary approach to intervention. We retrospectively reviewed a cohort of patients with calciphylaxis at our institution. Those who underwent surgical debridement and wound closure were analysed with emphasis on wound healing, progression to amputation and mortality. Sixty‐two patients with calciphylaxis underwent surgical debridement. Twenty patients had wound closure by skin grafting, five were excised with primary wound closure, and 37 were debrided and allowed to heal by secondary intention. There were excellent rates of healing in all groups, and no patients demonstrated wound progression or new lesions following operative intervention. Surgical debridement and wound closure are safe and effective in treating wounds related to calciphylaxis.

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Response to Letter Regarding “Sodium–Glucose Cotransporter‐2 Inhibitors and Stroke Risk in Patients With Atrial Fibrillation”

A Novel Workflow Combining Artificial Intelligence—Twelve Lead Electrocardiographic Analysis and Real‐Time Mapping for Hemodynamically Unstable Ventricular Tachycardia

ABSTRACT Background Activation mapping of scar‐mediated ventricular tachycardias (VT) are often limited by hemodynamic instability. Substrate mapping and 12‐lead ECG localization of VT exit site is often limited by variable scar complexity. Emphasis on other mapping strategies in sinus rhythm would improve catheter ablation success in such cases. Objective The aim was to investigate the level of agreement between artificial intelligence (AI) based 12‐lead ECG localization of VT exit site and mapping utilizing pace‐mapping and mapping of channels of slow conduction within the scar tissue of hemodynamically unstable VT. Methods This was a single‐center proof‐of‐concept study that included patients who underwent catheter ablation procedure of hemodynamically unstable scar‐mediated VT. The performance of AI‐assisted ECG analysis of VT exit site (Vektor Medical, San Diego, CA) was compared with sites of successful ablation based on substrate mapping in sinus rhythm. Results A total of nine hemodynamically unstable VT rhythms were induced in four patients. In the seven VTs were AI‐assisted ECG analysis was used; there was a 100% level of agreement with the site of successful ablation based on substrate mapping. Ablation targeting those sites resulted in non‐induction of all induced and mapped VTs. None of the four patients had device therapy for recurrent VT or all‐cause mortality at 6 months of follow‐up. Conclusion A multi‐strategic approach utilizing digitalized analysis of 12‐lead ECG of VT exit site, pace‐mapping and mapping of channels of slow conduction in scar tissue, has the potential to enhance successful catheter ablation of hemodynamically unstable VT.

Pulsed Field Ablation for the Treatment of Octogenarians With Atrial Fibrillation

ABSTRACT Introduction As patients with atrial fibrillation (AF) present with increasing age and comorbidities, the understanding of the safety and efficacy of catheter ablation in older patients is paramount. We sought to investigate outcomes of octogenarians undergoing catheter ablation of AF in the era of pulsed field ablation (PFA). Methods We retrospectively analyzed AF patients who underwent PFA with a pentaspline catheter. Patients were divided into two groups based on age: octogenarians (age ≥ 80 years) and younger group (age < 80 years). Baseline characteristics, procedural data, and recurrence of atrial arrhythmia during the follow‐up course were compared between the groups. Results Among 698 AF patients (69 ± 11 years old, 64% male), 124 (18%) were octogenarians and 574 (72%) were younger than 80 years. Octogenarians had a higher prevalence of comorbidities and underwent more extensive ablation, including the posterior wall and anterior wall. However, the procedure time, ablation catheter dwell time, and the fluoroscopy time did not differ between groups. There were zero complications in the octogenarian group and 9 in the younger group ( p  = 0.16). Early follow‐up data showed comparable recurrence rate of atrial arrhythmias after an 8 week‐blanking period (log‐rank p  = 0.80). Conclusion PFA was effective and demonstrated a highly safe profile for octogenarians despite higher baseline risks and more extensive ablation.

Metformin Alters Exercise Training Induced Blood Pressure and Aortic Waveform Adaptations in Adults at Risk for Metabolic Syndrome

ABSTRACT Metformin reduces hyperglycemia and cardiovascular disease risk. However, no study has determined if metformin alters blood pressure and/or aortic waveforms in an exercise intensity dependent manner. We tested if metformin alters blood pressure and aortic waveforms before and during insulin‐stimulation following low and high intensity exercise training. In a double‐blind, placebo controlled trial, participants were randomized to low intensity exercise plus placebo (∼55% VO 2 max 5 days/week, LoEx+PL, n = 22) or metformin (2000 mg/day, LoEx+Met, n = 21) and high intensity exercise plus placebo (∼85% VO 2 max 5 days/week, HiEx+PL, n = 24) or metformin (HiEx+Met, n = 24) for 16 weeks. Carotid‐femoral pulse wave velocity (cfPWV) was assessed to determine arterial stiffness. A 120 min euglycemic‐hyperinsulinemic clamp (40mU/m 2 /min, 90 mg/dL) was conducted to assess peripheral and central blood pressures as well as aortic waveforms via applanation tonometry. Inflammatory measures (e.g., hs‐CRP, IL‐8, MMP‐1 and MMP‐7) along with fitness (VO 2 max) and body composition (DXA) were also analyzed. While LoEx+PL tended to decrease cfPWV ( p = 0.051), HiEx+Met reduced fasting peripheral diastolic blood pressure (pDBP; p  < 0.05) and all treatments except HiEx+Met increased fasting central pulse pressure ( p  < 0.05). Upon insulin‐stimulation, pDBP and reflection magnitude increased while pulse pressure amplification (PPA) decreased after LoEx+Met and HiEx+Met compared with LoEx+PL and HiEx+PL independent of exercise intensity (all, p  < 0.05). Interestingly, fasting MMP‐1 ( p  < 0.05) and MMP‐7 ( p = 0.063) tended to be higher after Met compared with PL, independent of exercise intensity. In conclusion, metformin altered blood pressure and aortic waveform adaptations in relation to inflammation following exercise training in adults at risk for metabolic syndrome. Trial Registration : NCT03355469

Statement from the frontal fibrosing alopecia international expert alliance: SOFFIA 2024

Abstract Background As the incidence of frontal fibrosing alopecia (FFA) continues to rise, there is a need for an optimal treatment algorithm for FFA. Objectives To produce an international consensus statement on the treatment modalities and prognostic indicators of FFA. Methods Sixty‐nine hair experts from six continents were invited to participate in a three‐round Delphi process. The final stage was held as a virtual meeting facilitated via Zoom. The consensus threshold was set at ≥66%. Results Of 365 questions, expert consensus was achieved in 204 (56%) questions following completion of the three rounds. Three additional questions were included at the final meeting. The category with the strongest consensus agreement was disease monitoring (9; 100%). Questions pertaining to physical therapies achieved the least category consensus (15; 40%), followed by systemic therapy (45; 43%). Limitations The study lacked sufficient representation from Africa and South America. Conclusions SOFFIA highlights areas of agreement and disagreement among experts. Robust research is warranted to provide evidence‐based treatment recommendations.

Compassionate use efficacy of the interferon‐beta inhibitor dazukibart in dermatomyositis

An Apple a Day Does Not Keep the Weevils Away: Enhancing Vine Weevil Monitoring With Fruit‐Based Volatiles

ABSTRACT Vine weevil ( Otiorhynchus sulcatus Fabricius; Coleoptera: Curculionidae) is an economically important pest of soft fruit and ornamental crops worldwide. Despite extensive research over three decades, the development of an effective semiochemical lure to improve monitoring for this pest remains a challenge. This study investigated the behavioural and electrophysiological responses of adult vine weevils to apple sauce volatiles under laboratory conditions, using Y‐tube olfactometer bioassays and headspace analysis using gas chromatography coupled to mass spectrometry (GC–MS) and GC coupled to electroantennographic detection (GC‐EAD). In Y‐tube bioassays, more adults selected the olfactometer arm containing apple sauce volatiles compared to the control arm at lower doses (0.1, 1 and 10 g) but not at higher doses (20 g). Thirteen compounds were identified in volatiles collected from apple sauce, with the major components being furfural and sorbic acid. Consistent electrophysiological responses were recorded to (E)‐2‐heptenal, 1‐hexanol, (Z)‐3‐hexenol and (E)‐2‐hexenol. The behavioural response of vine weevil adults to refuges baited with semiochemical lures was also tested under glasshouse conditions. In this scenario, a greater proportion of individuals were recorded in refuges baited with apple sauce compared to unbaited refuges. A similar behavioural response was also recorded when refuges were baited with a combination of apple sauce and Fortune's spindle ( Euonymus fortunei (Turcz.) Hand.‐Maz.; Celastrales: Celastraceae) compared to those that were unbaited or individually baited with Fortune's spindle or apple sauce. This study indicates that apple sauce positively influences positively vine weevil behaviour and could serve as a basis for developing a novel lure for improved monitoring.