How much atrial fibrillation is too much? The net clinical benefit of anticoagulation therapy in atrial fibrillation patients with an intermediate CHA2DS2-VASc Score

Background: Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia seen in medical practice, affecting 33.5 million people worldwide. Arterial thromboembolism, particularly ischemic stroke (IS), is a significant complication of AF. The most widely recommended tool used to evaluate AF patient’s risk of IS is the CHA2DS2-VASc score, which assigns a numerical value to predetermined IS risk factors and allows an overall estimation of the patient’s risk by adding these individual numerical values together. Current guidelines offer varying recommendations regarding oral anticoagulation (OAC) therapy use in patients with varying CHA2DS2-VASc scores, especially in those patients with intermediate scores, and so it is difficult for clinicians to know whether OAC use for these patients is beneficial or incurring unnecessary risk. Objective: The purpose of this review is to evaluate the net clinical benefit (NCB) when comparing IS risk to that of hemorrhagic complications when prescribing OAC therapy to patients who have at least 1 nongender-related (NGR) risk factor for IS or an intermediate CHA2DS2-VASc score. Design: Systematic literature review. Methods: Searches were performed on the PubMed database. The search terms used were “Atrial Fibrillation” and “CHA2DS2-VASc” with filters for full text and English. Results: The PubMed search resulted in finding three articles Chao T-F et al.,1 Faucher L et al.,2 and Joundi RA et al.3 Conclusions: Based on our review of the current literature, we found that the presence of even 1 NGR risk factor significantly increases a patient’s risk of IS. Therefore, we agree with the European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE) guidelines that support considering OAC therapy in AF patients with 1 NGR risk factor, and we suggest that the American College of Cardiology, American Heart Association, and the Heart Rhythm Society (ACC/AHA/HRS) guidelines follow suit

Diving Deep: Deepening the Intervention and Setting Strategic Vision for the Future

Richmond YPQI has provided a quality improvement process since 2012, growing from 12 sites to 50. Network leads will describe efforts to respond to network participant and funder/stakeholder needs to deepen the intervention and set strategic goals for the continuous quality improvement process. This includes creating a strategic plan, impact framework and rubric to assess the readiness of an organization to participate. Additional items include advanced Methods trainings and a professional learning community. A portion of the workshop will allow participants to reflect on their networks and consider opportunities to deepen the intervention and/or set strategic goals

Special Libraries, March 1941

Volume 32, Issue 3https://scholarworks.sjsu.edu/sla_sl_1941/1002/thumbnail.jp

Microbiological Characterization of the International Space Station Water Processor Assembly External Filter Assembly S/N 01

The External Filter Assembly (EFA) S/N 01 is a mesh screen filter with a pore size of approximately 300 micron that was installed in the International Space Station (ISS) Water Processor Assembly (WPA) between the Waste Tank and the Mostly Liquid Separator (MLS) on February 11, 2010 to protect clearances in the MLS solenoid valve SV_1121_3. A removal & replacement of the EFA Filter was performed on March 22, 2011 in response to increasing pressure across the Waste Tank solenoid valve SV_1121_1 and the EFA Filter. The EFA Filter was returned on ULF6 and received in the Boeing Huntsville Laboratory on June 13, 2011. The filter was aseptically removed from the housing, and the residual water was collected for enumeration and identification of bacteria and fungi. Swab samples of the filter surface were also collected for microbiological enumeration and identification. Sample analyses were performed by Boeing Huntsville Laboratory and NASA Johnson Space Center Microbiology for comparison. Photographic documentation of the EFA filter was performed using a stereo microscope and environmental scanning electron microscope. This paper characterizes the amount and types of microorganisms on the filter surface and in the residual water from the filter housing following 1 year of utilization in the ISS WPA

Exited Prostitution Survivor Policy Platform

Survivors of prostitution propose a policy reform platform including three main pillars of priority: criminal justice reforms, fair employment, and standards of care. The sexual exploitation of prostituted individuals has lasting effects which can carry over into many aspects of life. In order to remedy these effects and give survivors the opportunity to live a full and free life, we must use a survivor-centered approach to each of these pillars to create change. First, reform is necessary in the criminal justice system to recognize survivors as victims of crime and not perpetrators, while holding those who exploited them fully responsible. Second, reform is necessary to assist survivors in finding fair employment by offering vocational training, financial counseling, and educational scholarships, as well as offering employment opportunities that utilize survivors’ vast array of skills and interests. Finally, standards of care for survivors exiting prostitution should focus on supporting survivors in our journeys and support short- and long-term resources that empower us. These systemic changes are necessary to recognize survivors as the valuable human beings we are and to support survivors in fulfilling our vast potential

The Photoeccentric Effect and Proto-Hot Jupiters I. Measuring photometric eccentricities of individual transiting planets

Exoplanet orbital eccentricities offer valuable clues about the history of planetary systems. Eccentric, Jupiter-sized planets are particularly interesting: they may link the "cold" Jupiters beyond the ice line to close-in hot Jupiters, which are unlikely to have formed in situ. To date, eccentricities of individual transiting planets primarily come from radial velocity measurements. Kepler has discovered hundreds of transiting Jupiters spanning a range of periods, but the faintness of the host stars precludes radial velocity follow-up of most. Here we demonstrate a Bayesian method of measuring an individual planet's eccentricity solely from its transit light curve using prior knowledge of its host star's density. We show that eccentric Jupiters are readily identified by their short ingress/egress/total transit durations -- part of the "photoeccentric" light curve signature of a planet's eccentricity --- even with long-cadence Kepler photometry and loosely-constrained stellar parameters. A Markov Chain Monte Carlo exploration of parameter posteriors naturally marginalizes over the periapse angle and automatically accounts for the transit probability. To demonstrate, we use three published transit light curves of HD 17156 b to measure an eccentricity of e = 0.71 +0.16/-0.09, in good agreement with the discovery value e = 0.67+/-0.08 based on 33 radial-velocity measurements. We present two additional tests using actual Kepler data. In each case the technique proves to be a viable method of measuring exoplanet eccentricities and their confidence intervals. Finally, we argue that this method is the most efficient, effective means of identifying the extremely eccentric, proto hot Jupiters predicted by Socrates et al. (2012).Comment: ApJ, 756, 122. Received 2012 April 5; accepted 2012 July 9; published 2012 August 2

Four PCR primers necessary for the detection of periplasmic nitrate reductase genes in all groups of Proteobacteria and in environmental DNA

Generic primers are available for detecting bacterial genes required for almost every reaction of the biological nitrogen cycle, the one notable exception being napA (gene for the molybdoprotein of the periplasmic nitrate reductase) encoding periplasmic nitrate reductases. Using an iterative approach, we report the first successful design of three forward oligonucleotide primers and one reverse primer that, in three separate PCRs, can amplify napA DNA from all five groups of Proteobacteria. All 140 napA sequences currently listed in the NCBI (National Center for Biotechnology Information) database are predicted to be amplified by one or more of these primer pairs. We demonstrate that two pairs of these primers also amplify PCR products of the predicted sizes from DNA isolated from human faeces, confirming their ability to direct the amplification of napA fragments from mixed populations. Analysis of the resulting amplicons by high-throughput sequencing will enable a good estimate to be made of both the range and relative abundance of nitrate-reducing bacteria in any community, subject only to any unavoidable bias inherent in a PCR approach to molecular characterization of a highly diverse target

The Photoeccentric Effect and Proto-Hot Jupiters II. KOI-1474.01, a candidate eccentric planet perturbed by an unseen companion

The exoplanets known as hot Jupiters---Jupiter-sized planets with periods less than 10 days---likely are relics of dynamical processes that shape all planetary system architectures. Socrates et al. (2012) argued that high eccentricity migration (HEM) mechanisms proposed for situating these close-in planets should produce an observable population of highly eccentric proto-hot Jupiters that have not yet tidally circularized. HEM should also create failed-hot Jupiters, with periapses just beyond the influence of fast circularization. Using the technique we previously presented for measuring eccentricities from photometry (the "photoeccentric effect"), we are distilling a collection of eccentric proto- and failed-hot Jupiters from the Kepler Objects of Interest (KOI). Here we present the first, KOI-1474.01, which has a long orbital period (69.7340 days) and a large eccentricity e = 0.81+0.10/-0.07, skirting the proto-hot Jupiter boundary. Combining Kepler photometry, ground-based spectroscopy, and stellar evolution models, we characterize host KOI-1474 as a rapidly-rotating F-star. Statistical arguments reveal that the transiting candidate has a low false-positive probability of 3.1%. KOI-1474.01 also exhibits transit timing variations of order an hour. We explore characteristics of the third-body perturber, which is possibly the "smoking-gun" cause of KOI-1474.01's large eccentricity. Using the host-star's rotation period, radius, and projected rotational velocity, we find KOI-1474.01's orbit is marginally consistent with aligned with the stellar spin axis, although a reanalysis is warranted with future additional data. Finally, we discuss how the number and existence of proto-hot Jupiters will not only demonstrate that hot Jupiters migrate via HEM, but also shed light on the typical timescale for the mechanism.Comment: ApJ, in press. Received 2012 July 7; accepted 2012 October 1