Capturing Vacuum Fluctuations and Photon Correlations in Cavity Quantum Electrodynamics with Multi-Trajectory Ehrenfest Dynamics

We describe vacuum fluctuations and photon-field correlations in interacting quantum mechanical light-matter systems, by generalizing the application of mixed quantum-classical dynamics techniques. We employ the multi-trajectory implementation of Ehrenfest mean field theory, traditionally developed for electron-nuclear problems, to simulate the spontaneous emission of radiation in a model quantum electrodynamical cavity-bound atomic system. We investigate the performance of this approach in capturing the dynamics of spontaneous emission from the perspective of both the atomic system and the cavity photon field, through a detailed comparison with exact benchmark quantum mechanical observables and correlation functions. By properly accounting for the quantum statistics of the vacuum field, while using mixed quantum-classical (mean field) trajectories to describe the evolution, we identify a surprisingly accurate and promising route towards describing quantum effects in realistic correlated light-matter systems

Telehealth methods to deliver multifactorial dietary interventions in adults with chronic disease: A systematic review protocol

Background: The long-term management of chronic diseases requires adoption of complex dietary recommendations, which can be facilitated by regular coaching to support sustained behaviour change. Telehealth interventions can overcome patient-centred barriers to accessing face-to-face programs and provide feasible delivery methods, ubiquitous and accessible regardless of geographic location. The protocol for this systematic review explains the methods that will be utilised to answer the review question of whether telehealth interventions are effective at promoting change in dietary intake and improving diet quality in people with chronic disease. Methods/design: A structured search of Medline, EMBASE, CINAHL, and PsychINFO, from their inception, will be conducted. We will consider randomised controlled trials which evaluate complex dietary interventions in adults with chronic disease. Studies must provide diet education in an intervention longer than 4 weeks in duration, and at least half of the intervention contact must be delivered via telehealth. Comparisons will be made against usual care or a non-telehealth intervention. The primary outcome of interest is dietary change with secondary outcomes relating to clinical markers pre-specified in the methodology. The process for selecting studies, extracting data, and resolving conflicts will follow a set protocol. Two authors will independently appraise the studies and extract the data, using specified methods. Meta-analyses will be conducted where appropriate, with parameters for determining statistical heterogeneity pre-specified. The GRADE tool will be used for determining the quality of evidence for analysed outcomes. Discussion: To date, there has been a considerable variability in the strategies used to deliver dietary education, and the overall effectiveness of telehealth dietary interventions for facilitating dietary change has not been reviewed systematically in adults with chronic disease. A systematic synthesis of telehealth strategies will inform the development of evidence-based telehealth programs that can be tailored to deliver dietary interventions specific to chronic disease conditions. Systematic review registration: PROSPERO CRD42015026398

Feasibility Test of the MedaCube

Poor adherence is a significant barrier to achieve better patient outcomes. Rates of non-adherence approach 40% resulting in 10% of all emergency department visits and 23% of admissions into skilled nursing facilities. Many factors contribute to medication non-adherence including psychological and memory disorders, aging and pill burden. The MedaCube is a medication management system intended to help solve unintentional medication non-adherence. The device is designed to dispense scheduled and as-needed oral medications. The MedaCube provides audio and visual prompts alerting subjects to administer their medications. Caregivers receive notification of missed doses, late doses and refill requests. The null hypothesis is that use of the MedaCube results in no difference in medication adherence when compared with six month prior adherence in individual subjects

Financial consequences of competitive set choice

This study examines the financial consequences of competitive set choice using a sample of 312 hotels in a major metropolitan area in the United States. We document existence of asymmetric competitor monitoring, finding just 55% of monitoring is reciprocal; that is, about half of managers “agree,” by virtue of monitoring one another, on being direct competitors. Monitoring reciprocity is positively associated with performance through average daily rates. With total revenue unchanged, profits are higher through lower occupancy and lower total costs. We examine alternative competitive sets formed using strategic groups- and customer-based approaches, comparing these to actual compsets. We found that performance declines when managers deviate from these alternative sets. Post-hoc analyses provide insight on how overlapping compsets impact rates, occupancy and revenue. Our study is of value to academics and practitioners, providing evidence on the financial impact of competitive monitoring, and insights for managers who choose competitive sets

Patient Experiences of Dietary Management in Chronic Kidney Disease: A Focus Group Study

Objective: People with chronic kidney disease (CKD) contend with complex dietary recommendations. The challenge in practice is for clinicians to provide individualized support with the frequency and consistency required to sustain dietary changes. This study aimed to describe the experiences of patients with managing dietary recommendations, including their perspectives on the potential to use telehealth to support dietary management in CKD. Design: Focus group study. Subjects: Twenty-one adult patients with CKD (nondialysis) and 3 caregivers (total N = 24) purposively sampled to achieve diverse demographic and clinical characteristics, from two nephrology units in Queensland, Australia. Methods: Five focus groups were conducted, audio recorded, and transcribed. Transcripts were analyzed using thematic analysis drawing on the principles of grounded theory. Main Outcome Measure: Themes aligned with the research question. Results: We identified five themes: exasperating stagnancy (patronized by redundant advice, confused and unprepared for dietary change, inevitability of failure, and barriers to accessing dietetic services); supporting and sustaining change (receiving regular feedback, incremental and comprehendible modification, practical guidance on food, flexibility in monitoring schedule, and valuing peer advice); fostering ownership (seeking kidney diet information, enacting behavior change, making reminders, and tracking progress against targets); motivators and positive learning instruction (relying on reassurance, positive reinforcement, focusing on allowable foods, and involving family); threats and ambiguities of risk (sugar as the culprit, ubiquity of salt, illegible food labeling, avoiding processed foods, and questioning credibility of sources). Conclusions: Patients with CKD desire a preventative approach to CKD progression and maintaining their health, however, are stymied by dietary restrictions and a lack of reliable dietetic advice. Easy-to-use telehealth options have the potential to overcome the shortcomings in current health service delivery which may be limiting factors to providing these approaches. They provide patients with pragmatic tools, comprehensible and consistent information which fosters ownership and self-monitoring

Pesquisa quantitativa acerca do conhecimento sobre descarte de medicamentos vencidos por alunos de escolas de ensino médio do município de Porto Alegre-RS Porto Alegre

OBJETIVO: Avaliar conhecimentos prévios dos estudantes de escolas de ensino médio sobre descarte de medicamentos, através da aplicação de um questionário (APÊNDICE A), e a partir disso elaborar estratégias que impliquem mudanças de atitude dessas comunidades com relação a essa temática. MÉTODOS: O delineamento da pesquisa segue um modelo de estudo transversal. A amostra é composta de 209 alunos do ensino médio, com idade entre 15 e 19 anos, de duas escolas (Escola Técnica Estadual Parobé e Colégio Estadual Protásio Alves) de Porto Alegre/RS, acompanhados no período de outubro de 2018 a julho de 2019. O instrumento utilizado para a coleta de dados foi um questionário previamente elaborado, com uma pesquisa quantitativa. Os participantes preencheram o questionário, cujas perguntas se referem inicialmente sobre os dados pessoais idade e sexo, estas informações foram desconsideradas nos resultados, e posteriormente se referem ao descarte de medicamentos, abordando seus conhecimentos prévios acerca do tema, esses dados foram registrados e analisados. RESULTADOS: Constatou-se que a maioria dos participantes da pesquisa (82%) descarta de forma incorreta seus medicamentos vencidos, distribuídos em 49% descartam em lixo seco, 24% em lixo orgânico, 3% em pia e 6% em vaso sanitário. Entretanto, 18% dos participantes descartam corretamente, 9% devolvem as sobras de medicamentos à farmácia e 9% aos postos de saúde. O conhecimento dos alunos sobre o assunto foi considerado baixo. Métodos educativos ambientais são importantes para a conscientização da problemática que o descarte incorreto pode gerar, bem como para transformar esse cenário atual. CONCLUSÕES: Os resultados demonstram que há a necessidade de estratégias para se chegar ao objetivo desejado e que, analisando-se o perfil dessas comunidades, podem-se planejar ações em prol do meio ambiente, ou seja, o encaminhamento dos resíduos de medicamentos aos devidos locais designados para isso

Feasibility and acceptability of telehealth coaching to promote healthy eating in chronic kidney disease: A mixed-methods process evaluation

Objective To evaluate the feasibility and acceptability of a personalised telehealth intervention to support dietary self-management in adults with stage 3-4 chronic kidney disease (CKD). Design Mixed-methods process evaluation embedded in a randomised controlled trial. Participants People with stage 3-4 CKD (estimated glomerular filtration rate [eGFR]15-60 mL/min/1.73 m 2). Setting Participants were recruited from three hospitals in Australia and completed the intervention in ambulatory community settings. Intervention The intervention group received one telephone call per fortnight and 2-8 tailored text messages for 3 months, and then 4-12 tailored text messages for 3 months without telephone calls. The control group received usual care for 3 months then non-tailored education-only text messages for 3 months. Main outcome measures Feasibility (recruitment, non-participation and retention rates, intervention fidelity and participant adherence) and acceptability (questionnaire and semistructured interviews). Statistical analyses performed Descriptive statistics and qualitative content analysis. Results Overall, 80/230 (35%) eligible patients who were approached consented to participate (mean±SD age 61.5±12.6 years). Retention was 93% and 98% in the intervention and control groups, respectively, and 96% of all planned intervention calls were completed. All participants in the intervention arm identified the tailored text messages as useful in supporting dietary self-management. In the control group, 27 (69%) reported the non-tailored text messages were useful in supporting change. Intervention group participants reported that the telehealth programme delivery methods were practical and able to be integrated into their lifestyle. Participants viewed the intervention as an acceptable, personalised alternative to face-face clinic consultations, and were satisfied with the frequency of contact. Conclusions This telehealth-delivered dietary coaching programme is an acceptable intervention which appears feasible for supporting dietary self-management in stage 3-4 CKD. A larger-scale randomised controlled trial is needed to evaluate the efficacy of the coaching programme on clinical and patient-reported outcomes. Trial registration number ACTRN12616001212448; Results

Use of allogeneic apheresis stem cell products as an interlaboratory proficiency challenge

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137204/1/trf14107.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137204/2/trf14107_am.pd

Stents in Gastrointestinal Diseases

Stent is a medical device originally designed for recanalization and/or sealing of any obstructing or leaking lesion. In gastroenterology, it has a major role in recanalization of gastrointestinal (GI) tumors and postoperative leak sealing. Among several materials and models used in stent manufacturing, self-expandable metallic stents (SEMS) are the most common used stents. Over the years, SEMS has evolved into a standard of care medical device in several oncological conditions, such as advanced esophageal cancer. Other potential applications are drug-eluting devices, scar tissue modeling for benign conditions, and GI tract drainage/anastomosis. The aim of this chapter is to review the most common GI stent models and its indications in gastrointestinal diseases