Gastrointestinal Bleeding and Anticoagulant or Antiplatelet Drugs

Gastrointestinal (GI) bleeding is a frequently encountered and very serious problem in emergency room patients who are currently being treated with anticoagulant or antiplatelet medications. There is, however, a lack of clinical practice guidelines about how to respond to these situations. The goal of this study was to find published articles that contain specific information about how to safely adjust anticoagulant and antiplatelet therapy when GI bleeding occurs.The investigators initiated a global search on the PubMed and Google websites for published information about GI bleeding in the presence of anticoagulant or antiplatelet therapy. After eliminating duplicate entries, the medical articles that remained were screened to narrow the sets of articles to those that met specific criteria. Articles that most closely matched study criteria were analyzed in detail and compared to determine how many actual guidelines exist and are useful.We could provide only minimal information about appropriate therapeutic strategies because no articles provided sufficient specific advice about how to respond to situations involving acute GI bleeding and concurrent use of anticoagulant or antiplatelet drugs. Only 4 articles provided enough detail to be of any use in an emergency situation.Clinical practice guidelines and also clinical trials for GI hemorrhaging should be expanded to state in which situations the use of anticoagulant or antiplatelet drugs should be suspended and the medications should later be resumed, and they should state the level of risk for any particular action

The workday of hospital surgeons: what they do, what makes them satisfied, and the role of core tasks and administrative tasks; a diary study.

BACKGROUND Many surgeons report passion for their work, but not all tasks are likely to be satisfying. Little is known about how hospital surgeons spend their days, how they like specific tasks, and the role of core tasks (i.e. surgery-related tasks) versus tasks that may keep them from core tasks (e.g., administrative work). This study aimed at a more detailed picture of hospital surgeons' daily work - how much time they spend with different tasks, how they like them, and associations with satisfaction. METHODS Hospital surgeons (N = 105) responded to a general survey, and 81 of these provided up to five daily questionnaires concerning daily activities and their attractiveness, as well as their job satisfaction. The data were analyzed using t-tests, analysis of variance, as well as analysis of covariance and repeated measures analysis of variance for comparing means across tasks. RESULTS Among 14 tasks, surgery-related tasks took 21.2%, patient-related tasks 21.7% of the surgeons' time; 10.4% entailed meetings and communicating about patients, and 18.6% documentation and administration. The remaining time was spent with teaching, research, leadership and management, and not task-related activities (e.g. walking between rooms). Surgery was rated as most (4.25; SD = .66), administration as least attractive (2.63; SD = .78). A higher percentage of administration predicted lower perceived legitimacy; perceived legitimacy of administrative work predicted job satisfaction (r = .47). Residents were least satisfied; there were few gender differences. CONCLUSIONS Surgeons seem to thrive on their core tasks, most notably surgery. By contrast, administrative duties are likely perceived as keeping them from their core medical tasks. Increasing the percentage of medical tasks proper, notably surgery, and reducing administrative duties may contribute to hospital surgeons' job satisfaction

Combining the bulk transfer formulation and surface renewal analysis for estimating the sensible heat flux without involving the parameter KB-1

The single‐source bulk transfer formulation (based on the Monin‐Obukhov Similarity Theory, MOST) has been used to estimate the sensible heat flux, H, in the framework of remote sensing over homogeneous surfaces (HMOST). The latter involves the canopy parameter, , which is difficult to parameterize. Over short and dense grass at a site influenced by regional advection of sensible heat flux, HMOST with  = 2 (i.e., the value recommended) correlated strongly with the H measured using the Eddy Covariance, EC, method, HEC. However, it overestimated HEC by 50% under stable conditions for samples showing a local air temperature gradient larger than the measurement error, 0.4 km−1. Combining MOST and Surface Renewal analysis, three methods of estimating H that avoid dependency have been derived. These new expressions explain the variability of H versus , where is the friction velocity, is the radiometric surface temperature, and is the air temperature at height, z. At two measurement heights, the three methods performed excellently. One of the methods developed required the same readily/commonly available inputs as HMOST due to the fact that the ratio between and the ramp amplitude was found fairly constant under stable and unstable cases. Over homogeneous canopies, at a site influenced by regional advection of sensible heat flux, the methods proposed are an alternative to the traditional bulk transfer method because they are reliable, exempt of calibration against the EC method, and are comparable or identical in cost of application. It is suggested that the methodology may be useful over bare soil and sparse vegetation.This research was funded by CERESS project AGL2011–30498 (Ministerio de Economía y Competitividad of Spain, cofunded FEDER), CGL2012–37416‐C04‐01 (Ministerio de Ciencia y Innovación of Spain), and CEI Iberus, 2014 (Proyecto financiado por el Ministerio de Educación en el marco del Programa Campus de Excelencia Internacional of Spain)

Vortex-unbinding and finite-size effects in Tl2Ba2CaCu2O8 thin films

Current-voltage ($I$-$V$) characteristics of Tl$_2$Ba$_2$CaCu$_2$O$_8$ thin films in zero magnetic field are measured and analyzed with the conventional Kosterlitz-Thouless-Berezinskii (KTB) approach, dynamic scaling approach and finite-size scaling approach, respectively. It is found from these results that the $I$-$V$ relation is determined by the vortex-unbinding mechanism with the KTB dynamic critical exponent $z=2$. On the other hand, the evidence of finite-size effect is also found, which blurs the feature of a phase transition.Comment: Typo corrected & reference adde

The FCC-ee study: Progress and challenges

The FCC (Future Circular Collider) study represents a vision for the next large project in high energy physics, comprising an 80-100 km tunnel that can house a future 100 TeV hadron collider. The study also includes a high luminosity e+e- collider operating in the centre-of-mass energy range of 90-350 GeV as a possible intermediate step, the FCC-ee. The FCC-ee aims at definitive electro-weak precision measurements of the Z, W, H and top particles, and search for rare phenomena. Although FCC-ee is based on known technology, the goal performance in luminosity and energy calibration make it quite challenging. During 2014 the study went through an exploration phase. The study has now entered its second year and the aim is to produce a conceptual design report during the next three to four years. We here report on progress since the last IPAC conference.Comment: Poster presented at IPAC15,Richmond, VA, USA, May 201

Prospective Newborn Screening for SCID in Germany: A First Analysis by the Pediatric Immunology Working Group (API)

Background: T-cell receptor excision circle (TREC)-based newborn screening (NBS) for severe combined immunodeficiencies (SCID) was introduced in Germany in August 2019. / Methods: Children with abnormal TREC-NBS were referred to a newly established network of Combined Immunodeficiency (CID) Clinics and Centers. The Working Group for Pediatric Immunology (API) and German Society for Newborn Screening (DGNS) performed 6-monthly surveys to assess the TREC-NBS process after 2.5 years. / Results: Among 1.9 million screened newborns, 88 patients with congenital T-cell lymphocytopenia were identified (25 SCID, 17 leaky SCID/Omenn syndrome (OS)/idiopathic T-cell lymphocytopenia, and 46 syndromic disorders). A genetic diagnosis was established in 88%. Twenty-six patients underwent hematopoietic stem cell transplantation (HSCT), 23/26 within 4 months of life. Of these, 25/26 (96%) were alive at last follow-up. Two patients presented with in utero onset OS and died after birth. Five patients with syndromic disorders underwent thymus transplantation. Eight syndromic patients deceased, all from non-immunological complications. TREC-NBS missed one patient, who later presented clinically, and one tracking failure occurred after an inconclusive screening result. / Conclusion: The German TREC-NBS represents the largest European SCID screening at this point. The incidence of SCID/leaky SCID/OS in Germany is approximately 1:54,000, very similar to previous observations from North American and European regions and countries where TREC-NBS was implemented. The newly founded API-CID network facilitates tracking and treatment of identified patients. Short-term HSCT outcome was excellent, but NBS and transplant registries will remain essential to evaluate the long-term outcome and to compare results across the rising numbers of TREC-NBS programs across Europe

Persistence of small-scale anisotropies and anomalous scaling in a model of magnetohydrodynamics turbulence

The problem of anomalous scaling in magnetohydrodynamics turbulence is considered within the framework of the kinematic approximation, in the presence of a large-scale background magnetic field. The velocity field is Gaussian, $\delta$-correlated in time, and scales with a positive exponent $\xi$. Explicit inertial-range expressions for the magnetic correlation functions are obtained; they are represented by superpositions of power laws with non-universal amplitudes and universal (independent of the anisotropy and forcing) anomalous exponents. The complete set of anomalous exponents for the pair correlation function is found non-perturbatively, in any space dimension $d$, using the zero-mode technique. For higher-order correlation functions, the anomalous exponents are calculated to $O(\xi)$ using the renormalization group. The exponents exhibit a hierarchy related to the degree of anisotropy; the leading contributions to the even correlation functions are given by the exponents from the isotropic shell, in agreement with the idea of restored small-scale isotropy. Conversely, the small-scale anisotropy reveals itself in the odd correlation functions : the skewness factor is slowly decreasing going down to small scales and higher odd dimensionless ratios (hyperskewness etc.) dramatically increase, thus diverging in the $r\to 0$ limit.Comment: 25 pages Latex, 1 Figur