Care of terminally-ill patients: an opinion survey among critical care healthcare providers in the Middle East

Background: Modern medicine has allowed physicians to support the dying terminally-ill patient with artificial means. However, a common dilemma faced by physicians in general, and intensivist in particular is when to limit or withdraw aggressive intervention.Objective: To study the effect of training background and seniority on Do-not to resuscitate (DNR) decisions in the Middle East.Methods: Anonymous questionnaire sent to members of the Pan Arab Society of Critical Care.Results: The response rate was 46.2%. Most of the responders were Muslim (86%) and consultants (70.9%). Majority of the responders were trained in western countries. Religion played a major role in 59.3% for making the DNR decision. DNR was considered equivalent to comfort care by 39.5%. In a futile case scenario, Do Not Escalate Therapy was preferred (54.7%). The likelihood of a patient, once labeled DNR, being clinically neglected was a concern among 46.5%. Admission of DNR patients to the ICU was acceptable for 47.7%. Almost one-half of the responders (46.5%) wanted physicians to have the ultimate authority in the DNR decision. Training background was a significant factor affecting the interpretation of the term no code DNR (P< 0.008).Conclusion: Training background and level of seniority in critical care provider does not impact opinion on most of end of life issues related to care of terminally-ill patients. However, DNR is considered equivalent to comfort care among majority of Middle Eastern trained physicians.Keywords: Do-not resuscitate, Islam, care of terminally-ill, opinion, trainingAfrican Health Sciences 2013; 13(4): 893 - 89

OCCURRENCE OF LANCEFIELD GROUP C STREPTOCOCCAL SPECIES IN STRANGLES CASES OF FOALS IN PUNJAB, PAKISTAN

Three equine rearing districts of Punjab, Pakistan including Sargodha, Okara and Faisalabad were surveyed. The occurrence of strangles was highest in foals during February to the start of May compared to winter and summer seasons. Strangles-inflicted foals showed inability to eat, strangled breathing with roaring sounds, swollen submandibular and submaxillary lymph nodes, abscessation in the lymph nodes, hyperthermia and anorexia with general debilitating conditions. Morbidity and case fatality rates were 78 and 2%, respectively. Pus samples were collected from 70 foals showing burst lymph node abscesses and processed on blood agar. Typical growth showing pinpoint mucoid colonies, with beta hemolysis and catalase negative characteristics were subjected to API Strep 20 system. The isolates of streptococcus recovered from pus samples include S. equi subspecies equi (54%), S. equi subspecies zooepidemicus (11%), S. dysgalactia subspecies equisimilis (11%) and mixed isolates of S. equisimilis and S. equi (23%). Streptococcus species were found sensitive to Penicillin and Cefotoxime, whereas Gentamycine and Tetracycline were ineffective

Quantum memory assisted entropic uncertainty and entanglement dynamics: Two qubits coupled with local fields and Ornstein Uhlenbeck noise

Entropic uncertainty and entanglement are two distinct aspects of quantum mechanical procedures. To estimate entropic uncertainty relations, entropies are used: the greater the entropy bound, the less effective the quantum operations and entanglement are. In this regard, we analyze the entropic uncertainty, entropic uncertainty lower bound, and concurrence dynamics in two non-interacting qubits. The exposure of two qubits is studied in two different qubit-noise configurations, namely, common qubit-noise and independent qubit-noise interactions. To include the noisy effects of the local external fields, a Gaussian Ornstein Uhlenbeck process is considered. We show that the rise in entropic uncertainty gives rise to the disentanglement in the two-qubit Werner type state and both are directly proportional. Depending on the parameters adjustment and the number of environments coupled, different classical environments have varying capacities to induce entropic uncertainty and disentanglement in quantum systems. The entanglement is shown to be vulnerable to current external fields; however, by employing the ideal parameter ranges we provided, prolonged entanglement retention while preventing entropic uncertainty growth can be achieved. Besides, we have also analyzed the intrinsic behavior of the classical fields towards two-qubit entanglement without any imperfection with respect to different parameter

Memory Threads: Organizing Digital Memories to Organize Social P2P Networks

Human remember their memories based on some reference which helps in recalling those memories. These references are usually common for many people, objects, places and so on. We organize human digital memories in the form of memory threads, according to the references of the memories in order to present information about different places, persons, etc. We organize peers in our Entity-based social peer-to-peer network according to memory threads in the form of memory threads-based communities. In our approach, peers having human digital memories with similar reference keys are grouped together under certain criteria. The criteria for thread selects peers with similar digital memories and arrange them in a specific order that define a structure of thread, which allows tracing via memories and accessing peers at different locations in threads easily. This approach is more scalable because it brings the most similar peer together in a community of similar peer. The known location of peer and data allows fast data searching. Also, a community presents useful information about the entity in network

Gamow-Teller transitions from 24Mg and its impact on the electron capture rates in the O + Ne + Mg cores of stars

Electron captures on nuclei play an important role in the collapse of stellar core in the stages leading to a type-II supernova. Recent observations of subluminous Type II-P supernovae (e.g. 2005cs, 2003gd, 1999br) were able to rekindle the interest in 8 - 10 which develop O+Ne+Mg cores. We used the proton-neutron quasiparticle random phase approximation (pn-QRPA) theory to calculate the B(GT) strength for 24Mg \rightarrow 24Na and its associated electron capture rates for incorporation in simulation calculations. The calculated rates, in this letter, have differences with the earlier reported shell model and Fuller, Fowler, Newman (hereafter F2N) rates. We compared Gamow-Teller strength distribution functions and found fairly good agreement with experiment and shell model. However, the GT centroid and the total GT strength, which are useful in the calculation of electron capture rates in the core of massive pre-supernova stars, lead to the enhancement of our rate up to a factor of four compared to the shell model rates at high temperatures and densities.Comment: 13 pages, 3 figure