New Concepts in Pacemaker Syndrome

After implantation of a permanent pacemaker, patients may experience severe symptoms of dyspnea, palpitations, malaise, and syncope resulting from pacemaker syndrome. Although pacemaker syndrome is most often ascribed to the loss of atrioventricular (A-V) synchrony, more recent data may also implicate left ventricular dysynchrony caused by right ventricular pacing. Previous studies have not shown reductions in mortality or stroke with rate-modulated dual-chamber (DDDR) pacing as compared to ventricular-based (VVI) pacing. The benefits in A-V sequential pacing with the DDDR mode are likely mitigated by the interventricular (V-V) dysynchrony imposed by the high percentage of ventricular pacing commonly seen in the DDDR mode. Programming DDDR pacemakers to encourage intrinsic A-V conduction and reduce right ventricular pacing will likely decrease heart failure and pacemaker syndrome. Studies are currently ongoing to address these questions

Paleoindian Occupations in the Great Basin: A Comparative Study of Lithic Technological Organization, Mobility, and Landscape Use from Jakes Valley, Nevada

Previous research on Paleoindian occupations in the Great Basin has provided many more questions than answers. Central to understanding this early period is the relationship between its Western Fluted and Western Stemmed Tradition occupants. Little is known of the temporal, cultural, and technological behaviors of Western Fluted peoples, while the Western Stemmed Tradition inhabitants are only slightly better understood. This thesis presents the results of intensive technological studies that focused on determining raw material provisioning strategies, lithic conveyance zones, and landscape use to identify mobility and settlement patterns. Lithic assemblages from 19 Paleoindian era occupations, encompassing several environmental zones within Jakes Valley in eastern Nevada, provide data on the technological organization and movement patterns of early humans in the Great Basin, and reveal previously unknown behaviors that help differentiate the early hunter-gatherer groups who made Fluted and Stemmed projectile points

Letter to Steven Thorpe regarding the SEAALL Constitution and Bylaws, October 1, 1984

A letter from Mark Estes to Steven Thrope regarding review of changes to the SEAALL Constitution and Bylaws by the AALL Constitution and Bylaws Committee

A review of the ecological effectiveness of subtidal marine reserves in Central California, Part I: Synopsis of scientific investigations

Marine reserves, often referred to as no-take MPAs, are defined as areas within which human activities that can result in the removal or alteration of biotic and abiotic components of an ecosystem are prohibited or greatly restricted (NRC 2001). Activities typically curtailed within a marine reserve are extraction of organisms (e.g., commercial and recreational fishing, kelp harvesting, commercial collecting), mariculture, and those activities that can alter oceanographic or geologic attributes of the habitat (e.g., mining, shore-based industrial-related intake and discharges of seawater and effluent). Usually, marine reserves are established to conserve biodiversity or enhance nearby fishery resources. Thus, goals and objectives of marine reserves can be inferred, even if they are not specifically articulated at the time of reserve formation. In this report, we review information about the effectiveness of the three marine reserves in the Monterey Bay National Marine Sanctuary (Hopkins Marine Life Refuge, Point Lobos Ecological Reserve, Big Creek Ecological Reserve), and the one in the Channel Islands National Marine Sanctuary (the natural area on the north side of East Anacapa Island). Our efforts to objectively evaluate reserves in Central California relative to reserve theory were greatly hampered for four primary reasons; (1) few of the existing marine reserves were created with clearly articulated goals or objectives, (2) relatively few studies of the ecological consequences of existing reserves have been conducted, (3) no studies to date encompass the spatial and temporal scope needed to identify ecosystem-wide effects of reserve protection, and (4) there are almost no studies that describe the social and economic consequences of existing reserves. To overcome these obstacles, we used several methods to evaluate the effectiveness of subtidal marine reserves in Central California. We first conducted a literature review to find out what research has been conducted in all marine reserves in Central California (Appendix 1). We then reviewed the scientific literature that relates to marine reserve theory to help define criteria to use as benchmarks for evaluation. A recent National Research Council (2001) report summarized expected reserve benefits and provided the criteria we used for evaluation of effectiveness. The next step was to identify the research projects in this region that collected information in a way that enabled us to evaluate reserve theory relative to marine reserves in Central California. Chapters 1-4 in this report provide summaries of those research projects. Contained within these chapters are evaluations of reserve effectiveness for meeting specific objectives. As few studies exist that pertain to reserve theory in Central California, we reviewed studies of marine reserves in other temperate and tropical ecosystems to determine if there were lessons to be learned from other parts of the world (Chapter 5). We also included a discussion of social and economic considerations germane to the public policy decision-making processes associated with marine reserves (Chapter 6). After reviewing all of these resources, we provided a summary of the ecological benefits that could be expected from existing reserves in Central California. The summary is presented in Part II of this report. (PDF contains 133 pages.

Cardiac Resynchronization Therapy in Mild Heart Failure/ REVERSE, MADIT-CRT & RAFT studies & Meta-analyses / Expanding CRT-D Indications to Lower Risk Patients

Cardiac resynchronization therapy (CRT), effected via biventricular pacing, has been shown to improve symptoms and left ventricular (LV) systolic function and to reduce mortality and hospitalizations among patients with moderate to severe heart failure symptoms (class III and IV), reduced LV ejection fraction (EF), and a wide QRS complex on electrocardiogram, usually in the form of left bundle branch block. Recent evidence from randomized clinical trials and meta-analyses demonstrate that the beneficial effects of CRT on LV remodeling, heart failure symptoms, hospitalizations, and mortality also extend to patients with milder heart failure symptoms (class II). These data support the expansion of indications for CRT to less symptomatic patients with heart failure who have LVEF <0.35 and wide QRS duration in sinus rhythm. Accordingly the guidelines for CRT therapy by the European Society of Cardiology (ESC) and the American heart Association (AHA) have been updated to expand CRT indications to patients with milder heart failure symptoms

Law Librarianship: A Forum

Law librarianship is a profession that has a proud history and a bright future, yet it is not without its problems and concerns. For this issue of Law Library Lights, we have gathered together a number of luminaries in the field and asked them a number of questions related to the most important issues facing our community: professional image, additional roles, education and training, ethics, minority recruitment, budget crunch, technology, vendors, and the future. This exchange was published in volume 35, issue number 5, May/June 1992

The Clinical Challenge of Predicting and Preventing Sudden Cardiac Death Immediately after Myocardial Infarction

Despite many advances in treatment of myocardial infarction (MI) with percutaneous coronary intervention (PCI) and pharmacologic therapies, mortality immediately after MI remains high in patients with impaired left ventricular function. One of the greatest challenges facing the contemporary cardiologist is predicting and preventing sudden cardiac death (SCD) immediately after MI. Unfortunately, the trials assessing the role of the implantable cardioverter defibrillator (ICD) in patients at high risk for SCD immediately post MI have failed to show survival benefit. Current clinical guidelines restrict ICD implants to patients at least 40 days after MI with continued left ventricular dysfunction while on optimal medical therapy. It is evident that additional research is needed to identify strategies to prevent SCD and improve survival immediately after MI. In the meantime, clinicians should optimize and individualize therapy in the immediate post MI patient while carefully considering the risk of SCD and the competing risk of mortality from other causes

Nutritional characteristics of dormant season grazing within a winterfat (Krascheninnikovia lanata (Gueldenstaedt)) dominated plant community, and the effect of seedbed preparation on the emergence and survival of winterfat and squirreltail (Elymus elymoides (Raf.) Swezey) seedlings

The effect of seedbed preparation on the emergence and survival of winterfat (Krascheninnikovia lanata (Gueldenstaedt)) and squirreltail (Elymus elymoides (Raf.) Swezey)) seedlings was determined, while quantifying nutritional changes through the dormant season for four range species. In November of 2004 twenty 9m x 8m plots were randomly prepared with one of four treatments (rip, harrow, till, or control) for both winterfat and squirreltail. Seed was hand broadcasted and chain harrowed to complete the seeding. Seedling counts were taken in June, July, August, and September 2005, and again in June of 2006. Mature perennial species, annual frequency, and soil moisture were also monitored in each plot. Concurrently, forage samples of winterfat, squirreltail, creeping wildrye (Leymus triticoides (Buckl.), and Nuttall’s saltbush (Atriplex nuttallii (S. Wats.)) were collected for the months of November through April. Above ground biomass and fecal samples were also collected. Winterfat seedling emergence and survival was highest in the tilled treatments. Tilling treatments had the highest amount of soil moisture and reduced mature perennials and annual frequency better than the ripping, tilling, and control treatments. Squirreltail seedling emergence and survival did not differ between the treatments. However, surface roughness not provided by the tilled treatment may play a large role in capturing and providing microsite conditions necessary for natural recruitment. Analysis of the forage sampling showed crude protein to be the limiting factor for cattle to maintain fat reserves during the dormant season grazing period. This was supported by the microhistological analysis of the fecal collections that revealed 50% of the animal’s diet consisted of shrubby species, which were higher in crude protein than the grasses sampled. The results of this study demonstrated the importance of winterfat to cattle grazing dormant winter range, and the surprising potential to use both it and squirreltail in range rehabilitation efforts. The study also revealed that cattle grazing the current plant community could maintain body condition given managed properly