Little Pomerania and Other Stories

The stories in this thesis represent a portion of the work I have done during my time as a student in the creative writing program at the University of Maryland. They were ultimately chosen for their thematic links and because they--I feel--best represent the writer I have become over the last three years. Collectively, the stories deal with class, communication, culture, disappointment, displacement, marriage, and maturity, sometimes all in the same story. While each story is meant to stand alone, it is arranged here in a deliberate order, relative to the others, as there is a discernible arc

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

1.1 W continuous-wave, narrow spectral width (<1 angstrom) emission from broad-stripe, distributed-feedback diode lasers (λ = 0.893 μm)

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Purification and partial amino acid sequence analysis of human erythrocyte acetylcholinesterase

AbstractA single step immunoaffinity purification procedure for human erythrocyte acetylcholinesterase is described which permitted the isolation of milligram quantities of enzyme from 10 U of erythrocytes, with 113 000-fold purification and a yield of about 22%. In SDS-PAGE analysis, the enzyme corresponds to a disulfide linked dimer of 140 kDa which is converted to a 70 kDa monomer upon disulfide reduction. The tryptic peptides generated from purified enzyme were separated by reverse-phase HPLC. Five of these peptides were analysed to determine the amino acid sequences. The obtained sequences showed no homology to the already known amino acid sequences for human serum and brain butyryl-cholinesterase and Torpedo californica acetylcholinesterase

International Cooperation for Small Satellites Development

Participants at the CANEUS 2006 Conference in Toulouse, France agreed that in order to open up the market for small satellites and facilitate dialogue between the many stakeholders in the industry, it was necessary to create an international consortium for the coordination and standardization of the small satellite industry. The CANEUS Small Satellite Sector Consortium aims to take an approach similar to that designed for the semiconductor industry, namely the SEMATECH industry group. The Small Sat Sector Consortium focuses on providing opportunities for industry representatives to participate in cutting-edge technical discussions while establishing the future direction of the small satellite industry. It oversees five projects and initiatives dedicated to (a) developing standards so as to ensure international interoperability, (b) identifying launch opportunities and services, (c) providing stakeholder liaison and strategic development, (d) addressing Intellectual Property and ITAR issues in accordance with CANEUS International’s broader mission, and (e) organizing launch certification services. This presentation describes Small Satellite developments within the international cooperation framework of the CANEUS network

0.45 W diffraction-limited beam and single-frequency operation from antiguided phase-locked laser array with distributed feedback grating

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Interfacial Mixing Analysis for Strained Layer Superlattices by Atom Probe Tomography

Quantum wells and barriers with precise thicknesses and abrupt composition changes at their interfaces are critical for obtaining the desired emission wavelength from quantum cascade laser devices. High-resolution X-ray diffraction and transmission electron microscopy are commonly used to calibrate and characterize the layers&#8217; thicknesses and compositions. A complementary technique, atom probe tomography, was employed here to obtain a direct measurement of the 3-dimensional spatially-resolved compositional profile in two InxGa1&#8722;xAs/InyAl1&#8722;yAs III-V strained-layer superlattice structures, both grown at 605 &#176;C. Fitting the measured composition profiles to solutions to Fick&#8217;s Second Law yielded an average interdiffusion coefficient of 3.5 &#215; 10&#8722;23 m2 s&#8722;1 at 605 &#176;C. The extent of interdiffusion into each layer determined for these specific superlattices was 0.55 nm on average. The results suggest that quaternary active layers will form, rather than the intended ternary compounds, in structures with thicknesses and growth protocols that are typically designed for quantum cascade laser devices