Advanced Practice Pharmacists: a retrospective evaluation of the efficacy and cost of ClinicaL Pharmacist PractitionErs managing ambulatory Medicare patients in North Carolina (APPLE-NC)

Abstract Background Clinical Pharmacist Practitioners are advanced practicing pharmacists in North Carolina that provide disease-specific management. The purpose of this retrospective cohort study was to compare the efficacy and charges from referrals to a Clinical Pharmacist Practitioner by the primary care provider, to those managed by a primary care provider alone. Methods Patients were separated into cohorts depending if they had at least two appointments with a Clinical Pharmacist Practitioner from November 2008 to November 2011. A primary care provider saw all patients at least twice during the study period. Cohorts were then matched by age, gender, and disease states. Medicare billed data was evaluated from outpatient visits related to hypertension, diabetes mellitus, and peripheral neuropathy, as well as emergency department visits and inpatient admissions. Cost of medications was estimated using 2009 AWP data corresponding to medication histories within the electronic medical record. Efficacy was defined as ability to reach disease state goal determined using national guidelines and reduction in pain score. Efficacy was analyzed by difference-in-differences test and all other numerical data tested by paired t-tests. Results The Clinical Pharmacist Practitioners cohort experienced more outpatient visits (1338 vs. 858, p < 0.001), fewer emergency department visits (115 vs. 190, p < 0.05), and similar inpatient admissions (88 vs. 117, p > 0.05) than the primary care providers cohort, respectively. The Clinical Pharmacist Practitioners cohort showed changes in charges of +22.6 % for outpatient visits, −45.5 % emergency department visits, and −13.2 % inpatient admissions relative to the primary care provider cohort. There was no difference in average daily medication cost (Clinical Pharmacist Practitioners $38.52 vs. primary care providers$38.23, p = 0.97) or achievement of disease state goals. Conclusion APPLE-NC demonstrated that through referrals, Clinical Pharmacist Practitioners provide services comparable in charges and efficacy to primary care providers. Consequently, the current increased need for primary care practitioners can be met in part by increasing the utilization of advanced practice pharmacists for chronic disease management. Trial registration This does not apply for this retrospective cohort study

Singular value decomposition and matrix reorderings in quantum information theory

We review Schmidt and Kraus decompositions in the form of singular value decomposition using operations of reshaping, vectorization and reshuffling. We use the introduced notation to analyse the correspondence between quantum states and operations with the help of Jamiolkowski isomorphism. The presented matrix reorderings allow us to obtain simple formulae for the composition of quantum channels and partial operations used in quantum information theory. To provide examples of the discussed operations we utilize a package for the Mathematica computing system implementing basic functions used in the calculations related to quantum information theory.Comment: 11 pages, no figures, see http://zksi.iitis.pl/wiki/projects:mathematica-qi for related softwar

MASE: A New Data--Reduction Pipeline for the Magellan Echellette Spectrograph

We introduce a data reduction package written in Interactive Data Language (IDL) for the Magellan Echellete Spectrograph (MAGE). MAGE is a medium-resolution (R ~4100), cross-dispersed, optical spectrograph, with coverage from ~3000-10000 Angstroms. The MAGE Spectral Extractor (MASE) incorporates the entire image reduction and calibration process, including bias subtraction, flat fielding, wavelength calibration, sky subtraction, object extraction and flux calibration of point sources. We include examples of the user interface and reduced spectra. We show that the wavelength calibration is sufficient to achieve ~5 km/s RMS accuracy and relative flux calibrations better than 10%. A light-weight version of the full reduction pipeline has been included for real-time source extraction and signal-to-noise estimation at the telescope.Comment: 10 pages (ApJ format), accepted PAS

Tests of the fundamental symmetries in eta meson decays

Patterns of chiral symmetry violation and tests of the conservation of the fundamental C, P and CP symmetries are key physics issues in studies of the pi0, eta and eta' meson decays. These tests include searches for rare or forbidden decays and searches for asymmetries among the decay products in the not-so-rare decays. Some examples for the rare decays are eta-->2pi, eta-->4pi0 (CP tests), decays into an odd number of photons (e.g., eta-->3g) and the decay eta-->pi0e+e- (C tests). The experimental studies of the pi0, eta and eta' meson decays are carried out at four European accelerator research facilities: KLOE/KLOE-2 at DAFNE (Frascati), Crystal Ball at MAMI (Mainz), WASA at COSY (J\"ulich), Crystal Barrel at ELSA (Bonn).Comment: 9 pages, 2 figures, proceedings of Symposium on Prospects in the Physics of Discrete Symmetries, DISCRETE 2010, 6 - 11 December, Rome; v2: added reference

Nanoparticles in cigarette smoke; real-time undiluted measurements by a scanning mobility particle sizer

Cigarette smoke is a complex mixture of smoke constituents, often characterised by size-resolved particle distributions. Since descriptions of ultrafine particles <50 nm are absent, our aim was to explore the existence of these nanoparticles in fresh and undiluted cigarette smoke. We measured undiluted smoke particles real-time by a scanning mobility particle sizer with Faraday cup electrometer, integrated in our custom-made smoking machine. Cigarettes were smoked by 2 s puffs, 30 s puff intervals and 50 ml puff volume. We tested six different cigarettes (1–10 mg tar per cigarette) at ten particle size-ranges between 6 and 50 nm, and repeated measurements five times. The formation of nanoparticles in fresh cigarette smoke was observed over the entire range between 6 and 50 nm, and reproduced in all cigarettes. The highest mean yield was 8.8 × 109 (SD = 1.1 × 109) particles per cigarette at the largest particle size range by high-tar cigarettes. Nanoparticle counts appear to increase with particle size, claimed tar values and blocking of filter ventilation holes, and inversely with butt length. Fresh undiluted cigarette smoke contains large amounts of potentially toxic nanoparticles <50 nm. We recommend to further study nanoparticles in the characterisation of cigarette smoke

Vitamin D receptor ChIP-seq in primary CD4+ cells: relationship to serum 25-hydroxyvitamin D levels and autoimmune disease

PMCID: PMC3710212This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Design and Performance of the XENON10 Dark Matter Experiment

XENON10 is the first two-phase xenon time projection chamber (TPC) developed within the XENON dark matter search program. The TPC, with an active liquid xenon (LXe) mass of about 14 kg, was installed at the Gran Sasso underground laboratory (LNGS) in Italy, and operated for more than one year, with excellent stability and performance. Results from a dark matter search with XENON10 have been published elsewhere. In this paper, we summarize the design and performance of the detector and its subsystems, based on calibration data using sources of gamma-rays and neutrons as well as background and Monte Carlo simulations data. The results on the detector's energy threshold, energy and position resolution, and overall efficiency show a performance that exceeds design specifications, in view of the very low energy threshold achieved (<10 keVr) and the excellent energy resolution achieved by combining the ionization and scintillation signals, detected simultaneously

Epigenetic and transcriptional dysregulation in CD4+ T cells in patients with atopic dermatitis

Atopic dermatitis (AD) is one of the most common skin disorders among children. Disease etiology involves genetic and environmental factors, with 29 independent AD risk loci enriched for risk allele-dependent gene expression in the skin and CD4+ T cell compartments. We investigated the potential epigenetic mechanisms responsible for the genetic susceptibility of CD4+ T cells. To understand the differences in gene regulatory activity in peripheral blood T cells in AD, we measured chromatin accessibility (an assay based on transposase-accessible chromatin sequencing, ATAC-seq), nuclear factor kappa B subunit 1 (NFKB1) binding (chromatin immunoprecipitation with sequencing, ChIP-seq), and gene expression levels (RNA-seq) in stimulated CD4+ T cells from subjects with active moderate-to-severe AD, as well as in age-matched non-allergic controls. Open chromatin regions in stimulated CD4+ T cells were highly enriched for AD genetic risk variants, with almost half of the AD risk loci overlapping AD-dependent ATAC-seq peaks. AD-specific open chromatin regions were strongly enriched for NF-κB DNA-binding motifs. ChIP-seq identified hundreds of NFKB1-occupied genomic loci that were AD- or control-specific. As expected, the AD-specific ChIP-seq peaks were strongly enriched for NF-κB DNA-binding motifs. Surprisingly, control-specific NFKB1 ChIP-seq peaks were not enriched for NFKB1 motifs, but instead contained motifs for other classes of human transcription factors, suggesting a mechanism involving altered indirect NFKB1 binding. Using DNA sequencing data, we identified 63 instances of altered genotype-dependent chromatin accessibility at 36 AD risk variant loci (30% of AD risk loci) that might lead to genotype-dependent gene expression. Based on these findings, we propose that CD4+ T cells respond to stimulation in an AD-specific manner, resulting in disease- and genotype-dependent chromatin accessibility alterations involving NFKB1 binding

Design principles for riboswitch function

Scientific and technological advances that enable the tuning of integrated regulatory components to match network and system requirements are critical to reliably control the function of biological systems. RNA provides a promising building block for the construction of tunable regulatory components based on its rich regulatory capacity and our current understanding of the sequence–function relationship. One prominent example of RNA-based regulatory components is riboswitches, genetic elements that mediate ligand control of gene expression through diverse regulatory mechanisms. While characterization of natural and synthetic riboswitches has revealed that riboswitch function can be modulated through sequence alteration, no quantitative frameworks exist to investigate or guide riboswitch tuning. Here, we combined mathematical modeling and experimental approaches to investigate the relationship between riboswitch function and performance. Model results demonstrated that the competition between reversible and irreversible rate constants dictates performance for different regulatory mechanisms. We also found that practical system restrictions, such as an upper limit on ligand concentration, can significantly alter the requirements for riboswitch performance, necessitating alternative tuning strategies. Previous experimental data for natural and synthetic riboswitches as well as experiments conducted in this work support model predictions. From our results, we developed a set of general design principles for synthetic riboswitches. Our results also provide a foundation from which to investigate how natural riboswitches are tuned to meet systems-level regulatory demands

Dimensionless cosmology

Although it is well known that any consideration of the variations of fundamental constants should be restricted to their dimensionless combinations, the literature on variations of the gravitational constant $G$ is entirely dimensionful. To illustrate applications of this to cosmology, we explicitly give a dimensionless version of the parameters of the standard cosmological model, and describe the physics of Big Bang Neucleosynthesis and recombination in a dimensionless manner. The issue that appears to have been missed in many studies is that in cosmology the strength of gravity is bound up in the cosmological equations, and the epoch at which we live is a crucial part of the model. We argue that it is useful to consider the hypothetical situation of communicating with another civilization (with entirely different units), comparing only dimensionless constants, in order to decide if we live in a Universe governed by precisely the same physical laws. In this thought experiment, we would also have to compare epochs, which can be defined by giving the value of any {\it one} of the evolving cosmological parameters. By setting things up carefully in this way one can avoid inconsistent results when considering variable constants, caused by effectively fixing more than one parameter today. We show examples of this effect by considering microwave background anisotropies, being careful to maintain dimensionlessness throughout. We present Fisher matrix calculations to estimate how well the fine structure constants for electromagnetism and gravity can be determined with future microwave background experiments. We highlight how one can be misled by simply adding $G$ to the usual cosmological parameter set