Non–housestaff medicine services in academic centers: Models and challenges

Non–housestaff medicine services are growing rapidly in academic medical centers (AMCs), partly driven by efforts to comply with resident duty hour restrictions. Hospitalists have emerged as a solution to providing these services given their commitment to delivering efficient and high-quality care and the field's rapid growth. However, limited evidence is available on designing these services, including the similarities and differences of existing ones. We describe non–housestaff medicine services at 5 AMCs in order to share our experiences and outline important considerations in service development. We discuss common challenges in building and sustaining these models along with local institutional factors that affect decision making. Keys to success include ensuring an equitable system for scheduling and staffing, fostering opportunities for scholarly activities and academic promotion (defining the “academic hospitalist”), and providing compensation that supports recruitment and retention of hospitalists. With further work hour restrictions expected in the future and increased requests for surgical comanagement, the relationship between AMCs and hospitalists will continue to evolve. To succeed in developing hospitalist faculty who follow long careers in hospital medicine, academic leadership must carefully plan for and evaluate the methods of providing these clinical services while expanding on our academic mission. Journal of Hospital Medicine 2008;3:247–255. © 2008 Society of Hospital Medicine.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/60235/1/311_ftp.pd

Reporting trends, practices, and resource utilization in neuroendocrine tumors of the prostate gland: a survey among thirty-nine genitourinary pathologists

Background: Neuroendocrine differentiation in the prostate gland ranges from clinically insignificant neuroendocrine differentiation detected with markers in an otherwise conventional prostatic adenocarcinoma to a lethal high-grade small/large cell neuroendocrine carcinoma. The concept of neuroendocrine differentiation in prostatic adenocarcinoma has gained considerable importance due to its prognostic and therapeutic ramifications and pathologists play a pivotal role in its recognition. However, its awareness, reporting, and resource utilization practice patterns among pathologists are largely unknown. Methods: Representative examples of different spectrums of neuroendocrine differentiation along with a detailed questionnaire were shared among 39 urologic pathologists using the survey monkey software. Participants were specifically questioned about the use and awareness of the 2016 WHO classification of neuroendocrine tumors of the prostate, understanding of the clinical significance of each entity, and use of different immunohistochemical (IHC) markers. De-identified respondent data were analyzed. Results: A vast majority (90%) of the participants utilize IHC markers to confirm the diagnosis of small cell neuroendocrine carcinoma. A majority (87%) of the respondents were in agreement regarding the utilization of type of IHC markers for small cell neuroendocrine carcinoma for which 85% of the pathologists agreed that determination of the site of origin of a high-grade neuroendocrine carcinoma is not critical, as these are treated similarly. In the setting of mixed carcinomas, 62% of respondents indicated that they provide quantification and grading of the acinar component. There were varied responses regarding the prognostic implication of focal neuroendocrine cells in an otherwise conventional acinar adenocarcinoma and for Paneth cell-like differentiation. The classification of large cell neuroendocrine carcinoma was highly varied, with only 38% agreement in the illustrated case. Finally, despite the recommendation not to perform neuroendocrine markers in the absence of morphologic evidence of neuroendocrine differentiation, 62% would routinely utilize IHC in the work-up of a Gleason score 5 + 5 = 10 acinar adenocarcinoma and its differentiation from high-grade neuroendocrine carcinoma. Conclusion: There is a disparity in the practice utilization patterns among the urologic pathologists with regard to diagnosing high-grade neuroendocrine carcinoma and in understanding the clinical significance of focal neuroendocrine cells in an otherwise conventional acinar adenocarcinoma and Paneth cell-like neuroendocrine differentiation. There seems to have a trend towards overutilization of IHC to determine neuroendocrine differentiation in the absence of neuroendocrine features on morphology. The survey results suggest a need for further refinement and development of standardized guidelines for the classification and reporting of neuroendocrine differentiation in the prostate gland

Enhancing Security through Hardware-assisted Run-time Validation of Program Data Properties

The growing number of information security breaches in electronic and computing systems calls for new design paradigms that consider security as a primary design objective. This is particularly relevant in the embedded domain, where the security solution should be customized to the needs of the target system, while considering other design objectives such as cost, performance, and power. Due to the increasing complexity and shrinking design cycles of embedded software, most embedded systems present a host of software vulnerabilities that can be exploited by security attacks. Many attacks are initiated by causing a violation in the properties of data (e.g., integrity, privacy, access control rules, etc.) associated with a "trusted" program that is executing on the system, leading to a range of undesirable effects

Anesthetic management of craniosynostosis repair in patient with Apert syndrome

Apert syndrome is an autosomal dominant disease characterized by craniosynostosis, midface hypoplasia and syndactyly. In general, patients present in early childhood for craniofacial reconstruction surgery. Anesthetic implications include difficult airway, airway hyper-reactivity; however, possibility of raised intracranial pressure especially when operating for craniosynostosis and associated congenital heart disease should not be ignored. Most of the cases described in literature talk of management of syndactyly. We describe the successful anesthetic management of a patient of Aperts syndrome with craniosynostosis posted for bicornual strip craniotomy and fronto-orbital advancement in a 5-year-old child

Secure embedded processing through hardware-assisted run-time monitoring

Abstract — Security is emerging as an important concern in embedded system design. The security of embedded systems is often compromised due to vulnerabilities in “trusted ” software that they execute. Security attacks exploit these vulnerabilities to trigger unintended program behavior, such as the leakage of sensitive data or the execution of malicious code. In this work, we present a hardware-assisted paradigm to enhance embedded system security by detecting and preventing unintended program behavior. Specifically, we extract properties of an embedded program through static program analysis, and use them as the bases for enforcing permissible program behavior in real-time as the program executes. We present an architecture for hardware-assisted run-time monitoring, wherein the embedded processor is augmented with a hardware monitor that observes the processor’s dynamic execution trace, checks whether the execution trace falls within the allowed program behavior, and flags any deviations from the expected behavior to trigger appropriate response mechanisms. We present properties that can be used to capture permissible program behavior at different levels of granularity within a program, namely inter-procedural control flow, intra-procedural control flow, and instruction stream integrity. We also present a systematic methodology to design application-specific hardware monitors for any given embedded program. We have evaluated the hardware requirements and performance of the proposed architecture for several embedded software benchmarks. Hardware implementations using a commercial design flow, and architectural simulations using the SimpleScalar framework, indicate that the proposed technique can thwart several common software and physical attacks, facilitating secure program execution with minimal overheads. I

Architectural support for safe software execution on embedded processors

The lack of memory safety in many popular programming languages, including C and C++, has been a cause for great concern in the realm of software reliability, verification, and more recently, system security. Despite their limitations, the flexibility, performance, and ease of use of these languages have made them the choice of most embedded software developers. Researchers have proposed various techniques to enhance programs for memory safety; however, they are all subject to severe performance penalties, making their use impractical in most scenarios. In this paper, we present architectural enhancements to enable efficient, memory-safe execution of software on embedded processors. The key insight behind our approach is to extend embedded processors with hardware that significantly accelerates the execution of th

Electrical and optical studies of corona poled 4-hydroxy-4-nitroazobenzene doped polymethylmethacrylate films

618-623Guest-host polymeric systems with 4-hydroxy-4'-nitroazobenzene as guest and polymethylmethacrylate (PMMA) as host have been prepared by taking different concentrations of the guest and characterized by observing their electrical and optical behaviour. The prepared guest-host system has been found to have large band gap ~2.86 eV and transmission over visible range. Pure polymer (PMMA) was not found to show any observable electrical non-linearity whereas mixing of dye (guest) has shown remarkable effect on its non-linear electrical behaviour. Moreover, the model guest-host blend (4-hydroxy-4'-nitroazobenzene/PMMA) has been found to exhibit desired order of non-linearity by optimizing the concentration of guest, poling current and poling temperature

Конструкція компактної чотиридіапазонної антени з подвійною поляризацією, виготовленої з метаматеріалів

Нову компактну чотиридіапазонну антену з подвійною поляризацією розроблено та реалізовано з використанням метаматеріалів. Запропонована антена сконструйована з узгодженою мікросмуговою лінією з фазовим зсувом і обертовою мікросмуговою патч-антеною, вбудованою в роз'ємний кільцевий резонатор (SRR). Антена працює в чотирьох окремих діапазонах з шириною смуг пропускання 500 МГц (1.13-1.63 ГГц), 640 МГц (2.05-2.69 ГГц), 470 МГц (4.86-5.33 ГГц) і 950 МГц (7.1-8.05 ГГц). За допомогою узгодженого живлення з фазовим зсувом λ/4 реалізується кругова поляризація, яка перевіряється за допомогою експериментальної установки. Нарешті, як лінійна, так і кругова поляризації мають місце для кожної смуги і спостерігаються за допомогою коефіцієнту еліптичності (AR). Властивості метаматеріалів вилучаються за допомогою періодичних граничних умов. Прототип конструкції виготовлений та випробуваний з використанням VNA та звуконепроникної камери. Було помічено, що коефіцієнт підсилення та діаграма спрямованості ідеально узгоджуються для змодельованого та виміряного прототипів, що робить запропоновану антену придатним кандидатом для бездротових додатків.A compact novel quad-band compact antenna with dual polarization characteristics is designed and implemented using metamaterial. The proposed antenna is designed with matched phase shifted microstrip line and fed rotated microstrip patch antenna embedded with split ring resonator (SRR). The antenna operates at four separate impedance bandwidth of 500 MHz (1.13-1.63 GHz), 640 MHz (2.05- 2.69 GHz), 470 MHz (4.86-5.33 GHz) and 950 MHz (7.1-8.05 GHz). With the use of λ/4 phase-shifted matched feed, the circular polarization is realized and verified with experimental setup. Finally, both the linear and circular polarization is obtained for each band and is observed using Axial Ratio (AR). The metamaterial properties are extracted using periodic boundary conditions. The prototype of design has also been fabricated and tested using VNA and Anechoic Chamber. It was observed that gain and radiation pattern was perfectly matched for simulated and measured prototype, this makes proposed antenna a suitable candidate for wireless application