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IMPORTANCE: Patients with early-onset atrial fibrillation (AF) are enriched for rare variants in cardiomyopathy and arrhythmia genes. The clinical significance of these rare variants in patients with early-onset AF is unknown. OBJECTIVE: To assess the association between rare variants in cardiomyopathy and arrhythmia genes detected in patients with early-onset AF and time to death. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included participants with AF diagnosed before 66 years of age who underwent whole-genome sequencing through the National Heart, Lung and Blood Institute’s Trans-Omics for Precision Medicine program. Participants were enrolled from November 23, 1999, to June 2, 2015. Data were analyzed from February 26 to September 19, 2021. EXPOSURES: Rare variants identified in a panel of 145 genes that are included in cardiomyopathy and arrhythmia panels used by commercial clinical genetic testing laboratories. MAIN OUTCOMES AND MEASURES: The primary study outcome was time to death and was adjudicated from medical records and the National Death Index. Multivariable Cox proportional hazards regression was used to evaluate the association of disease-associated variants with risk of death after adjustment for age at AF diagnosis, sex, race, body mass index, left ventricular ejection fraction, and an interaction term of age at AF diagnosis and disease-associated variant status. RESULTS: Among 1293 participants (934 [72%] male; median age at enrollment, 56.0 years; IQR, 48.0-61.0 years), disease-associated (pathogenic or likely pathogenic) rare variants were found in 131 (10%). During a median follow-up of 9.9 years (IQR, 6.9-13.2 years), 219 participants (17%) died. In univariable analysis, disease-associated variants were associated with an increased risk of mortality (hazard ratio, [HR], 1.5; 95% CI, 1.0-2.1; P = .05); the association remained significant in multivariable modeling when adjusted for age at AF diagnosis, sex, race, body mass index, left ventricular ejection fraction, and an interaction term between disease-associated variant status and age at AF diagnosis. The interaction demonstrated that disease-associated variants were associated with a significantly higher risk of mortality compared with no disease-associated variant when AF was diagnosed at a younger age (P = .008 for interaction). Higher body mass index (per IQR: HR, 1.4; 95% CI, 1.2-1.6; P < .001) and lower left ventricular ejection fraction (per IQR: HR, 0.8; 95% CI, 0.7-0.8; P < .001) were associated with higher mortality risk. There were 73 cardiomyopathy-related deaths, 40 sudden deaths, and 10 stroke-related deaths. Mortality among patients with the most prevalent genes with disease-associated variants was 26% (10 of 38 patients) for TTN, 33% (6 of 18) for MYH7, 22% (2 of 9) for LMNA, 0% (0 of 10) for MYH6, and 0% (0 of 8) for KCNQ1. CONCLUSIONS AND RELEVANCE: The findings suggest that rare variants in cardiomyopathy and arrhythmia genes may be associated with increased risk of mortality among patients with early-onset AF, especially those diagnosed at a younger age. Genetic testing may provide important prognostic information for patients with early-onset AF.

Bubblers can improve and simplify furnace operation especially in the production of colored glass but the lack of flexibility and significant maintenance costs could still affect the total costs. A barrier booster offers higher melting capacity, better glass quality, greater flexibility, and lower maintenance costs but is more expensive to install and uses electrical energy which could be a costly energy source.

IMPORTANCE: Early-onset atrial fibrillation (AF) can be the initial manifestation of a more serious underlying inherited cardiomyopathy or arrhythmia syndrome. OBJECTIVE: To examine the results of genetic testing for early-onset AF. DESIGN, SETTING, AND PARTICIPANTS: This prospective, observational cohort study enrolled participants from an academic medical center who had AF diagnosed before 66 years of age and underwent whole genome sequencing through the National Heart, Lung, and Blood Institute’s Trans-Omics for Precision Medicine program. Participants were enrolled from November 23, 1999, to June 2, 2015. Data analysis was performed from October 24, 2020, to March 11, 2021. EXPOSURES: Rare variants identified in a panel of 145 genes that are included on cardiomyopathy and arrhythmia panels used by commercial clinical genetic testing laboratories. MAIN OUTCOMES AND MEASURES: Sequencing data were analyzed using an automated process followed by manual review by a panel of independent, blinded reviewers. The primary outcome was classification of rare variants using American College of Medical Genetics and Genomics criteria: benign, likely benign, variant of undetermined significance, likely pathogenic, or pathogenic. Disease-associated variants were defined as pathogenic/likely pathogenic variants in genes associated with autosomal dominant or X-linked dominant disorders. RESULTS: Among 1293 participants (934 [72.2%] male; median [interquartile range] age at enrollment, 56 [48-61] years; median [interquartile range] age at AF diagnosis, 50 [41-56] years), genetic testing identified 131 participants (10.1%) with a disease-associated variant, 812 (62.8%) with a variant of undetermined significance, 92 (7.1%) as heterozygous carriers for an autosomal recessive disorder, and 258 (20.0%) with no suspicious variant. The likelihood of a disease-associated variant was highest in participants with AF diagnosed before the age of 30 years (20 of 119 [16.8%; 95% CI, 10.0%-23.6%]) and lowest after the age of 60 years (8 of 112 [7.1%; 95% CI, 2.4%-11.9%]). Disease-associated variants were more often associated with inherited cardiomyopathy syndromes compared with inherited arrhythmias. The most common genes were TTN (n = 38), MYH7 (n = 18), MYH6 (n = 10), LMNA (n = 9), and KCNQ1 (n = 8). CONCLUSIONS AND RELEVANCE: In this cohort study, genetic testing identified a disease-associated variant in 10% of patients with early-onset AF (the percentage was higher if diagnosed before the age of 30 years and lower if diagnosed after the age of 60 years). Most pathogenic/likely pathogenic variants are in genes associated with cardiomyopathy. These results support the use of genetic testing in early-onset AF.

Diminished visual abilities may be an important risk factor for automobile crashes in older people. Researchers compared 99 drivers over age 55 who had had an at-fault car accident and 75 older drivers who had not. Drivers involved in an accident were significantly more likely to have a 40% or greater decrease in vision as measured by the useful field of view (UFOV) test. Drivers who had caused an accident were also more likely to be of black race or to have recently fallen down, and less likely to be taking beta-blocker medications.

Introduction Since its introduction in 1929, Arkansas' statutory income tax structure has changed very little. However, due to changes in the economy and in inflation, the real effects of that [...]

The methods of reducing the energy consumption by furnaces during the production of glass and ensuring compliance with the environmental regulations are described.

Electric boosting systems are often used to add energy to a conventional fossil fuel fired furnace. The technology is devolved from all-electric melting and normally involves the use of molybdenum [...]

Innovations in glass melting furnace design have resulted in higher melting rates per furnace which in turn, has led to more glass to condition and hotter glass that leave the melter. Cooling is therefore of great importance to the glass conditioning process of high capacity container facilities. The three basic factors to consider in cooling design are heat transfer, conduction and radiation. A discussion of various cooling systems is presented.

Melting furnace developments have increased melting rates for glass conditioning furnaces. Thus, hotter glass raises energy removal demand for the glass conditioning process. A preferred cooling process for such cases is heat transfer by radiation. Open radiation, direct air and indirect air cooling systems all offer distinct benefits and problems. Glass product users can apply the best possible cooling process that suits the glass conditioning process.

Describes the Japanese experience in the 1930s as fascist. Event that influenced the trend towards totalitarianism in the country; Major reason for the lack of consensus over the validity of the term Japanese fascism; Parallels and differences which existed between Japan and Italy and Germany.

Research shows a significant survival benefit in using angiotensin-converting enzyme (ACE) inhibitors for hospitalized elderly cardiac patients despite perceived contraindications. Studies were conducted on 295 heart failure patients aged 65 and older; ACE inhibitor prescription after hospital discharge was linked to lower overall one-year mortality.

While other hot end operations have advanced dramatically in recent years, there seems little apparent change in glass conditioning systems in the last twenty years. However, a closer look shows [...]

Takemae Eiji Continuum xlv + 751pp 40 £ ISBN 0 8264 6246 4 Japan: A Modern History James L. McClain W. W. Norton & Co. xxiii + 724pp 27.50 [pounds [...]

Compares the data disk drives in redundant arrays of independent disks (RAID)-1, RAID-5 and RAID-1+0. Raid level; Data availability; Performance comparison.

Part III. Considers several redundant array of independent disk configurations for optimal performance and efficiency in the field of information technology. Ways to measure disk system performance; Factors affecting data availability; Steps in maximizing computer input/output performance. INSET: Key Definitions.

Examines how disk drives impact application performance. Overview of benchmarking online data processing (OLTP); Dependence of transaction-intensive OLTP database applications; Discussion on queue depth.

Focuses on Japanese relations with France during the Franco-Chinese dispute of 1883-1885. French interest in military cooperation; Inclusion of cooperation with China under the Japanese foreign policy; Concerns on the maintenance of peace in the Far East.

OBJECTIVES:To examine associations between medical and functional variables and at‐fault car crashes in a cohort of older drivers.

Abstract: In recent years, the need for increasing the geriatrics component of residency training has been repeatedly addressed; however, there are still many programs that have been unable to meet this need. While alternative sites, such as geriatric evaluation units and nursing homes, may be the ideal sites to teach some aspects of geriatrics, this article argues that the ambulatory care program, required in all residency programs, is the appropriate setting for teaching many of the core skills needed to care for most older adults. Teaching geriatrics in the ambulatory setting, which eliminates the strategic and financial obstacles of developing non-hospital-based sites, can be accomplished with relatively modest additional resources. This article describes the methods used to integrate geriatrics into the ambulatory care component of one internal medicine residency program and the necessary faculty resources as well as the documentation, via chart audit, of the interns’ compliance with recommended practice patterns in five categories. With the exception of vaccination status, interns documented 18% or less of possible pieces of information for their patients. While this assessment showed statistically significant improvement in interns’ care of older patients after the program intervention, the overall level of performance was still low, underscoring the need for the integration of geriatrics principles in the ambulatory curriculum.

Dementia, delirium and depression are the 3 most prevalent mental disorders in the elderly. While dementia and depression are prevalent in the community, hospitals and nursing homes, delirium is seen most often in acute care hospitals. Much of the management of these syndromes is undertaken by primary care physicians rather than psychiatrists. Therefore, it is imperative that generalist physicians be adept at recognising, evaluating and managing patients with these syndromes.

In this article, the author reflects on his experiences with cowboy culture and horses in the Southwestern U.S. He begins by commenting on the practice of eating horse meat in foreign countries, and goes on to explain how feral horses were often caught and slaughtered for dog food in the 1930s. He also comments on the sculpture "Journey's End" by Sonny Rivera in Santa Fe, New Mexico, which depicts travel along the Santa Fe Trail.

The article provides information for visiting the Fort Sumner, New Mexico, Historic Site and Bosque Redondo Memorial as of autumn 2013.

The article discusses a bill passed by the New Mexico State Legislature in 2013 that was sponsored by state senator Pete Campos and state representative Don Tripp that changed the name of New Mexico State Monuments to New Mexico Historic Sites, and the interpretation of the word monument.