Cost-Benefit Analysis of a Redundant System with Server having Refreshment Facility Subject to Inspection

In this paper two units cold standby system has been discussed with the facility that server inspect the failed unit before repair/replacement of the unit and server may allow to take refreshment whenever needed. The operative unit may fail directly from normal mode and the cold standby unit may be failed owing to remain unused for a longer period of time. There is single server who serves the dual purpose of inspection and repair immediately whenever required. Also, after having refreshment the server may eventually perform the better service efficiently. The time to take refreshment and repair activity follows negative exponential distribution whereas the distributions of unit failure and server failure are taken as arbitrary with different probability density functions. The expressions of various stochastic measures are analyzed in steady state using semi-Markov process and regenerative point technique. The graphs are sketched for arbitrary values of the parameters to delineate the behavior of some important performance measures to check the efficacy of the system model under such situations

Physicians Infrequently Adhere to Hepatitis Vaccination Guidelines for Chronic Liver Disease

Background and Goals:Hepatitis A (HAV) and hepatitis B (HBV) vaccination in patients with chronic liver disease is an accepted standard of care. We determined HAV and HBV vaccination rates in a tertiary care referral hepatology clinic and the impact of electronic health record (EHR)-based reminders on adherence to vaccination guidelines.Methods:We reviewed the records of 705 patients with chronic liver disease referred to our liver clinic in 2008 with at least two follow-up visits during the subsequent year. Demographics, referral source, etiology, and hepatitis serology were recorded. We determined whether eligible patients were offered vaccination and whether patients received vaccination. Barriers to vaccination were determined by a follow-up telephone interview.Results:HAV and HBV serologic testing prior to referral and at the liver clinic were performed in 14.5% and 17.7%; and 76.7% and 74% patients, respectively. Hepatologists recommended vaccination for HAV in 63% and for HBV in 59.7% of eligible patients. Patient demographics or disease etiology did not influence recommendation rates. Significant variability was observed in vaccination recommendation amongst individual providers (30-98.6%), which did not correlate with the number of patients seen by each physician. Vaccination recommendation rates were not different for Medicare patients with hepatitis C infection for whom a vaccination reminder was automatically generated by the EHR. Most patients who failed to get vaccination after recommendation offered no specific reason for noncompliance; insurance was a barrier in a minority.Conclusions:Hepatitis vaccination rates were suboptimal even in an academic, sub-speciality setting, with wide-variability in provider adherence to vaccination guidelines. © 2013 Thudi et al

Quality of Life in Chronic Pancreatitis is Determined by Constant Pain, Disability/Unemployment, Current Smoking, and Associated Co-Morbidities

OBJECTIVES: Chronic pancreatitis (CP) has a profound independent effect on quality of life (QOL). Our aim was to identify factors that impact the QOL in CP patients. METHODS: We used data on 1,024 CP patients enrolled in the three NAPS2 studies. Information on demographics, risk factors, co-morbidities, disease phenotype, and treatments was obtained from responses to structured questionnaires. Physical and mental component summary (PCS and MCS, respectively) scores generated using responses to the Short Form-12 (SF-12) survey were used to assess QOL at enrollment. Multivariable linear regression models determined independent predictors of QOL. RESULTS: Mean PCS and MCS scores were 36.7+/-11.7 and 42.4+/-12.2, respectively. Significant (P \u3c 0.05) negative impact on PCS scores in multivariable analyses was noted owing to constant mild-moderate pain with episodes of severe pain or constant severe pain (10 points), constant mild-moderate pain (5.2), pain-related disability/unemployment (5.1), current smoking (2.9 points), and medical co-morbidities. Significant (P \u3c 0.05) negative impact on MCS scores was related to constant pain irrespective of severity (6.8-6.9 points), current smoking (3.9 points), and pain-related disability/unemployment (2.4 points). In women, disability/unemployment resulted in an additional 3.7 point reduction in MCS score. Final multivariable models explained 27% and 18% of the variance in PCS and MCS scores, respectively. Etiology, disease duration, pancreatic morphology, diabetes, exocrine insufficiency, and prior endotherapy/pancreatic surgery had no significant independent effect on QOL. CONCLUSIONS: Constant pain, pain-related disability/unemployment, current smoking, and concurrent co-morbidities significantly affect the QOL in CP. Further research is needed to identify factors impacting QOL not explained by our analyses

Cecal Perforation in the Setting of Campylobacter jejuni Infection

Campylobacter infection is the leading cause of bacterial gastroenteritis worldwide, yet life-threatening complications are extremely rare. We present a 32-year-old previously healthy man who presented with dysentery from Campylobacter jejuni, which was complicated by cecal perforation and secondary bacterial peritonitis

CAIC anjur kolokium memperkasa program pengajaran dan pembelajaran

Seramai 180 dalam kalangan tenaga akademik dan pensyarah dari Universiti Malaysia Pahang (UMP) dan institut pengajian tinggi hadir menyertai Kolokium Pengajaran dan Pembelajaran 2014 bertemakan `Innovation Towards Creative Pedagogy’ anjuran Pusat Inovasi dan Daya Saing Akademik (CAIC) universiti ini

Quantum-enhanced super-sensitivity of Mach-Zehnder interferometer using squeezed Kerr state

We study the phase super-sensitivity of a Mach-Zehnder interferometer (MZI) with the squeezed Kerr and coherent states as the inputs. We discuss the lower bound in phase sensitivity by considering the quantum Fisher information (QFI) and corresponding quantum Cramer-Rao bound (QCRB). With the help of single intensity detection (SID), intensity difference detection (IDD) and homodyne detection (HD) schemes, we find that our scheme gives better sensitivity in both the lossless as well as in lossy conditions as compared to the combination of well-known results of inputs as coherent plus vacuum, coherent plus squeezed vacuum and double coherent state as the inputs. Because of the possibility of generation of squeezed Kerr state (SKS) with the present available quantum optical techniques, we expect that SKS may be an alternative nonclassical resource for the improvement in the phase super-sensitivity of the MZI under realistic scenario.Comment: Comments are welcome

Apolipoprotein C-II Deposition Amyloidosis: A Potential Misdiagnosis as Light Chain Amyloidosis.

Hereditary amyloidoses are rare and pose a diagnostic challenge. We report a case of hereditary amyloidosis associated with apolipoprotein C-II deposition in a 61-year-old female presenting with renal failure and nephrotic syndrome misdiagnosed as light chain amyloidosis. Renal biopsy was consistent with amyloidosis on microscopy; however, immunofluorescence was inconclusive for the type of amyloid protein. Monoclonal gammopathy evaluation revealed kappa light chain. Bone marrow biopsy revealed minimal involvement with amyloidosis with kappa monotypic plasma cells on flow cytometry. She was started on chemotherapy for light chain amyloidosis. She was referred to the Mayo clinic where laser microdissection and liquid chromatography mass spectrometry detected high levels of apolipoprotein C-II, making a definitive diagnosis. Apolipoprotein C-II is a component of very low-density lipoprotein and aggregates in lipid-free conditions to form amyloid fibrils. The identification of apolipoprotein C-II as the cause of amyloidosis cannot be solely made with routine microscopy or immunofluorescence. Further evaluation of biopsy specimens with laser microdissection and mass spectrometry and DNA sequencing of exons should be done routinely in patients with amyloidoses for definitive diagnosis. Our case highlights the importance of determining the subtype of amyloidosis that is critical for avoiding unnecessary therapy such as chemotherapy