Non-Traumatic Urologic Emergencies in Men: A Clinical Review

Although true urologic emergencies are extremely rare, they are a vital part of any emergency physician’s (EP) knowledge base, as delays in treatment lead to permanent damage. The four urologic emergencies discussed are priapism, paraphimosis, testicular torsion, and Fournier’s gangrene. An overview is given for each, including causes, pathophysiology, diagnosis, treatment, and new developments. The focus for priapism is on diagnosis and distinguishing high-flow from low-flow forms, as the latter requires emergent treatment. For paraphimosis, we describe various methods of relieving the stricture, from manual reduction to surgery in extreme cases. For testicular torsion, the most important factor in salvaging the testicle is decreasing time to treatment. This is accomplished through experience and understanding which signs and symptoms strongly suggest it, so that time-consuming tests are avoided. Lastly, Fournier’s gangrene is potentially fatal. While aggressive medical and surgical therapy will improve chances of survival and outcome, it is vital for the emergency department (ED) physician to diagnose Fournier’s. It often presents in the elderly, immunocompromised, or those with depressed mental status. The goal of this paper is to arm EPs with information to recognize urological emergencies and intervene quickly to preserve tissue, fertility, and life

Much Ado About Weak Measurement

I had to write again. My research lay in science, and it was a science of three parts. The first part made a careful, introductory chapter, begged for by things that were lacking. It summarizes the von Neumann measurement model, derived from the Stern-Gerlach experiment, and it explains how weak values arise from weak interactions between quantum systems and von Neumann probes. If there had been more literature about the error of the weak value approximation and how to bound it, then perhaps I would have read myself into a satisfied sleep and never written this chapter. If there had been talk of operator norms . . . but no, of course there was not. In fact, the focus of the literature was elsewhere, and so I had to provide these things; now the first chapter remains. In the course of my research, a method came to my attention, which sought to justify the role of the weak value in approximating the effect of a weak interaction. This method, feedback compensation, estimates the effect of the interaction and applies it in reverse to attempt to reset the probe state. Weak values (at least, their real parts) were found to be the optimal estimates of interactions, providing the ideal amount of compensation to reset probes. After explaining how others found this, I added a specific application to the nested Mach-Zehnder interferometer as a proof-of-concept, along with some interpretational caveats. In doing this, I added a second, more tangible chapter to the first. They made a dynamic duo of sorts, a partnership. The third part was not a common thing to be familiar with. If you worked in quantum cosmology, you would be keenly aware of the need to generalize the Copenhagen interpretation, and might then know about the consistent histories formalism. It comes from the need to determine when probabilities should be assigned to the outcomes of a quantum system, even in the absence of classical measurements. Consistent histories has been used by others to look at the odd implications of weak values, and a condition relating the consistency of a family of histories to the strangeness of weak values has been derived before, suggesting an incompatibility between non-sharp weak values and consistent families. My research comes to an end with my extension to this third part (not counting appendices). I deem this appropriate, as it is the most niche science of the three. I mixed weak values and consistent histories while including a weakly coupled probe in the composite system, and accounted for its end state while reasoning about the viable histories of the system. It is the patient, late-hour science of a man who is waiting to graduate

Consistent Histories Formulation of the Double-Slit Experiment

The standard interpretation of quantum mechanics (known as the Copenhagen interpretation) divides the world into quantum phenomena and classical observers that perform measurements upon the phenomena. This provides a quite functional framework for calculating probabilities of measurement outcomes, but it lacks the generality necessary for such things as retrodiction, and examination of situations in which there cannot be classical observers. Enter the consistent (or decoherent) histories formalism, which provides a consistent framework for assigning and interpreting quantum probabilities even in the absence of classical observers. In order to aid others in adopting the formalism, I herein examine the double-slit experiment within the framework of the consistent histories formalism. For my first trick, I replicate the results of basic geometric optics applied to Young’s experiment. Second, a detector model is included to make the interference pattern vanish, demonstrating the shift from wave behavior to particle behavior. Finally, certain approximations are removed to examine the case of non-infinitesimal slits. By not appealing to the outside world of observers, the consistent histories formalism is ideally suited for demonstrating the link between persistent records and the transition to the classical realm, crossing smoothly through paradoxical domains where a particle can diffract like a wave

Evaluating Fish Impingement and Entrainment at the Comanche Peak Steam Electric Station

This study was designed to determine if impingement and entrainment by cooling water intake at the Comanche Peak Steam Electric Station have an adverse impact upon the Squaw Creek Reservoir fish population. The yearly impingement of fish was estimated to be 262,994 of 14 species. The threadfin shad (Dorosoma petenense) accounted for 96% of this total. Entrainment of eggs and larvae for a five month period was estimated to be 15,989,987 and 42,448,794 respectively. Two fish population studies were performed on Squaw Creek Reservoir to help assess impact. It was determined that the losses due to impingement and entrainment have no adverse impact upon the fish population of Squaw Creek Reservoir

Action Civics in Rural Communities

We used an action civics curriculum and conducted a qualitative analysis of two fifth-grade classrooms in a rural setting called Green Independent School District (pseudonym). We organized the curriculum into a week-long study whereby we conducted interviews, collected student work, and analyzed teacher and student data. We focused on Baiocchi et al.\u27s (2014) concept of the civic imagination to analyze rural students\u27 beliefs about themselves as citizens as they engaged in an action civics inquiry model of learning. Three primary findings emerged from our data; an emphasis on solidarity by citizens in the community, student use of problem-solving through civic imagination, and challenging discussions in classroom settings

Spectral properties of the 2D Holstein t-J model

Employing the Lanczos algorithm in combination with a kernel polynomial moment expansion (KPM) and the maximum entropy method (MEM), we show a way of calculating charge and spin excitations in the Holstein t-J model, including the full quantum nature of phonons. To analyze polaron band formation we evaluate the hole spectral function for a wide range of electron-phonon coupling strengths. For the first time, we present results for the optical conductivity of the 2D Holstein t-J model

Survival outcome according to KRAS mutation status in newly diagnosed patients with stage IV non-small cell lung cancer treated with platinum doublet chemotherapy

INTRODUCTION: Mutations (MT) of the KRAS gene are the most common mutation in non-small cell lung cancer (NSCLC), seen in about 20-25% of all adenocarcinomas. Effect of KRAS MT on response to cytotoxic chemotherapy is unclear. METHODS: We undertook a single-institution retrospective analysis of 93 consecutive patients with stage IV NSCLC adenocarcinoma with known KRAS and EGFR MT status to determine the association of KRAS MT with survival. All patients were treated between January 1, 2008 and December 31, 2011 with standard platinum based chemotherapy at the University of Pennsylvania. Overall and progression free survival were analyzed using Kaplan-Meier and Cox proportional hazard methods. RESULTS: All patients in this series received platinum doublet chemotherapy, and 42 (45%) received bevacizumab. Overall survival and progression free survival for patients with KRAS MT was no worse than for patients with wild type KRAS. Median overall survival for patients with KRAS MT was 19 months (mo) vs. 15.6 mo for KRAS WT, p = 0.34, and progression-free survival was 6.2 mo in patients with KRAS MT vs. 7mo in patients with KRAS WT, p = 0.51. In multivariable analysis including age, race, gender, and ECOG PS, KRAS MT was not associated with overall survival (HR 1.12, 95% CI 0.58-2.16, p = 0.74) or progression free survival (HR 0.80, 95% CI 0.48-1.34, p = 41). Of note, receipt of bevacizumab was associated with improved overall survival only in KRAS WT patients (HR 0.34, p = 0.01). CONCLUSIONS: KRAS MT are not associated with inferior progression-free and overall survival in advanced NSCLC patients treated with standard first-line platinum-based chemotherapy

Versatile relative entropy bounds for quantum networks

We provide a versatile upper bound on the number of maximally entangled qubits, or private bits, shared by two parties via a generic adaptive communication protocol over a quantum network when the use of classical communication is not restricted. Although our result follows the idea of Azuma et al (2016 Nat. Commun. 7 13523) of splitting the network into two parts, our approach relaxes their strong restriction, consisting of the use of a single entanglement measure in the quantification of the maximum amount of entanglement generated by the channels. In particular, in our bound the measure can be chosen on a channel-by-channel basis, in order to make it as tight as possible. This enables us to apply the relative entropy of entanglement, which often gives a state-of-the-art upper bound, on every Choi-simulable channel in the network, even when the other channels do not satisfy this property. We also develop tools to compute, or bound, the max-relative entropy of entanglement for channels that are invariant under phase rotations. In particular, we present an analytical formula for the max-relative entropy of entanglement of the qubit amplitude damping channel

Amivantamab compared with real-world therapies in patients with advanced non-small cell lung cancer harboring EGFR exon 20 insertion mutations who progressed after platinum-based chemotherapy

BACKGROUND: In the single-arm CHRYSALIS study, amivantamab showed durable responses and manageable safety in patients with advanced non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) exon 20 insertion mutations (ex20ins) who progressed on prior platinum-based chemotherapy. External controls can provide context for interpreting amivantamab efficacy. METHODS: External controls were selected from three US-based databases (ConcertAI, COTA, and Flatiron). Key inclusion criteria were diagnosis of EGFR ex20ins advanced NSCLC, prior platinum-based chemotherapy, and performance status score ≤ 1. Duplicate external controls were identified using a tokenization procedure and removed, and adjustment for differences in baseline characteristics between amivantamab-treated and external control cohorts was achieved using propensity score weighting. RESULTS: Amivantamab-treated and pooled external control cohorts included 81 and 125 patients, respectively. Baseline characteristics were generally similar across cohorts, except more amivantamab-treated patients were Asian (56% vs 13%). Most common therapies received by external controls were non-platinum-based chemotherapy (25.1%), immuno-oncology therapies (24.2%), EGFR tyrosine kinase inhibitors (16.3%), and platinum-based chemotherapy (16.3%). Overall response rate was 40% among amivantamab-treated patients and 16% among external controls. Amivantamab-treated patients had longer progression-free survival (median 8.3 vs 2.9 months; hazard ratio [HR; 95% CI]: 0.47 [0.34-0.65]), time to next therapy (median 14.8 vs 4.8 months; HR [95% CI]: 0.40 [0.28-0.57]), and overall survival (median 22.8 vs 12.8 months; HR [95% CI]: 0.49 [0.31-0.77]) than external controls. Results were consistent in sensitivity analyses comparing each external control dataset against the amivantamab-treated group separately. CONCLUSION: Among post-platinum patients with EGFR ex20ins advanced NSCLC, those treated with amivantamab had improved outcomes, including 10-month longer overall survival, versus external controls