Quantum-limited measurements of optical signals from a geostationary satellite

The measurement of quantum signals that traveled through long distances is of fundamental and technological interest. We present quantum-limited coherent measurements of optical signals, sent from a satellite in geostationary Earth orbit to an optical ground station. We bound the excess noise that the quantum states could have acquired after having propagated 38600 km through Earth's gravitational potential as well as its turbulent atmosphere. Our results indicate that quantum communication is feasible in principle in such a scenario, highlighting the possibility of a global quantum key distribution network for secure communication.Comment: 8 pages (4 pages main article, 4 pages supplementary material), 9 figures (4 figures main article, 5 figures supplementary material), Kevin G\"unthner and Imran Khan contributed equally to this wor

Awareness and perception of multidrug-resistant organisms and antimicrobial therapy among internists vs. surgeons of different specialties: Results from the German MR2 Survey

Background: Recently, antibiotic resistance rates have risen substantially and care for patients infected with multidrug-resistant organisms (MDRO) has become a common problem in most in – and outpatient settings. The objectives of the study were to compare the awareness, perception, and knowledge of MDRO and rational antibiotic use between physicians from different medical specialties in German hospitals. Methods: A 35-item questionnaire was sent to specialists in internal medicine (internists), gynecologists, urologists, and general surgeons (non-internists) in 18 German hospitals. Likert-scales were used to evaluate awareness and perception of personal performance regarding care for patients infected with MDRO and rational use of antibiotics. Additionally, two items assessing specific knowledge in antibiotic therapy were included. The impact of medical specialty on four predetermined endpoints was assessed by multivariate logistic regression. Results: 43.0 (456/1061) of recipients responded. Both internists and non-internists had low rates of training in antibiotic stewardship. 50.8 of internists and 58.6 of non-internists had attended special training in rational antibiotic use or care for patients infected with MDRO in the 12 months prior to the study. Internists deemed themselves more confidently to choose the indications for screening patients for colonization with methicillin-resistant Staphylococcus aureus (P=0.004) and to initiate adequate infection control measures (P=0.002) than other specialties. However, there was no significant difference between internists and other specialists regarding the two items assessing specific knowledge in antibiotic therapy and infection control. Conclusion: Among the study participants, a considerable need for advanced training in the study subjects was seen, regardless of the medical specialty

Influence of Gender and Age on the Willingness to Reduce Nicotine Consumption—Results of a Survey in Urological Cancer Patients (KRAUT Study)

Although it is well-known that smoking can cause lung cancer, the relationship between smoking and urologic cancers seems not as obvious and awareness is not widespread in the general population. For the KRAUT (knowledge of the relation between smoking and urological tumors among patients with a urological tumor disease) study, 258 patients with the diagnosis of urological cancer were interviewed using a questionnaire. Most (72.1%) stated that they never had a conversation regarding this topic with any doctor. Educational work in this field should be intensified to reduce the development and progression of urologic cancer. Purpose: Our objective was to investigate whether patients with urologic tumors were aware of smoking as a risk factor for the development and progression of several urologic cancers and the extent of the medical education they had received. Another aim was to investigate whether gender or age influenced patients' willingness to change their smoking habits. Materials and Methods: Patients with histologically malignant urologic tumors were enrolled in our questionnaire-based study from September 2013 to December 2014 in 2 urology departments. Patients were asked about their smoking habits and their general understanding of the relationship between smoking and the onset of cancer (urologic cancer and lung cancer). Also, the extent of information they had acquired from a physician was assessed. The descriptive and oncologic data of the patients were recorded. Results: Of 258 enrolled patients, 186 (72.1%) had never had an informational discussion with a doctor about smoking and their urologic tumor disease. Of the 160 active and former smokers, only 45 (28.1%) were planning to stop or reduce smoking because of their tumor disease. The willingness to change smoking habits was greater for women, with a statistically significant difference (odds ratio, 5.59; P = .002). Younger patients aged <58 years were also more willing to reduce or stop smoking. Conclusion: In our study, most patients with urologic cancer were unaware of smoking as the most probable cause of tumor development. The patients had not received proper counseling from doctors on smoking and the risk it poses for tumor progression. Efforts to balance compliance among the genders and age groups through risk-adapted counseling should be undertaken. (C) 2018 Elsevier Inc. All rights reserved

What do patients with urothelial cancer know about the association of their tumor disease with smoking habits? Results of a German survey study

Purpose: Smoking represents a primary risk factor for the development of urothelial carcinoma (UC) and a relevant factor impacting UC-specific prognosis. Data on the accordant knowledge of UC-patients in this regard and the significance of physicians in the education of UC-patients is limited. Materials and Methods: Eighty-eight UC-patients were enrolled in a 23-items-survey-study aimed to analyse patient knowledge and awareness of their tumor disease with smoking along with physician smoking cessation counselling. Results: The median age of the study patients was 69 years; 26.1% (n=23), 46.6% (n=41), and 27.3% (n=24), respectively, were non-smokers, previous, and active smokers. Exactly 50% of active smokers reported a previous communication with a physician about the association of smoking and their tumor disease; however, only 25.0% were aware of smoking as main risk factor for UC development. Merely 33% of the active smokers had been prompted directly by their physicians to quit smoking. About 42% of active smokers had received the information that maintaining smoking could result in a tumor-specific impairment of their prognosis. Closely 29% of active and about 5% of previous smokers (during the time-period of active smoking) had been offered support from physicians for smoking cessation. No association was found between smoking anamnesis (p=0.574) and pack-years (p=0.912), respectively, and tumor stage of UC. Conclusions: The results of this study suggest that the medical conversation of physicians with UC-patients about the adverse significance of smoking is limited. Implementation of structured educational programs for smoking cessation may be an opportunity to further enhance comprehensive cancer care

Fühlen sich Chirurgen gerüstet für die komplexen Fragestellungen im Umgang mit multiresistenten Erregern? – Ergebnisse der Fragebogenstudie MR2

Background At the present time, there is no evidence available as to the knowledge of general surgeons regarding multi-resistant pathogens (MRP) and the rational use of antibiotic medication (antibiotic stewardship/ABS) compared with physicians from other disciplines. Methods As part of the MR2 survey (Multiinstitutional Reconnaissance of practice with MultiResistant bacteria - a survey focussing on German hospitals), a questionnaire comprising 4 + 35 items was distributed to urologists, internists, gynaecologists and general surgeons in 18 hospitals. Multivariate regression models were applied to assess the impact of each discipline affiliation on predefined endpoints. Results 456 evaluable surveys were analysed. The response rate of surgeons (156/330; 47%) and physicians from other disciplines (300/731; 41%) did not differ significantly. Based on their self-assessment, surgeons indicated a significantly lower certainty regarding the correct choice of dose, frequency and duration of antibiotic treatment (p = 0.005), the decision between intravenous or oral application (p = 0.005), as well as the accurate interpretation of microbiological reports (p = 0.023). Both surgeons and doctors from other disciplines rated their knowledge of ABS as limited. An insignificant difference was found between surgeons and non-surgeons regarding the knowledge of E. coli resistance against Ciprofloxacin in their own hospital 27.6 vs. 35.3% estimated the correct category; p = 0.114), with 64% of surgeons underestimating the local resistance rates. Both physician groups assumed that the frequent use of broad-spectrum antibiotics is substantially responsible for the increase in MRP. However, in the given case study of a highly symptomatic female patient with uncomplicated urinary tract infection, both physician groups were almost equally likely to propose treatment with a broad-spectrum antibiotic (34.0 vs. 29.3%; p = 0.331). Based on the results of the multivariate models, there were no significant differences between surgeons and non-surgeons with regard to both the attendance of training courses related to MRP/ABS over the past 12months and the quality of discharge summaries in their hospitals regarding the correct listing of MRP. Conclusion In due consideration of the results of the MR2 survey, mandatory ABS programs should be implemented in hospitals, including regular training of physicians regardless of their discipline

Impact of the medical specialty on knowledge regarding multidrug-resistant organisms and strategies toward antimicrobial stewardship

Evidence is scarce on subject-specific knowledge of multidrug-resistant organisms and rational use of antibiotics. We aimed at evaluating attitude, perception, and knowledge about multidrug-resistant organisms (MDRO) and antibiotic prescribing among urologists versus other medical specialties. Within the MR2-study (Multiinstitutional Reconnaissance of practice with MultiResistant bacteria), a questionnaire was conducted targeting general surgeons, internists, gynecologists, and urologists in 18 German hospitals. The influence of medical specialty on predetermined endpoints was assessed by multivariable logistic regression models. With 456 evaluable questionnaires, the response rate was 43% (456/1061). Within seven workdays prior to survey, urologists prescribed antibiotics to > 5 patients more often than non-urologists (50.7 vs. 24.3%; p < 0.001). Urologists were more confident regarding dosage, frequency, and duration of antibiotic treatment (p = 0.038) as well as in interpreting antibiograms (p < 0.001). Both urologists and non-urologists had poor knowledge about antibiotic stewardship. Urologists were more confident regarding local resistance patterns (p < 0.001). However, local rates of ciprofloxacin-resistant E. coli strains were correctly categorized by only 36.3 and 31.2% of urologists and non-urologists, respectively (p = 0.168). Compared to non-urologists, urologists more often acknowledged the use of broad-spectrum antibiotic agents as a problem, potentially resulting in increased resistance pattern (p = 0.036). Conversely, 31.5 and 30.7% of urologists and non-urologists (p = 0.424), respectively, would prescribe broad-spectrum antibiotics to a female patient with an uncomplicated urinary tract infection. Urologists did not attend more training courses regarding multidrug-resistance or antibiotic prescribing and did not perceive a better quality of discharge letters regarding MDRO. There is substantial need for advanced training regarding MDRO and antibiotic stewardship, regardless of medical specialty

Impact of photodynamic diagnosis-assisted transurethral resection of bladder tumors on the prognostic outcome after radical cystectomy: results from PROMETRICS 2011

Results of a retrospective single-institution study recently suggested improved prognostic outcomes in patients undergoing photodynamic diagnosis (PDD)-assisted transurethral resection of bladder tumor (TURBT) prior to radical cystectomy (RC). We sought to validate the prognostic influence of PDD-assisted TURBT on survival after RC by relying on a multi-institutional dataset. To provide a homogeneous study population, patients with organ metastasis at the time of RC and/or after neoadjuvant chemotherapy were excluded from analysis, which resulted in overall 549 bladder cancer (BC) patients from 18 centers of the Prospective Multicenter Radical Cystectomy Series 2011 (PROMETRICS 2011). To evaluate the influence of PDD conducted during primary or final TURBT on cancer-specific mortality (CSM) and overall mortality (OM) after RC, bootstrap-corrected multivariate Cox proportional-hazards regression models were applied (median follow-up: 25 months; IQR: 19-30). Sensitivity analyses were performed for both patients with pure urothelial carcinoma and patients undergoing one single TURBT only. In 88 (16.0 %) and 100 (18.2 %) patients, PDD was used in primary and final TURBTs, respectively. In 335 (61.0 %) patients, a single TURBT was performed prior to RC; in 194 patients (35.3 %), TURBT had been performed in a different center. CSM and OM rates at 3 years were 32 and 40 %, respectively. Use of PDD during primary or final TURBT was no independent predictor of CSM or OM. These results were internally valid and were confirmed in sensitivity analyses. PDD utilization during TURBT prior to RC does not independently impact the prognosis of BC patients after RC