The Role of the Financial Aid Office as a Student Service

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Long-term Aquatic Invertebrate Monitoring at Buffalo National River, Arkansas

Aquatic invertebrate community structure was used to assess long-term water quality integrity in the mainstem of the Buffalo National River, Arkansas from 2005 to 2013. Nine benthic invertebrate samples were collected from each of six sampling sites using a Slack-Surber sampler. The Stream Condition Index (SCI) developed for Ozark streams was used to assess integrity of the invertebrate communities. This index is calculated using taxa richness, EPT (Ephemeroptera, Plecoptera, Trichoptera) Richness, Shannon’s Diversity Index, and Hilsenhoff Biotic Index (HBI). Sørensen’s similarity index was used to assess community similarity among sites, and scores were then analyzed using ascendant hierarchical cluster analysis. The benthic invertebrate fauna was diverse with 167 distinct taxa identified from all sites, with similarities ranging from 70% to 83%. Cluster analysis showed that sites were clustered in a longitudinal progression, with those sites closest to one another in linear distance generally being the most closely related. Overall, the invertebrate taxa of the Buffalo River are largely intolerant (mean tolerance value= 4.38). Taxa richness was typically greater than 20 among samples, and EPT richness values consistently were greater than 12 for all sites in most years. Shannon’s diversity index values generally ranged from 2.0 to 2.5 among sites and years. Metric values tended to decrease in a downstream direction to Site 4, and then increase to levels observed upstream. The exception was for HBI, which did not show this response and values for this metric generally were below 5. SCI scores among sampling sites were variable but not generally impaired and were fully biologically-supporting. Water quality (temperature, dissolved oxygen, specific conductance, pH, turbidity) met state standards in all instances. Habitat data were summarized, but found to be poorly correlated with invertebrate metrics (\u3c30% significant). Although the condition of invertebrate communities and water quality in the Buffalo River are largely sound and have high integrity, numerous ongoing and projected threats to these resources remain, and those threats largely originate outside of the park’s jurisdictional boundaries. Inherent variability of invertebrate community diversity and density across sites and years highlights the importance of using multi-metric assessment and multiyear monitoring to support management decisions

Multicenter Clinical Evaluation of the Xpert GBS LB Assay for Detection of Group B Streptococcus in Prenatal Screening Specimens

Neonatal infection with Streptococcus agalactiae (group B Streptococcus [GBS]) is a leading cause of sepsis and meningitis in newborns. Recent guidelines have recommended universal screening of all pregnant women to identify those colonized with GBS and administration of peripartum prophylaxis to those identified as carriers to reduce the risk of early-onset GBS disease in neonates. Enriched culture methods are the current standard for prenatal GBS screening; however, the implementation of more sensitive molecular diagnostic tests may be able to further reduce the risk of early-onset GBS infection. We report a clinical evaluation of the Xpert GBS LB assay, a molecular diagnostic test for the identification of GBS from broth-enriched vaginal/rectal specimens obtained during routine prenatal screening. A total of 826 specimens were collected from women undergoing prenatal screening (35 to 37 weeks' gestation) and tested at one of three clinical centers. Each swab specimen was tested directly prior to enrichment using the Xpert GBS assay. Following 18 to 24 h of broth enrichment, each specimen was tested using the Xpert GBS LB assay and the FDA-cleared Smart GBS assay as a molecular diagnostic comparator. Results obtained using all three molecular tests were compared to those for broth-enriched culture as the gold standard. The sensitivity and specificity of the Xpert GBS LB assay were 99.0% and 92.4%, respectively, compared to those for the gold standard culture. The Smart GBS molecular test demonstrated sensitivity and specificity of 96.8% and 95.5%, respectively. The sensitivities of the two broth-enriched molecular methods were superior to those for direct testing of specimens using the Xpert GBS assay, which demonstrated sensitivity and specificity of 85.7% and 96.2%, respectively

Multicenter Evaluation of the Portrait Staph ID/R Blood Culture Panel for Rapid Identification of Staphylococci and Detection of the mecA Gene

Bloodstream infections are a leading cause of morbidity and mortality in the United States and are associated with increased health care costs. We evaluated the Portrait Staph ID/R blood culture panel (BCP) multiplex PCR assay (Great Basin Scientific, Salt Lake City, UT) for the rapid and simultaneous identification (ID) of Staphylococcus aureus, Staphylococcus lugdunensis, and Staphylococcus species to the genus level and the detection of the mecA gene directly from a positive blood culture bottle. A total of 765 Bactec bottles demonstrating Gram-positive cocci in singles or clusters were tested during the prospective trial at 3 clinical sites. The Portrait Staph ID/R BCP results were compared with results from conventional biochemical and cefoxitin disk methods performed at an independent laboratory. Discordant ID and mecA results were resolved by rpoB gene sequencing and mecA gene sequencing, respectively. A total of 658 Staphylococcus species isolates (S. aureus, 211 isolates; S. lugdunensis, 3 isolates; and Staphylococcus spp., 444 isolates) were recovered from monomicrobial and 33 polymicrobial blood cultures. After discrepant analysis, the overall ratios of Portrait Staph ID/R BCP positive percent agreement and negative percent agreement were 99.4%/99.9% for Staphylococcus ID and 99.7%/99.2% for mecA detection

Rapid early Holocene deglaciation of the Laurentide ice sheet

Author Posting. © Nature Publishing Group, 2008. This is the author's version of the work. It is posted here by permission of Nature Publishing Group for personal use, not for redistribution. The definitive version was published in Nature Geoscience 1 (2008): 620-624, doi:10.1038/ngeo285.The early Holocene deglaciation of the Laurentide Ice Sheet (LIS) is the most recent and best constrained disappearance of a large Northern Hemisphere ice sheet. Its demise is a natural experiment for assessing rates of ice sheet decay and attendant contributions to sea level rise. Here we demonstrate with terrestrial and marine records that the final LIS demise occurred in two stages of rapid melting from ~9.0- 8.5 and 7.6-6.8 kyr BP with the LIS contributing ~1.3 and 0.7 cm yr-1 to sea level rise, respectively. Simulations using a fully coupled atmosphere-ocean general circulation model suggest that increased ablation from enhanced early Holocene boreal summer insolation may have been the predominant cause of the LIS contributions to sea level rise. Although the boreal summer surface radiative forcing of early Holocene LIS retreat is twice that of projections for 2100 C.E. greenhouse gas radiative forcing, the associated summer surface air temperature increase is the same. The geologic evidence for rapid LIS retreat under a comparable forcing provides a prehistoric precedent for a possible large negative mass balance response of the Greenland Ice Sheet by the end of the coming century.This research was funded by National Science Foundation grants ATM-05-01351 & ATM-05-01241 to D.W.O. & G.A.S., start-up funds from the University of Wisconsin-Madison and a Woods Hole Oceanographic Institution Postdoctoral Scholarship to A.E.C., and the Woods Hole Oceanographic Institution's Ocean and Climate Change Institute (D.W.O. & R.E.C.)

Geochronology and paleoclimatic implications of the last deglaciation 2 of the Mauna Kea Ice Cap, Hawaii

This is the author's final peer-reviewed manuscript. It contains no copyediting.We present new 3He surface exposure ages on moraines and bedrock near the summit of Mauna Kea, Hawaii, which refine the age of the Mauna Kea Ice Cap during the Local Last Glacial Maximum (LLGM) and identify a subsequent fluctuation of the ice margin. The 3He ages, when combined with those reported previously, indicate that the local ice-cap margin began to retreat from its LLGM extent at 20.5 ± 2.5 ka, in agreement with the age of deglaciation determined from LLGM moraines elsewhere in the tropics. The ice-cap margin receded to a position at least 3 km upslope for ~5.1 kyr before readvancing nearly to its LLGM extent. The timing of this readvance at ~15.4 ka corresponds to a large reduction of the Atlantic meridional overturning circulation (AMOC) following Heinrich Event 1. Subsequent ice-margin retreat began at 14.6 ± 1.9 ka, corresponding to a rapid resumption of the AMOC and onset of the Bølling warm interval, with the ice cap melting rapidly to complete deglaciation. Additional 3He ages obtained from a flood deposit date the catastrophic outburst of a moraine-dammed lake roughly coeval with the Younger Dryas cold interval, suggesting a more active hydrological cycle on Mauna Kea at this time. A coupled mass balance and ice dynamics model is used to constrain the climate required to generate ice caps of LLGM and readvance sizes. The depression of the LLGM equilibrium line altitude requires atmospheric cooling of 4.5 ± 1 oC, whereas the mass balance modeling indicates an accompanying increase in precipitation of as much as three times that of present. We hypothesize (1) that the LLGM temperature depression was associated with global cooling, (2) that the temperature depression that contributed to the readvance occurred in response to an atmospheric teleconnection to the North Atlantic, and (3) that the precipitation enhancement associated with both events occurred in response to a southward shift in the position of the inter-tropical convergence zone (ITCZ). Such a shift in the ITCZ would have allowed midlatitude cyclones to reach Mauna Kea more frequently which would have increased precipitation at high elevations and caused additional cooling.Keywords: Glacial, Paleoclimate, Geochronolog

Multicenter evaluation of the Xpert Norovirus assay for detection of norovirus genogroups I and II in fecal specimens

Norovirus is the most common cause of sporadic gastroenteritis and outbreaks worldwide. The rapid identification of norovirus has important implications for infection prevention measures and may reduce the need for additional diagnostic testing. The Xpert Norovirus assay recently received FDA clearance for the detection and differentiation of norovirus genogroups I and II (GI and GII), which account for the vast majority of infections. In this study, we evaluated the performance of the Xpert Norovirus assay with both fresh, prospectively collected ( n = 914) and frozen, archived ( n = 489) fecal specimens. A Centers for Disease Control and Prevention (CDC) composite reference method was used as the gold standard for comparison. For both prospective and frozen specimens, the Xpert Norovirus assay showed positive percent agreement (PPA) and negative percent agreement (NPA) values of 98.3% and 98.1% for GI and of 99.4% and 98.2% for GII, respectively. Norovirus prevalence in the prospective specimens (collected from March to May of 2014) was 9.9% ( n = 90), with the majority of positives caused by genogroup II (82%, n = 74). The positive predictive value (PPV) of the Xpert Norovirus assay was 75% for GI-positive specimens, whereas it was 86.5% for GII-positive specimens. The negative predictive values (NPV) for GI and GII were 100% and 99.9%, respectively

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362