Comparison of the diagnostic yield and outcomes between standard 8 h capsule endoscopy and the new 12 h capsule endoscopy for investigating small bowel pathology

AIM: To evaluate the completion rate and diagnostic yield of the PillCam SB2-ex in comparison to the PillCam SB2. METHODS: Two hundred cases using the 8-h PillCam SB2 were retrospectively compared to 200 cases using the 12 h PillCam SB2-ex at a tertiary academic center. Endoscopically placed capsules were excluded from the study. Demographic information, indications for capsule endoscopy, capsule type, study length, completion of exam, clinically significant findings, timestamp of most distant finding, and significant findings beyond 8 h were recorded. RESULTS: The 8 and 12 h capsule groups were well matched respectively for both age (70.90 +/- 14.19 vs 71.93 +/- 13.80, P = 0.46) and gender (45.5% vs 48% male, P = 0.69). The most common indications for the procedure in both groups were anemia and obscure gastrointestinal bleeding. PillCam SB2-ex had a significantly higher completion rate than PillCam SB2 (88% vs 79.5%, P = 0.03). Overall, the diagnostic yield was greater for the 8 h capsule (48.5% for SB2 vs 35% for SB2-ex, P = 0.01). In 4/70 (5.7%) of abnormal SB2-ex exams the clinically significant finding was noted in the small bowel beyond the 8 h mark. CONCLUSION: In our study, we found the PillCam SB2-ex to have a significantly increased completion rate, though without any improvement in diagnostic yield compared to the PillCam SB2

An Exploratory Graphical Method for Identifying Associations in r x c Contingency Tables

On finding a significant association between rows and columns of an r x c contingency table, the next step is to study the nature of the association in more detail. The use of a scree plot to visualize the largest contributions to Χ2 among all cells in the table in order to determine the nature of the association in more detail is proposed

Reduce, Reuse, Recycle: Planetary Nebulae as Green Galactic Citizens

We review gas-phase abundances in PNe and describe their dual utility as archives of original progenitor metallicity via the alpha elements, as well as sources of processed material from nucleosynthesis during the star's evolution, i.e., C, N, and s-process elements. We describe the analysis of PN spectra to derive abundances and discuss the discrepancies that arise from different choices at each step. Abundance results for the Milky Way and Magellanic Clouds from various groups of investigators are presented; the observational results are compared with theoretical predictions of AGB stellar yields. Finally, we suggest areas where more work is needed to improve our abilities to determine abundances in PNe.Comment: 8 pages, 7 figures, 1 table. Invited review presented at the IAU Symposium No. 283, Planetary Nebulae: an Eye to the Futur

Zero Field precession and hysteretic threshold currents in spin torque oscillators with tilted polarizer

Using non-linear system theory and numerical simulations we map out the static and dynamic phase diagram in zero applied field of a spin torque oscillator with a tilted polarizer (TP-STO).We find that for sufficiently large currents, even very small tilt angles (beta>1 degree) will lead to steady free layer precession in zero field. Within a rather large range of tilt angles, 1 degree< beta <19 degree, we find coexisting static states and hysteretic switching between these using only current. In a more narrow window (1 degree<beta<5 degree) one of the static states turns into a limit cycle (precession). The coexistence of static and dynamic states in zero magnetic field is unique to the tilted polarizer and leads to large hysteresis in the upper and lower threshold currents for TP-STO operation.Comment: 5 pages, 4 figure

Oxo and Oxofree Rhenium(V) Complexes with N,O-donor Schiff Bases

The reaction between cis-[ReVO2I(PPh3)2] and H3duo (N-(2-hydroxybenzylidene)-5-amino-1,3-dimethyl uracil) led to the formation of the oxofree, imido compound, trans-[ReV(ddd)(Hduo)(PPh3)2]I (1) (H2ddd=5,6-diamino-1,3-dimethyluracil). An oxo complex, cis-[ReV(bcp)OCl2(PPh3)](2) [Hbcp = N-(2-hydroxybenzylidene)-benzothiazole] was isolated from the reaction of trans-[ReOVCl3(PPh3)2] with Hbcp. The crystal structures of the compounds were determined by single crystal X-ray diffraction.Keywords: Rhenium(V), imido, oxo, crystal structure, spectral characterizatio

Flow cytometric S-phase fraction in soft-tissue sarcoma: prognostic importance analysed in 160 patients.

We could determine the S-phase fraction (SPF) by flow cytometric DNA analysis of paraffin archival material in 160 of 260 patients with soft-tissue sarcoma of extremity and trunk wall. The prognostic value of SPF was compared with other clinicopathological factors. The median follow-up time was 16 (6-31) years. In a univariate analysis, deep tumour location, increasing tumour size and histological malignancy grade, microscopic tumour necrosis, vascular invasion, DNA non-diploidy and high SPF (>3.0%) were associated with poor metastasis-free survival. In a multivariate analysis, microscopic tumour necrosis and high SPF were independently prognostic for metastasis. Used in combination with tumour size, microscopic tumour necrosis and vascular invasion, SPF could identify a group of patients with a 5-year metastasis-free survival rate of 0.97. This group constituted one-quarter of all patients. Patients with low SPF who did recur had a prolonged clinical course both as regards metastases and local recurrence. We conclude that SPF is a valuable adjunct in prognostication in soft-tissue sarcoma

Did we do everything we could have? Nurses’ contributions to medicines optimisation: a mixed method study

Aim To explore UK professionals’ interpretations of medicines optimization and expansion of nurses’ roles. Design This mixed‐methods study sought professionals’ views on nurses’ involvement, competency and engagement in monitoring patients for adverse effects of medicines, monitoring adherence, prescribing and patient education. Method An online survey and interviews were undertaken with nurses, doctors and pharmacists in Wales and England, May 2018 to July 2019. Results In all, 220 nurses, 17 doctors and 62 pharmacists responded to the online survey, and 24 professionals were interviewed. Nurses were divided over extending their roles, with 123/220 (55.9%) wishing to extend roles in monitoring patients for possible adverse drug reactions (ADRs), 111/220 (50.5%) in adherence monitoring, 121/220 (55.0%) in prescribing and 122/220 (55.4%) in patient education. The best‐qualified nurses were the most willing to increase involvement in monitoring patients for ADRs (aOR 13.00, 1.56–108.01). Interviews revealed that both nurses and doctors assumed the other profession was undertaking this monitoring. Respondents agreed that increasing nurses’ involvement in medicines optimization would improve patient care, but expressed reservations about nurses’ competencies. Collaboration between nurses and doctors was suboptimal (rated 7/10 at best) and between nurses and pharmacists even more so (6/10 at best). Conclusion Juxtaposition of datasets identified problems with medicines optimization: although most respondents agreed that increasing nurses’ involvement would positively impact practice, their educational preparation was a barrier. Only ~50% of nurses were willing to expand their roles to fill the hiatus in care identified and ensure that at least one profession was taking responsibility for ADR monitoring. Impact To improve multiprofessional team working and promote patient safety, nurse leaders should ensure patients are monitored for possible ADRs by at least one profession. Initiatives expanding nurses’ roles in medicines optimization and prescribing might be best targeted towards the more educated nurses, who have multidisciplinary support

Competence acquisition for single-incision laparoscopic cholecystectomy

BACKGROUND AND OBJECTIVES: Within the past few years, there has been a push for an even more minimally invasive approach to biliary disease with the adoption of single-incision laparoscopic cholecystectomy. We sought to compare 4 individual surgeon experiences to define whether there exists a learning curve for performing single-incision laparoscopic cholecystectomy. METHODS: We performed a retrospective review 290 single-incision laparoscopic cholecystectomies performed by a group of general surgeons, with varying levels of experience and training, at 3 institutions between May 2008 and September 2010. The procedure times were recorded for each single-incision laparoscopic cholecystectomy, ordered chronologically for each surgeon, and subsequently plotted on a graph. The patients were also combined into cohorts of 5 and 10 cases to further evaluate for signs of improvement in operative efficiency. RESULTS: Of the 4 surgeons involved in the study, only 1 (surgeon 4, laparoscopic fellowship trained with \u3c5 \u3eyears\u27 experience) confirmed the presence of a learning curve, reaching proficiency within the first 15 cases performed. The other surgeons had more variable procedure times, which did not show a distinct trend. When we evaluated the cases by cohorts of 5 cases, surgeon 4 had a significant difference between the first and last cohort. Increased body mass index resulted in a slightly longer operative time (P \u3c .0063). The conversion rate to multiport laparoscopic surgery was 3.1%. CONCLUSIONS: Our results indicate that among experienced general surgeons, there does not seem to be a significant learning curve when transitioning from conventional laparoscopic cholecystectomy to single-incision laparoscopic cholecystectomy. The least experienced surgeon in the group, surgeon 4, appeared to reach proficiency after 15 cases. Greater than 5 years of experience in laparoscopic surgery appears to provide surgeons with a sufficient skill set to obviate the need for a single-incision laparoscopic cholecystectomy learning curve

Lightweight composite fighting cover prototype development program

The U.S. Army Field Assistance Science and Technology Program requested Oak Ridge National Laboratory (ORNL) to demonstrate the use of lightweight composite materials in construction of overhead covers for reinforced infantry fighting positions. In recent years, ORNL researchers have designed and tested several concepts for lightweight ballistic protection structures, and they have developed numerous prototype composite structures for military and civilian applications. In the current program, composite panel designs and materials are tested and optimized to meet anticipated static and dynamic load conditions for the overhead cover structure. Ten prototype composite covers were built at ORNL for use in Army field tests. Each composite cover has a nominal surface area of 12 ft[sup 2] and a nominal weight of 8 lb. Four of the prototypes are made with folding sections to improve their handling characteristics. The composite covers exhibit equivalent performance in Army field tests to covers made with conventional materials that weigh four times as much