Early Identification and Intervention in Patients with Atrial Fibrillation Using an Implantable Cardiac Monitor to Significantly Improve Guideline-Based Anticoagulation Therapy in an Outpatient Cardiology Clinic

The purpose of this research was to (a) examine the demographics of patients receiving care in an outpatient cardiology clinic, (b) describe the relationship between the atrial fibrillation (AF) and other variables (e.g., BMI), (c) examine the frequency and the length of time to AF diagnosis in patients implanted with an implantable cardiac monitoring (ICM) device, (d) observe provider patterns of treatment with oral anticoagulants (OACs), and (e) investigate documented considerations to either diagnose or rule out OSA in a group of outpatient AF patients in a cardiology clinic. Background: AF is largely undiagnosed but can cause major morbidity and mortality. AF is the most prevalent sustained arrhythmia encountered in the emergency department, is frequently detected in those without a prior diagnosis of AF, and is the most common cause for stroke. All relevant guidelines suggest patients from intermediate to high risk for stroke should receive OAC; however, this therapy is prescribed in less than 55% of eligible patients. AF accounts for nearly 1 in 7 strokes and affects approximately 5.8 million people in the United States. Objectives: The purpose of this study is to identify and intervene in patients with atrial fibrillation using an implantable cardiac monitor to significantly improve guideline-based anticoagulation therapy. Methods: A retrospective database from an outpatient clinic in southern California was analyzed in this non-experimental study design; it comprised routinely-collected data on patients with ICMs implanted between June 1, 2014 and December 31, 2018. This study was designed to establish the incidence of AF using an ICM device (i.e., Medtronic LINQ) in the outpatient setting. Conclusions: As evidenced by this study, most patients would not have been diagnosed with AF utilizing the shorter-duration monitoring devices typically used as the first line of treatment. Longer monitoring capabilities promise early identification of disease and reduction in morbidity for AF patients. Discussion: The incidence of AF using an ICM (i.e., Medtronic LINQ) device in an outpatient clinic was 23.4% (63 out of 269 patients), similar to national studies stating that longer monitoring of cardiac rhythms increased the diagnosis of arrythmias. Only 12.7% of detected AFs (11 out of 63 patients) occurred before 14 days, the maximum time available through the use of other, traditional monitoring devices in standard use; therefore, an alarming 87.3% of ICM-detected arrythmias could have remained unidentified. This research observed a reduction of potential, highly-debilitating embolic stroke through detection as well as a lessened risk of all-cause mortality with OACs for AF patients without stroke prophylaxis; early identification and treatment is possible utilizing an ICM device

Metabolomic Analysis Reveals Contributions of Citric and Citramalic Acids to Rare Earth Bioleaching by a Paecilomyces Fungus.

Conventional methods for extracting rare earth elements from monazite ore require high energy inputs and produce environmentally damaging waste streams. Bioleaching offers a potentially more environmentally friendly alternative extraction process. In order to better understand bioleaching mechanisms, we conducted an exo-metabolomic analysis of a previously isolated rare earth bioleaching fungus from the genus Paecilomyces (GenBank accession numbers KM874779 and KM 874781) to identify contributions of compounds exuded by this fungus to bioleaching activity. Exuded compounds were compared under two growth conditions: growth with monazite ore as the only phosphate source, and growth with a soluble phosphate source (K2HPO4) added. Overall metabolite profiling, in combination with glucose consumption and biomass accumulation data, reflected a lag in growth when this organism was grown with only monazite. We analyzed the relationships between metabolite concentrations, rare earth solubilization, and growth conditions, and identified several metabolites potentially associated with bioleaching. Further investigation using laboratory prepared solutions of 17 of these metabolites indicated statistically significant leaching contributions from both citric and citramalic acids. These contributions (16.4 and 15.0 mg/L total rare earths solubilized) accounted for a portion, but not all, of the leaching achieved with direct bioleaching (42 ± 15 mg/L final rare earth concentration). Additionally, citramalic acid released significantly less of the radioactive element thorium than did citric acid (0.25 ± 0.01 mg/L compared to 1.18 ± 0.01 mg/L), suggesting that citramalic acid may have preferable leaching properties for a monazite bioleaching process

The Foundations of Latino Voter Partisanship: Evidence from the 2000 Election

Traditionally, the Latino electorate has been considered to be Democratic in partisan affiliation. However, during the 2000 presidential election there were many efforts made by the Republican Party to court Latino voters, suggesting that perhaps Latino voters may be becoming more Republican in orientation. Using a telephone survey of Latino likely voters conducted in the 2000 election, we examine three different sets of correlates of Latino voter partisanship: social and demographic, issue and ideological, and economic. We find that Latino voter partisanship is strongly structured by social and demographic, as well as issue and ideological, factors. We also find that while it is unlikely that changes in economic factors or abortion attitudes will significantly change which parties the different Latino nation-origin groups identify with, it is possible that changes in ideological positions regarding the role of government in providing social services could result in significant changes in Latino party identification

Effects of Arsenic on Trichloroethene-Dechlorination Activities of Dehalococcoides mccartyi 195.

Arsenic and trichloroethene (TCE) are among the most prevalent groundwater contaminants in the United States. Co-contamination of these two compounds has been detected at 63% of current TCE-contaminated National Priorities List sites. When in situ TCE reductive dechlorination is stimulated by the addition of fermentable substrates to generate a reducing environment, the presence of arsenic can be problematic because of the potential for increased mobilization and toxicity caused by the reduction of arsenate [As(V)] to arsenite [As(III)]. This study assesses the effects of arsenic exposure on the TCE-dechlorinating activities of Dehalococcoides mccartyi strain 195. Our results indicate that 9.1 μM As(III) caused a 50% decrease in D. mccartyi cell growth. While As(V) concentrations up to 200 μM did not initially impact TCE dechlorination, inhibition was observed in cultures amended with 200 μM As(V) and 100 μM As(V) in 12 and 17 days, respectively, corresponding with the accumulation of As(III). Transcriptomic and metabolomic analyses were performed to evaluate cellular responses to both As(V) and As(III) stress. Amendment of amino acids enhanced arsenic tolerance of D. mccartyi. Results from this study improve our understanding of potential inhibitions of D. mccartyi metabolism caused by arsenic and can inform the design of bioremediation strategies at co-contaminated sites

Nurse Practitioner-Led Obstructive Sleep Apnea Screening in Patients with an Implantable Cardiac Monitor, and Confirmed or Suspected Atrial Fibrillation

Background: Obstructive sleep apnea (OSA) has been linked to heart disease and vice versa. Millions of Americans suffer from this chronic sleep condition, and a great number of those affected are unaware they have it. According the American Sleep Apnea Association, 80% of patients who fall in the moderate to severe OSA category are undiagnosed. Evidence suggest that untreated OSA can lead to atrial fibrillation (AF), and other cardiovascular problems. These cardiovascular complications can increase the mortality and morbidity of patients who suffer from this sleep syndrome. Purpose of Project: The goal of the project was to provide OSA screening to patients with implantable cardiac monitors who were observed due to confirmed or suspected AF. The aim of this study was to identify the prevalence of those at high risk. Our overall purpose was to establish early screening protocols, that could potentially lead to early detection and treatment. The screening tool used was the STOP-BANG OSA screening tool due to its high sensitivity and specificity for detecting moderate to severe cases. Methods: Patients were screened for OSA risk by using the STOP-BANG tool. The phone screening calls were conducted between the hours of 9:00 am to 5:00pm on week days over a period of six months. The scores of 100 patients were obtained, and analyzed by using Microsoft Excel software. Evaluation/Results: The results showed that 63% of patients screened, scored as high risk for OSA. Of those who scored as high risk, 61.90% were males, 38.10% were female, 25.39% had previously been diagnosed with OSA, 4.76% were previously referred for sleep studies, and 69.84% have never been screened for OSA or referred for a sleep study. These findings suggested that the majority of patients at high risk for OSA are neither screened nor referred for sleep studies. The patients found to be at highest risk were males, older than 50y/o, obese, with a history of hypertension and syncope. Discussion: This project has the potential to provide information regarding the prevalence of OSA in patients who are diagnosed or are suspected to have AF. The prevalence of OSA in this patient population can give us knowledge regarding their health care needs. It can also help providers focus interventions that can potentially improve health care outcomes. Early screening can lead to early referral and treatment. This in turn may lead to decrease exacerbation of AF, and improved overall quality of life for patients who have coexisting AF and OSA

Influence of trace erythromycin and eryhthromycin-H2O on carbon and nutrients removal and on resistance selection in sequencing batch reactors (SBRs).

Three sequencing batch reactors (SBRs) were operated in parallel to study the effects of trace erythromycin (ERY) and ERY-H2O on the treatment of a synthetic wastewater. Through monitoring (1) daily effluents and (2) concentrations of nitrogen (N) and phosphorous (P) in certain batch cycles of the three reactors operated from transient to steady states, the removal of carbon, N, and P was affected negligibly by ERY (100 microg/L) or ERY-H2O (50 microg/L) when compared with the control reactor. However, through analyzing microbial communities of the three steady state SBRs on high-density microarrays (Phylo-Chip), ERY, and ERY-H2O had pronounced effects on the community composition of bacteria related to N and P removal, leading to diversity loss and abundance change. The above observations indicated that resistant bacteria were selected upon exposure to ERY or ERY-H2O. Shortterm batch experiments further proved the resistance and demonstrated that ammonium oxidation (56-95%) was inhibited more significantly than nitrite oxidation (18-61%) in the presence of ERY (100, 400, or 800 microg/L). Therefore, the presence of ERY or ERY-H2O (at microg/L levels) shifted the microbial community and selected resistant bacteria, which may account for the negligible influence of the antibiotic ERY or its derivative ERY-H2O (at microg/L levels) on carbon, N, and P removal in the SBRs

Incomplete Wood-Ljungdahl pathway facilitates one-carbon metabolism in organohalide-respiring Dehalococcoides mccartyi.

The acetyl-CoA "Wood-Ljungdahl" pathway couples the folate-mediated one-carbon (C1) metabolism to either CO2 reduction or acetate oxidation via acetyl-CoA. This pathway is distributed in diverse anaerobes and is used for both energy conservation and assimilation of C1 compounds. Genome annotations for all sequenced strains of Dehalococcoides mccartyi, an important bacterium involved in the bioremediation of chlorinated solvents, reveal homologous genes encoding an incomplete Wood-Ljungdahl pathway. Because this pathway lacks key enzymes for both C1 metabolism and CO2 reduction, its cellular functions remain elusive. Here we used D. mccartyi strain 195 as a model organism to investigate the metabolic function of this pathway and its impacts on the growth of strain 195. Surprisingly, this pathway cleaves acetyl-CoA to donate a methyl group for production of methyl-tetrahydrofolate (CH3-THF) for methionine biosynthesis, representing an unconventional strategy for generating CH3-THF in organisms without methylene-tetrahydrofolate reductase. Carbon monoxide (CO) was found to accumulate as an obligate by-product from the acetyl-CoA cleavage because of the lack of a CO dehydrogenase in strain 195. CO accumulation inhibits the sustainable growth and dechlorination of strain 195 maintained in pure cultures, but can be prevented by CO-metabolizing anaerobes that coexist with D. mccartyi, resulting in an unusual syntrophic association. We also found that this pathway incorporates exogenous formate to support serine biosynthesis. This study of the incomplete Wood-Ljungdahl pathway in D. mccartyi indicates a unique bacterial C1 metabolism that is critical for D. mccartyi growth and interactions in dechlorinating communities and may play a role in other anaerobic communities

A bioassay for the detection of benzimidazoles reveals their presence in a range of environmental samples.

Cobamides are a family of enzyme cofactors that include vitamin B12 (cobalamin) and are produced solely by prokaryotes. Structural variability in the lower axial ligand has been observed in cobamides produced by diverse organisms. Of the three classes of lower ligands, the benzimidazoles are uniquely found in cobamides, whereas the purine and phenolic bases have additional biological functions. Many organisms acquire cobamides by salvaging and remodeling cobamides or their precursors from the environment. These processes require free benzimidazoles for incorporation as lower ligands, though the presence of benzimidazoles in the environment has not been previously investigated. Here, we report a new purification method and bioassay to measure the total free benzimidazole content of samples from microbial communities and laboratory media components. The bioassay relies on the "calcofluor-bright" phenotype of a bluB mutant of the model cobalamin-producing bacterium Sinorhizobium meliloti. The concentrations of individual benzimidazoles in these samples were measured by liquid chromatography-tandem mass spectrometry. Several benzimidazoles were detected in subpicomolar to subnanomolar concentrations in host-associated and environmental samples. In addition, benzimidazoles were found to be common contaminants of laboratory media components. These results suggest that benzimidazoles present in the environment and in laboratory media have the potential to influence microbial metabolic activities

New Barriers to Participation: Application of New Mexico's Voter Identification Law

In democratic societies there is a tension between maximizing ballot access and minimizing voter fraud. Since the 2000 presidential election, this tension has been central to discussions about election reform, at the national and local level. We examine this tension by focusing on the implementation of voter identification laws in one state that has experienced significant issues in recent elections, and that is now implementing significant attempts at election reform: New Mexico. We hypothesized that Hispanic voters were more likely to show some form of identification than other types of voters. Using a voter data set from New Mexico’s First Congressional District in the 2006 election, we find that Hispanic, male and Election Day voters were more likely to show some form of identification than non-Hispanic, female and early voters. In addition, using an overlapping study of Bernalillo County 2006 poll workers, we find no evidence that certain groups of poll workers were more likely to ask for voter identification. Our findings suggest that broad voter identification laws, which may be applied unequally, may be perceived as discriminatory

The New York City Principals Pandemic Flu Survey: Are Schools Prepared?

It will be only a matter of time before another influenza pandemic occurs. Pandemic flu refers to a novel human influenza virus that causes a global outbreak, or pandemic. Researchers cannot accurately predict the timing, severity, or source of the next pandemic, but are certain it would present a myriad of issues for the public health infrastructures of our local communities. In the case of a pandemic flu outbreak, daily routine would be interrupted and school administrators would have many challenges to face. School principals in particular serve a unique role in their communities -- they are the link between their schools and the outside world, as well as a means of communication between these two sectors. It is important for individuals in this role to be seen as a clear and constant channel of communication at all times, especially during an emergency. In October of 2006, researchers from the National Center for Disaster Preparedness (NCDP), in coordination with the New York City (NYC) based Council of School Supervisors and Administrators (CSA), conducted a web based survey of NYC school principals to gauge their level of preparedness and to address the concern of principals for the many consequences that may arise for their schools if a pandemic flu outbreak is to occur. 330 of the 1260 principals responded (26.2%). Among key findings were the following: 1) 84.1% of principals did not have a pandemic flu plan; 2) Among the few schools with a plan, four out of five principals were not familiar with it; 3) The overwhelming majority of principals said their school had no process for talking with parents, and few have been involved in community level planning efforts. Schools are a resource to the safety of the community, and the well-being of schools and the community are inexorably intertwined. Recommendations for the future center on the need for schools and communities to work together to prepare for pandemic flu, as well as other emergencies. Other important recommendations include improving upon the role of the principal as a risk communicator and integrating the pandemic flu plan into the school's existing safety plan