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Acute aortic dissection is a challenging diagnosis for emergency physicians because of its high mortality and wide range of clinical presentations. We report a case of a previously healthy man who presented with hyperfamiliarity for faces syndrome as the predominant symptom of a large type A aortic dissection diagnosed by computed tomography angiography in the emergency department. Different elements of his presentation suggested possible other diagnoses, including transient global amnesia and transient ischemic attack. We discuss how evaluating these other diagnostic possibilities led to the correct diagnosis. Given increasing reports of painless aortic dissection, this case demonstrates the need to consider aortic dissection in patients with acute neurological symptoms.
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Disección Aórtica , Esposos , Humanos , Disección Aórtica/complicaciones , Disección Aórtica/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Tomografía Computarizada por Rayos X , AngiografíaRESUMEN
BACKGROUND: The Coronavirus disease 2019 (Covid-19) pandemic caused an abrupt disruption in clinical care and medical education, putting patients at increased risk for social stressors and displacing medical students from traditional clerkships. The pandemic also exposed the need for virtual tools to supplement clinical care and an opportunity to create meaningful roles for learners. METHODS: An interdisciplinary group designed a student-led virtual outreach program for patients with HIV whose care was limited by the pandemic. Patients were identified by clinicians and social workers using a clinic-based registry. Students called patients to conduct needs assessments, provide Covid-19 education, and to facilitate connection to services. Students participated in case-based didactics and workshops on motivational interviewing and patient engagement using virtual tools. Facilitated team meetings were held weekly during which themes of calls were identified. RESULTS: During a three-month period, five students participated in the outreach program. Two hundred sixteen patients were identified for outreach calls, of which 174 (75.9%) were successfully reached by telephone. Rate of completed phone call did not differ by age or gender. Sixty patients had a preferred language other than English of which 95.6% were reached in their preferred language. CONCLUSIONS: Virtual proactive outreach can be used as a tool to support patients and engage students in clinical care when access to in-person care is limited. This model of care could be adapted to other ambulatory practices and integrated into pre-clerkship curriculum as an introduction to the social history and structural drivers of health (SDOH) (245/350).
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COVID-19 , Infecciones por VIH , Estudiantes de Medicina , Centros Médicos Académicos , Boston , Curriculum , Infecciones por VIH/terapia , Humanos , Pandemias , Proyectos PilotoAsunto(s)
Negro o Afroamericano , Internado y Residencia , Racismo Sistemático , Humanos , Población Negra , Internado y Residencia/organización & administración , Internado y Residencia/normas , Estados Unidos , Racismo Sistemático/etnología , Racismo Sistemático/prevención & control , Racismo Sistemático/psicologíaRESUMEN
OBJECTIVE: To assess the value of transvaginal ultrasound parameters after cerclage placement in estimating the risk of spontaneous preterm birth. STUDY DESIGN: This is a retrospective cohort at a single tertiary care center from 2013 to 2016. Women carrying a singleton, nonanomalous fetus with cerclage in situ and at least one postcerclage transvaginal ultrasound from 160/7 to 256/7 weeks' gestation were included. In addition to abstracting maternal demographic and obstetric characteristics, two study investigators separately reviewed each of the images from the first transvaginal ultrasound after cerclage placement, masked to pregnancy outcomes. We measured the angle between the anterior uterine wall and cervical canal at the internal os and external os, closed canal length above and below the stitch, width of the anterior and posterior cervix at the level of the cerclage, and stitch distance from the cervical canal. The presence of additional ultrasound findings such as sludge and cervical funneling was also noted. The main outcomes were preterm birth < 34 weeks and preterm birth < 37 weeks. Transvaginal ultrasound parameters were compared between women with preterm birth and those without preterm birth using chi-square, Fisher's exact, and Wilcoxon's rank-sum tests, as appropriate. Log binomial regression was used to estimate the relative risk of preterm birth for all significant obstetric and ultrasound characteristics. RESULTS: A total of 102 women met inclusion criteria: 58% had history-indicated, 20% ultrasound-indicated, and 23% exam-indicated cerclages. Of these, 28 (27.5%) women delivered at < 34 weeks' gestation, and 48 (47.0%) women delivered at < 37 weeks' gestation. Preterm birth did not vary by race, maternal age, insurance, smoking, or gestational age of the earliest prior preterm birth (for multiparous women), but women who had preterm birth were more likely to have exam-indicated cerclage. There were several transvaginal ultrasound parameters associated with preterm birth < 34 weeks and preterm birth < 37 weeks. Of these, cervical length below the stitch, stitch distance from the cervical canal, straight cervical canal, funneling to or past the stitch, and presence of sludge had the greatest effect sizes. CONCLUSION: Rates of preterm birth are high postcerclage. In addition to measuring cervical length, utilization of postcerclage transvaginal ultrasound to evaluate the location of the cerclage within the cervix, the curvature of the cervical canal, and the presence of funneling and sludge may help identify women who are at the highest risk for preterm birth.
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Cerclaje Cervical , Medición de Longitud Cervical , Cuello del Útero/diagnóstico por imagen , Nacimiento Prematuro , Adulto , Cuello del Útero/anatomía & histología , Cuello del Útero/cirugía , Femenino , Humanos , Embarazo , Segundo Trimestre del Embarazo , Estudios Retrospectivos , Factores de Riesgo , Ultrasonografía PrenatalRESUMEN
We demonstrated the production of hydrogen, ethanol, and a variety of acids by several Clostridium species using cheese whey as substrate. These species were isolated from the anaerobic sediments of a municipal wastewater stabilization pond. Eight isolates were obtained and all were classified taxonomically as Clostridium spp. based on 16S rRNA sequencing. Sludge isolates showed maximum bioproduct production yields and productivities after approximately 24 h of batch cultivation with 6% (m/v) cheese whey. Fermentation byproducts measured included hydrogen, ethanol, acetic acid, butyric acid, and lactic acid. The maximum yields of bioproducts were 0.59 mol H(2)/mol lactose, 0.071 g ethanol/g, 0.204 g acetic acid/g, 0.218 g butyric acid/g, and 0.144 g lactic acid/g. The production of these high value biofuels and biofuel intermediates from cheese whey could have significant implications for conversion of waste to high value bioproducts to enhance domestic energy economies.
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Productos Biológicos/metabolismo , Queso/microbiología , Clostridium/metabolismo , Aguas Residuales/microbiología , Ácido Acético/metabolismo , Biocombustibles , Ácido Butírico/metabolismo , Clostridium/clasificación , Clostridium/genética , Etanol/metabolismo , Fermentación , Hidrógeno/metabolismo , Ácido Láctico/metabolismo , Lactosa/metabolismo , Filogenia , ARN Ribosómico 16S/química , Aguas del Alcantarillado/microbiologíaRESUMEN
Image-guided tumor ablative therapies are mainstay cancer treatment options but often require intra-procedural protective tissue displacement to reduce the risk of collateral damage to neighboring organs. Standard of care strategies, such as hydrodissection (fluidic injection), are limited by rapid diffusion of fluid and poor retention time, risking injury to adjacent organs, increasing cancer recurrence rates from incomplete tumor ablations, and limiting patient qualification. Herein, a "gel-dissection" technique is developed, leveraging injectable hydrogels for longer-lasting, shapeable, and transient tissue separation to empower clinicans with improved ablation operation windows and greater control. A rheological model is designed to understand and tune gel-dissection parameters. In swine models, gel-dissection achieves 24 times longer-lasting tissue separation dynamics compared to saline, with 40% less injected volume. Gel-dissection achieves anti-dependent dissection between free-floating organs in the peritoneal cavity and clinically significant thermal protection, with the potential to expand minimally invasive therapeutic techniques, especially across locoregional therapies including radiation, cryoablation, endoscopy, and surgery.
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With the rapid development of molecular techniques, particularly 'omics' technologies, the field of microbial ecology is growing rapidly. The applications of next generation sequencing have allowed researchers to produce massive amounts of genetic data on individual microbes, providing information about microbial communities and their interactions through in situ and in vitro measurements. The ability to identify novel microbes, functions, and enzymes, along with developing an understanding of microbial interactions and functions, is necessary for efficient production of useful and high value products in bioreactors. The ability to optimize bioreactors fully and understand microbial interactions and functions within these systems will establish highly efficient industrial processes for the production of bioproducts. This chapter will provide an overview of bioreactors and metagenomic technologies to help the reader understand microbial communities, interactions, and functions in bioreactors.
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Reactores Biológicos/microbiología , Seguimiento de Parámetros Ecológicos/métodos , Variación Genética , Metagenómica/métodos , Productos Biológicos/metabolismo , Reactores Biológicos/normas , Biota/genética , Seguimiento de Parámetros Ecológicos/normas , Ecosistema , Microbiología Industrial/métodos , Microbiología Industrial/normas , Metagenómica/normas , Interacciones Microbianas/genéticaRESUMEN
Objectives: Despite decades of literature recognizing racial disparities (RDs) in emergency medicine (EM), published curricula dedicated to addressing them are sparse. We present details of our novel RD curriculum for EM clerkships and its educational outcomes. Methods: We created a 30-min interactive didactic module on the topic designed for third- and fourth-year medical students enrolled in our EM clerkships. Through a modified Delphi process, education faculty and content experts in RD developed a 10-question multiple-choice test of knowledge on RD that the students completed immediately prior to and 2 weeks following the activity. Students also completed a Likert-style learner satisfaction survey. Median pre- and posttest scores were compared using a paired Wilcoxon signed-rank test and presented using medians and 95% confidence intervals (CIs). Satisfaction survey responses were dichotomized into favorable and neutral/not favorable. Results: For the 36 students who completed the module, the median pretest score was 40% (95% CI 36%-50%) and the posttest score was 70% (95% CI 60%-70%) with a p-value of <0.001. Thirty-five of the 36 students improved on the posttest with a mean increase of 24.2% (95% CI 20.2-28.2). The satisfaction survey also showed a positive response, with at least 83% of participants responding favorably to all statements (overall mean favorable response 93%, 95% CI 90%-96%).ConclusionsThis EM-based module on RD led to improvement in students' knowledge on the topic and positive reception by participants. This is a feasible option for educating students in EM on the topic of RD.
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Globally, treatment outcomes for people with multi-drug/rifampin-resistant tuberculosis (MDR/RR-TB) are sub-optimal, with MDR/RR-TB programs further weakened due to the COVID-19 pandemic, and in Haiti, by severe civil unrest. We assessed the impact of these disruptions on treatment outcomes at GHESKIO, in Port-au-Prince, Haiti. We conducted a retrospective analysis including all adults (age ≥18 years) who initiated MDR/RR-TB treatment at GHESKIO from 2010 to 2020. We assessed predictors of poor treatment outcome using multivariable logistic regression, adjusting for baseline characteristics and year of treatment. 453 patients initiated treatment for MDR/RR-TB at GHESKIO. Median age was 31 (IQR: 25, 40), 233 (51.4%) were male, and 100 (22.1%) were living with HIV. Three hundred sixty-nine patients (81.5%) achieved cure, 42 (9.3%) died, 40 (8.8%) were lost to follow-up and 2 (<1%) failed treatment. HIV status was associated with poor treatment outcome (aRR: 1.65 (95% CI: 1.09, 2.48)) but there was no difference by year of treatment initiation. Outcomes for patients with MDR/RR-TB remained outstanding, even during the COVID-19 pandemic and severe civil unrest in Haiti. We attribute this resilience in care to the adaptability of program staff and provision of economic and psychosocial support.
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I arrived to my shift early, nervous about caring for critically ill patients as a first-year fellow. I sat in the workroom alone, paralyzed, not sure how to preround despite being months into fellowship. The senior fellow appeared minutes before sign-out; fresh, knowledgeable, and calm, despite her busy night and lack of sleep. She asked me how I was doing. With tears in my eyes, my emotions poured out. I explained that I felt lost, unsure of myself, my place, and my knowledge. For the first time, I confessed out loud, "I don't think I'm supposed to be here. I have no idea what I'm doing." I could trust her in a way I couldn't trust others. She was like me: othered by her identity, minoritized by society. Though different from my own, her identity allowed her to understand my own experiences. We were different from one another and we were also the same. Unlike the senior faculty, it was safe to talk to her. And, unlike my other cofellows, there was a kinship between us in our otherness. She looked at me, closed the door, and shared words of strength that I needed to hear. I belonged. I was more than enough. She shared that the pressure I was experiencing was common among systematically minoritized individuals; she too had felt it before. Sitting with her, I was finally seen, supported, and comforted. As a peer mentor from a minoritized background, she provided a sense of security and belonging that had not been provided in my training and was distinct from the support of senior faculty.
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Docentes , Mentores , Femenino , Humanos , Grupo Paritario , SueñoRESUMEN
Patients with multidrug-resistant tuberculosis who received regimens containing high-dose isoniazid (INHHD) had similar time to culture conversion and treatment outcomes as patients who received regimens with bedaquiline. INHHD is an inexpensive and safe medication that may contribute additive efficacy in combination regimens.
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PURPOSE: To evaluate type II endoleak nidus volume (ENV) in the arterial phase (ENVAP) and delayed phase (ENVDP) of the first postoperative CT angiography (CTA) as a predictor of persistent endoleak and aneurysm sac enlargement at follow-up CTA in patients with endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm. MATERIALS AND METHODS: Ninety-three patients (mean age ± standard deviation, 72 years ± 8; range, 56-88 years) with EVAR and type II endoleak were included in a single-institution retrospective study conducted between March 1, 2005, and December 31, 2018. ENVAP, ENVDP, change of volume (ENVDP-AP), and percentage of ENVAP and ENVDP in aneurysm sac volume (ASV) (ENVAP/ASV%, ENVDP/ASV%, respectively) were measured on first postoperative CTA images. The mean follow-up was 31.6 months ± 26.6 (range, 6-163.8 months). Patients were divided into two groups (group A, spontaneous resolution of endoleak without intervention [n = 29] and group B, persistent endoleak at follow-up CTA [n = 64]) and compared by using the Mann-Whitney U, Wilcoxon signed rank, and Pearson χ2 tests. Receiver operating characteristic (ROC) analysis was used to compare accuracies of parameters at first postoperative CTA. RESULTS: The accuracy of ENVDP (area under the ROC curve [AUC], 0.78) was superior to the accuracy of ENVDP/ASV% (AUC, 0.76), ENVDP-AP (AUC, 0.74), ENVAP (AUC, 0.71), and ENVAP/ASV% (AUC, 0.69) in indicating persistent endoleak. In group B, 46 patients (72%) showed ASV enlargement and 44 patients (69%) underwent endoleak embolization. ENVAP (1.7 cm3 ± 2.9 vs 3.4 cm3 ± 4.2; P = .001), ENVDP (2.9 cm3 ± 3.8 vs 8.0 cm3 ± 9.6; P < .001), ENVDP-AP (1.1 cm3 ± 1.8 vs 4.5 cm3 ± 7.8; P < .001), ENVAP/ASV% (0.9% ± 1.5 vs 1.7% ± 2.2; P = .003), and ENVDP/ASV% (1.6% ± 2.2 vs 3.7% ± 3.6; P < .001) were smaller in group A than in group B. CONCLUSION: ENVDP of the first postoperative CTA is an accurate predictor of persistent endoleak compared with ENVAP, and persistent endoleak is associated with aneurysm sac enlargement, in which earlier intervention is recommended.© RSNA, 2021.
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OBJECTIVE: To promote equity in the Alpha Omega Alpha Honor Medical Society (AOA) selection process, clear and timely communication of eligibility criteria is needed. Herein, the authors describe and assess the effectiveness of a novel method for improving transparency in the AOA selection process while also teaching students key professional development skills. METHODS: The authors hosted curriculum vitae (CV) workshops for interested medical students. One part of each session was dedicated to sharing information about AOA and its selection process, while the rest focused on teaching students how to build effective CVs. After the most recent session, students were asked to complete a survey about the effectiveness of the workshop. RESULTS: Between 2019 and 2020, three CV workshops were hosted. Interest in the events was high, with approximately 15 to 30 first- and second-year medical students participating in each. Based on survey results, participants found the workshop helped them gain a better understanding of AOA eligibility and selection (100%, n = 10) and taught them key CV development skills (100%, n = 10). CONCLUSION: These workshops are a novel approach to disseminating AOA eligibility criteria and can be employed by medical schools to promote transparency in the AOA selection process. They also give students the skills to craft CVs that will better prepare them for applying to residency and other academic opportunities. As such medical schools and AOA chapters should consider implementing a similar model at their institutions.
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BACKGROUND: Gun violence in the United States is a significant public health concern. The high rate of weapons carriage by Americans places medical providers at risk for exposure to firearms in the workplace and provides an opportunity for patient safety counseling. Few curricular interventions have been published on teaching firearms safety principles to medical providers. Given the risk of encountering firearms in the workplace and the opportunity to engage patients in firearms safety counseling, providers may benefit from dedicated training on safely handling firearms. METHODS: This was a prospective cohort pilot study of a simulation-based educational intervention for third- and fourth-year medical students enrolled in an emergency medicine subinternship and emergency medicine bootcamp elective. Before undergoing the educational intervention, students completed a preintervention simulation case during which they discovered a model firearm in the patient's belongings and were asked to remove it. Students then received the intervention that included a discussion and demonstration on how to safely remove a firearm in the clinical setting. Two weeks later, the students were presented with a model firearm in a different simulation case, which they needed to remove. During the preintervention and postintervention simulations, students were evaluated on their performance of the critical actions in firearm removal using an 8-item checklist. Students' scores on this checklist were compared. RESULTS: Fifty-three students participated in the study, 25 of whom completed the postintervention assessment. The median number of correctly performed critical actions preintervention was 5 (interquartile range = 4-6) and postintervention was 7 (interquartile range = 6-8, P < 0.001). Students showed particular improvement in 4 steps: holding the firearm by the grip only, pointing the firearm in a safe direction at all times, removing the firearm from the immediate patient care area and placing it in a safe area, and ensuring that the firearm is monitored and untouched until police or security personnel arrive to secure it. CONCLUSIONS: This educational intervention is the first to formally teach students about the safe handling of firearms found in the clinical care space. This low-cost pilot project is easily transferrable to other training centers for teaching principles of safe firearms handling.
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Medicina de Emergencia , Armas de Fuego , Consejo , Humanos , Proyectos Piloto , Estudios Prospectivos , Seguridad , Estados UnidosRESUMEN
RATIONALE AND OBJECTIVES: Studies of medical school clerkship websites have reported efficient time management, resource utilization, and hands-on activities. We built a website devoted to medical student education in radiology to address student, educator, and school curricular needs and surveyed students to assess their satisfaction with the site. MATERIALS AND METHODS: The website was created using an easily-recalled name, no-cost institutional software, and no-cost enterprise-level university hardware. The main menu links to the student formal didactic lecture calendar, custom-built health sciences library e-resources in radiology, American College of Radiology Appropriateness Criteria, each radiology course page, and teaching files. Each course tab includes faculty-curated content from course lectures, supplemental articles and educational modules. At 6, 12, and 24 months, website analytics were assessed. At 12 and 24 months postimplementation, data were evaluated to include student assessment and satisfaction surveys and student course comments. This project was IRB-exempted. RESULTS: At 6 months, the website had received 5792 views, at 12 months 10,022 views and at 24 months 19,478 views. The website homepage with the formal didactic lecture calendar received 7156 views, the general clerkship page 4233 views, the teaching file page 3884, and thereafter subspecialty pages as follows: breast 1478, body 633, pediatrics 361, neuro 346, cardiothoracic 291, musculoskeletal 249, vascular interventional 178. One hundred fifty-two of 240 (63.3%) of students surveyed replied. Of students who utilized the website on the satisfaction survey, 80 of 97 (82.5%) indicated ratings of "extremely informative" and "very informative" to the question "How would you rate the website?." Students indicated convenience and structure as website strengths in their postcourse evaluations. CONCLUSION: The radiology medical student website incorporates demands and needs of today's students, faculty, and our medical school. A radiology clerkship website for medical students centralizes access to course resources and promotes an active learning experience with high satisfaction. Instructions on setting up a website are offered to today's radiology educators, including pearls and pitfalls.
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Prácticas Clínicas , Radiología , Estudiantes de Medicina , Niño , Curriculum , Humanos , Radiología/educación , Facultades de MedicinaRESUMEN
Spectra matching is widely used in various applications including the search for a spectrum of an unknown compound in an existing spectral database and quality control by means of comparing the spectra of products with standards. In this article, we present a new approach for calculating the similarities of Fourier-transform infrared (FTIR) spectra of organic compounds. Our method, named normalized local change (NLC) approach, incrementally calculates the spectral similarity based on the local spectral shapes. This allows for reducing the bias on the uneven weighing of large and/or broader peaks. In addition, the NLC approach is tolerant to the common issues in spectra matching including baseline offset, baseline sloping, and deviations in wavenumber axis alignment, suggesting its robustness and practical applicability. Performance evaluation confirmed that our NLC approach outperforms commonly used approaches for identifying FTIR spectra of an identical compound in a given dataset.
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INTRODUCTION: Tourniquets (TQs) save lives. Although military-approved TQs appear more effective than improvised TQs in controlling exsanguinating extremity hemorrhage, their bulk may preclude every day carry (EDC) by civilian lay-providers, limiting availability during emergencies. STUDY OBJECTIVE: The purpose of the current study was to compare the efficacy of three novel commercial TQ designs to a military-approved TQ. METHODS: Nine Emergency Medicine residents evaluated four different TQ designs: Gen 7 Combat Application Tourniquet (CAT7; control), Stretch Wrap and Tuck Tourniquet (SWAT-T), Gen 2 Rapid Application Tourniquet System (RATS), and Tourni-Key (TK). Popliteal artery flow cessation was determined using a ZONARE ZS3 ultrasound. Steady state maximal generated force was measured for 30 seconds with a thin-film force sensor. RESULTS: Success rates for distal arterial flow cessation were 89% CAT7; 67% SWAT-T; 89% RATS; and 78% TK (H 0.89; P = .83). Mean (SD) application times were 10.4 (SD = 1.7) seconds CAT7; 23.1 (SD = 9.0) seconds SWAT-T; 11.1 (SD = 3.8) seconds RATS; and 20.0 (SD = 7.1) seconds TK (F 9.71; P <.001). Steady state maximal forces were 29.9 (SD = 1.2) N CAT7; 23.4 (SD = 0.8) N SWAT-T; 33.0 (SD = 1.3) N RATS; and 41.9 (SD = 1.3) N TK. CONCLUSION: All novel TQ systems were non-inferior to the military-approved CAT7. Mean application times were less than 30 seconds for all four designs. The size of these novel TQs may make them more conducive to lay-provider EDC, thereby increasing community resiliency and improving the response to high-threat events.
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Traumatismos del Brazo/terapia , Hemorragia/prevención & control , Traumatismos de la Pierna/terapia , Torniquetes , Servicios Médicos de Urgencia , Socorristas , Diseño de Equipo , HumanosRESUMEN
BACKGROUND: Current reforms in K-12 STEM education call for integration between science, technology, engineering, and mathematics (STEM). Such integration of STEM disciplines at the K-12 level offers students an opportunity to experience learning in real-world, multidisciplinary contexts; however, there is little reported research about teachers' experiences in engaging in integrated STEM instruction. The purpose of this phenomenological multiple case study is to understand nine science teachers' first-time experiences in implementing integrated STEM curricular units in their middle school physical science classrooms. This study draws upon both classroom implementation data and teacher reflective interviews to illustrate different degrees of integrated STEM instruction and to understand teachers' challenges and successes with these varying approaches. RESULTS: Our results indicate three distinct cases of integration within our sample that represent low, medium, and high degrees of STEM integration throughout curriculum implementations. Interviews with teachers from each case revealed three themes that varied across teachers' experiences: the nature of integration, choosing between science and engineering, and student engagement and motivation. Teachers in all three cases were challenged to make explicit connections between science, engineering, and mathematics while simultaneously maintaining a motivating and engaging context for their students throughout their instruction. Further, it appears that the degree of STEM integration that occurs in instruction may be related to teachers' ability to make explicit connections between the disciplines. CONCLUSIONS: The work presented here informs educational researchers, policy makers, and K-12 STEM educators that there are several challenges when it comes to implementing new STEM initiatives in K-12 education. Although this work is limited to middle school physical science teachers' experiences with first-time STEM instruction, many of the identified themes are not content-specific; therefore, this work may shed light on general struggles that are common to educators who are integrating across content disciplines for the first time.
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Nitrate and radioiodine (129I) contamination is widespread in groundwater underneath the Central Plateau of the Hanford Site. 129I, a byproduct of nuclear fission, is of concern due to a 15.7 million year half-life, and toxicity. The Hanford 200 West Area contains plumes covering 4.3â¯km2 with average 129I concentrations of 3.5 pCi/L. Iodate accounts for 70.6% of the iodine present and organo-iodine and iodide make up 25.8% and 3.6%, respectively. Nitrate plumes encompassing the 129I plumes have a surface area of 16â¯km2 averaging 130â¯mg/L. A nitrate and iodate reducing bacterium closely related to Agrobacterium, strain DVZ35, was isolated from sediment incubated in a 129I plume. Iodate removal efficiency was 36.3% in transition cultures, and 47.8% in anaerobic cultures. Nitrate (10â¯mM) was also reduced in the microcosm. When nitrate was spiked into the microcosms, iodate removal efficiency was 84.0% and 69.2% in transition and anaerobic cultures, respectively. Iodate reduction was lacking when nitrate was absent from the growth medium. These data indicate there is simultaneous reduction of nitrate and iodate by DVZ35, and iodate is reduced to iodide. Results provide the scientific basis for combined nitrogen and iodine cycling throughout the Hanford Site.