How Family Physicians in Saskatchewan Make Lung Cancer Screening Decisions

Aims: This study explored family physicians’ (FPs) stated practices and decision-making for lung cancer screening. Methods: Cross-sectional survey of a stratified random sample of Saskatchewan FPs using single item questions and simulated clinical scenarios. Findings: Wide variations in FPs’ lung cancer screening practices exist in their decision to screen and choice of screening test. Certain physician, patient and non-medical factors influence FPs’ decision-making contrary to their perception of guidelines. Conclusions: The high self-reported prevalence and measured inclination to screen in clinical scenarios contrary to prevailing guidelines adds unnecessary health care costs and has potential to cause harm. Significance: First and unique study regarding lung cancer screening in family practice in Canada. It contributes to the literature about existing FP practices and decision-making regarding lung cancer screening and highlights implications to health care cost, patient care and CME initiatives. Keywords: Lung Cancer Screening, Decision-making, Clinical Practice Guidelines, Family Medicine

Delay models for static and adaptive persistent resource allocations in wireless systems

A variety of scheduling strategies can be employed in wireless systems to satisfy different system objectives and to cater for different traffic types. Static persistent resource allocations can be employed to transfer small M2M data packets efficiently compared to dynamic packet-by-packet scheduling, even when the M2M traffic model is non-deterministic. Recently, adaptive persistent allocations have been proposed in which the volume of allocated resources can change in sympathy with the instantaneous queue size at the M2M device and without expensive signaling on control channels. This increases the efficiency of resource usage at the expense of a (typically small) increased packet delay. In this paper, we derive a statistical model for the device queue size and packet delay in static and adaptive persistent allocations which can be used for any arrival process (i.e., Poisson or otherwise). The primary motivation is to assist with dimensioning of persistent allocations given a set of QoS requirements (such as a prescribed delay budget). We validate the statistical model via comparison with queue size and delay statistics obtained from a discrete event simulation of a persistent allocation system. The validation is performed for both exponential and gamma distributed packet inter-arrivals to demonstrate the model generality

MicroRNA: A Signature for Cancer Diagnostics

Various tools and techniques are being used for the diagnosis of cancer, but not a sole technique provides powerful result at the very early stages of cancer. This provides the need for type of tools which could detect cancer at early stages so that survival rate could be augmented. There are various diagnostic ways to identify cancer, but in each case, there are always circumstances to compromise on the sensitivity. In this framework, a new and more advanced approach of diagnosis for cancer is microRNA (miRNA). miRNAs are conserved regions among humans and animals, and their synthesis takes place in the nucleus and cytoplasm. There are several types of microRNAs that could be upregulated and downregulated in various cancers. A cancer cell could be identified by measurement of the expression pattern of miRNA. By examining the expression level for different types of cancers, miRNA can be used as biomarker for early detection of cancer in human beings

A Multi-Service Adaptive Semi-Persistent LTE Uplink Scheduler for Low Power M2M Devices

The prominence of Machine-to-Machine (M2M) communications in the future wide area communication networks place various challenges to the cellular technologies such as the Long Term Evolution (LTE) standard, owing to the large number of M2M devices generating small bursts of infrequent data packets with a wide range of delay requirements. The channel structure and Quality of Service (QoS) framework of LTE networks fail to support M2M traffic with multiple burst sizes and QoS requirements while a bottleneck often arises from the limited control resources to communicate future uplink resource allocations to the M2M devices. Moreover, many of the M2M devices are battery-powered and require a low-power consuming wide area technology for wide-spread deployments. To alleviate these issues, in this article we propose an adaptive semipersistent scheduling (SPS) scheme for the LTE uplink which caters for multi-service M2M traffic classes with variable burst sizes and delay tolerances. Instead of adhering to the rigid LTE QoS framework, the proposed algorithm supports variation of uplink allocation sizes based on queued data length yet does not require control signaling to inform those allocations to the respective devices. Both the eNodeB and the M2M devices can determine the precise uplink resource allocation related parameters based on their mutual knowledge, thus omitting the burden of regular control signaling exchanges. Based on a control parameter, the algorithm can offer different capacities and levels of QoS satisfaction to different traffic classes. We also introduce a pre-emptive feature by which the algorithm can prioritize new traffic with low delay tolerance over ongoing delay-tolerant traffic. We also build a model for incorporating the Discontinuous Reception (DRX) mechanism in synchronization with the adaptive SPS transmissions so that the UE power consumption can be significantly lowered, thereby extending their battery lives. The simulation and performance analysis of the proposed scheme shows significant improvement over the traditional LTE scheduler in terms of QoS satisfaction, channel utilization and low power requirements of multi-service M2M traffic

Massive Fluid Requirements and an Unusual BUN/Creatinine Ratio for Pre-Renal Failure in Patients with Cholera

Background: Cholera is an important infectious cause of secretory diarrhea. The primary symptom of infection is the sudden onset of watery diarrhea with subsequent volume depletion causing renal insufficiency. The objective of this research is to study the level of dehydration at presentation and subsequent fluid management in Patients with cholera. Methods: This study was conducted on 191 Patients of Cholera admitted at a tertiary care hospital in Karachi, Pakistan during the period of 5 years. Medical charts were evaluated retrospectively for initial hydration status, baseline lab investigations on admission and discharge and fluid therapy given to all the Patients while their stay in the hospital and the data was analyzed on SPSS 15.0. Results: Out of the 191 Patients, 83(43%) were males and 108 (57%) were females with mean age of 42.3 years (SD+/-18.34). The average duration of symptoms was 3.75 days (SD+/-2.04). Of 191 Patients, 175 (92.1%) presented with dehydration, 80 (42.3%) were given Ringer\u27s Lactate (R/L) + Normal Saline (N/S), 45 (24%) Patients were given R/L + N/S + Oral Rehydration Therapy (ORS), 27 (14.3%) of the Patients were kept on R/L only and remaining were given various combinations of R/L, N/S, ORS and Dextrose Saline (D/S). On admission mean Blood Urea Nitrogen (BUN) was 24.54 (SD+/-16.6), mean creatinine was 2.47 (SD+/-2.35) and mean BUN/Creatinine ratio was 11.63 (SD+/-5.7). Conclusion: Aggressive fluid rehydration remains the cornerstone of management of cholera. Instead of presenting with a classical BUN/Creatinine ratio of \u3e20:1, Patients with pre-renal failure in cholera may present with a BUN/Creatinine ratio of \u3c15:1

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Bioconversion of Tyrosine and Tryptophan Derived Biogenic Amines by Neuropathogenic Bacteria

The biochemical potential of pathogenic bacteria may cause alteration in the neurophysiological environment; consequently, neuroendocrine and immune responses of the host are modulated by endogenously produced metabolic products of neuropathogenic bacteria. The present study was designed to detect the derived biogenic amines in spent culture media of Bacillus cereus (Bc), Clostridium tetani (Ct), Listeria monocytogenes (Lm), and Neisseria meningitidis (Nm). Overnight grown culture in different culture media i.e., Nutrient broth (NB), Luria basal broth (LB), Brain Heart Infusion broth (BHI), and human serum supplemented RPMI 1640 medium (RPMI) were used to prepare filter-sterilized, cell-free cultural broths (SCFBs) and subjected to high performance liquid chromatography with electrochemical detection (HPLC-EC) along with the control SCFBs. Comparative analysis of biogenic amines in neuropathogenic bacterial SCFBs with their respective control (SCFB) revealed the complete degradation of dopamine (DA) into its metabolic products by Bc, Ct, and Nm, whereas Lm showed negligible degradation of DA. A relatively high concentration of 5-hydroxyindol acetic acid (5HIAA) by Bc in NB and LB indicated the tryptophan metabolism by the serotonin (5HT) pathway. Our study suggests that microbial endocrinology could help unravel new perspectives to the progression of infectious diseases

Hepatitis C virus, human immunodeficiency virus and pseudomonas phage PS5 triad share epitopes of immunogenic determinants

Abstract A lytic phage for Pseudomonas aeruginosa belongs to the Myoviridea family was isolated from urine for use in therapeutics. Pair of hepatitis C virus (HCV) primers highlighted segments on the genome of this phage. The sequence of these PCR products as well as the possible serological cross reactivity/relationship between HCV and the phage were investigated. One hundred HCV positive human sera were analyzed by ELISA. Ninety six well plates were coated with multiple epitopes of HCV proteins (Kit), phage and Pseudomonas cells. Initially the positive and negative control sera supplied in the test kit were used to evaluate the cross reactivity between the phage and anti-HCV antibodies. The results suggested a value over than 0.105 for a HCV positive reaction. Of the 100 HCV positive sera tested, sixty five and thirty percent showed cross reaction with phage lysate and Pseudomonas aeruginosa, respectively. High HCV antibody titer correlated to high cut off value for phage cross reaction, whereas no such correlation existed between HCV antibody titer and Pseudomonas cross reaction. The PCR products were sequenced and aligned with the HCV genome of H77. Sequence homology was detected in the 5', 3' UTRs and NS3 regions. Further these products showed similarity with HIV-1 Env, Pol & 3'LTR regions as well.</p

Cerebrospinal Fluid Concentrations of Biogenic Amines: Potential Biomarkers for Diagnosis of Bacterial and Viral Meningitis

Catecholamine and serotonin are biogenic amines (BAs) that serve as neurotransmitters and play an important role in the regulation of cardinal functions that are mainly altered during central nervous system (CNS) infections. A total 92 samples of cerebrospinal fluid (CSF) were classified into 4 groups based on their etiology. In these samples, BAs/neurotransmitters i.e., dopamine (DA), 3,4-dihydroxyphenylacetic acid (DOPAC), homovanillic acid (HVA), and 5-hydroxyindoleacetic acid (5HIAA) were detected and quantified by high performance liquid chromatography with electrochemical detection (HPLC-EC) to determine the neurophysiology of the CNS infections by bacteria (Listeria monocytogenes (Lm) and Neisseria meningitidis (Nm)) and herpes simplex virus (HSV). CSF concentration of DA, DOPAC, HVA, and 5HIAA were found significantly elevated in all test cohorts. Present study highlights that the analysis of BAs is pivotal for the early diagnosis of bacterial and viral meningitis. In addition, coinfections of varied etiology can also be diagnosed by their quantification. Thus, BAs can serve as potential biomarkers of these CNS infections

A packet age based LTE uplink packet scheduler for M2M traffic

M2M applications exhibit a wide variety of QoS requirements, but many, particularly those associated with monitoring and/or control, are delay sensitive and therefore have specific packet delay budgets. One of the issues when supporting such delay sensitive M2M applications over a wide area cellular standard such as LTE is that the base station scheduling entity cannot precisely ascertain when pending uplink packets at devices were generated. This makes scheduling according to deadlines based upon packet delay budgets very challenging and ultimately involves some degree of error. In this paper, we propose a new delay sensitive scheduler that increases the probability of satisfying the delay budget of packets by exploiting Packet Age (PA) data explicitly reported by devices. The PA is a new MAC Control Element that represents the age of the oldest pending packet in the device buffers and is sent by devices in parallel with the existing Buffer Status Report (BSR) that contains volume and priority data. The overhead associated with the PA MAC control element is extremely small (2 bytes). We demonstrate the performance of the new technique with an OPNET simulation of an LTE TDD system serving event driven delay sensitive M2M traffic, comparing the results when PA reporting is enabled versus disabled for essentially the same uplink scheduling algorithm