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New Medicare Coverage Policy for Next-Generation Tumor Sequencing: A Key Shift in Coverage Criteria With Broad Implications Beyond Medicare.
A Case Of Invasive Aspergillosis in a Patient with No Identifiable Immunodeficiencies
Invasive fungal infections usually affect patients with immunodeficiencies and very rarely patients with no known or identifiable risk factors. Diagnosis could be delayed in patients without previously known immunodeficiencies due to a low index of suspicion, leading to a delay in treatment and a potential poor outcome. We report a case of a postpartum woman with no history of immuno-compromised disease who developed left hemiparesis with evidence of invasive aspergollosis affecting the nervous system, and leading to fatal outcome. The patient had a mass-like lesion in the neuroimaging with soft tissue shadowing in the chest x-ray leading to initial diagnosis of tuberculosis. The brain biopsy showed changes consistent with a diagnosis of aspergillosis. The source of the aspergillus infection was not clear. Aspergillus infection should be considered in patients with no identifiable immunodeficiencies who have abnormal brain imaging and chest x-ray, as early treatment may alter the outcome
Patient prioritisation for hospital pharmacy services: current approaches in the UK
Objectives To survey and explore current approaches to deployment of pharmaceutical care prioritisation tools in acute hospitals in the UK.Methods A national online survey was circulated electronically to chief pharmacists of hospitals to determine if they use a prioritisation tool or process. Where such mechanisms exist, respondents were invited to participate in a semistructured telephone interview to explore the development, evaluation and application of their tool and share relevant documentation. Interviews were transcribed and thematically analysed.Results Seventy hospitals (70/130) used a tool or process to prioritise clinical pharmacy services. Thirty-six interviews were conducted, and two were excluded. The majority of tools had been developed in-house. Few hospitals had undertaken formal evaluations of their prioritisation tool. Pharmacy prioritisation tools ranged in complexity and often included a combination of pharmacy service prioritisation, such as medicines reconciliation, and a section to assign an individual patient prioritisation level. Determining the priority of a patient based on the identification of set indicators instilled confidence in pharmacists by ensuring they were not missing high-risk patients. Electronic prioritisation tools were especially useful at retrieving real-time data to prioritise workload, improving workflow and ensuring continuity in patient care. Drawbacks of using prioritisation tools included lack of tool sensitivity across certain specialties and time spent using the tool if not all information was accessible.Conclusions Prioritisation tools were seen to be useful for prioritising workload and ensuring the right patients are seen at the right time. As few hospitals had formally evaluated their tools, it is important to rigorously and systematically develop an evidence-based prioritisation tool that is both useable and acceptable. Further research to evaluate such tools would be needed to ensure it improves patient health outcomes and efficiency in pharmacy services
Using High Fluoride Concentration Products in Public Policy – A Rapid Review of Current Guidelines for High Fluoride Concentration products
Despite improvements in dental caries levels since the widespread introduction of fluoride toothpastes, it is still a disease which is considered to be a priority in many countries around the world. Individuals at higher risk of caries can be targeted with products with a high fluoride concentration to help reduce the amount and severity of the disease. This paper compares guidance from around the world on the use of products with a high fluoride concentration and gives examples of how guidance has been translated into activity in primary care dental practice. A rapid review of electronic databases was conducted to identify the volume and variation of guidance from national or professional bodies on the use of products with a high fluoride concentration. Fifteen guidelines published within the past 10 years and in English were identified and compared. The majority of these guidelines included recommendations for fluoride varnish use as well as for fluoride gels, while a smaller number offered guidance on high fluoride strength toothpaste and other vehicles. Whilst there was good consistency in recommendations for fluoride varnish in particular, there was sometimes a lack of detail in other areas of recommendation for other vehicles with a high fluoride concentration. There are good examples within the UK, such as the Childsmile project and Delivering Better Oral Health, which highlight that the provision of evidence-based guidance can be influential in directing scarce resources towards oral health improvements. Policy can be influenced by evidence-based national recommendations and used to help encourage dental professionals and commissioners and third-party payers to adopt higher levels of practices aimed at oral health improvement
Compactification on negatively curved manifolds
We show that string/M theory compactifications to maximally symmetric
space-times using manifolds whose scalar curvature is everywhere negative, must
have significant warping, large stringy corrections, or both.Comment: 18 pages, JHEP3.cl
Unified force law for granular impact cratering
Experiments on the low-speed impact of solid objects into granular media have
been used both to mimic geophysical events and to probe the unusual nature of
the granular state of matter. Observations have been interpreted in terms of
conflicting stopping forces: product of powers of projectile depth and speed;
linear in speed; constant, proportional to the initial impact speed; and
proportional to depth. This is reminiscent of high-speed ballistics impact in
the 19th and 20th centuries, when a plethora of empirical rules were proposed.
To make progress, we developed a means to measure projectile dynamics with 100
nm and 20 us precision. For a 1-inch diameter steel sphere dropped from a wide
range of heights into non-cohesive glass beads, we reproduce prior observations
either as reasonable approximations or as limiting behaviours. Furthermore, we
demonstrate that the interaction between projectile and medium can be
decomposed into the sum of velocity-dependent inertial drag plus
depth-dependent friction. Thus we achieve a unified description of low-speed
impact phenomena and show that the complex response of granular materials to
impact, while fundamentally different from that of liquids and solids, can be
simply understood
Randomized trial of bilateral versus single internal-thoracic-artery grafts
Background: The use of bilateral internal thoracic (mammary) arteries for coronary-artery bypass grafting (CABG) may improve long-term outcomes as compared with the use of a single internal-thoracic-artery plus vein grafts. Methods: We randomly assigned patients scheduled for CABG to undergo single or bilateral internal-thoracic-artery grafting in 28 cardiac surgical centers in seven countries. The primary outcome was death from any cause at 10 years. The composite of death from any cause, myocardial infarction, or stroke was a secondary outcome. Interim analyses were prespecified at 5 years of follow-up. Results: A total of 3102 patients were enrolled; 1554 were randomly assigned to undergo single internal-thoracic-artery grafting (the single-graft group) and 1548 to undergo bilateral internal-thoracic-artery grafting (the bilateral-graft group). At 5 years of follow-up, the rate of death was 8.7% in the bilateral-graft group and 8.4% in the single-graft group (hazard ratio, 1.04; 95% confidence interval [CI], 0.81 to 1.32; P=0.77), and the rate of the composite of death from any cause, myocardial infarction, or stroke was 12.2% and 12.7%, respectively (hazard ratio, 0.96; 95% CI, 0.79 to 1.17; P=0.69). The rate of sternal wound complication was 3.5% in the bilateral-graft group versus 1.9% in the single-graft group (P=0.005), and the rate of sternal reconstruction was 1.9% versus 0.6% (P=0.002). Conclusions: Among patients undergoing CABG, there was no significant difference between those receiving single internal-thoracic-artery grafts and those receiving bilateral internal-thoracic-artery grafts with regard to mortality or the rates of cardiovascular events at 5 years of follow-up. There were more sternal wound complications with bilateral internal-thoracic-artery grafting than with single internal-thoracic-artery grafting. Ten-year follow-up is ongoing. (Funded by the British Heart Foundation and others; ART Current Controlled Trials number, ISRCTN46552265.
Stability Constraints on Classical de Sitter Vacua
We present further no-go theorems for classical de Sitter vacua in Type II
string theory, i.e., de Sitter constructions that do not invoke
non-perturbative effects or explicit supersymmetry breaking localized sources.
By analyzing the stability of the 4D potential arising from compactification on
manfiolds with curvature, fluxes, and orientifold planes, we found that
additional ingredients, beyond the minimal ones presented so far, are necessary
to avoid the presence of unstable modes. We enumerate the minimal setups for
(meta)stable de Sitter vacua to arise in this context.Comment: 18 pages; v2: argument improved, references adde
The problematic backreaction of SUSY-breaking branes
In this paper we investigate the localisation of SUSY-breaking branes which,
in the smeared approximation, support specific non-BPS vacua. We show, for a
wide class of boundary conditions, that there is no flux vacuum when the branes
are described by a genuine delta-function. Even more, we find that the smeared
solution is the unique solution with a regular brane profile. Our setup
consists of a non-BPS AdS_7 solution in massive IIA supergravity with smeared
anti-D6-branes and fluxes T-dual to ISD fluxes in IIB supergravity.Comment: 27 pages, Latex2e, 5 figure
Longitudinal impact of process-oriented guided inquiry learning on the attitudes, self-efficacy and experiences of pre-medical chemistry students
A follow-up study was conducted with foundation-year chemistry students who were taught in an
inquiry- and role-based, small-group active learning environment in order to evaluate their attitudes,
experiences and self-efficacy during pre-medical chemistry courses. The study adopted a mixedmethods research design that involved both experimental and comparison groups. Using the CAEQ
(Chemistry Attitudes and Experiences Questionnaire) and the ASCI v2 (Attitude toward the Study of
Chemistry Inventory), the findings of this study indicated that inquiry-based chemistry learning
experience improves the students’ intellectual accessibility and emotional satisfaction as well as
develops their self-efficacy levels while pursuing intensive pre-medical courses in chemistry. The
results of the qualitative data analyses using a course experience questionnaire indicated that the
process-oriented guided inquiry learning (POGIL) experience helped the students succeed in rigorous
pre-medical chemistry courses and gained some process skills required in the medical programme as
listed by the AAMC (American Association of Medical Colleges)
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