Polarization resonance with sub-wavelength switching of random light self-interfering in open-end cavity.

Following recent work [Sci. China Phys. Mech. Astron.66, 274213 (2023)10.1007/s11433-023-2097-9] that revealed the sub-wavelength scale resonance phenomenon in scalar random beams counterpropagating in an open-end cavity, we extend the analysis to the vectorial domain and show a similar effect for the polarization properties. We found that, in contrast with the changes in the scalar properties, being of harmonic nature, changes in polarization involve alternating regions of constant values followed by sharp and complex changes.

OAM-resolved polarization in random light beams.

We establish the properties of the cross-spectral density orbital angular momentum (CSD-OAM) matrix of a stationary optical beam-like field and use them to introduce the OAM-resolved polarization properties. It is shown that sufficiently general random fields contain two types of polarization, one relating to a single OAM mode and the other to a pair of modes.

Matrices characterizing non-local OAM transformations of light beams.

Matrices characterizing the orbital angular momentum (OAM) transformations of deterministic and random light beams by commonly used OAM-modulating optical systems are revealed. Such matrices are the counterparts of the Jones and the Mueller matrices in polarization optics defined for the input and output OAM indices and the radial variables. In particular, matrices of systems leading to OAM mode shift, dispersion, and coupling are discussed.

Clinical Characteristics of Patients with Staphylococcus aureus Bile Infection.

BACKGROUND: The hepatobiliary system is a sterile micro-environment. Bacterial infection in this system is most commonly associated with anaerobes as well as gram-positive and gram-negative bacteria. Biliary infections with Staphylococcus aureus are poorly characterized. OBJECTIVES: To depict the clinical characteristics and outcome of patients with S. aureus infection of the hepatobiliary system. METHODS: Medical records of patients with bile cultures positive for S. aureus from January 2006 to November 2020 were extracted from the computerized database of a hospital in Israel. RESULTS: We analyzed the results of 28 cases that were found in the database. The mean age of study patients was 62.2 ± 19 years. Hypertension, dyslipidemia, chronic kidney disease, diabetes, and benign prostatic hypertrophy were the most common co-morbidities (57.1%, 32.1%, 25%, 25%, and 25%, respectively). Fourteen of the methicillin-resistant S. aureus (MRSA) bile cultures (82.3%) were a result of primary S. aureus biliary infections (no other source for S. aureus infection) and the remainder were of a secondary infection. Eight of the MRSA cultures (47.1%) were from hospital acquired infections. Increased hospital mortality in patients with S. aureus hepatobiliary infection was associated with hypertension (P = 0.04), bedridden status (P = 0.01), and nursing home residence (P = 0.003). CONCLUSIONS: Hepatobiliary infection with S. aureus can manifest in a variety of ways. S. aureus should be especially considered in patients who are bedridden, present with hypertension, or live in nursing homes because of their association with in-hospital mortality resulting from this entity.

Coherence-orbital angular momentum matrix of non-uniformly correlated sources.

The structure of the coherence-orbital angular momentum (OAM) matrix of a scalar, non-uniformly correlated source is revealed and its relation with the degree of coherence is established. It is shown that while this source class has a real-valued coherence state, it possesses a rich OAM correlation content and highly controllable OAM spectrum. In addition, the degree of OAM purity based on the information entropy measure is employed for, we believe, the first time, and is shown to be controlled by the choice of location and variance of the correlation center.

Candida Prophylaxis and Treatment in Critically Ill Patients after Abdominal Surgery: A Survey of Practice.

Purpose: To survey current intensive care unit (ICU) practice in initiating antifungal therapy for prophylaxis and treatment of suspected candidiasis after abdominal surgery. The goal was to establish the need to prioritize research toward standardized care of such patients. Methods: Online questionnaire survey of clinical practice based on theoretical case scenarios. These were structured with expert input to investigate management of: hemodynamically stable/unstable patient after urgent upper/lower gastrointestinal surgery with/without fungal growth in culture. The link to the survey was sent to all active members of the European Society of Intensive Care Medicine (ESICM). Results: The survey was completed by 101 respondents from 29 countries. Fewer than half (48.5%) stated that in their center, ICU antibiotic and antifungal therapy is managed by a dedicated specialist physician/team that manages all ICU patients. Respondents exhibited a greater tendency toward administering antifungal agents, mainly fluconazole, to hemodynamically unstable patients. One week after surgery for a perforated duodenal ulcer, only half responded they would use antifungal agents when a patient develops septic shock. Most respondents chose to administer antifungal therapy in patients with septic shock if Candida had been identified in any culture. The source of infection, location of surgery, or type of Candida were not viewed as triggers for therapeutic decisions. Conclusion: The current survey demonstrates large variability in antifungal use. Decisions are made irrespective of existing guidelines and seem to be driven by patient hemodynamic condition and identification of any Candida in any culture alone.

Starplasty tracheostomy: case series and literature review.

OBJECTIVES: The starplasty tracheostomy (SPT) technique has been suggested to reduce the short-term complications of tracheostomy, including accidental decannulation and pneumothorax. The aim of the present study was to conduct a review of key parameters prior to and following treatment of neonates and children with the SPT technique, including indications, complications, perioperative department stay, and overall length of stay in one University-Affiliated Medical Center. METHODS: A retrospective chart review of all children under the age of 18 underwent SPT in a single center between February 2006 and January 2012. RESULTS: Among the 39 patients reviewed, the median age at the time of surgery was 14.5 months, ranging from 3 days to 8.8 years. The most common indication for SPT was respiratory insufficiency resulting from central nervous system disorders (15, 38.4%) followed by neuromuscular disorders (14, 35.9%). Ten (25.6%) operations were performed on neonatal intensive care unit (NICU) patients and 29 (74.4%) on pediatric intensive care unit (PICU) patients. The median postoperative hospital stay was 19.5 days (range of 3-207 days); however, the median postoperative stay in the PICU was 13.5 days. There were no decannulations or any other short-term complications after SPT, and no SPT-related deaths occurred. CONCLUSIONS: In our series, pediatric SPT was not associated with any major complications. Therefore, we conclude that SPT should be considered as a safe and advantageous alternative for traditional tracheotomy, especially in patients with low probability of future decannulation, and, therefore, at low risk of a persistent tracheocutaneous fistula.

Inhaled medicinal cannabis and the immunocompromised patient.

Medicinal cannabis is an invaluable adjunct therapy for pain relief, nausea, anorexia, and mood modification in cancer patients and is available as cookies or cakes, as sublingual drops, as a vaporized mist, or for smoking. However, as with every herb, various microorganisms are carried on its leaves and flowers which when inhaled could expose the user, in particular immunocompromised patients, to the risk of opportunistic lung infections, primarily from inhaled molds. The objective of this study was to identify the safest way of using medicinal cannabis in immunosuppressed patients by finding the optimal method of sterilization with minimal loss of activity of cannabis. We describe the results of culturing the cannabis herb, three methods of sterilization, and the measured loss of a main cannabinoid compound activity. Systematic sterilization of medicinal cannabis can eliminate the risk of fatal opportunistic infections associated with cannabis among patients at risk.

Prevalence and characteristics of cluster B personality disorder in a consultation-liaison psychiatry practice.

OBJECTIVE: Quantitative studies on cluster B-personality disorder (PD) in the general hospital are scarce. The aim of this study is to examine the prevalence and characteristics of cluster B-PD patients in a consultation-liaison practice. METHODS: Files of 258 consecutive patients referred for psychiatric consultation were examined. Cluster B patients were compared with the remaining patients. RESULTS: Eleven point six percent of these patients were diagnosed with a cluster B-PD. On univariate analysis, cluster B patients were more likely to be younger (P < 0.001), unmarried (P = 0.005), and without organic medical illness (P < 0.001).These patients had a shorter admission (P < 0.0001), and were more frequently treated in the emergency room (66.6% versus 37.5%, P = 0.02).There was a trend toward comorbid substance use disorder (P = 0.09). On multivariate analysis, cluster B patients presented significantly with self-harming behavior/ideation (80% versus 18%, OR = 12.07; 95% CI = 4.37-33.31; P < 0.0001). CONCLUSIONS: In view of the high prevalence of cluster B-PD in our preliminary study, general hospital staff requires practical skills for managing these high-maintenance patients. We believe that this study and further research will promote evidence-based recommendations for consultation-liaison psychiatrists.

Radiation dose reduction in fluoroscopic procedures: left varicocele embolization as a model.

OBJECTIVES: To investigate the effect of a radiation reduction program on total dose, fluoroscopy dose per second corrected for body habitus and degree of collimation in left varicocele embolizations (LVE). METHODS: A radiation reduction program for LVE was implemented, consisting of a technique minimizing fluoroscopy time, using low-dose presets, virtual collimation, and virtual patient positioning. Height, weight, fluoroscopy time, kerma area product (KAP) and reference air kerma (Ka,r) were recorded for 100 consecutive cases satisfying the inclusion criteria. For each patient, a device specific dose correction factor, determined using a phantom, was used to standardize the KAP to that of the cylindrical diameter of the standard man and a collimation index was derived from the KAP and Ka,r. RESULTS: Median fluoroscopy time was 3 minutes (mean 4.5, range 1-23.8). Median KAP was 0.54 Gy/cm(2) (mean 0.82, range 0.12-6.52). There was a significant decrease in KAP/second corrected for cylindrical diameter (p < 0.001) and the collimation index (p < 0.001) over time. CONCLUSIONS: This study shows that a dedicated dose reduction program can achieve very low total radiation dose rates for LVE. The significant decrease in collimation index and standardized KAP per second during this study suggest a learning curve for collimation. KEY POINTS: • Left varicocele embolization can be performed with very low radiation doses. • The most effective real time radiation reduction measure is collimation. • There is a learning curve to achieving optimal collimation.

Platelet factor 4/heparin-particle gel immunoassay (PaGIA) is a weak method for heparin-induced thrombocytopenia (HIT) evaluation of post cardio-pulmonary bypass surgery patients.

Diagnosis of heparin induced thrombocytopenia (HIT) is not always easy, especially when a confirmatory functional test is not available. In most cases the diagnosis relies on the combination of pretest probability and an immunologic test. Among patients post cardiopulmonary bypass (CPB) surgery, anti-platelet factor 4/heparin antibodies tend to be high but with low clinical implication. The current retrospective study examined the behavior of patients with positive PF4/heparin-PaGIA results, divided into two groups according to whether or not they have undergone CPB surgery. The main focus of the study was on the reliability of the PF4/heparin-PaGIA test in these two settings. The files of 104 single center patients, who had a positive PF4/heparin-PaGIA test, were reviewed. 62% were post CPB and 38% were not. An association between the intensity of positivity of PF4/heparin-PaGIA test and both the 4Ts pretest probability method (p = 0.003) and the incidence of thrombosis (p = 0.02) was found only in the patients who have not undergone CPB surgery, but not in the CPB patients. This study suggests that PF4/heparin-PaGIA is not a reliable method in patients post CPB surgery who are investigated for a possible diagnosis of HIT.

[Impact of a monitoring unit in the medical department on patient outcome].

PURPOSE: Many hospitals have established monitoring units (MU) in their medical departments, with operating costs that are significantly lower than Intensive Care Units, but with no data on their effectiveness. We determined the outcome of patients, who were treated in a new MU during their hospitalization, compared with that of a control group. METHODS: We included all patients, who were admitted to the MU during a five months period. The control group consisted of patients, who were admitted to medical departments and did not stay in the MU during their hospitalization. Patients and controls were matched according to gender, age +/- 10 years, and need for mechanical ventilation. The main endpoint was the 28-day survival rate. RESULTS: There were minor differences between baseline characteristics of patients and controls. The patient cohort included a higher rate of acute renal failure (20/100, 20%) and chronic renal failure (23/100, 23%), compared to the control group (respectively, 10/100, 10%, p < 0.05 and 8/100, 8%, p < 0.05), and a higher rate of respiratory support (83/94, 82% and 72/99, 72%, p < 0.05). Contrarily, a GLasgow coma scale of 3-5 was found in 10/100 (10%) of MU patients and in 20/100 (20%) of control patients (p < 0.05). Despite these differences, there was no difference in predicted mortality score. Nevertheless, the observed survival rate of patients who stayed in the monitoring unit (76/100, 76%) was higher than that of the control group (64/100, 64%) (p < 0.05). CONCLUSIONS: The results of this pilot study indicate that a monitoring unit may contribute to improved survival.

Alcohol use disorder in an Israeli general hospital: sociodemographic, ethnic and clinical characteristics.

BACKGROUND: Alcohol consumption in Israel has increased over the last 20 years. Patients with alcohol use disorder (AUD) who present at a hospital enable early intervention. OBJECTIVES: To examine, for the first time, the characteristics of AUD patients in an Israel general hospital, and whether their alcohol use was documented in their files. METHODS: A group of 178 consecutive patients referred for psychiatric consultation was compared to a second group of 105 hospitalized patients who were not referred. These two groups were studied to compare risk factors for AUD. Patients in both groups were prospectively interviewed using a CAGE questionnaire, demonstrated as an effective screening instrument for AUD. Patients' files in both groups were examined for documentation of alcohol use. RESULTS: There was no significant difference between the prevalence of AUD in the two groups. The groups were then merged since no significant difference in the risk factor effects between the two groups was found. The risk factors for AUD in the final statistical analysis were lower educational status, living alone, being born in the Former Soviet Union and weaker religious observance. Post-traumatic stress disorder (PTSD), cigarette smoking and substance use were found to be independent risk factors. Soldier status was associated with significant alcohol misuse and AUD (CAGE1-4). Alcohol consumption was documented in the files of AUD patients in 48% of the first group and 21% of the second. CONCLUSIONS: Physicians often neglect to take a history of alcohol consumption. Routine use of the CAGE questionnaire is recommended in Israeli general hospitals. Special attention should be given to PTSD patients and to soldiers.

Global responsibility in mass casualty events: the Israeli experience in Japan.

OBJECTIVE: To describe humanitarian aid following the 2011 earthquake and tsunami in Japan. SETTING: A field hospital deployed in a small Japanese coastal village devastated by a major tsunami. PATIENTS: Thousands of Japanese refugees with minimal access to medical care. RESULTS: After well-coordinated diplomatic efforts, our medical delegation was the first foreign team to deploy in Japan. Our facility served as a regional referral center for specialized medical treatment. CONCLUSIONS: Following major disasters, even highly modernized countries will face an urgent surge in the need of medical resources. These situations emphasize the need for global responsibility to provide assistance.

Absence of leukocytosis in bacteraemic pneumococcal pneumonia.

BACKGROUND: Evaluation of patients with respiratory symptoms in primary care medicine is often based on peripheral WBC count that dictates the extent of diagnostic investigation. A normal WBC count may result in a limited investigation, often omitting chest radiography. AIMS: To determine the extent to which patients hospitalised with bacteraemic pneumococcal pneumonia have no leukocytosis at presentation. METHODS: A retrospective analysis was performed of patients with bacteraemic community-acquired pneumococcal pneumonia from 2000 to 2007 in a community care academic medical centre. Records were reviewed for symptoms, signs, and laboratory data including pneumococcal serotypes, chest radiographs on admission, and outcome. RESULTS: 21% of the patients presented with a normal WBC count (16.7% of the children and 25.6% of the adults). Among this population with a normal WBC count at presentation, 90% of the adults and 70% of the children developed leukocytosis within a few days after admission. CONCLUSIONS: In this study, in as many as one-fifth of all the patients with bacteraemic pneumococcal pneumonia, there was no leukocytosis at presentation. We therefore suggest that every patient with clinically suspected pneumonia should undergo chest radiography even if the WBC count is normal.

A costly covenant: ritual circumcision and urinary tract infection.

BACKGROUND: Ritual circumcision in neonates may cause a urinary tract infection within 2 weeks of the procedure. OBJECTIVES: To evaluate the prevalence of urinary tract infection among Jewish male circumcised neonates < or = 28 days old) evaluated for fever in the emergency room. METHODS: All available medical records of neonates presenting to the pediatric emergency room for evaluation of fever over a 10 year period were reviewed. Data included gender, ethnic background, age (in days) on presentation to the emergency room, age (in days) when circumcision was performed (in males > or = 8 days of age), and results of urine, blood and cerebrospinal fluid cultures. Families of males older than 8 days of age who had a UTI were contacted by telephone to verify the circumcision status when the infant presented to the ER, to ascertain whether the circumcision had been performed ritually by a mohel* or by a physician, and, if not recorded in the chart, to verify the day of life on which circumcision was performed. RESULTS: Among neonates older than 8 days of age, 60 (24.7%) of the 243 febrile Jewish males had a UTI, as compared to 12 (8.4%) of 143 females (P < 0.0001). In 39 of 54 male neonates (72%) for whom circumcision was performed ritually on the eighth day of life, UTI occurred within 9 days of the circumcision. For females, there was no such clustering of UTI cases in the second week of life, nor during any other time period. CONCLUSIONS: Febrile male neonates who have undergone ritual circumcision have a high prevalence of UTI and must be evaluated and treated accordingly.