Attention, the intersection of cost and quality in health care

A method for assessing health care technology that models the demand on the clinician's attention exerted by patients' data (diagnostic and therapeutic) can provide a means for simultaneously reducing the cost and improving the quality of health care. The attentional demand exerted by patients' data can be measured by the amount of uncertainty in the data. Uncertainty can be expressed mathematically by the concept of entropy in information theory.     

Study of 18-cm long single-sided AC-coupled silicon microstripdetectors

The SSC GEM silicon Central Tracker design incorporated 18-cm long single-sided AC-coupled silicon microstrip ladders. Compared to the 12-cm long ladders considered in the preliminary stages of the tracker design, the 18-cm long ladders have the advantage of reduced cost, channel count and overall power consumption, and led to a simplified tracker assembly. However, such long ships also present the challenge of maintaining satisfactory performance. The increased capacitance and series resistance contribute to lower signal-to-noise ratios, longer time walk, higher power consumption per channel and increased probability of crosstalk to neighboring channels. In this paper, an accurate method to calculate the geometric capacitance of the AC-coupled microstrips is presented and the calculated results are compared with measurements, SPICE simulations are performed to predict the noise, the extent of interstrip capacitive coupling and the dispersion of the detector signal due to the finite series resistance of the metal strips and the long length of the detector. The influence of the preamplifier current and the shaping time on the signal and noise levels is also presented. The study concludes that the 18-cm long ladders can successfully satisfy the performance goals of the GEM silicon Central Tracker     

Metronidazole resistant trichomoniasis successfully treated with paromomycin

Thoracic infection by anaerobes are uncommon diseases and often presents difficulty in diagnosis. We report a case of thoracic infection due to Fusobacterium Nucleatum. A 60-year old man presented a lesion infiltrating from the lung to the thoracic wall. Fusobacterium Nucleatum was isolated on pus collected. Treatment by penicillin, metronidazole combined with surgical drainage was highly effective.     

Morphological variations of the human gastric mucosa after omeprazole treatment: a scanning electron microscopic study

The effects of antiepileptic drugs on cognitive function in 48 healthy volunteers were assessed using event-related potentials (ERP) and the Attention Index included in the Wechsler Memory Scale, revised edition (WMS-R). The study was conducted over 1 week, using a double-blind design. Four drugs, carbamazepine (CBZ), phenytoin (PHT), valproate (VPA) and zonisamide (ZNS) were tested. Using an auditory oddball task, ERP measurements were made under two conditions with different tone intensities: Condition 1 used 70 db SPL; and Condition 2 used 30 db SPL. Results showed that CBZ prolonged target N1 and P3 latencies in Condition 1, and reduced frequent N1 amplitude in Condition 2, which suggests that CBZ may cause a change in sensory memory and prolong stimulus evaluation time. It is suggested that under a low stimulus intensity level, the sensory function itself was affected. Phenytoin was found to prolong target N1 latency in Condition 2, which also indicates a change in the sensory memory function. However, VPA did not significantly affect ERP components, except for the shortened frequent N1 latency, which could not be explained due to the limited information. It was found that ZNS augmented P3 amplitude in Condition 2, and reduced scores on the Attention Index. It is suggested that the augmentation of P3 amplitude was caused by the reduction of processing negativity as a result of the detrimental effect of ZNS on subjects' attention. However, the apparent difference between the ERP and behavioral indices suggests that caution should be exercised in assessing the results obtained only from ERP measurements.     

Primary hybrid total hip arthroplasty: an interim followup

The senior authors' initial experience with primary hybrid hip replacement in patients with osteoarthritis was studied to evaluate the efficacy of the procedure. Hybrid total hip arthroplasty (uncemented Harris-Galante acetabular component and cemented Iowa precoated femoral component) was performed in 131 consecutive, nonselected hips in 118 patients with the diagnosis of primary osteoarthritis. Followup was performed at 8 to 9 years after the procedure. The average age at the time of the procedure was 68 years (range, 45-87 years). There were 50 men (55 hips) and 68 women (76 hips). At final followup 19 patients (22 hips) had died. The femoral component had been revised for aseptic loosening in 8 hips (6.1%). One additional hip showed definite radiographic loosening. Hence, the prevalence of radiographic femoral failure was 6.9% (9 hips). No acetabular component had been revised for aseptic loosening and no acetabular component had migrated. The senior author continues to perform hybrid total hip arthroplasty in all patients with primary osteoarthritis. However, design modifications have been made in the femoral component that is used.     

Combination cytotoxic effects of cis-diamminedichloroplatinum(II) and 5-fluorouracil with and without leucovorin against human non-small cell lung cancer cell lines

Both cisplatin (CDDP) and leucovorin (LV) have been shown to enhance cytotoxicity of 5-fluorouracil (FUra) against murine and human neoplasms by increasing intracellular reduced folate concentrations. We were interested in their use in a combination to inhibit non-small cell lung cancer (NSCLC) cell growth and therefore conducted an in vitro study to investigate the cytotoxic activities of combinations of CDDP plus FUra, with and without LV (20 microM), against seven NSCLC cell lines. A tetrazolium assay with application of the classical isobole method was used to test drug combinations. We found that LV enhanced FUra but not CDDP cytotoxicity and that the degree of enhancement was negatively correlated with the effect of FUra. There was an overall additive combination effect of CDDP plus FUra, although there may be synergy at higher effect levels. There was synergy to a combination of CDDP, FUra, and LV, presumably primarily related to the synergistic effects of adding LV to FUra. In summary, LV and CDDP enhanced FUra cytotoxicity in a complementary fashion and there was clear synergy of a combination of CDDP, FUra, and LV against a panel of NSCLC cell lines. Our in vitro results provide a rationale for controlled clinical studies of this three-drug regimen in patients with NSCLC.     

Early detection and trellis splicing: reduced-complexity iterativedecoding

The bit-error rate (BER) performance of new iterative decoding algorithms (e,g,, turbodecoding) is achieved at the expense of a computationally burdensome decoding procedure. We present a method called early detection that can be used to reduce the computational complexity of a variety of iterative decoders. Using a confidence criterion, some information symbols, state variables, and codeword symbols are detected early on during decoding. In this way, the computational complexity of further processing is reduced with a controllable increase in the BER. We present an easily implemented instance of this algorithm, called trellis splicing, that can be used with turbodecoding. For a simulated system of this type, we obtain a reduction in the computational complexity of up to a factor of four, relative to a turbodecoder that obtains the same increase in the BER by performing fewer iterations