Nurse-Initiated Treatment Reduces Costs for Acute Asthma in a Pediatric Emergency Department

Standardized emergency department (ED) pathways can improve care delivery to children with acute asthma, though their impact on hospitalization and costs is unclear. An Acute Asthma Care Pathway (AACP) that facilitates nurse initiation of treatment was implemented at a tertiary care pediatric ED using standard quality improvement methodology. The impact of implementation was assessed using process control methodology and multivariable time series analyses between pre- and post-implementation periods. Provision of a steroid within 30 minutes and 60 minutes of arrival increased by 21 and 22 percentage points respectively, IV magnesium sulfate administration increased by 30 percentage points, the proportion hospitalized decreased from 44.8% to 32.2%, and mean direct costs per patient decreased from $2,663 to$2,303 (13.5%). In multivariable analysis, these improvements remained significant. Implementation of the AACP improved timeliness of treatment, hospitalization, and direct costs of children receiving ED treatment for acute asthma

Pollination Biology and Adaptive Radiation of Agavaceae, with Special Emphasis on the Genus Agave

Agavaceae are an American family that comprises nine genera and ca. 300 species distributed in arid and semiarid environments, mainly in Mexico. The family is very successful and displays a wide array of ecological, reproductive, and morphological adaptations. Many of its members play important roles as keystone species, because they produce abundant resources during the reproductive season. In this paper we analyze the current knowledge about the pollination ecology of the different genera in the family and the role that pollination systems have played in the ecological and phylogenetic success of the group. After providing an overview of each of the genera in the family, we discuss in detail aspects of the reproductive ecology of species in the genus Agave s.l., which is composed of ca. 208 species and includes subgenera of Agave (Agave and Littaea), Manfreda, Polianthes, and Prochnyanthes. Finally, we describe the results of analyses to test the hypothesis that there has been an adaptive radiation in the genus Agave. Using chloroplast and nuclear DNA sequences we estimate the age of the Agavaceae family and the genus Agave to be 12-26 millions of years ago (MYA) and 10 MYA, respectively, and show that mean rates of diversification were higher in the genus Agave than the genus Yucca. The values we report for rates of diversification in Agave s.l. are high when compared to other radiations in plants and animals. We suggest that the desertification of North America, which started ca. 15 MY A was critical in the radiation of agaves and that the generalist pollination system of Agave has been more successful in generating new species than the extreme specialization of Yucca

High-fidelity operation and algorithmic initialisation of spin qubits above one kelvin

The encoding of qubits in semiconductor spin carriers has been recognised as a promising approach to a commercial quantum computer that can be lithographically produced and integrated at scale. However, the operation of the large number of qubits required for advantageous quantum applications will produce a thermal load exceeding the available cooling power of cryostats at millikelvin temperatures. As the scale-up accelerates, it becomes imperative to establish fault-tolerant operation above 1 kelvin, where the cooling power is orders of magnitude higher. Here, we tune up and operate spin qubits in silicon above 1 kelvin, with fidelities in the range required for fault-tolerant operation at such temperatures. We design an algorithmic initialisation protocol to prepare a pure two-qubit state even when the thermal energy is substantially above the qubit energies, and incorporate high-fidelity radio-frequency readout to achieve an initialisation fidelity of 99.34 per cent. Importantly, we demonstrate a single-qubit Clifford gate fidelity of 99.85 per cent, and a two-qubit gate fidelity of 98.92 per cent. These advances overcome the fundamental limitation that the thermal energy must be well below the qubit energies for high-fidelity operation to be possible, surmounting a major obstacle in the pathway to scalable and fault-tolerant quantum computation

High-fidelity spin qubit operation and algorithmic initialization above 1 K

The encoding of qubits in semiconductor spin carriers has been recognized as a promising approach to a commercial quantum computer that can be lithographically produced and integrated at scale. However, the operation of the large number of qubits required for advantageous quantum applications will produce a thermal load exceeding the available cooling power of cryostats at millikelvin temperatures. As the scale-up accelerates, it becomes imperative to establish fault-tolerant operation above 1 K, at which the cooling power is orders of magnitude higher. Here we tune up and operate spin qubits in silicon above 1 K, with fidelities in the range required for fault-tolerant operations at these temperatures. We design an algorithmic initialization protocol to prepare a pure two-qubit state even when the thermal energy is substantially above the qubit energies and incorporate radiofrequency readout to achieve fidelities up to 99.34% for both readout and initialization. We also demonstrate single-qubit Clifford gate fidelities up to 99.85% and a two-qubit gate fidelity of 98.92%. These advances overcome the fundamental limitation that the thermal energy must be well below the qubit energies for the high-fidelity operation to be possible, surmounting a main obstacle in the pathway to scalable and fault-tolerant quantum computation

MFA15 (MFA 2015)

Catalogue of a culminating student exhibition held at the Mildred Lane Kemper Art Museum, May 1 - August 2, 2015 . Introduction / Heather Corcoran and Patricia Olynyk -- Diana Casanova / Emily J. Hanson -- Andrea M. Coates : in the operating theater / Stephanie Dering -- Margaux Crump -- Brandon Daniels -- Addoley Dzegede : do you prefer answers or truth? / Aaron Coleman -- Vita Eruhimovitz -- Carling Hale -- Amanda Helman -- Mike Helms / Ming Ying Hong -- Ming Ying Hong / Emily J. Hanson -- Sea A Joung / Ervin Malakaj -- Stephanie Kang / Jeremy Shipley -- Dayna Jean Kriz / Andrew Johnson -- Thomas Moore : you should move to the city / Nathaniel Rosenthalis -- Jacob Muldowney -- Laurel Panella / Garrett Clough -- Caitlin Penny -- On the bridge, between Juarez and El Paso / Eric Lyle Schultz -- Jeremy Shipley -- Emmeline Solomon -- Kellie Spano / Margaux Crump -- Michael Aaron Williams -- Austin R. Wolf : monumental labor / Adam Turl.https://openscholarship.wustl.edu/books/1015/thumbnail.jp

Role of Germination in Murine Airway CD8+ T-Cell Responses to Aspergillus Conidia

Pulmonary exposure to Aspergillus fumigatus has been associated with morbidity and mortality, particularly in immunocompromised individuals. A. fumigatus conidia produce β-glucan, proteases, and other immunostimulatory factors upon germination. Murine models have shown that the ability of A. fumigatus to germinate at physiological temperature may be an important factor that facilitates invasive disease. We observed a significant increase in IFN-γ-producing CD8+ T cells in bronchoalveolar lavage fluid (BALF) of immunocompetent mice that repeatedly aspirated A. fumigatus conidia in contrast to mice challenged with A. versicolor, a species that is not typically associated with invasive, disseminated disease. Analysis of tissue sections indicated the presence of germinating spores in the lungs of mice challenged with A. fumigatus, but not A. versicolor. Airway IFN-γ+CD8+ T-cells were decreased and lung germination was eliminated in mice that aspirated A. fumigatus conidia that were formaldehyde-fixed or heat-inactivated. Furthermore, A. fumigatus particles exhibited greater persistence in the lungs of recipient mice when compared to non-viable A. fumigatus or A. versicolor, and this correlated with increased maintenance of airway memory-phenotype CD8+ T cells. Therefore, murine airway CD8+ T cell-responses to aspiration of Aspergillus conidia may be mediated in part by the ability of conidia to germinate in the host lung tissue. These results provide further evidence of induction of immune responses to fungi based on their ability to invade host tissue