Redbook: 1997

Advice compiled by Boston University School of Medicine students for incoming first year students and third or fourth year students preparing for clinical rotations

Oxaliplatin-induced acquired long QT syndrome with torsades de pointes and myocardial injury in a patient with dilated cardiomyopathy and rectal cancer

AbstractA 67-year-old woman presented with a history of dilated cardiomyopathy with congestive heart failure since 2003, who subsequently developed lower rectal cancer (adenocarcinoma) with liver, bone, and lymph node metastasis. Abdominoperineal resection and hepatectomy were performed. The patient received two rounds of intravenous chemotherapy, including 12 and six courses of FOLFOX4 (5-fluorouracil, leucovorin, and oxaliplatin; 85 mg/m2 per cycle). She underwent a third round of intravenous FOLFOX4 because of tumor progression. During the 21st course of FOLFOX4 regimen, the patient developed ST segment depression in lead II and prolongation of QT interval with polymorphic ventricular tachycardia, torsades de pointes right after the start of oxaliplatin infusion. Immediate defibrillation and cardiopulmonary resuscitation were administered, and the patient regained spontaneous circulation and consciousness. Twelve-lead electrocardiogram showed ST segment elevation in III, aVF, and ST segment depression in V4–6 after resuscitation. To our knowledge, prolongation of QT interval with torsades de pointes and coronary spasm with myocardial injury that were stabilized in one patient following oxaliplatin infusion has not been reported. We present a patient with these rare complications

Comparison of extracorporeal shock wave lithotripsy running models between outsourcing cooperation and rental cooperation conducted in Taiwan

Background/PurposeWe conducted a retrospective study to compare the cost and effectiveness between two different running models for extracorporeal shock wave lithotripsy (SWL), including the outsourcing cooperation model (OC) and the rental cooperation model (RC).MethodsBetween January 1999 and December 2005, we implemented OC for the SWL, and from January 2006 to October 2011, RC was utilized. With OC, the cooperative company provided a machine and shared a variable payment with the hospital, according to treatment sessions. With RC, the cooperative company provided a machine and received a fixed rent from the hospital. We calculated the cost of each treatment session, and evaluated the break-even point to estimate the lowest number of treatment sessions to make the balance between revenue and cost every month. Effectiveness parameters, including the stone-free rate, the retreatment rate, the rate of additional procedures and complications, were evaluated.ResultsCompared with OC there were significantly less treatment sessions for RC every month (42.6±7.8 vs. 36.8±6.5, p=0.01). The cost of each treatment session was significantly higher for OC than for RC (751.6±20.0 USD vs. 684.7±16.7 USD, p=0.01). The break-even point for the hospital was 27.5 treatment sessions/month for OC, when the hospital obtained 40% of the payment, and it could be reduced if the hospital got a greater percentage. The break-even point for the hospital was 27.3 treatment sessions/month for RC. No significant differences were noticed for the stone-free rate, the retreatment rate, the rate of additional procedures and complications.ConclusionOur study revealed that RC had a lower cost for every treatment session, and fewer treatment sessions of SWL/month than OC. The study might provide a managerial implication for healthcare organization managers, when they face a situation of high price equipment investment

A new cable clip module with moveable cable clip

For a server system, we would have many kinds of configurations for customer’s different application. Some configurations like 2.5” / 3.5” HDD or different length PSU might have different PCBA, cable, mechanical part and cable clip in the chassis. It will have the part’s maintenance and inventory cost on these parts for different configuration. So if we could use the same part at different configuration, it will reduce our cost. So we propose a new cable clip module with moveable cable clip to let the cable routing more flexible by moving the location of the cable clip. By using this cable clip module, we could use the same cable for different configuration like different length PSU and different size HDD. And we also could use the cable clip module at the same location in the chassis for these configurations

Porosity-engineered carbons for supercapacitive energy storage using conjugated microporous polymer precursors

Conjugated microporous polymers (CMPs) are considered an important material, combining aspects of both microporosity and extended π-conjugation. However, pristine CMP electrodes suffer from poor electrical conductivity which limits the material in electrochemical applications. In this work, direct carbonisation of conjugated microporous polymers (CMPs) yields porosity-engineered carbons, important for the flow of ions through the electrode. These conductive carbonised CMPs show specific capacitance as high as 260 F g−1, excellent rate capability and no loss in performance after 10 000 charge/discharge cycles. This study provides a procedure to enhance the performance of CMP-based materials, opening up a new source of electroactive materials

Two Cases of Acute Leukopenia Induced by Colchicine with Concurrent Immunosuppressants Use in Behçet's Disease

Colchicine-induced leukopenia usually occurrs in intentional or accidental overdoses or inappropriate use in combination with intravenous and oral colchine; however, there have been several reports of hematologic toxicity in short-term and small-dose colchicine medication courses. We present two cases of leukopenia induced by colchicine use concurrent with immunosuppressants in Behçet's disease. We postulate that the mechanism of colchicine-induced leukopenia might be the destruction of circulating leukocytes and an inhibition of leukocyte production by the immediate and direct toxic effect of colchicine on idiosyncrasies unique to each patient. The concurrently administered immunosuppressant might decrease the threshold for hematologic toxicity of colchicine in the leukocytes and their precursor cells

Microsimulation models incorporating both demand and supply dynamics

There has been rapid growth in interest in real-time transport strategies over the last decade, ranging from automated highway systems and responsive traffic signal control to incident management and driver information systems. The complexity of these strategies, in terms of the spatial and temporal interactions within the transport system, has led to a parallel growth in the application of traffic microsimulation models for the evaluation and design of such measures, as a remedy to the limitations faced by conventional static, macroscopic approaches. However, while this naturally addresses the immediate impacts of the measure, a difficulty that remains is the question of how the secondary impacts, specifically the effect on route and departure time choice of subsequent trips, may be handled in a consistent manner within a microsimulation framework. The paper describes a modelling approach to road network traffic, in which the emphasis is on the integrated microsimulation of individual trip-makers’ decisions and individual vehicle movements across the network. To achieve this it represents directly individual drivers’ choices and experiences as they evolve from day-to-day, combined with a detailed within-day traffic simulation model of the space–time trajectories of individual vehicles according to car-following and lane-changing rules and intersection regulations. It therefore models both day-to-day and within-day variability in both demand and supply conditions, and so, we believe, is particularly suited for the realistic modelling of real-time strategies such as those listed above. The full model specification is given, along with details of its algorithmic implementation. A number of representative numerical applications are presented, including: sensitivity studies of the impact of day-to-day variability; an application to the evaluation of alternative signal control policies; and the evaluation of the introduction of bus-only lanes in a sub-network of Leeds. Our experience demonstrates that this modelling framework is computationally feasible as a method for providing a fully internally consistent, microscopic, dynamic assignment, incorporating both within- and between-day demand and supply dynamic

SO(10) theory of R-parity and neutrino mass

We study the Higgs sector of a SO(10) grand unified theory which predicts exact conservation of R-parity at all scales and incorporates the see-saw mechanism. We find possible intermediate scales and light states compatible with the constraints coming from the running of the gauge couplings. Such a pattern could lower the SO(10) breaking scale, allowing the d=6 proton decay operators to be comparable in magnitude to the d=5 ones.Comment: 22 pages, 4 figure

Be Stars in the Open Cluster NGC 6830

We report the discovery of 2 new Be stars, and re-identify one known Be star in the open cluster NGC 6830. Eleven H-alpha emitters were discovered using the H-alpha imaging photometry of the Palomar Transient Factory Survey. Stellar membership of the candidates was verified with photometric and kinematic information using 2MASS data and proper motions. The spectroscopic confirmation was carried out by using the Shane 3-m telescope at Lick observatory. Based on their spectral types, three H-alpha emitters were confirmed as Be stars with H-alpha equivalent widths > -10 Angstrom. Two objects were also observed by the new spectrograph SED-Machine on the Palomar 60 inch Telescope. The SED-Machine results show strong H-alpha emission lines, which are consistent with the results of the Lick observations. The high efficiency of the SED-Machine can provide rapid observations for Be stars in a comprehensive survey in the future.Comment: 11 pages, 8 figures, AJ in pres