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The Wolff-Parkinson-White (WPW) syndrome has been a known clinical entity for over fifty years. In 1967 Durrer et al postulated WPW syndrome was due to an accessory pathway, bypassing the AV node, from the atria to the ventricles1. This was later confirmed by epicardial mapping. WPW is the second most common cause of paroxysmal supraventricular tachycardias in the western world and the most common cause in China2. WPW syndrome has a prevalence of 1.5 to 3.1 per 1000 persons in western countries3,4,5 . Patients with the WPW syndrome may present with palpitations, presyncope, syncope, or sudden cardiac death (SCD). In some patients the first and only manifestation of the disease is SCD. This is more likely to occur in the setting of atrial fibrillation with a rapid ventricular response. Electrocardiographic findings of WPW syndrome consist of preexcitation manifested by a shortened PR interval (<120 msec), a widened QRS (>100 msec) a delta wave (abnormal initial QRS vector) and supraventricular tachycardia. The EKG finding of preexcitation is a result of early ventricular depolarization through the accessory pathway. SVT can occur with retrograde or antigrade conduction through the accessory pathway forming the basis of the so-called “macro-reentrant” arrhythmia model 6. Rapid conduction through the accessory pathway in the setting of atrial fibrillation markedly increases the risk of SCD7. We recently identified the gene responsible for familial Wolff-Parkinson-White 8. The gene (PRKAG2) which encodes for a protein AMPK (AMP- activated protein kinase) was identified as the causal gene. Missense (single nucleotide change) mutations in this gene were identified in families with WPW. Six such mutations have been identified. Along with preexcitation the affected families had conduction abnormalities (AV block) and cardiac hypertrophy. more...

The United States Supreme Court in Kennedy v. Bremerton Sch. Dist. held that a local school district violated the First Amendment freedom of religious expression rights when it directed an assistant football coach to stop praying on the fifty-yard line of a high school football field after each game. In finding for the high-school football coach, the U.S. Supreme Court significantly narrowed the use of the Establishment Clause of the Constitution to limit workplace religious activities of public-school teachers, school administrators, and other school district employes. The article argues that the decision will force school districts across the country to reassess their policies regarding the workplace religious activities of their employes including teachers. The article examines how the decision will impact school districts' regulation of workplace prayers by public school teachers and several types of symbolic religious speech. Finally, the article argues that school districts may need to update their policies and practices governing the workplace religious activities of their employes including teachers. more...

Probiotics are consumed in fermented dairy products or as capsules for their putative health benefits. However, little research has been done to evaluate the effects of the delivery matrix on the health benefits of probiotics in humans. To examine the effects of delivering Bifidobacterium animalis subsp. lactis BB-12 (BB-12) (log10 10 ± 0.5 CFU/day) via a yogurt smoothie versus a capsule, we monitored the fecal microbiota, gut transit times (GTTs), and fecal excretion of short-chain fatty acids (SCFAs) in healthy adults. In a randomized, four-period, crossover study performed in a partially blind manner, 36 adults were recruited and randomly assigned to four treatments: control yogurt smoothie (YS), yogurt smoothie with BB-12 added prefermentation (PRE), yogurt smoothie with BB-12 added postfermentation (POST), and capsule containing BB-12 (CAP). Participants' fecal microbiota was assessed using 16S rRNA sequencing, GTTs via SmartPill, and fecal SCFAs by gas chromatography (GC) before (baseline) and after each intervention. Participants had significantly higher percentage of Streptococcus after consuming YS versus CAP (P = 0.01). Bifidobacterium-specific terminal restriction fragment length polymorphism analysis revealed a significantly higher percentage of B. animalis after consuming PRE and POST compared to baseline, YS, CAP, and final washout (P < 0.0001). The predominant SCFAs were negatively correlated with GTTs. Consumption of BB-12 delivered in a yogurt smoothie or capsule did not significantly alter the composition of the gut microbiota, GTTs, or fecal SCFA concentration of the study cohort. However, daily consumption of BB-12 in yogurt smoothie may result in higher relative abundance of B. animalis in healthy adults. (This trial has been registered at ClinicalTrials.gov under identifier NCT01399996.) IMPORTANCE Bifidobacterium animalis subsp. lactis BB-12 is a probiotic strain that has been used worldwide since 1985. It has commonly been delivered in fermented dairy products for perceived benefits associated with gut health and enhanced immune function. In addition to fermented dairy products, many new probiotic-containing alternatives such as probiotic-containing juice, probiotic-containing chocolate, and capsules have been developed. While these products provide more options for people to access probiotics, little research has been done on the effect of delivery matrix (dairy versus nondairy) on their efficacy in humans. In addition, it was unclear how yogurt fermentation may influence the survival of BB-12 in the product or on its performance in vivo. The significance of our study is in simultaneously assessing the effect of BB-12, alone and in different delivery vehicles, on the gut transit time, fecal short-chain fatty acids, and the composition of the gut microbiota of the study cohort. more...

The United States Supreme Court in Groff v. DeJoy rejected a 50-year precedent regarding the application of Title VII of the United States Civil Rights to requests by private and public employees for Title VII workplace religious accommodations. The article evaluates the impact of 73 U.S. District Court and U.S. Court of Appeals decisions decided after Groff to determine whether Groff has had an impact on how lower federal courts have evaluated requests for Title VII workplace religious accommodations. The article also evaluates the role of U.S. District Courts as gatekeepers for Title VII workplace religious accommodation lawsuits. Finally, the article discusses the impact of Groff on the most common types of workplace religious accommodation requests. The article argues that employers will have greater difficulty persuading U.S. District Court to grant motions to dismiss or motions for summary judgment to end Title religious accommodation lawsuits. [ABSTRACT FROM AUTHOR] more...

Abstract\nPLAIN LANGUAGE SUMMARYIn the early 1970s, the FBI and federal prosecutors launched a war against state and local government public corruption. This crusade would not have been possible without the cooperation of the U.S. Supreme Court and lower federal prosecutors. Federal courts broadly construed the scope of several federal criminal statutes to prohibit certain types of state and local public corruption, even though Congress never intended that federal prosecutors use these statutes to prosecute state and local government officials on federal public corruption charges. Recent decades have seen the U.S. Supreme Court reverse course and narrowly construe several statutes to ally only to traditional types of public corruption, such as bribery and extortion by state and local government officials, and not apply to non-quid pro quo public corruption offenses. The article argues that these decisions will force state governments to take responsibility for regulating non-quid pro quo public corruption offenses that seriously weaken public trust in state and local government officials.The commentary discusses the impact of several U.S. Supreme Court decisions on the ability of the FBI and Federal prosecutors to prosecute state and local government officials on federal public corruption charges. What is the purpose of this summary?: To help readers understand the impact of U.S. Supreme Court decisions on federal prosecution of state and local government officials on federal public corruption charges. This summary is about the impact of recent U.S. Supreme Court decisions on federal prosecution of state and local government officials on federal public corruption charges. What is known?: A series of U.S. Supreme Court decisions have made it more difficult for federal prosecutors to use several federal criminal statutes to prosecute state and local officials on federal public corruption charges. What is new?: The summary helps to explain why the U.S. Supreme Court has narrowed the use of several criminal statutes to prosecute state and local governments on federal public corruption statutes. The summary explains that these decisions do not block federal prosecutors from prosecuting state and local government officials for bribery, false claims, and extortion but do block federal prosecutors from prosecuting, allowing federal prosecutors to prosecute state and local government officials for bribery, false claims, and extortion. In a series of decisions, the U.S. Supreme Court found that federal prosecutors had overreached by too broadly construing the scope of several federal criminal statutes. [ABSTRACT FROM AUTHOR] more...

IFT Approval of undergraduate food science and technology programs has continued to evolve since its inception in the 1960s. This report provides rationale and outlines key changes in the latest revisions of the IFT Approval Guidelines that were approved by the IFT Board of Directors in 2018. The 2018 Guidelines retained the previously established outcomes-based assessment model, but includes changes to Program Goals, redefined Standards, and measurable Essential Learning Outcomes. In addition, this report describes a new online submission platform. The report also provides insights into the training and review systems employed by the Higher Education Review Board. more...

ObjectivesTo identify the top priority areas for research to optimize pharmacotherapy in older adults with cardiovascular disease (CVD).DesignConsensus meeting.SettingMultidisciplinary workshop supported by the National Institute on Aging, the American College of Cardiology, and the American Geriatrics Society, February 6-7, 2017.ParticipantsLeaders in the Cardiology and Geriatrics communities, (officers in professional societies, journal editors, clinical trialists, Division chiefs), representatives from the NIA; National Heart, Lung, and Blood Institute; Food and Drug Administration; Centers for Medicare and Medicaid Services, Alliance for Academic Internal Medicine, Patient-Centered Outcomes Research Institute, Agency for Healthcare Research and Quality, pharmaceutical industry, and trainees and early career faculty with interests in geriatric cardiology.MeasurementsSummary of workshop proceedings and recommendations.ResultsTo better align older adults' healthcare preferences with their care, research is needed to improve skills in patient engagement and communication. Similarly, to coordinate and meet the needs of older adults with multiple comorbidities encountering multiple healthcare providers and systems, systems and disciplines must be integrated. The lack of data from efficacy trials of CVD medications relevant to the majority of older adults creates uncertainty in determining the risks and benefits of many CVD therapies; thus, developing evidence-based guidelines for older adults with CVD is a top research priority. Polypharmacy and medication nonadherence lead to poor outcomes in older people, making research on appropriate prescribing and deprescribing to reduce polypharmacy and methods to improve adherence to beneficial therapies a priority.ConclusionThe needs and circumstances of older adults with CVD differ from those that the current medical system has been designed to meet. Optimizing pharmacotherapy in older adults will require new data from traditional and pragmatic research to determine optimal CVD therapy, reduce polypharmacy, increase adherence, and meet person-centered goals. Better integration of the multiple systems and disciplines involved in the care of older adults will be essential to implement and disseminate best practices. J Am Geriatr Soc 67:371-380, 2019. more...

Exploring the concept of virtuous humility helps to highlight paths of human flourishing. Yet humility is difficult to study because it is often stereotyped as shame or self-abasement, it tends to defy uniform conceptualization across contexts and cultures, definitions are difficult to justify, and operationalizing humility challenges standard approaches in the social sciences. The present work develops a theory of interactive humility as openness to others (IHO) by foregrounding interaction and interpersonal context. IHO theory builds on a previously published theory of humility as the absence of the vices of pride and tests the new proposal against research done in conjunction with l'Arche communities. Conceptual networks from core l'Arche texts showed that openness ranks second among concepts most similar to humility (0.85), while humility ranks first for openness. These networks support the view that humility as openness in the context of l'Arche is primarily interactive and interpersonal, rather than intellectual. more...