Pharmacological Review of Anticoagulants

The art and science of anticoagulation have never gotten more complicated than it has now. Newer anticoagulants have entered the market and have provided more options to the patients and healthcare professionals. This chapter will review the basic physiology of hemostasis, pharmacology of the anticoagulants, and how these medications are used in the clinical setting. The mechanism of action, pharmacokinetics and pharmacodynamics, clinical evidence of use and clinical pearls, laboratory monitoring in clinical practice, and adverse effects will be examined individually for each drug considered. This chapter will serve as a review for the practicing clinician and a thorough introduction for the beginning reader

A Kidney Biopsy Simulation Training Program: First Year\u27s Results

BACKGROUND: Nephrology attracts fewer medical graduates despite the growing care and workforce demand. Interventional Nephrology could re-foster interest in this subspecialty. Percutaneous kidney biopsy (PKB) is the most common procedure and should be adequately taught through simulation training according to ACGME requirements. We initiated a PKB simulation training program and we designed a two-year study in order to examine its effect on the confidence level, the procedural competence and the satisfaction with this training of Nephrology fellows compared to historical controls (fellows trained on PKBs before the initiation of the program). METHODS: All fellows were consented and trained at UNM’s simulation center (BATCAVE) with a renal biopsy ultrasound training model (CAE Healthcare Blue PhantomTM). Participants demographics and previous PKB experience was collected. Pre-assigned readings, online videos and hands-on practice on the simulation model were utilized as educational strategies. Performance of the trainee during each one-hour session was graded by the use of an evaluation form specifically designed for PKBs. Pre-and post-simulation surveys evaluated the participants’ confidence level quantitatively. All participants completed the satisfaction with PKB simulation experience scale (PKB-SSE). RESULTS: All three 1st and 2nd year current renal fellows completed the simulation training. The following table summarizes the basic information acquired from their training. Overall, the program enhanced the confidence level of fellows without previous experience on performing PKBs. All fellows expressed a high level of satisfaction from their participation in this training. CONCLUSIONS: PKB simulation training may improve trainees’ confidence level especially for those without prior experience as well as their satisfaction with the training. The procedural competence of the trainees on PKBs will be evaluated during the second year of their fellowship and will be compared to the procedural competence of historical controls

A Kidney Biopsy Simulation Training Program for Renal Fellows: Two Years of Results

Renal interventions could re-foster interest in Nephrology and attract more medical graduates. Percutaneous kidney biopsy (PKB) is an important diagnostic tool and should be taught through simulation. We initiated a PKB simulation training program and designed a 2-year study to examine its effect on the confidence level, the procedural competence and the satisfaction with this training of Nephrology fellows compared to historical controls. All fellows were consented and trained at UNM’s simulation center (BATCAVE) with a simulation training model (CAE Healthcare Blue PhantomTM). Trainees’ demographics and previous PKB experience were collected. We utilized pre-assigned readings, online videos and hands-on simulation practice. Performance of each trainee during each session was graded with a procedural competence evaluation form. Drs. JO and MER were present in all sessions and completed these forms. Each session lasted 1 to 1-1 1/2 h. Pre-and post-simulation surveys evaluated the participants’ confidence level quantitatively on a 5-point Likert scale. All participants completed the satisfaction with PKB simulation experience scale (PKB-SSE). All three 1st and 2nd year renal fellows completed the simulation training in 2018 and two first year fellows completed the training in 2019. Independent of their previous experience on PKBs all renal fellows expressed a high level of satisfaction from their participation (4 to 5) and increased their confidence level. This year’s trainees increased their performance level from 2 to 5 and from 1 to 5, respectively. PKB simulation may improve trainees’ confidence level and their satisfaction with the training. The procedural competence of the trainees on PKBs will be evaluated during the 2nd year of their fellowship and will be compared to the procedural competence of historical controls. We expect that the simulation training will reduce the discomfort and minimize the adverse PKB outcomes in patients undergoing PKB in UNMH

Prospects of observing continuous gravitational waves from known pulsars

Several past searches for gravitational waves from a selection of known pulsars have been performed with data from the science runs of the Laser Inferometer Gravitational-wave Observatory (LIGO) gravitational wave detectors. So far these have lead to no detection, but upper limits on the gravitational wave amplitudes have been set. Here we study our intrinsic ability to detect, and estimate the gravitational wave amplitude for non-accreting pulsars. Using spin-down limits on emission as a guide we examine amplitudes that would be required to observe known pulsars with future detectors (Advanced LIGO, Advanced Virgo and the Einstein Telescope), assuming that they are triaxial stars emitting at precisely twice the known rotation frequency. Maximum allowed amplitudes depend on the stars' equation of state (e.g. a normal neutron star, a quark star, a hybrid star) and the theoretical mass quadrupoles that they can sustain. We study what range of quadrupoles, and therefore equations of state, would be consistent with being able to detect these sources. For globular cluster pulsars, with spin-downs masked by accelerations within the cluster, we examine what spin-down values gravitational wave observations would be able to set. For all pulsars we also alternatively examine what internal magnetic fields they would need to sustain observable ellipticities.Comment: version to be published in Monthly Notices of the Royal Astronomical Societ

Prophylactic radiotherapy against heterotopic ossification following internal fixation of acetabular fractures: a comparative estimate of risk.

OBJECTIVE: Radiotherapy (RT) is effective in preventing heterotopic ossification (HO) around acetabular fractures requiring surgical reconstruction. We audited outcomes and estimated risks from RT prophylaxis, and alternatives of indometacin or no prophylaxis. METHODS: 34 patients underwent reconstruction of acetabular fractures through a posterior approach, followed by a 8-Gy single fraction. The mean age was 44 years. The mean time from surgery to RT was 1.1 days. The major RT risk is radiation-induced fatal cancer. The International Commission on Radiological Protection (ICRP) method was used to estimate risk, and compared with a method (Trott and Kemprad) specifically for estimating RT risk for benign disease. These were compared with risks associated with indometacin and no prophylaxis. RESULTS: 28 patients (82%) developed no HO; 6 developed Brooker Class I; and none developed Class II-IV HO. The ICRP method suggests a risk of fatal cancer in the range of 1 in 1000 to 1 in 10,000; the Trott and Kemprad method suggests 1 in 3000. For younger patients, this may rise to 1 in 2000; and for elderly patients, it may fall to 1 in 6000. The risk of death from gastric bleeding or perforation from indometacin is 1 in 180 to 1 in 900 in older patients. Without prophylaxis risk of death from reoperation to remove HO is 1 in 4000 to 1 in 30,000. CONCLUSION: These results are encouraging, consistent with much larger series and endorse our multidisciplinary management. Risk estimates can be used in discussion with patients. ADVANCES IN KNOWLEDGE: The risk from RT prophylaxis is small, it is safer than indometacin and substantially overlaps with the range for no prophylaxis.NGB is supported by the National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre. JES is supported by Cancer Research UK through the Cambridge Cancer Centre.This is the accepted manuscript version. The final version is available from the BIR at http://www.birpublications.org/doi/abs/10.1259/bjr.20140398?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed&

Diamond Dicing

In OLAP, analysts often select an interesting sample of the data. For example, an analyst might focus on products bringing revenues of at least 100 000 dollars, or on shops having sales greater than 400 000 dollars. However, current systems do not allow the application of both of these thresholds simultaneously, selecting products and shops satisfying both thresholds. For such purposes, we introduce the diamond cube operator, filling a gap among existing data warehouse operations. Because of the interaction between dimensions the computation of diamond cubes is challenging. We compare and test various algorithms on large data sets of more than 100 million facts. We find that while it is possible to implement diamonds in SQL, it is inefficient. Indeed, our custom implementation can be a hundred times faster than popular database engines (including a row-store and a column-store).Comment: 29 page