Thoracic aorta transobturator bipopliteal bypass as eventual durable reconstruction after removal of an infected aortofemoral graft

AbstractA 36-year-old man was referred with aortofemoral graft infection and perigraft duodenal erosion. The aortofemoral graft was removed, and bilateral axillo–superficial femoral grafts were constructed. Recurrent failures of these grafts prompted us to convert to a more-durable reconstruction. A straight graft was anastomosed to the lower thoracic aorta, routed retroperitoneally, and attached to an inverted U-shaped bilateral transobturator bypass graft, which was anastomosed to both above-knee popliteal arteries. After 3 years, the patient has remained well and the grafts are patent. This operation represents a durable in-line reconstruction that avoids all previously infected areas after removal of an infected aortofemoral graft. (J Vasc Surg 1997;26:693-6.

An audit of discharge summaries

Background: In the continuum of patient care, admission to the department of medicine constitutes a brief yet critical period. Subsequent patient care depends on the discharge summary (DS) and its implementation. Aim: To evaluate the department of medicine -family physician interface by a discharge summaries audit. Method: A retrospective study analyzing all admissions and discharges between a department of medicine and a primary care clinic over a period of ten months. Results: 129 DS were evaluated and compared to 97 available primary care medical charts. Most admissions were due to a medical emergency (95%), the patients were often elderly and 23% lived alone. Hospital stay averaged 4.0±2.4 days, readmission rate was 15.8%. In 73% of the DS at least one new drug was prescribed. The family physician was the one expected to continue treatment in most of the cases, but in over a third of the patients, a referral to further consultation was deemed necessary. The DS was found in 82% of the primary care charts. Median time interval between discharge and consultation with the family physician was three days (range 1-30). Home visits by physicians were documented in eight cases only. Conclusion: Most discharged patients require further evaluation and newly prescribed medications, making a timely and coordinated continuous care in the community mandatory. A high quality, rapidly available DS is therefore important for the family physician. Whether improved communication will reduce readmissions and improve patient prognosis and quality of care should be clarified by further study.peer-reviewe

On the origin of the λ\lambda-transition in liquid Sulphur

Developing a novel experimental technique, we applied photon correlation spectroscopy using infrared radiation in liquid Sulphur around $T_\lambda$, i.e. in the temperature range where an abrupt increase in viscosity by four orders of magnitude is observed upon heating within few degrees. This allowed us - overcoming photo-induced and absorption effects at visible wavelengths - to reveal a chain relaxation process with characteristic time in the ms range. These results do rehabilitate the validity of the Maxwell relation in Sulphur from an apparent failure, allowing rationalizing the mechanical and thermodynamic behavior of this system within a viscoelastic scenario.Comment: 5 pages, 4 eps figures, accepted in Phys. Rev. Let

Parameterized complexity of DPLL search procedures

We study the performance of DPLL algorithms on parameterized problems. In particular, we investigate how difficult it is to decide whether small solutions exist for satisfiability and other combinatorial problems. For this purpose we develop a Prover-Delayer game which models the running time of DPLL procedures and we establish an information-theoretic method to obtain lower bounds to the running time of parameterized DPLL procedures. We illustrate this technique by showing lower bounds to the parameterized pigeonhole principle and to the ordering principle. As our main application we study the DPLL procedure for the problem of deciding whether a graph has a small clique. We show that proving the absence of a k-clique requires n steps for a non-trivial distribution of graphs close to the critical threshold. For the restricted case of tree-like Parameterized Resolution, this result answers a question asked in [11] of understanding the Resolution complexity of this family of formulas

Sonic: Zero-Knowledge SNARKs from Linear-Size Universal and Updateable Structured Reference Strings

Ever since their introduction, zero-knowledge proofs have become an important tool for addressing privacy and scalability concerns in a variety of applications. In many systems each client downloads and verifies every new proof, and so proofs must be small and cheap to verify. The most practical schemes require either a trusted setup, as in (pre-processing) zk-SNARKs, or verification complexity that scales linearly with the complexity of the relation, as in Bulletproofs. The structured reference strings required by most zk-SNARK schemes can be constructed with multi-party computation protocols, but the resulting parameters are specific to an individual relation. Groth et al. discovered a zk-SNARK protocol with a universal structured reference string that is also updatable, but the string scales quadratically in the size of the supported relations. Here we describe a zero-knowledge SNARK, Sonic, which supports a universal and continually updatable structured reference string that scales linearly in size. We also describe a generally useful technique in which untrusted "helpers" can compute advice that allows batches of proofs to be verified more efficiently. Sonic proofs are constant size, and in the "helped" batch verification context the marginal cost of verification is comparable with the most efficient SNARKs in the literature

Media Witnessing: Exploring the Audience of Distant Suffering

This article aims at demonstrating the relevance of the concept of ‘media witnessing’ as an analytical lens for the study of audience engagement with media reports of distant suffering. Drawing upon existing theoretical work on the concept, the article approaches media witnessing as a distinct modality of audience experience and constructs an analytical framework for its study. Applying this framework on an empirical study of Greek audiences, the article provides a typology of witnessing, consisting of four different types of audience engagement with media stories of human suffering. This typology illustrates the complexities inherent in the practice of watching suffering on television, as well as the limitations of mediated cosmopolitan imagination

Regions of High Out-Of-Hospital Cardiac Arrest Incidence and Low Bystander CPR Rates in Victoria, Australia

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) remains a major public health issue and research has shown that large regional variation in outcomes exists. Of the interventions associated with survival, the provision of bystander CPR is one of the most important modifiable factors. The aim of this study is to identify census areas with high incidence of OHCA and low rates of bystander CPR in Victoria, Australia. METHODS: We conducted an observational study using prospectively collected population-based OHCA data from the state of Victoria in Australia. Using ArcGIS (ArcMap 10.0), we linked the location of the arrest using the dispatch coordinates (longitude and latitude) to Victorian Local Government Areas (LGAs). We used Bayesian hierarchical models with random effects on each LGA to provide shrunken estimates of the rates of bystander CPR and the incidence rates. RESULTS: Over the study period there were 31,019 adult OHCA attended, of which 21,436 (69.1%) cases were of presumed cardiac etiology. Significant variation in the incidence of OHCA among LGAs was observed. There was a 3 fold difference in the incidence rate between the lowest and highest LGAs, ranging from 38.5 to 115.1 cases per 100,000 person-years. The overall rate of bystander CPR for bystander witnessed OHCAs was 62.4%, with the rate increasing from 56.4% in 2008-2010 to 68.6% in 2010-2013. There was a 25.1% absolute difference in bystander CPR rates between the highest and lowest LGAs. CONCLUSION: Significant regional variation in OHCA incidence and bystander CPR rates exists throughout Victoria. Regions with high incidence and low bystander CPR participation can be identified and would make suitable targets for interventions to improve CPR participation rates