Treatment of Electrical Storm with Amiodarone in Brugada Syndrome- an Unexpected Protective Effect

We are reporting on a 53 year old man with proven Brugada syndrome and ICD implantation for resuscitation in context of polymorphic VT. After recurrent arrhythmia he was treated with Amiodarone. This showed to have a protective effect despite various reports suggesting avoiding Amiodarone in Brugada syndrome

The Impacts of Triclosan on Anaerobic Community Structures, Function, and Antimicrobial Resistance

Triclosan is a widespread antimicrobial agent that accumulates in anaerobic digesters used to treat the residual solids generated at municipal wastewater treatment plants; there is very little information, however, about how triclosan impacts microbial communities in anaerobic digesters. We investigated how triclosan impacts the community structure, function and antimicrobial resistance genes in lab-scale anaerobic digesters. Previously exposed (to triclosan) communities were amended with 5, 50, and 500 mg/kg of triclosan, corresponding to the median, 95th percentile, and 4-fold higher than maximum triclosan concentration that has been detected in U.S. biosolids. Triclosan amendment caused all of the Bacteria and Archaea communities to structurally diverge from that of the control cultures (based on ARISA). At the end of the experiment, all triclosan-amended Archaea communities had diverged from the control communities, regardless of the triclosan concentration added. In contrast, over time the Bacteria communities that were amended with lower concentrations of triclosan (5 mg/kg and 50 mg/kg) initially diverged and then reconverged with the control community structure. Methane production at 500 mg/kg was nearly half the methane production in control cultures. At 50 mg/kg, a large variability in methane production was observed, suggesting that 50 mg/kg may be a tipping point where function begins to fail in some communities. When previously unexposed communities were exposed to 500 mg triclosan/kg, function was maintained, but the abundance of a gene encoding for triclosan resistance (mexB) increased. This research suggests that triclosan could inhibit methane production in anaerobic digesters if concentrations were to increase and may also select for resistant Bacteria. In both cases, microbial community composition and exposure history alter the influence of triclosan

The Impacts of Triclosan on Anaerobic Community Structures, Function, and Antimicrobial Resistance

Triclosan is a widespread antimicrobial agent that accumulates in anaerobic digesters used to treat the residual solids generated at municipal wastewater treatment plants; there is very little information, however, about how triclosan impacts microbial communities in anaerobic digesters. We investigated how triclosan impacts the community structure, function and antimicrobial resistance genes in lab-scale anaerobic digesters. Previously exposed (to triclosan) communities were amended with 5, 50, and 500 mg/kg of triclosan, corresponding to the median, 95th percentile, and 4-fold higher than maximum triclosan concentration that has been detected in U.S. biosolids. Triclosan amendment caused all of the Bacteria and Archaea communities to structurally diverge from that of the control cultures (based on ARISA). At the end of the experiment, all triclosan-amended Archaea communities had diverged from the control communities, regardless of the triclosan concentration added. In contrast, over time the Bacteria communities that were amended with lower concentrations of triclosan (5 mg/kg and 50 mg/kg) initially diverged and then reconverged with the control community structure. Methane production at 500 mg/kg was nearly half the methane production in control cultures. At 50 mg/kg, a large variability in methane production was observed, suggesting that 50 mg/kg may be a tipping point where function begins to fail in some communities. When previously unexposed communities were exposed to 500 mg triclosan/kg, function was maintained, but the abundance of a gene encoding for triclosan resistance (mexB) increased. This research suggests that triclosan could inhibit methane production in anaerobic digesters if concentrations were to increase and may also select for resistant Bacteria. In both cases, microbial community composition and exposure history alter the influence of triclosan

Evaluation of the Specialist Community Public Health Nursing Peripatetic Assessment Model

The Health Visitor Implementation Plan 2011-15: a call to action, called for an additional 4200 health visitors to be trained by 2015. To accommodate larger numbers of students, specialist community public health nursing (SCPHN) programmes across the UK have undergone significant transformation in terms of practice supervision. Somerset Partnership NHS Trust introduced a peripatetic assessment model involving practice teachers and practice mentors. This differed from traditional one-to-one approaches of supervision to one-to-three. Practice teachers mostly supervised students through close collaboration with mentors who worked directly with students on a daily basis. Using a mixed methods approach, the evaluation aimed to assess the effectiveness of the new model from the perspective of SCPHN students, mentors, practice teachers (PTs) and managers. Data was collected through an anonymous online survey and individual interviews or focus groups. Overall, participants were positive about the peripatetic model’s impact on student learning and practice experience, in addition to the general up-skilling of the wider health visiting workforce and possible implications of continuation into the future. Any concerns raised focused on adequate preparation and support for mentors and the need for clear communication and role differentiation between practice teachers and mentors

Radiative Transfer and Radiative driving of Outflows in AGN and Starbursts

To facilitate the study of black hole fueling, star formation, and feedback in galaxies, we outline a method for treating the radial forces on interstellar gas due to absorption of photons by dust grains. The method gives the correct behavior in all of the relevant limits (dominated by the central point source; dominated by the distributed isotropic source; optically thin; optically thick to UV/optical; optically thick to IR) and reasonably interpolates between the limits when necessary. The method is explicitly energy conserving so that UV/optical photons that are absorbed are not lost, but are rather redistributed to the IR where they may scatter out of the galaxy. We implement the radiative transfer algorithm in a two-dimensional hydrodynamical code designed to study feedback processes in the context of early-type galaxies. We find that the dynamics and final state of simulations are measurably but only moderately affected by radiative forces on dust, even when assumptions about the dust-to-gas ratio are varied from zero to a value appropriate for the Milky Way. In simulations with high gas densities designed to mimic ULIRGs with a star formation rate of several hundred solar masses per year, dust makes a more substantial contribution to the dynamics and outcome of the simulation. We find that, despite the large opacity of dust to UV radiation, the momentum input to the flow from radiation very rarely exceeds L/c due to two factors: the low opacity of dust to the re-radiated IR and the tendency for dust to be destroyed by sputtering in hot gas environments. We also develop a simplification of our radiative transfer algorithm that respects the essential physics but is much easier to implement and requires a fraction of the computational cost.Comment: 25 pages, 17 figures, submitted to MNRA

Chelydra serpentina

Number of Pages: 4Integrative BiologyEarth and Planetary Science

Association of inferior vena cava filter placement for venous thromboembolic disease and a contraindication to anticoagulation with 30-day mortality

Importance: Despite the absence of data from randomized clinical trials, professional societies recommend inferior vena cava (IVC) filters for patients with venous thromboembolic disease (VTE) and a contraindication to anticoagulation therapy. Prior observational studies of IVC filters have suggested a mortality benefit associated with IVC filter insertion but have often failed to adjust for immortal time bias, which is the time before IVC filter insertion, during which death can only occur in the control group. Objective: To determine the association of IVC filter placement with 30-day mortality after adjustment for immortal time bias. Design, Setting, and Participants: This comparative effectiveness, retrospective cohort study used a population-based sample of hospitalized patients with VTE and a contraindication to anticoagulation using the State Inpatient Database and the State Emergency Department Database, part of the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality, from hospitals in California (January 1, 2005, to December 31, 2011), Florida (January 1, 2005, to December 31, 2013), and New York (January 1, 2005, to December 31, 2012). Data analysis was conducted from September 15, 2015, to March 14, 2018. Exposure: Inferior vena cava filter placement. Main Outcomes and Measures: Multivariable Cox proportional hazard models were constructed with IVC filters as a time-dependent variable that adjusts for immortal time bias. The Cox model was further adjusted using the propensity score as an adjustment variable. Results: Of 126 030 patients with VTE, 61 281 (48.6%) were male and the mean (SD) age was 66.9 (16.6) years. In this cohort, 45 771 (36.3%) were treated with an IVC filter, whereas 80 259 (63.7%) did not receive a filter. In the Cox model with IVC filter status analyzed as a time-dependent variable to account for immortal time bias, IVC filter placement was associated with a significantly increased hazard ratio of 30-day mortality (1.18; 95% CI, 1.13-1.22; P \u3c .001). When the propensity score was included in the Cox model, IVC filter placement remained associated with an increased hazard ratio of 30-day mortality (1.18; 95% CI, 1.13-1.22; P \u3c .001). Conclusions and Relevance: After adjustment for immortal time bias, IVC filter placement was associated with increased 30-day mortality in patients with VTE and a contraindication to anticoagulation. Randomized clinical trials are needed to determine the efficacy of IVC filter placement in patients with VTE and a contraindication to anticoagulation