Interlayer coherent composite Fermi liquid phase in quantum Hall bilayers

Composite fermions have played a seminal role in understanding the quantum Hall effect, particularly the formation of a compressible `composite Fermi liquid' (CFL) at filling factor nu = 1/2. Here we suggest that in multi-layer systems interlayer Coulomb repulsion can similarly generate `metallic' behavior of composite fermions between layers, even if the electrons remain insulating. Specifically, we propose that a quantum Hall bilayer with nu = 1/2 per layer at intermediate layer separation may host such an interlayer coherent CFL, driven by exciton condensation of composite fermions. This phase has a number of remarkable properties: the presence of `bonding' and `antibonding' composite Fermi seas, compressible behavior with respect to symmetric currents, and fractional quantum Hall behavior in the counterflow channel. Quantum oscillations associated with the Fermi seas give rise to a new series of incompressible states at fillings nu = p/[2(p \pm 1)] per layer (p an integer), which is a bilayer analogue of the Jain sequence.Comment: 4 pages, 3 figure

Adiabatic manipulations of Majorana fermions in a three-dimensional network of quantum wires

It has been proposed that localized zero-energy Majorana states can be realized in a two-dimensional network of quasi-one-dimensional semiconductor wires that are proximity-coupled to a bulk superconductor. The wires should have strong spin-orbit coupling with appropriate symmetry, and their electrons should be partially polarized by a strong Zeeman field. Then, if the Fermi level is in an appropriate range, the wire can be in a topological superconducting phase, with Majorana states that occur at wire ends and at $Y$ junctions, where three topological superconductor segments may be joined. Here we generalize these ideas to consider a three-dimensional network. The positions of Majorana states can be manipulated, and their non-Abelian properties made visible, by using external gates to selectively deplete portions of the network, or by physically connecting and redividing wire segments. Majorana states can also be manipulated by reorientations of the Zeeman field on a wire segment, by physically rotating the wire about almost any axis, or by evolution of the phase of the order parameter in the proximity-coupled superconductor. We show how to keep track of sign changes in the zero-energy Hilbert space during adiabatic manipulations by monitoring the evolution of each Majorana state separately, rather than keeping track of the braiding of all possible pairs. This has conceptual advantages in the case of a three-dimensional network, and may be computationally useful even in two dimensions, if large numbers of Majorana sites are involved.Comment: 18 pages, 6 figure

Factors Affecting the Nutritional Status of Chittenden Emergency Food Shelf Clients

Objectives: Using a twenty-four hour food recall and the USDA MyPyramid guidelines, we considered how various factors affect the nutritional status of Chittenden Emergency Food Shelf clients. The factors we considered were housing stability, body mass index, sharing of food with dependants, skipping meals, and enrollment in the Food Stamp Program. The results of our study will inform the Food Shelf about their clients and the barriers they face in trying to maintain a healthy diet and potentially be used to improve programs.https://scholarworks.uvm.edu/comphp_gallery/1024/thumbnail.jp

Winnowing DNA for Rare Sequences: Highly Specific Sequence and Methylation Based Enrichment

Rare mutations in cell populations are known to be hallmarks of many diseases and cancers. Similarly, differential DNA methylation patterns arise in rare cell populations with diagnostic potential such as fetal cells circulating in maternal blood. Unfortunately, the frequency of alleles with diagnostic potential, relative to wild-type background sequence, is often well below the frequency of errors in currently available methods for sequence analysis, including very high throughput DNA sequencing. We demonstrate a DNA preparation and purification method that through non-linear electrophoretic separation in media containing oligonucleotide probes, achieves 10,000 fold enrichment of target DNA with single nucleotide specificity, and 100 fold enrichment of unmodified methylated DNA differing from the background by the methylation of a single cytosine residue

An international effort towards developing standards for best practices in analysis, interpretation and reporting of clinical genome sequencing results in the CLARITY Challenge

There is tremendous potential for genome sequencing to improve clinical diagnosis and care once it becomes routinely accessible, but this will require formalizing research methods into clinical best practices in the areas of sequence data generation, analysis, interpretation and reporting. The CLARITY Challenge was designed to spur convergence in methods for diagnosing genetic disease starting from clinical case history and genome sequencing data. DNA samples were obtained from three families with heritable genetic disorders and genomic sequence data were donated by sequencing platform vendors. The challenge was to analyze and interpret these data with the goals of identifying disease-causing variants and reporting the findings in a clinically useful format. Participating contestant groups were solicited broadly, and an independent panel of judges evaluated their performance. RESULTS: A total of 30 international groups were engaged. The entries reveal a general convergence of practices on most elements of the analysis and interpretation process. However, even given this commonality of approach, only two groups identified the consensus candidate variants in all disease cases, demonstrating a need for consistent fine-tuning of the generally accepted methods. There was greater diversity of the final clinical report content and in the patient consenting process, demonstrating that these areas require additional exploration and standardization. CONCLUSIONS: The CLARITY Challenge provides a comprehensive assessment of current practices for using genome sequencing to diagnose and report genetic diseases. There is remarkable convergence in bioinformatic techniques, but medical interpretation and reporting are areas that require further development by many groups

Causal effect of plasminogen activator inhibitor type 1 on coronary heart disease

Background--Plasminogen activator inhibitor type 1 (PAI-1) plays an essential role in the fibrinolysis system and thrombosis. Population studies have reported that blood PAI-1 levels are associated with increased risk of coronary heart disease (CHD). However, it is unclear whether the association reflects a causal influence of PAI-1 on CHD risk. Methods and Results--To evaluate the association between PAI-1 and CHD, we applied a 3-step strategy. First, we investigated the observational association between PAI-1 and CHD incidence using a systematic review based on a literature search for PAI-1 and CHD studies. Second, we explored the causal association between PAI-1 and CHD using a Mendelian randomization approach using summary statistics from large genome-wide association studies. Finally, we explored the causal effect of PAI-1 on cardiovascular risk factors including metabolic and subclinical atherosclerosis measures. In the systematic meta-analysis, the highest quantile of blood PAI-1 level was associated with higher CHD risk comparing with the lowest quantile (odds ratio=2.17; 95% CI: 1.53, 3.07) in an age- and sex-adjusted model. The effect size was reduced in studies using a multivariable-adjusted model (odds ratio=1.46; 95% CI: 1.13, 1.88). The Mendelian randomization analyses suggested a causal effect of increased PAI-1 level on CHD risk (odds ratio=1.22 per unit increase of log-transformed PAI-1; 95% CI: 1.01, 1.47). In addition, we also detected a causal effect of PAI-1 on elevating blood glucose and high-density lipoprotein cholesterol. Conclusions--Our study indicates a causal effect of elevated PAI-1 level on CHD risk, which may be mediated by glucose dysfunction

Practice guideline: Idiopathic normal pressure hydrocephalus: Response to shunting and predictors of response: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology

OBJECTIVE: We evaluated evidence for utility of shunting in idiopathic normal pressure hydrocephalus (iNPH) and for predictors of shunting effectiveness. METHODS: We identified and classified relevant published studies according to 2004 and 2011 American Academy of Neurology methodology. RESULTS: Of 21 articles, we identified 3 Class I articles. CONCLUSIONS: Shunting is possibly effective in iNPH (96% chance subjective improvement, 83% chance improvement on timed walk test at 6 months) (3 Class III). Serious adverse event risk was 11% (1 Class III). Predictors of success included elevated Ro (1 Class I, multiple Class II), impaired cerebral blood flow reactivity to acetazolamide (by SPECT) (1 Class I), and positive response to either external lumbar drainage (1 Class III) or repeated lumbar punctures. Age may not be a prognostic factor (1 Class II). Data are insufficient to judge efficacy of radionuclide cisternography or aqueductal flow measurement by MRI. RECOMMENDATIONS: Clinicians may choose to offer shunting for subjective iNPH symptoms and gait (Level C). Because of significant adverse event risk, risks and benefits should be carefully weighed (Level B). Clinicians should inform patients with iNPH with elevated Ro and their families that they have an increased chance of responding to shunting compared with those without such elevation (Level B). Clinicians may counsel patients with iNPH and their families that (1) positive response to external lumbar drainage or to repeated lumbar punctures increases the chance of response to shunting, and (2) increasing age does not decrease the chance of shunting being successful (both Level C)

Evaluation of an HIV Pre-Exposure Prophylaxis Referral System: From Sexual Health Center to Federally Qualified Health Center Pre-Exposure Prophylaxis Clinic

Innovative delivery strategies are needed to facilitate access to HIV pre-exposure prophylaxis (PrEP). The objective of this study was to evaluate a navigator-facilitated PrEP referral process from a sexual health center (SHC) to a co-located PrEP clinic as an alternative delivery model. Electronic health record (EHR) data were used to calculate the number of clients seen at the SHC in 2019. Charts were manually reviewed to determine whether a PrEP clinic referral was made and document type of referral method: face-to-face appointment scheduling with the navigator (warm handoff), EHR messaging to navigator to schedule the appointment at a later time (EHR message), or provision of navigator's contact information to the client (card only). In 2019, 2481 unique potentially PrEP-eligible clients were seen at the SHC; 220 (9%) received a PrEP referral. Of referred clients, median age was 30 years (interquartile range, 24-34), 182 (83%) were male, 89 (40%) were non-Hispanic Black, and 24 (11%) were Latinx. In total, 94/220 (43%) referred clients attended an initial PrEP visit with a provider, and the proportion attending by referral method was 81%, 36%, and 27% for warm handoff, EHR message, and card only, respectively (p < 0.0001). Despite co-location of these two clinics, there were significant drop-offs along the PrEP care continuum for this referral system. Warm handoff was the most effective referral method, but further efforts are needed to understand barriers to referral. Implementation of same-day PrEP services at SHCs is one potential solution to engaging additional clients