236 research outputs found
Superoperator Analysis of Entanglement in a Four-Qubit Cluster State
In this paper we utilize superoperator formalism to explore the entanglement
evolution of four-qubit cluster states in a number of decohering environments.
A four-qubit cluster state is a resource for the performance of an arbitrary
single logical qubit rotation via measurement based cluster state quantum
computation. We are specifically interested in the relationship between
entanglement evolution and the fidelity with which the arbitrary single logical
qubit rotation can be implemented in the presence of decoherence as this will
have important experimental ramifications. We also note the exhibition of
entanglement sudden death (ESD) and ask how severely its onset affects the
utilization of the cluster state as a means of implementing an arbitrary single
logical qubit rotation.Comment: 9 pages, 9 composite figures, presentation of results completely
rewritte
Teaching advocacy communication to pediatric residents: the efficacy of applied improvisational theater (AIT) as an instructional tool
In today’s communication landscape, the public often turn to the Internet and social media instead of their physician for health information. To remain relevant and respected amidst the wealth of health information available online, physicians need to offer something the Internet cannot fully emulate: empathetic imagination and an ability to instantaneously tailor messages to reach and teach worried and often confused audiences effectively. We developed an instructional communication module for pediatric residents that used applied improvisational theater to help residents develop complex and dynamic communication skills. The module included opportunities to develop empathy, practice audience analysis, distill messages to key points, and apply these skills in media and community contexts. Attendees completed surveys regarding their perceptions of curricular structure, efficacy, and utility. Preliminary results indicate gains in communication confidence and skills. This type of instructional communication and training module encourages healthcare practitioners to position themselves as trusted experts and partners in helping clients make meaning of health information, thus empowering a new generation of pediatricians to bridge communication gaps created by new technologies and increased access to multiple information sources
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Assessment of Fractionated Exhaled Nitric Oxide as a Biomarker for the Treatment of Eosinophilic Esophagitis
Diagnosis of eosinophilic esophagitis (EoE) and determination of response to therapy is based on histological assessment of the esophagus, which requires upper endoscopy. In children, in whom a dietary approach is commonly used, multiple endoscopies are needed, because foods are eliminated and then gradually reintroduced. Ideally, noninvasive methods could supplement or replace upper endoscopy to facilitate management. Fractionated exhaled nitric oxide (FeNO) has been proposed as a useful measure for monitoring disease activity in studies of patients with eosinophil-predominant asthma and in other atopic disorders. Thus, we evaluated whether FeNO levels could be a useful biomarker to assess the response to therapy in EoE patients. This study was designed to determine whether there is a change in FeNO levels during treatment with topical corticosteroids and whether changes correlated with clinical response. This was a prospective, multicenter study that enrolled nonasthmatic patients with established EoE. FeNO levels and symptom scores were measured at baseline, biweekly during 6-week swallowed fluticasone treatment, and 4 weeks posttreatment. Twelve patients completed the trial. We found a statistically significant difference between median pre- and posttreatment FeNO levels [20.3 ppb (16.0–29.0 ppb) vs 17.6 ppb (11.7–27.3 ppb), p=0.009]. However, neither the pretreatment FeNO level, a change of FeNO level after 2 weeks of treatment, nor the FeNO level at the end of treatment confidently predicted a clinical or histological response. Although our findings suggest nitric oxide possibly has a physiological role in EoE, our observations do not support a role of FeNo determination for management of EoE
Cost Savings of Universal Decolonization to Prevent Intensive Care Unit Infection: Implications of the REDUCE MRSA Trial
ObjectiveTo estimate and compare the impact on healthcare costs of 3 alternative strategies for reducing bloodstream infections in the intensive care unit (ICU): methicillin-resistant Staphylococcus aureus (MRSA) nares screening and isolation, targeted decolonization (ie, screening, isolation, and decolonization of MRSA carriers or infections), and universal decolonization (ie, no screening and decolonization of all ICU patients).DesignCost analysis using decision modeling.MethodsWe developed a decision-analysis model to estimate the health care costs of targeted decolonization and universal decolonization strategies compared with a strategy of MRSA nares screening and isolation. Effectiveness estimates were derived from a recent randomized trial of the 3 strategies, and cost estimates were derived from the literature.ResultsIn the base case, universal decolonization was the dominant strategy and was estimated to have both lower intervention costs and lower total ICU costs than either screening and isolation or targeted decolonization. Compared with screening and isolation, universal decolonization was estimated to save $171,000 and prevent 9 additional bloodstream infections for every 1,000 ICU admissions. The dominance of universal decolonization persisted under a wide range of cost and effectiveness assumptions.ConclusionsA strategy of universal decolonization for patients admitted to the ICU would both reduce bloodstream infections and likely reduce healthcare costs compared with strategies of MRSA nares screening and isolation or screening and isolation coupled with targeted decolonization
Considerations in the evaluation and management of oral potentially malignant disorders during the COVID-19 pandemic
Aim: The COVID-19 pandemic has resulted in society experiencing unprecedented challenges for health care practitioners and facilities serving at the frontlines of this pandemic. With regard to oral cancer, there is a complete absence of literature regarding the long-term impact of pandemics on patients with oral potentially malignant disorders (OPMDs). The objective of this article is to put forth an institutional multidisciplinary approach for the evaluation and management of OPMDs. Methods: A multidisciplinary approach was put formalized within our institution to risk stratify patients based on need for in-person assessment vs telehealth assessment during the COVID-19 pandemic. Results: With judicious risk stratification of patients based on clinical features of their OPMD and with consideration of ongoing mitigation efforts and regional pandemic impact, providers are able to safely care for their patients. Conclusions: The COVID-19 pandemic has required health care practitioners to make novel decisions that are new to us with development of creative pathways of care that focused on patient safety, mitigation efforts, and clinical management of disease processes. The care of patients with OPMDs requires special considerations especially as patients at high risk for severe COVID-19 illness are also higher risk for the development of OPMDs. © 2020 Wiley Periodicals, Inc
Slowing and cooling molecules and neutral atoms by time-varying electric field gradients
A method of slowing, accelerating, cooling, and bunching molecules and
neutral atoms using time-varying electric field gradients is demonstrated with
cesium atoms in a fountain. The effects are measured and found to be in
agreement with calculation. Time-varying electric field gradient slowing and
cooling is applicable to atoms that have large dipole polarizabilities,
including atoms that are not amenable to laser slowing and cooling, to Rydberg
atoms, and to molecules, especially polar molecules with large electric dipole
moments. The possible applications of this method include slowing and cooling
thermal beams of atoms and molecules, launching cold atoms from a trap into a
fountain, and measuring atomic dipole polarizabilities.Comment: 13 pages, 10 figures. Scheduled for publication in Nov. 1 Phys. Rev.
TLR7-dependent and FcγR-independent production of type I interferon in experimental mouse lupus
Increased type I interferon (IFN-I) production and IFN-stimulated gene (ISG) expression are linked to the pathogenesis of systemic lupus erythematosus (SLE). Although the mechanisms responsible for dysregulated IFN-I production in SLE remain unclear, autoantibody-mediated uptake of endogenous nucleic acids is thought to play a role. 2,6,10,14-tetramethylpentadecane (TMPD; also known as pristane) induces a lupus-like disease in mice characterized by immune complex nephritis with autoantibodies to DNA and ribonucleoproteins. We recently reported that TMPD also causes increased ISG expression and that the development of the lupus is completely dependent on IFN-I signaling (Nacionales, D.C., K.M. Kelly-Scumpia, P.Y. Lee, J.S. Weinstein, R. Lyons, E. Sobel, M. Satoh, and W.H. Reeves. 2007. Arthritis Rheum. 56:3770–3783). We show that TMPD elicits IFN-I production, monocyte recruitment, and autoantibody production exclusively through a Toll-like receptor (TLR) 7– and myeloid differentiation factor 88 (MyD88)–dependent pathway. In vitro studies revealed that TMPD augments the effect of TLR7 ligands but does not directly activate TLR7 itself. The effects of TMPD were amplified by the Y-linked autoimmune acceleration cluster, which carries a duplication of the TLR7 gene. In contrast, deficiency of Fcγ receptors (FcγRs) did not affect the production of IFN-I. Collectively, the data demonstrate that TMPD-stimulated IFN-I production requires TLR7/MyD88 signaling and is independent of autoantibody-mediated uptake of ribonucleoproteins by FcγRs
B cells enhance early innate immune responses during bacterial sepsis
Type I interferon–responsive B cells provide early protection against bacterial sepsis
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