Monitoring the performance of residents during training in off-pump coronary surgery.

OBJECTIVE: Control charts (eg, cumulative sum charts) plot changes in performance with time and can alert a surgeon to suboptimal performance. They were used to compare performance of off-pump coronary artery bypass surgery between a consultant and four resident surgeons and to compare performance of off-pump coronary artery bypass surgery and conventional coronary artery bypass grafting within surgeons. METHODS: Data were analyzed for consecutive patients undergoing coronary artery bypass grafting who were operated on by one consultant or one of four residents. Conversions were analyzed by intention to treat. Perioperative death or one or more of 10 adverse events constituted failure. Predicted risks of failure for individual patients were derived from the study population. Variable life-adjusted displays and risk-adjusted sequential probability ratio test charts were plotted. RESULTS: Data for 1372 patients were analyzed; 769 of the procedures were off-pump coronary artery bypass operations (56.0%). The consultant operated on 382 patients (293 off-pump, 76.7%), and the residents operated on 990 (474 off-pump, 47.9%). Patients operated on by residents tended to be older, more obese, more likely to require an urgent operation, and more likely to need a circumflex artery graft but less likely to have triple-vessel disease. There were 7 conversions (consultant 5, residents 2). The overall failure rate was 8.5% (9.2% for consultant's operations and 8.2% for residents' operations), including 10 deaths (0.7%). Predicted and observed risks of failure were similar for all five surgeons. After 100 off-pump coronary artery bypass operations, performance was the same or better for the residents as for the consultant. For all surgeons, performance was the same or better for off-pump as for conventional coronary artery bypass grafting. CONCLUSIONS: Off-pump coronary artery bypass surgery can be safely taught to cardiothoracic residents. Implementation of continuous performance monitoring for residents is practicable

Engineering exotic phases for topologically-protected quantum computation by emulating quantum dimer models

We use a nonperturbative extended contractor renormalization (ENCORE) method for engineering quantum devices for the implementation of topologically protected quantum bits described by an effective quantum dimer model on the triangular lattice. By tuning the couplings of the device, topological protection might be achieved if the ratio between effective two-dimer interactions and flip amplitudes lies in the liquid phase of the phase diagram of the quantum dimer model. For a proposal based on a quantum Josephson junction array [L. B. Ioffe {\it et al.}, Nature (London) {\bf 415}, 503 (2002)] our results show that optimal operational temperatures below 1 mK can only be obtained if extra interactions and dimer flips, which are not present in the standard quantum dimer model and involve three or four dimers, are included. It is unclear if these extra terms in the quantum dimer Hamiltonian destroy the liquid phase needed for quantum computation. Minimizing the effects of multi-dimer terms would require energy scales in the nano-Kelvin regime. An alternative implementation based on cold atomic or molecular gases loaded into optical lattices is also discussed, and it is shown that the small energy scales involved--implying long operational times--make such a device impractical. Given the many orders of magnitude between bare couplings in devices, and the topological gap, the realization of topological phases in quantum devices requires careful engineering and large bare interaction scales.Comment: 12 pages, 10 figure

Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past

© 2020 Elsevier B.V. Coronavirus disease 2019 (COVID-19) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus strain disease, has recently emerged in China and rapidly spread worldwide. This novel strain is highly transmittable and severe disease has been reported in up to 16% of hospitalized cases. More than 600,000 cases have been confirmed and the number of deaths is constantly increasing. COVID-19 hospitalized patients, especially those suffering from severe respiratory or systemic manifestations, fall under the spectrum of the acutely ill medical population, which is at increased venous thromboembolism risk. Thrombotic complications seem to emerge as an important issue in patients infected with COVID-19. Preliminary reports on COVID-19 patients’ clinical and laboratory findings include thrombocytopenia, elevated D-dimer, prolonged prothrombin time, and disseminated intravascular coagulation. As the pandemic is spreading and the whole picture is yet unknown, we highlight the importance of coagulation disorders in COVID-19 infected patients and review relevant data of previous coronavirus epidemics caused by the severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) and the Middle East Respiratory Syndrome coronavirus (MERS-CoV)