Analysis of variation in pre-procedural fasting duration for common inpatient gastrointestinal procedures

BACKGROUND: Gastrointestinal procedures generally require pre-procedural fasting to optimize sedation safety. While the American Society of Anesthesiologists (ASA) recommends no intake of clear liquids and solid food 2-4 and 6-8 hours respectively prior to endoscopic procedures, the actual nil per os (NPO) duration for these procedures in practice is unknown. Our objective was to analyze NPO duration for patients undergoing these procedures and to determine its association with clinical and administrative variables. METHODS: Inpatient data from 2016-2018 for the three procedures was extracted from electronic medical records and administrative data at a single-center tertiary academic medical center. Various statistical tests (Kruskal-Wallis, Wilcoxon, Pearson) were employed depending on the outcome type and data distribution. RESULTS: One thousand three hundred and twenty-five esophagogastroduodenoscopies (EGDs), 753 colonoscopies, and 550 endoscopic retrograde cholangiopancreatographies (ERCPs) were included. The median NPO time for all procedures was 12.6 hours (IQR, 9.6-16.1 hours). The median NPO times were 12.6, 11.9, and 13.1 hours for EGD, colonoscopy, and ERCP respectively. NPO duration was greater for Hispanic than non-Hispanic patients (median 13.9 CONCLUSIONS: NPO times for common inpatient gastroenterology (GI) procedures generally exceeded 12 hours, suggesting there is an opportunity to adopt changes to decrease NPO duration for low-risk patients while maintaining adherence to guidelines and best practice

Primers for Castilleja and their utility across Orobanchaceae: I. Chloroplast primers1

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141726/1/aps31700020.pd

Primers for Castilleja and their Utility Across Orobanchaceae: I. Chloroplast Primers

Premise of the study: Chloroplast primers were developed from genomic data for the taxonomically challenging genus Castilleja. We further tested the broader utility of these primers across Orobanchaceae, identifying a core set of chloroplast primers amplifying across the clade.Methods and Results: Using a combination of three low-coverage Castilleja genomes and sequence data from 12 Castilleja plastomes, 76 primer combinations were specifically designed and tested for Castilleja. The primers targeted the most variable portions of the plastome and were validated for their applicability across the clade. Of these, 38 primer combinations were subsequently evaluated in silico and then validated across other major clades in Orobanchaceae.Conclusions: These results demonstrate the utility of these primers, not only across Castilleja, but for other clades in Orobanchaceae— particularly hemiparasitic lineages—and will contribute to future phylogenetic studies of this important clade of parasitic plants

Two-Bit Gates are Universal for Quantum Computation

A proof is given, which relies on the commutator algebra of the unitary Lie groups, that quantum gates operating on just two bits at a time are sufficient to construct a general quantum circuit. The best previous result had shown the universality of three-bit gates, by analogy to the universality of the Toffoli three-bit gate of classical reversible computing. Two-bit quantum gates may be implemented by magnetic resonance operations applied to a pair of electronic or nuclear spins. A ``gearbox quantum computer'' proposed here, based on the principles of atomic force microscopy, would permit the operation of such two-bit gates in a physical system with very long phase breaking (i.e., quantum phase coherence) times. Simpler versions of the gearbox computer could be used to do experiments on Einstein-Podolsky-Rosen states and related entangled quantum states.Comment: 21 pages, REVTeX 3.0, two .ps figures available from author upon reques

The environmental security debate and its significance for climate change

Policymakers, military strategists and academics all increasingly hail climate change as a security issue. This article revisits the (comparatively) long-standing “environmental security debate” and asks what lessons that earlier debate holds for the push towards making climate change a security issue. Two important claims are made. First, the emerging climate security debate is in many ways a re-run of the earlier dispute. It features many of the same proponents and many of the same disagreements. These disagreements concern, amongst other things, the nature of the threat, the referent object of security and the appropriate policy responses. Second, given its many different interpretations, from an environmentalist perspective, securitisation of the climate is not necessarily a positive development

‘Smart Cities’ - Issues and Challenges for ‘Old World’ Economies: A Case from the United Kingdom.

The rapid and dynamic rate of urbanization, particularly in emerging world economies, has resulted in a need to find\ud sustainable ways of dealing with the excessive strains and pressures that come to bear on existing infrastructures and\ud relationships. Increasingly during the twenty-first century policy makers have turned to technological solutions to deal\ud with this challenge and the dynamics inherent within it. This move towards the utilization of technology to underpin\ud infrastructure has led to the emergence of the term ‘Smart City’. Smart cities incorporate technology based solutions\ud in their planning development and operation. This paper explores the organizational issues and challenges facing a\ud post-industrial agglomeration in the North West of England as it attempted to become a ‘Smart City’. In particular the\ud paper identifies and discusses the factors that posed significant challenges for the dynamic relationships residents,policymakers and public and private sector organizations and as a result aims to use these micro-level issues to inform the macro-debate and context of wider Smart City discussions. In order to achieve this, the paper develops a range of recommendations that are designed to inform Smart City design, planning and implementation strategies

Testing foundations of quantum mechanics with photons

The foundational ideas of quantum mechanics continue to give rise to counterintuitive theories and physical effects that are in conflict with a classical description of Nature. Experiments with light at the single photon level have historically been at the forefront of tests of fundamental quantum theory and new developments in photonics engineering continue to enable new experiments. Here we review recent photonic experiments to test two foundational themes in quantum mechanics: wave-particle duality, central to recent complementarity and delayed-choice experiments; and Bell nonlocality where recent theoretical and technological advances have allowed all controversial loopholes to be separately addressed in different photonics experiments.Comment: 10 pages, 5 figures, published as a Nature Physics Insight review articl

Circumstellar discs: What will be next?

This prospective chapter gives our view on the evolution of the study of circumstellar discs within the next 20 years from both observational and theoretical sides. We first present the expected improvements in our knowledge of protoplanetary discs as for their masses, sizes, chemistry, the presence of planets as well as the evolutionary processes shaping these discs. We then explore the older debris disc stage and explain what will be learnt concerning their birth, the intrinsic links between these discs and planets, the hot dust and the gas detected around main sequence stars as well as discs around white dwarfs.Comment: invited review; comments welcome (32 pages