Unilateral Blurred Vision as the Sole Presenting Symptom of Chronic Lymphocytic Leukemia

Purpose: To describe a case of infiltrative optic neuropathy caused by chronic lymphocytic leukemia. Case Report: A 41-year-old white male presented with painless, blurry vision in the left eye. Examination revealed unilateral optic nerve swelling confirmed by optical coherence tomography (OCT). Initial workup revealed mild leukocytosis, eventually diagnosed as chronic lymphocytic leukemia (CLL). No other cause of optic neuropathy was identified despite extensive investigation. The patient developed rapidly progressive retinal ganglion cell nerve fiber layer (NFL) atrophy and relative afferent pupillary defect (RAPD) of the left eye despite steroid treatment but stabilized after four cycles of CLLtargeted chemotherapy. Although infiltrative optic neuropathy is well-known in leukemia, presentation with only subtle vision loss is rare. Vision loss usually presents late in leukemic infiltrative optic neuropathy and therefore must be considered in patients with optic disc swelling and leukocytosis. Conclusion: When treating CLL, progressive visual decline with coexistent optic neuropathy may warrant chemotherapy

Cache coherency controller for MESI protocol based on FPGA

In modern techniques of building processors, manufactures using more than one processor in the integrated circuit (chip) and each processor called a core. The new chips of processors called a multi-core processor. This new design makes the processors to work simultanously for more than one job or all the cores working in parallel for the same job. All cores are similar in their design, and each core has its own cache memory, while all cores shares the same main memory. So if one core requestes a block of data from main memory to its cache, there should be a protocol to declare the situation of this block in the main memory and other cores.This is called the cache coherency or cache consistency of multi-core. In this paper a special circuit is designed using very high speed integrated circuit hardware description language (VHDL) coding and implemented using ISE Xilinx software. The protocol used in this design is the modified, exclusive, shared and invalid (MESI) protocol. Test results were taken by using test bench, and showed all the states of the protocol are working correctly

A colorimetric competitive displacement assay for the evaluation of catalytic peptides

An assay based on competitive dye displacement was adapted to detect the formation of aldol product in crude reaction mixtures, and was used to evaluate minimal peptide aldol catalysts.</p

Structure, Scaling and Phase Transition in the Optimal Transport Network

We minimize the dissipation rate of an electrical network under a global constraint on the sum of powers of the conductances. We construct the explicit scaling relation between currents and conductances, and show equivalence to a a previous model [J. R. Banavar {\it et al} Phys. Rev. Lett. {\bf 84}, 004745 (2000)] optimizing a power-law cost function in an abstract network. We show the currents derive from a potential, and the scaling of the conductances depends only locally on the currents. A numerical study reveals that the transition in the topology of the optimal network corresponds to a discontinuity in the slope of the power dissipation.Comment: 4 pages, 3 figure

Mediated Communication and Customer Service Experiences: Psychological and Demographic Predictors of User Evaluations in the United States

People around the world who seek to interact with large organisations increasingly find they must do so via mediated and automated communication. Organisations often deploy both mediated and automated platforms, such as instant messaging and interactive voice response systems (IVRs), for efficiency and cost-savings. Customer and client responses to these systems range from delight to frustration. To better understand the factors affecting people's satisfaction with these systems, we conducted a representative U.S. national survey (N = 1321). We found that people overwhelmingly like and trust in-person customer service compared to mediated and automated modalities. As to demographic attitude predictors, age was important (older respondents liked mediated systems less), but income and education were not strong attitude predictors. For personality variables, innovativeness was positively associated with mediated system satisfaction. However, communication apprehensiveness, which we expected to be related to satisfaction, was not. We conclude by discussing implications for the burgeoning field of human-machine communication, as well as social policy, equity, and the pullulating digital services divide

From respect to reburial: negotiating pagan interest in prehistoric human remains in Britain, through the Avebury consultation

The recent Avebury Consultation on reburial has drawn considerable public and professional attention to the issue of pagan calls for respect towards the care of human remains. Our work has pointed to the importance of archaeologists and others engaging seriously and respectfully with pagans as significant stakeholders in our heritage. The Avebury Reburial Consultation suggests this dialogue is increasing in strength, but we identify problems in the process. We focus here on approaches to the prehistoric dead and worldviews enabling communication from which calls or ‘claims’ for the reburial of prehistoric pagan human remains, versus their retention for scientific study, are articulated; frameworks for assessing and adjudicating such ‘claims’; and implications for the interest groups concerned. We argue that room must be made for philosophical debate and the emotional and spiritual views of pagans, in order to improve dialogue, develop common ground, and enable participatory decision-making and situational pragmatism

Comparison of the impact of two national health and social care integration programmes on emergency hospital admissions

Background: Policy-makers expect that integration of health and social care will improve user and carer experience and reduce avoidable hospital use. [We] evaluate the impact on emergency hospital admissions of two large nationally-initiated service integration programmes in England: the Pioneer (November 2013 to March 2018) and Vanguard (January 2015 to March 2018) programmes. The latter had far greater financial and expert support from central agencies. Methods: Of the 206 Clinical Commissioning Groups (CCGs) in England, 51(25%) were involved in the Pioneer programme only, 22(11%) were involved in the Vanguard programme only and 13(6%) were involved in both programmes. We used quasi-experimental methods to compare monthly counts of emergency admissions between four groups of CCGs, before and after the introduction of the two programmes. Results: CCGs involved in the programmes had higher monthly hospital emergency admission rates than non-participants prior to their introduction [7.9 (95% CI:7.8–8.1) versus 7.5 (CI: 7.4–7.6) per 1000 population]. From 2013 to 2018, there was a 12% (95% CI:9.5–13.6%) increase in emergency admissions in CCGs not involved in either programme while emergency admissions in CCGs in the Pioneer and Vanguard programmes increased by 6.4% (95% CI: 3.8–9.0%) and 8.8% (95% CI:4.5–13.1%), respectively. CCGs involved in both initiatives experienced a smaller increase of 3.5% (95% CI:-0.3–7.2%). The slowdown largely occurred in the final year of both programmes. Conclusions: Health and social care integration programmes can mitigate but not prevent rises in emergency admissions over the longer-term. Greater financial and expert support from national agencies and involvement in multiple integration initiatives can have cumulative effects