Colonoscopy Quality Assessment

Colonoscopy is the cornerstone of colorectal cancer screening programs. There is significant variability in the quality of colonoscopy between endoscopists. Colonoscopy quality assessment tracks various metrics in  order  to  improve  the  effectiveness  of  colonoscopy,  aiming  at  reducing  the  incidence  and  mortality  from colorectal cancer. Adenoma detection rate is the prime metric, as it is associated with the risk of interval  cancers.  Implementing  processes  to  measure and improve the adenoma detection rate  is  essential to improve the quality of colonoscopy

Borel-Cantelli sequences

A sequence $\{x_{n}\}_1^\infty$ in $[0,1)$ is called Borel-Cantelli (BC) if for all non-increasing sequences of positive real numbers $\{a_n\}$ with $\underset{i=1}{\overset{\infty}{\sum}}a_i=\infty$ the set $$\underset{k=1}{\overset{\infty}{\cap}} \underset{n=k}{\overset{\infty}{\cup}} B(x_n, a_n))=\{x\in[0,1)\mid |x_n-x|<a_n \text{for} \infty \text{many}n\geq1\}$$ has full Lebesgue measure. (To put it informally, BC sequences are sequences for which a natural converse to the Borel-Cantelli Theorem holds). The notion of BC sequences is motivated by the Monotone Shrinking Target Property for dynamical systems, but our approach is from a geometric rather than dynamical perspective. A sufficient condition, a necessary condition and a necessary and sufficient condition for a sequence to be BC are established. A number of examples of BC and not BC sequences are presented. The property of a sequence to be BC is a delicate diophantine property. For example, the orbits of a pseudo-Anosoff IET (interval exchange transformation) are BC while the orbits of a "generic" IET are not. The notion of BC sequences is extended to more general spaces.Comment: 20 pages. Some proofs clarifie

Network Mutual Information and Synchronization under Time Transformations

We investigate the effect of general time transformations on the phase synchronization (PS) phenomenon and the mutual information rate (MIR) between pairs of nodes in dynamical networks. We demonstrate two important results concerning the invariance of both PS and the MIR. Under time transformations PS can neither be introduced nor destroyed and the MIR cannot be raised from zero. On the other hand, for proper time transformations the timing between the cycles of the coupled oscillators can be largely improved. Finally, we discuss the relevance of our findings for communication in dynamical networks.Comment: 15 p

Educational Intervention Improves Proton Pump Inhibitor Stewardship in Outpatient Gastroenterology Clinics

Background Improper chronic proton pump inhibitor (PPI) use has risen significantly in the last few decades. In our gastroenterology trainees’ clinics, we aimed to optimize PPI usage. Methods We collected baseline data on patients’ PPI use for 8 weeks. Based on gastroenterology society guidelines, we determined conditions for appropriate PPI use. If the indication could not be determined, it was categorized as “unknown”. Generated from the three most frequent causes for inappropriate PPI use, interventions were developed to correct each issue. Following a brief educational session, trainees implemented these interventions over a subsequent 8-week interval. Results During our pre-intervention period, trainees evaluated 263 patients who were prescribed a PPI. In 49% of the cases, the use of PPI was deemed inappropriate. The most common reasons were: gastroesophageal reflux disease (GERD) which was never titrated to the lowest effective dose, twice daily dosing for Barrett’s esophagus (BE) chemoprevention and unknown indication. During our intervention period, trainees evaluated 145 patients prescribed a PPI for GERD with well-controlled symptoms in 101 cases. PPI had not been titrated to lowest effective dose in 37 cases prompting intervention which was successful in 23 cases. PPI indication was unknown in 17 cases prompting a message to the prescribing provider to review appropriateness. Two cases of BE chemoprevention with twice daily dosing were appropriately reduced to daily dosing. Ultimately, after intervention, PPI use was deemed appropriate after intervention in 172 (77%) cases. Conclusions Improper chronic PPI use was significant. Focusing intervention efforts on PPI use for GERD, BE and unknown indications substantially increased appropriateness of PPI use

Optimal stability and instability for near-linear Hamiltonians

In this paper, we will prove a very general result of stability for perturbations of linear integrable Hamiltonian systems, and we will construct an example of instability showing that both our result and our example are optimal. Moreover, in the same spirit as the notion of KAM stable integrable Hamiltonians, we will introduce a notion of effectively stable integrable Hamiltonians, conjecture a characterization of these Hamiltonians and show that our result prove this conjecture in the linear case

Infinite ergodic theory and Non-extensive entropies

We bring into account a series of result in the infinite ergodic theory that we believe that they are relevant to the theory of non-extensive entropie

Markerless attenuation correction for carotid MRI surface receiver coils in combined PET/MR imaging.

The purpose of the study was to evaluate the effect of attenuation of MR coils on quantitative carotid PET/MR exams. Additionally, an automated attenuation correction method for flexible carotid MR coils was developed and evaluated.The attenuation of the carotid coil was measured by imaging a uniform water phantom injected with 37 MBq of 18F-FDG in a combined PET/MR scanner for 24 min with and without the coil. In the same session, an ultra-short echo time (UTE) image of the coil on top of the phantom was acquired. Using a combination of rigid and non-rigid registration, a CT-based attenuation map was registered to the UTE image of the coil for attenuation and scatter correction. After phantom validation, the effect of the carotid coil attenuation and the attenuation correction method were evaluated in five subjects.Phantom studies indicated that the overall loss of PET counts due to the coil was 6.3% with local region-of-interest (ROI) errors reaching up to 18.8%. Our registration method to correct for attenuation from the coil decreased the global error and local error (ROI) to 0.8% and 3.8%, respectively. The proposed registration method accurately captured the location and shape of the coil with a maximum spatial error of 2.6 mm. Quantitative analysis in human studies correlated with the phantom findings, but was dependent on the size of the ROI used in the analysis.MR coils result in significant error in PET quantification and thus attenuation correction is needed. The proposed strategy provides an operator-free method for attenuation and scatter correction for a flexible MRI carotid surface coil for routine clinical use

Holomorphic linearization of commuting germs of holomorphic maps

Let $f_1, ..., f_h$ be $h\ge 2$ germs of biholomorphisms of \C^n fixing the origin. We investigate the shape a (formal) simultaneous linearization of the given germs can have, and we prove that if $f_1, ..., f_h$ commute and their linear parts are almost simultaneously Jordanizable then they are simultaneously formally linearizable. We next introduce a simultaneous Brjuno-type condition and prove that, in case the linear terms of the germs are diagonalizable, if the germs commutes and our Brjuno-type condition holds, then they are holomorphically simultaneously linerizable. This answers to a multi-dimensional version of a problem raised by Moser.Comment: 24 pages; final version with erratum (My original paper failed to cite the work of L. Stolovitch [ArXiv:math/0506052v2]); J. Geom. Anal. 201