Image-Guided High-Dose Rate Intracavitary Brachytherapy in the Treatment of Medically Inoperable Early-Stage Endometrioid Type Endometrial Adenocarcinoma

To report the experience with high dose rate, image guided intracavitary brachytherapy in the treatment of medically inoperable, early stage endometrial cancer. Poster presented at: American Brachytherapy Society Annual Meeting April 20-22, 2017 in Boston MA

Early quick acuity score provides more complete data on emergency department walkouts.

INTRODUCTION: Many prior studies have compared the acuity of Emergency Department (ED) patients who have Left Without Being Seen (LWBS) against non-LWBS patients. A weakness in these studies is that patients may walk out prior to the assignment of a triage score, biasing comparisons. We report an operational change whereby acuity was assessed immediately upon patient arrival. We hypothesized more patients would receive acuity scores with EQAS. We also sought to compare LWBS and non-LWBS patient characteristics with reduced bias. SETTING: urban, academic medical center. Retrospective cohort study, electronic chart review, collecting data on all ED patients presenting between 4/1/2010 and 10/31/2011 ( Traditional Acuity Score period, TAS) and from 11/1/2011 to 3/31/2012 ( Early Quick Acuity Score period, EQAS). We recorded disposition (LWBS versus non-LWBS), acuity and demographics. For each subject during the EQAS period, we calculated how many prior ED visits and how many prior walkouts the subject had had during the TAS period. RESULTS: Acuity was recorded in 92,275 of 94,526 patients (97.6%) for TAS period, and 25,577 of 25,760 patients (99.3%) for EQAS period, a difference of 1.7% (1.5%, 1.8%). LWBS patients had acuity scores recorded in 5,180 of 7,040 cases (73.6%) during TAS period, compared with 897 of 1,010 cases (88.8%) during the EQAS period, a difference of 15.2% (14.8%, 15.7%). LWBS were more likely than non-LWBS to be male, were younger and had lower acuity scores. LWBS averaged 5.3 prior ED visits compared with 2.8 by non-LWBS, a difference of 2.5 (1.5, 3.5). LWBS averaged 1.3 prior ED walkouts compared with 0.2 among non-LWBS, a difference of 1.1 (0.8, 1.3). CONCLUSIONS: EQAS resulted in a higher proportion of patients receiving acuity scores, particularly among LWBS. This offers more complete data when comparing LWBS and non-LWBS patient characteristics. The comparison reinforced findings from prior studies

Role of Magnetic Resonance Imaging in the Diagnosis of Osteomyelitis in Diabetic Foot Infections.

PURPOSE: The role of magnetic resonance imaging (MRI) in the diagnosis of osteomyelitis in foot infections in diabetics was investigated. The accuracy, sensitivity, and specificity of MRI, plain radiography, and nuclear scanning were determined for diagnosing osteomyelitis, and a cost comparison was made. METHODS: Twenty-seven patients with diabetic foot infections were studied prospectively. All patients underwent MRI and plain radiography. Twenty-two patients had technetium bone scans, and 19 patients had Indium scans. Nineteen patients had all four tests performed. Patients with obvious gangrene or a fetid foot were excluded. RESULTS: The diagnosis of osteomyelitis was established by pathologic specimen (n = 18), bone culture (n = 3), or successful response to medical management (n = 6). Osteomyelitis was confirmed in nine of the pathologic specimens. The diagnostic sensitivity, specificity, and accuracy for MRI was 88%, 100%, and 95%, respectively, for plain radiography it was 22%, 94%, and 70%, respectively, for technetium bone scanning it was 50%, 50%, and 50%, respectively, and for Indium leukocyte scanning it was 33%, 69%, and 58%, respectively. The data were analyzed statistically with the two-tailed Fisher\u27s exact test. MRI was the only test that was statistically significant (p \u3c 0.01). CONCLUSIONS: MRI appeared to be the single best test for the diagnosis of osteomyelitis associated with diabetic foot infections. It had a better diagnostic accuracy than conventional modalities and appeared to be more cost-effective than the frequently used Indium scan

The Potential Short- and Long-Term Disruptions and Transformative Impacts of 5G and Beyond Wireless Networks: Lessons Learnt from the Development of a 5G Testbed Environment

The capacity and coverage requirements for 5 th generation (5G) and beyond wireless connectivity will be significantly different from the predecessor networks. To meet these requirements, the anticipated deployment cost in the United Kingdom (UK) is predicted to be between £30bn and £50bn, whereas the current annual capital expenditure (CapEX) of the mobile network operators (MNOs) is £2.5bn. This prospect has vastly impacted and has become one of the major delaying factors for building the 5G physical infrastructure, whereas other areas of 5G are progressing at their speed. Due to the expensive and complicated nature of the network infrastructure and spectrum, the second-tier operators, widely known as mobile virtual network operators (MVNO), are entirely dependent on the MNOs. In this paper, an extensive study is conducted to explore the possibilities of reducing the 5G deployment cost and developing viable business models. In this regard, the potential of infrastructure, data, and spectrum sharing is thoroughly investigated. It is established that the use of existing public infrastructure (e.g., streetlights, telephone poles, etc.) has a potential to reduce the anticipated cost by about 40% to 60%. This paper also reviews the recent Ofcom initiatives to release location-based licenses of the 5G-compatible radio spectrum. Our study suggests that simplification of infrastructure and spectrum will encourage the exponential growth of scenario-specific cellular networks (e.g., private networks, community networks, micro-operators) and will potentially disrupt the current business models of telecommunication business stakeholders - specifically MNOs and TowerCos. Furthermore, the anticipated dense device connectivity in 5G will increase the resolution of traditional and non-traditional data availability significantly. This will encourage extensive data harvesting as a business opportunity and function within small and medium-sized enterprises (SMEs) as well as large social networks. Consequently, the rise of new infrastructures and spectrum stakeholders is anticipated. This will fuel the development of a 5G data exchange ecosystem where data transactions are deemed to be high-value business commodities. The privacy and security of such data, as well as definitions of the associated revenue models and ownership, are challenging areas - and these have yet to emerge and mature fully. In this direction, this paper proposes the development of a unified data hub with layered structured privacy and security along with blockchain and encrypted off-chain based ownership/royalty tracking. Also, a data economy-oriented business model is proposed. The study found that with the potential commodification of data and data transactions along with the low-cost physical infrastructure and spectrum, the 5G network will introduce significant disruption in the Telco business ecosystem

Extremely high He isotope ratios in MORB-source mantle from the proto-Iceland plume

The high <sup>3</sup>He/<sup>4</sup>He ratio of volcanic rocks thought to be derived from mantle plumes is taken as evidence for the existence of a mantle reservoir that has remained largely undegassed since the Earth's accretion. The helium isotope composition of this reservoir places constraints on the origin of volatiles within the Earth and on the evolution and structure of the Earth's mantle. Here we show that olivine phenocrysts in picritic basalts presumably derived from the proto-Iceland plume at Baffin Island, Canada, have the highest magmatic <sup>3</sup>He/<sup>4</sup>He ratios yet recorded. A strong correlation between <sup>3</sup>He/<sup>4</sup>He and <sup>87</sup>Sr/<sup>86</sup>Sr, <sup>143</sup>Nd/<sup>144</sup>Nd and trace element ratios demonstrate that the <sup>3</sup>He-rich end-member is present in basalts that are derived from large-volume melts of depleted upper-mantle rocks. This reservoir is consistent with the recharging of depleted upper-mantle rocks by small volumes of primordial volatile-rich lower-mantle material at a thermal boundary layer between convectively isolated reservoirs. The highest <sup>3</sup>He/<sup>4</sup>He basalts from Hawaii and Iceland plot on the observed mixing trend. This indicates that a <sup>3</sup>He-recharged depleted mantle (HRDM) reservoir may be the principal source of high <sup>3</sup>He/<sup>4</sup>He in mantle plumes, and may explain why the helium concentration of the 'plume' component in ocean island basalts is lower than that predicted for a two-layer, steady-state model of mantle structure

Socio-demographic and health service factors associated with antibiotic dispensing in older Australian adults

© 2019 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Widespread use of antibiotics has led to the development of antibiotic resistance. However, there are limited data describing antibiotic use in the community setting, and examining factors associated with greater use. Our study aimed to quantify antibiotic dispensing in older adults in the community according to socio-demographics and health services use. Methods Prospective analysis of a population-based cohort study of 239,981 adults aged 45 years in Australia (the Sax Institute’s 45 and Up Study). Data on socio-demographics and health from a questionnaire, were linked to 2015 antibiotic dispensing data from the Pharmaceutical Benefits Scheme (PBS), as well as other administrative health databases. We estimated the Defined Daily Dose (DDD) of systemic antibiotics dispensed, defined by an Anatomic Therapeutic Classification code beginning with J01, in 2015. We also conducted Poisson regression with robust standard errors to identify factors associated with antibiotic dispensing. Results Overall, 49.3% of 45 and Up Study participants had at least one systemic antibiotic dispensed in 2015 with a total of 392,856 prescriptions dispensed and an average of 36.5 DDDs/1000-persons/day in the study population. The quantity of antibiotics dispensed increased with increasing age (25.6 DDDs/1000/day in 15 general practitioner consultations in the last year (80.5 and 88.3 DDDs/1000/day, respectively). These factors remained strongly associated with greater antibiotic dispensing after adjusting for age, sex, education, income, area of residence and co-morbidities. Conclusions Residence in aged care facilities and high GP visits are associated with greater antibiotic dispensing. This study provides important evidence regarding high use groups for antimicrobial stewardship

VA Centers of Excellence in Primary Care Education

VETERANS HEALTH ADMINISTRATION CoEPCE Purpose •Develop and test innovative approaches for curricula related to core competencies of patient-centered care. •Study the impact of new educational approaches and models on health professions education to include collaboration, cultural shifts in educational priorities, and educational and workforce outcomes within and beyond VA. •Improve primary care instructional strategies with emphasis on workplace learning Stuart C. Gilman, MD, MPH Director, Advanced Fellowships and Professional Development Centers of Excellence in Primary Care Education Office of Academic Affiliations Veterans Health Administration In his role as Director, Advanced Fellowships and Professional Development, Office of Academic Affiliations, Veterans Health Administration, Stuart is a leader in national education policy with the nation’s largest health profession education system. He has oversight of VA’s most in-depth and advanced training programs for physicians and others, including the VA Quality Scholars Program and Advanced Fellowships in Patient Safety, Mental Illness Treatment, and Health System Engineering. Stuart also oversees VA’s engagement with the Robert Wood Johnson Foundation Clinical Scholars Program. In addition, he directs the Centers of Excellence in Primary Care Education, a national demonstration project at five VA sites advancing interprofessional education in patient-centered primary care settings. Stuart’s undergraduate education was at Grinnell College, then he received his medical degree from Rush University. Stuart completed Internal Medicine residency at VA/ UC Irvine and obtained his MPH from UCLA. After his residency, he was a VA/Robert Wood Johnson Clinical Scholar at UC San Francisco. Based in Southern California, Stuart is a practicing primary care general internist and has rank of Professor, Clinical Health Sciences at University of California, Irvine. Kathryn Rugen, PhD, FNP-BC Nurse Practitioner Consultant Centers for Excellence in Primary Care Education Office of Academic Affiliations Veterans Health Administration Kathryn Rugen, PhD, FNP-BC is the nurse practitioner consultant to the VA Centers of Excellence in Primary Care Education. These Centers are funded by the VA Office of Academic Affiliations. Dr. Rugen is a member of the coordinating center which oversees the facilitation of the Centers and manages the operations, evaluation and sustainability efforts. She is responsible for assisting the sites in transforming primary care delivery models and developing and testing new models of education. Dr. Rugen is an assistant professor at the University of Illinois at Chicago, College of Nursing

Perturbations of nuclear C*-algebras

Kadison and Kastler introduced a natural metric on the collection of all C*-subalgebras of the bounded operators on a separable Hilbert space. They conjectured that sufficiently close algebras are unitarily conjugate. We establish this conjecture when one algebra is separable and nuclear. We also consider one-sided versions of these notions, and we obtain embeddings from certain near inclusions involving separable nuclear C*-algebras. At the end of the paper we demonstrate how our methods lead to improved characterisations of some of the types of algebras that are of current interest in the classification programme.Comment: 45 page

Genotypic characterization of Streptococcus pneumoniae serotype 19F in Malaysia

Streptococcus pneumoniae is an epidemiologically important bacterial pathogen. Recently, we reported the antibiotic susceptibility patterns of a limited collection of pneumococcal isolates in Malaysia with a high prevalence of erythromycin resistant strains. In the present study, 55 of the pneumococcal isolates of serotype 19F were further analysed by pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). The generated genotypic patterns were then correlated with the antibiograms previously reported. Forty-seven different PFGE profiles (PTs) were obtained, showing that the isolates were genetically diverse. MLST identified 16 sequence types (STs) with ST-236 being predominant (58.2%), followed by ST-81 (10.3%). Among the ST-236 isolates, 22 were erythromycin resistant S. pneumoniae (ERSP) and 15 were trimethoprim/sulfamethoxazole (TMP/SMX) resistant, while among ST-81, four isolates were ERSP and two were TMP/SMX resistant. The high prevalence of erythromycin resistant serotype 19F isolates of ST-236 in this study has also been reported in other North and South East Asian countries