Anxiety Associated With Increased Risk for Emergency Department Recidivism in Patients With Low-Risk Chest Pain

Anxiety contributes to the chest pain symptom complex in 30% to 40% of patients with low-risk chest pain seen in the emergency department (ED). The validated Hospital Anxiety Depression Scale-Anxiety subscale (HADS-A) has been used as an anxiety screening tool in this population. The objective was to determine the prevalence of abnormal HADS-A scores in a cohort of low-risk chest pain patients and test the association of HADS-A score with subsequent healthcare utilization and symptom recurrence. In a single-center, prospective, observational cohort study of adult ED subjects with low-risk chest pain, the HADS-A was used to stratify participants into 2 groups: low anxiety (score <8) and high anxiety (score ≥8). At 45-day follow-up, chest pain recurrence was assessed by patient report, whereas ED utilization was assessed through chart review. Of the 167 subjects enrolled, 78 (47%) were stratified to high anxiety. The relative risk for high anxiety being associated with at least one 30-day ED return visit was 2.6 (95% confidence interval 1.4 to 4.7) and this relative risk increased to 9.1 (95% confidence interval 2.18 to 38.6) for 2 or more ED return visits. Occasional chest pain recurrence was reported by more subjects in the high anxiety group, 68% vs 47% (p = 0.029). In conclusion, 47% of low-risk chest pain cohort had abnormal levels of anxiety. These patients were more likely to have occasional recurrence of their chest pain and had an increased risk multiple ED return visits

Adjuvant Chemotherapy for Early Stage Non-Small Cell Lung Cancer

For many years adjuvant chemotherapy has been a standard treatment after complete resection in malignancies such as breast and colon but only recently has its use become standard in early stage non-small cell lung cancer (NSCLC). Although surgery is regarded as the best possible treatment for early stage NSCLC, only 20–25% of patients have resectable disease at presentation. Despite optimal surgical treatment, 5-year survival rates for NSCLC remain 50–60% for stage IB, 40–50% for stage II, and 20–30% for stage III (Kohler et al., 2011; Siegel et al., 2011). Adjuvant chemotherapy provides additional survival benefit in resected NSCLC but questions remain as to how to select patients for therapy and which regimen is best. Other than work with tegafur/uracil in Japan, the positive adjuvant trials have all utilized a cisplatin backbone, but the drug(s) to pair with cisplatin are a matter of debate and will be discussed further in this manuscript

Life Test Based on Progressively Group-Censored Samples From Exponential Distribution With Periodic Change in Failure Rate

A life test experiment based on progressively group censored sample with periodic change in the failure rate of an exponential distribution is considered. Estimates of the two failure rates under different conditions of usage of an item together with their asymptotic standard error are obtained by the method of maximum likelihood. A numerical example is given using the data available in the form of grouped observations under two conditions of usage during alternate time intervals of fixed lengths T/Sub1 and T/Sub2

A pilot survey of junior doctors’ attitudes and awareness around medication review: time to change our educational approach?

© 2015, BMJ Publishing Group. All rights reserved.Objectives Our aim was to explore junior doctors attitudes and awareness around concepts related to medication review, in order to find ways to change the culture for reviewing, altering and stopping inappropriate or unnecessary medicines. Having already demonstrated the value of team working with senior doctors and pharmacists and the use of a medication review tool, we are now looking to engage first year clinicians and undergraduates in the process. Method An online survey about medication review was distributed among all 42 foundation year one (FY1) doctors at the Chelsea and Westminster Hospital NHS Foundation Trust in November 2014. Descriptive statistics were used for analysis. Results Twenty doctors completed the survey (48%). Of those, 17 believed that it was the pharmacists duty to review medicines; and 15 of 20 stated the general practitioner (GP). Sixteen of 20 stated that they would consult a senior doctor first before stopping medication. Eighteen of 20 considered the GP and consultant to be responsible for alterations, rather than themselves. Sixteen of 20 respondents were not aware of the availability of a medication review tool. Seventeen of 20 felt that more support from senior staff would help them become involved with medication review. Conclusions Junior doctors report feeling uncomfortable altering mediations without consulting a senior first. They appear to be building confidence with prescribing in their first year but not about the medication review process or questioning the drugs already prescribed. Consideration should be given to what we have termed a bottom-up educational approach to provide early experience of and change the culture around medication review, to include the education of undergraduate and foundation doctors and pharmacists

Techniques for the Synthesis of Reversible Toffoli Networks

This paper presents novel techniques for the synthesis of reversible networks of Toffoli gates, as well as improvements to previous methods. Gate count and technology oriented cost metrics are used. Our synthesis techniques are independent of the cost metrics. Two new iterative synthesis procedure employing Reed-Muller spectra are introduced and shown to complement earlier synthesis approaches. The template simplification suggested in earlier work is enhanced through introduction of a faster and more efficient template application algorithm, updated (shorter) classification of the templates, and presentation of the new templates of sizes 7 and 9. A novel ``resynthesis'' approach is introduced wherein a sequence of gates is chosen from a network, and the reversible specification it realizes is resynthesized as an independent problem in hopes of reducing the network cost. Empirical results are presented to show that the methods are effective both in terms of the realization of all 3x3 reversible functions and larger reversible benchmark specifications.Comment: 20 pages, 5 figure

Coexistence of high-bit-rate quantum key distribution and data on optical fiber

Quantum key distribution (QKD) uniquely allows distribution of cryptographic keys with security verified by quantum mechanical limits. Both protocol execution and subsequent applications require the assistance of classical data communication channels. While using separate fibers is one option, it is economically more viable if data and quantum signals are simultaneously transmitted through a single fiber. However, noise-photon contamination arising from the intense data signal has severely restricted both the QKD distances and secure key rates. Here, we exploit a novel temporal-filtering effect for noise-photon rejection. This allows high-bit-rate QKD over fibers up to 90 km in length and populated with error-free bidirectional Gb/s data communications. With high-bit rate and range sufficient for important information infrastructures, such as smart cities and 10 Gbit Ethernet, QKD is a significant step closer towards wide-scale deployment in fiber networks.Comment: 7 pages, 5 figure

Clinical, biochemical and haematological changes in leptospirosis

Background: Leptospirosis is a globally important zoonotic disease caused by pathogenic leptospira. Leptospira species are spirochetes belonging to the order spirochetes and the family leptospiraceae. Present study is done to find out the incidence of thrombocytopenia in leptospirosis and to correlate it with other parameters like renal dysfunction, hepatic dysfunction and bleeding manifestation.Methods: Study includes 51 clinically suspected and diagnosed cases of leptospirosis, in Government hospital, South Gujarat, during a period from January 2017 to December 2017. Clinical signs and symptoms and complications, biochemical profile like bilirubin and creatinine, haematological profile like Hb, WBC count and platelet count were recorded. Thrombocytopenia was defined as a platelet count below 1,50,000/cmm.Results: The present study includes 51 cases of Leptospirosis. Age ranged from 16 years to 61 years (male-39 and Females-12) There were 38 (74.5%) cases with thrombocytopenia and 13 (25.4%) cases with normal platelet count. Out of 38 thrombocytopenic cases, 32 (84.2%) cases had renal dysfunction, 26 (68.4%) cases had hepatic dysfunction and 16 (42.1%) cases had pulmonary haemorrhage. Among 13 cases with normal platelet count, 8 (61.5%) cases had hepatic dysfunction and 7 (53.8%) cases had renal dysfunction and 3 (23%) cases had pulmonary haemorrhage.Conclusions: Thrombocytopenia is a frequent complication (present in more than half of the patient) in leptospirosis and associated with more frequent and more severe complications. Therefore, early recognition of thrombocytopenia is recommended to prevent complications and mortality in leptospirosis