Energy Webs and Nursing Praxis: Patterning in the Lived Experience of Type 2 Diabetes

Diabetes is an illness best described as costly, complex, chronic, and epidemic in the United States, affecting nearly 24 million children and adults; 90% of who have type 2 diabetes (Centers for Disease Control and Prevention, 2008). On average, every 20 seconds in the United States, an individual 20 years of age and older receives a diagnosis of diabetes; yet, an estimated 6 million people with the disease remain undiagnosed (American Diabetes Association, 2010b). The financial burden of this disease, the inconsistent effectiveness of well-intentioned diabetes programs to educate and actualize change behavior, and the limited resources of millions of Americans give testimony to the need for a paradigm shift in diabetes care. Nursing is called to envision and actualize this paradigm shift. Using a hermeneutic dialectic approach based on a unitary transformative perspective as described by Margaret Newman in her theory of health as expanding consciousness (1994), this Doctor of Nursing Practice research project is an inquiry into the potential benefit of approaching “diabetes care” through nursing praxis. “There is a need for a shift from…eliminating the problem to the more inclusive perspective of helping people recognize the meaning of their lives when disease occurs” (Newman, 2008, p. 2). The Energy Web resulted as an emergent method and served as a visual tool that guided efforts to identify and enhance pattern recognition for both the nurse researcher and the participant. Use of praxis to illuminate choice points, the treasures and trappings in the lived experience of type 2 diabetes, to inform nursing practice opens possibilities of a transformative potential toward diabetes care engagement

The thermodynamics of creating correlations: Limitations and optimal protocols

We establish a rigorous connection between fundamental resource theories at the quantum scale. Correlations and entanglement constitute indispensable resources for numerous quantum information tasks. However, their establishment comes at the cost of energy, the resource of thermodynamics, and is limited by the initial entropy. Here, the optimal conversion of energy into correlations is investigated. Assuming the presence of a thermal bath, we establish general bounds for arbitrary systems and construct a protocol saturating them. The amount of correlations, quantified by the mutual information, can increase at most linearly with the available energy, and we determine where the linear regime breaks down. We further consider the generation of genuine quantum correlations, focusing on the fundamental constituents of our universe: fermions and bosons. For fermionic modes, we find the optimal entangling protocol. For bosonic modes, we show that while Gaussian operations can be outperformed in creating entanglement, their performance is optimal for high energies.Comment: 12 pages, 6 figure

Most energetic passive states

Passive states are defined as those states that do not allow for work extraction in a cyclic (unitary) process. Within the set of passive states, thermal states are the most stable ones: they maximize the entropy for a given energy, and similarly they minimize the energy for a given entropy. Here we find the passive states lying in the other extreme, i.e., those that maximize the energy for a given entropy, which we show also minimize the entropy when the energy is fixed. These extremal properties make these states useful to obtain fundamental bounds for the thermodynamics of finite-dimensional quantum systems, which we show in several scenarios.Comment: 6 pages, 2 figures; published versio

Extractable Work from Correlations

Work and quantum correlations are two fundamental resources in thermodynamics and quantum information theory. In this work we study how to use correlations among quantum systems to optimally store work. We analyse this question for isolated quantum ensembles, where the work can be naturally divided into two contributions: a local contribution from each system, and a global contribution originating from correlations among systems. We focus on the latter and consider quantum systems which are locally thermal, thus from which any extractable work can only come from correlations. We compute the maximum extractable work for general entangled states, separable states, and states with fixed entropy. Our results show that while entanglement gives an advantage for small quantum ensembles, this gain vanishes for a large number of systems.Comment: 5+6 pages; 1 figure. Some minor changes, close to published versio

Do standing orders help with chronic disease care and health maintenance in ambulatory practice?

Studies of standing orders tend to examine their effect on compliance with preventive interventions for chronic disease rather than disease outcomes. In the ambulatory setting, they improve rates of influenza vaccination (strength of recommendation [SOR]: C, consistent cohort studies measuring vaccination rates), pneumococcal vaccination (SOR: C, consistent randomized controlled trials [RCTs] measuring vaccination rates), childhood immunizations (SOR: C, inconsistent RCTs measuring vaccination rates), and mammograms (SOR: C, RCT measuring screening rate). Standing orders don�۪t improve screening rates for colorectal cancer (SOR: C, RCT measuring screening rate)

Thermodynamic cost of creating correlations

We investigate the fundamental limitations imposed by thermodynamics for creating correlations. Considering a collection of initially uncorrelated thermal quantum systems, we ask how much classical and quantum correlations can be obtained via a cyclic Hamiltonian process. We derive bounds on both the mutual information and entanglement of formation, as a function of the temperature of the systems and the available energy. While for a finite number of systems there is a maximal temperature allowing for the creation of entanglement, we show that genuine multipartite entanglement---the strongest form of entanglement in multipartite systems---can be created at any temperature when sufficiently many systems are considered. This approach may find applications, e.g. in quantum information processing, for physical platforms in which thermodynamic considerations cannot be ignored.Comment: 17 pages, 3 figures, substantially rewritten with some new result

Junctional Adhesion Molecule-C Mediates the Recruitment of Embryonic-Endothelial Progenitor Cells to the Perivascular Niche during Tumor Angiogenesis

The homing of Endothelial Progenitor Cells (EPCs) to tumor angiogenic sites has been described as a multistep process, involving adhesion, migration, incorporation and sprouting, for which the underlying molecular and cellular mechanisms are yet to be fully defined. Here, we studied the expression of Junctional Adhesion Molecule-C (JAM-C) by EPCs and its role in EPC homing to tumor angiogenic vessels. For this, we used mouse embryonic-Endothelial Progenitor Cells (e-EPCs), intravital multi-fluorescence microscopy techniques and the dorsal skin-fold chamber model. JAM-C was found to be expressed by e-EPCs and endothelial cells. Blocking JAM-C did not affect adhesion of e-EPCs to endothelial monolayers in vitro but, interestingly, it did reduce their adhesion to tumor endothelium in vivo. The most striking effect of JAM-C blocking was on tube formation on matrigel in vitro and the incorporation and sprouting of e-EPCs to tumor endothelium in vivo. Our results demonstrate that JAM-C mediates e-EPC recruitment to tumor angiogenic sites, i.e., coordinated homing of EPCs to the perivascular niche, where they cluster and interact with tumor blood vessels. This suggests that JAM-C plays a critical role in the process of vascular assembly and may represent a potential therapeutic target to control tumor angiogenesis