“Pseudo” Faraday cage: a solution for telemetry link interaction between a left ventricular assist device and an implantable cardioverter defibrillator

Patients implanted with left ventricular assist devices (LVAD) may have implantable cardioverter defibrillators (ICD) implanted for sudden cardiac death prevention. This opens the possibility of device–device communication interactions and thus interferences. We present a case of such interaction that led to ICD communication failure following the activation of an LVAD. In this paper, we describe a practical solution to circumvent the communication interference and review the communication links of ICDs and possible mechanisms of ICD–LVAD interactions.     

High performance and gate-controlled GeSe/HfS2 negative differential resistance device

Transition metal dichalcogenides (TMDs) have received significant attention owing to their thickness-dependent folded current–voltage (I_ds–V_ds) characteristics, which offer various threshold voltage values. Owing to these astonishing characteristics, TMDs based negative differential resistance (NDR) devices are preferred for the realization of multi-valued logic applications. In this study, an innovative and ground-breaking germanium selenide/hafnium disulfide (p-GeSe/n-HfS₂) TMDs van der Waals heterostructure (vdWH) NDR device is designed. An extraordinary peak-to-valley current ratio (≈5.8) was estimated at room temperature and was used to explain the tunneling and diffusion currents by using the tunneling mechanism. In addition, the p-GeSe/n-HfS₂ vdWH diode was used as a ternary inverter. The TMD vdWH diode, which can exhibit different band alignments, is a step forward on the road to developing high-performance multifunctional devices in electronics.

A novel and astonishing p-GeSe/n-HfS₂ NDR device shows a high value for the peak-to-valley current ratio in the range of 5.8.     

Hickman catheter embolism in a child during stem cell transplantation

The majority of stem cell recipients rely on indwelling central venous catheters situated in superior vena cava or right atrium. Semi-permanent tunneled silicone rubber Hickman catheters are widely used to provide durable central venous access for patients undergoing stem cell transplantation. A case of 5 years old child with diagnosis of severe aplastic anemia is reported. The patient received peripheral blood stem cells (PBSC) and had successful engraftment with complete hematological recovery. He had Hickman catheter embolism in the pulmonary circulation following unsuccessful attempt to remove the line. The catheter was successfully removed by midsternostomy operation. The child is normal with sustained remission on day +218 post stem cell transplant.     

Developing an Interactive Web-Based Learning Program on Skin Cancer: the Learning Experiences of Clinical Educators

Web-based learning in medical education is rapidly growing. However, there are few firsthand accounts on the rationale for and development of web-based learning programs. We present the experience of clinical educators who developed an interactive online skin cancer detection and management course in a time-efficient and cost-efficient manner without any prior skills in computer programming or technical construction of web-based learning programs. We review the current state of web-based learning including its general advantages and disadvantages as well as its specific utility in dermatology. We then detail our experience in developing an interactive online skin cancer curriculum for primary care clinicians. Finally, we describe the main challenges faced and lessons learned during the process. This report may serve medical educators who possess minimal computer programming and web design skills but want to employ the many strengths of web-based learning without the huge costs associated with hiring a professional development team.     

Factors affecting patient compliance in the acute setting: an analysis of 20,000 imaging reports

The aim of this study was to identify the risk factors associated with noncompliance of recommendations made by emergency radiologists. Between March 2012 and August 2012, our team retrospectively reviewed 20,000 consecutive emergency department (ED) patients receiving imaging to assess how often emergency radiologists made recommendations, how often they were followed, and what factors were associated with noncompliance. Faculty (Radiology or Emergency Medicine) were considered senior if they had been practicing for >5 years post residency/fellowship training. Faculty practicing <5 years were considered junior physicians. The following data was extracted from the electronic medical records and the hospital information system: recommendation in imaging report, age, gender, race (Caucasian, African-American, and others), insurance status, primary care contact, distance from the hospital to patient residence, and primary language. Recommendations were categorized as follows: (1) immediate follow-up, (2) follow-up 1–4 weeks, (3) follow-up 1–3 months, (4) follow-up 4–6 months, (5) follow-up 7–12 months, and (6) clinical/laboratory follow-up recommendations irrespective of time. We identified 1,650 recommendations (1,650/20,000?=?8.25 %). Using a one-to-one logistic regression analysis, the following factors were significant (P?<?0.05) when evaluating noncompliance: increasing age, no primary care physician, lack of insurance, primary language other than English, increased distance from hospital, and extended follow-up interval. Noncompliance with recommended additional imaging (RAI) is multifactorial. Primary and/or referring physicians should take notice of the aforementioned compliance trends and mitigating factors, adopt systematic safety measures and create interdepartmental dialogue with radiology to ensure compliance, and counsel and educate patients about the importance of imaging recommendations.