A 3 Week Geriatric Education Program for 4th Year Medical Students at Dalhousie University

Purpose -Population demographics are shifting towards an increased average age. Yet, many medical schools still do not have mandatory comprehensive education in Geriatric Medicine. In 2001, the Division of Geriatric Medicine at Dalhousie University developed a required three-week geriatric course for fourth year medical students. This paper describes the details of the curriculum so that it can be reproduced in other settings. Results - The curriculum was successfully implemented. An examination, held at the end of each 3-week rotation, documented extensive learning of important concepts in Geriatric Medicine. The students gave positive feedback about the benefits of this training program. Conclusion -A well developed formal education program teaches students specific skills in Geriatric Medicine, which may improve the care of the growing elderly populatio

Using the quantum probability ranking principle to rank interdependent documents

A known limitation of the Probability Ranking Principle (PRP) is that it does not cater for dependence between documents. Recently, the Quantum Probability Ranking Principle (QPRP) has been proposed, which implicitly captures dependencies between documents through “quantum interference”. This paper explores whether this new ranking principle leads to improved performance for subtopic retrieval, where novelty and diversity is required. In a thorough empirical investigation, models based on the PRP, as well as other recently proposed ranking strategies for subtopic retrieval (i.e. Maximal Marginal Relevance (MMR) and Portfolio Theory(PT)), are compared against the QPRP. On the given task, it is shown that the QPRP outperforms these other ranking strategies. And unlike MMR and PT, one of the main advantages of the QPRP is that no parameter estimation/tuning is required; making the QPRP both simple and effective. This research demonstrates that the application of quantum theory to problems within information retrieval can lead to significant improvements

Phosphorus limitation of primary productivity in the eastern Mediterranean Sea

Although NO3- is generally considered to limit primary productivity in most of the world’s oceans, previous studies have suggested the Mediterranean Sea may be an exception. In this study of the southeastern Mediterranean, we found that all the PO43- was removed from the upper water column during the winter phytoplankton bloom in the core and boundary of a warm-core eddy, while measurable (0.3-0.6 µM) NO3- remained. The N:P (NO3-: PO43-) ratio in the core and boundary of the Cyprus eddy was 27.4 and the slope of the linear portion of the N vs. P scattergram with 25.5 with a positive intercept of 0.5 µM on the NO3- axis. A similar N:P ratio (28-29), slope (21-23), and intercept (0.9-1.1) was found for the water column across much of the southern Levantine basin. These data, taken together with the results of incubation experiments, lead us to conclude that the southeastern Mediterranean is strongly P limited. The degree of P limitation increases from west to east across the entire basin. We suggest that removal of PO43 by adsorbtion on Fe- rich dust particles may be an important process controlling the concentration of P in the water column

Interferon Alfa-2b Alone or in Combination with Ribavirin for the Treatment of Relapse of Chronic Hepatitis C

BACKGROUND Interferon alfa is the only effective treatment for patients with chronic hepatitis C. Forty percent of patients have an initial response to this therapy, but most subsequently relapse. We compared the effect of interferon alone with that of interferon plus oral ribavirin for relapses of chronic hepatitis C. METHODS We studied 345 patients with chronic hepatitis C who relapsed after interferon treatment. A total of 173 patients were randomly assigned to receive standard-dose recombinant interferon alfa-2b concurrently with ribavirin (1000 to 1200 mg orally per day, depending on body weight) for six months, and 172 patients were assigned to receive interferon and placebo. RESULTS At the completion of treatment, serum levels of hepatitis C virus (HCV) RNA were undetectable in 141 of the 173 patients who were treated with interferon and ribavirin and in 80 of the 172 patients who were treated with interferon alone (82 percent vs. 47 percent, P\u3c0.001). Serum HCV RNA levels remained undetectable 24 weeks after the end of treatment in 84 patients (49 percent) in the combinationtherapy group, but in only 8 patients (5 percent) in the interferon group (P\u3c0.001). Sustained normalization of serum alanine aminotransferase concentrations and histologic improvement were highly correlated with virologic response. Base-line serum HCV RNA levels of 2¬106 copies per milliliter or less were associated with higher rates of response in both treatment groups. Viral genotypes other than type 1 were associated with sustained responses only in the combination-therapy group. Combined therapy caused a predictable fall in hemoglobin concentrations but otherwise had a safety profile similar to that of interferon alone. CONCLUSIONS In patients with chronic hepatitis C who relapse after treatment with interferon, therapy with interferon and oral ribavirin results in higher rates of sustained virologic, biochemical, and histologic response than treatment with interferon alone

Interferon Alfa-2b Alone or in Combination with Ribavirin as Initial Treatment for Chronic Hepatitis C

BACKGROUND Only 15 to 20 percent of patients with chronic hepatitis C have a sustained virologic response to interferon therapy. We compared the efficacy and safety of recombinant interferon alfa-2b alone with those of a combination of interferon alfa-2b and ribavirin for the initial treatment of patients with chronic hepatitis C. METHODS We randomly assigned 912 patients with chronic hepatitis C to receive standard-dose interferon alfa-2b alone or in combination with ribavirin (1000 or 1200 mg orally per day, depending on body weight) for 24 or 48 weeks. Efficacy was assessed by measurements of serum hepatitis C virus (HCV) RNA and serum aminotransferases and by liver biopsy. RESULTS The rate of sustained virologic response (defined as an undetectable serum HCV RNA level 24 weeks after treatment was completed) was higher among patients who received combination therapy for either 24 weeks (70 of 228 patients, 31 percent) or 48 weeks (87 of 228 patients, 38 percent) than among patients who received interferon alone for either 24 weeks (13 of 231 patients, 6 percent) or 48 weeks (29 of 225 patients, 13 percent) (P CONCLUSIONS In patients with chronic hepatitis C, initial therapy with interferon and ribavirin was more effective than treatment with interferon alone

Palliative Care

Palliative care bridges the gap between medically focused care with case management support, and hospice with focus on comfort only in the last 6 months of life. A multidisciplinary palliative team provides support, both medical and psycho-social, regardless of time to end of life. Patients do not forego any treatments or interrupt any current physician relationships when enrolling in palliative care. Programs may be in-patient, clinic based, home based, telehealth or a combination of venues. 24-hour availability is encouraged. Coordination with the existing medical team and the health plan is a key to success. Periodic rounding between the palliative providers and the health plan team facilitates making the managed care system seamless for members and providers. The most common adult diagnosis is cancer, but severe progressive disease of any organ system may be appropriate for referral. Some patients may stabilize or even improve. Pediatric palliative care is somewhat different with the diagnosis more likely being genetic, developmental, or neurologic. Severe diseases in children may be chronic and end of life discussions difficult. Communication skills facilitate advance care planning discussions whether advance directive or POLST. Palliative care is a cost-effective program that improves patient care without the patient relinquishing existing benefits

Quantum coherence in a degenerate two-level atomic ensemble: for a transition Fe=0↔Fg=1F_e=0\leftrightarrow F_g=1

For a transition $F_e=0\leftrightarrow F_g=1$ driven by a linearly polarized light and probed by a circularly light, quantum coherence effects are investigated. Due to the coherence between the drive Rabi frequency and Zeeman splitting, electromagnetically induced transparency, electromagnetically induced absorption, and the transition from positive to negative dispersion are obtained, as well as the populations coherently oscillating in a wide spectral region. At the zero pump-probe detuning, the subluminal and superluminal light propagation is predicted. Finally, coherent population trapping states are not highly sensitive to the refraction and absorption in such ensemble.Comment: 9 pages, 6 figure

Human Infection from an Unidentified Erythrocyte-Associated Bacterium

Abstract A 49-year-old splenectomized man had an infection from an unidentified, gram-positive, rodshaped bacterium that adhered to the majority of his peripheral-blood erythrocytes. On transmission electron microscopy, the bacterium was seen to be extraerythrocytic and was 0.2 μm wide by 1.0 to 1.7 μm long. It possessed a thick, granular cell wall, a trilamellar membrane external to the cell wall and prominent mesosomes. Attempts to cultivate the organism in vitro or to duplicate the patient\u27s disease in splenectomized animals were unsuccessful. The patient\u27s response suggested that the bacterium was susceptible to cell-wall-active antibiotics and to chloramphenicol but not to tetracycline. This bacterium may be the cause of other chronic, fever-producing, multisystem diseases of unknown origin. (N Engl J Med 301:897–900, 1979

The international normalized ratio overestimates coagulopathy in patients after major hepatectomy

Abstract BACKGROUND: The International Normalized Ratio (INR) is commonly used to guide therapy after hepatectomy. We hypothesized that the use of thrombelastography (TEG) would demonstrate a decreased incidence of hypocoagulability in this patient population. METHODS: Seventy-eight patients were prospectively enrolled before undergoing hepatectomy. INR, TEG, and coagulation factors were drawn before incision, postoperatively, and on postoperative days 1, 3, and 5. RESULTS: Patients demonstrated an elevated INR at all postoperative time points. However, TEG demonstrated a decreased R value postoperatively, with subsequent normalization. Other TEG measurements were equivalent to preoperative values. All procoagulant factors save factor VIII decreased postoperatively, with a simultaneous decrease in protein C. CONCLUSIONS: TEG demonstrated a brief hypercoagulable state after major hepatectomy, with coagulation subsequently normalizing. The INR significantly overestimates hypocoagulability after hepatectomy and these data call into question current practices using the INR to guide therapy in this patient population. Ó 2014 Elsevier Inc. All rights reserved. Partial hepatectomy remains the treatment of choice for a wide range of both benign and malignant diseases of the liver. Following major hepatectomy, derangement of hepatic synthetic function has been well characterized, including impaired synthesis of serum clotting factors and regulatory proteins