A crossover intervention trial evaluating the efficacy of a chlorhexidine-impregnated sponge in reducing catheter-related bloodstream infections among patients undergoing hemodialysis

BACKGROUND: Catheter-related bloodstream infections (BSI) account for the majority of hemodialysis-related infections. There are no published data on the efficacy of the chlorhexidine-impregnated foam dressing at reducing catheter-related BSI in hemodialysis patients. DESIGN: Prospective non-blinded cross-over intervention trial to determine the efficacy of a chlorhexidine-impregnated foam dressing (Biopatch®) to reduce catheter-related BSI in hemodialysis patients. SETTING: Two outpatient dialysis centers PATIENTS: A total of 121 patients who were dialyzed through tunneled central venous catheters received the intervention during the trial. METHODS: The primary outcome of interest was the incidence of catheter-related bloodstream infections. A nested cohort study of all patients who received the Biopatch® Antimicrobial Dressing was also conducted. Backward stepwise logistic regression analysis was used to determine independent risk factors for development of BSI. RESULTS: 37 bloodstream infections occurred in the intervention group for a rate of 6.3 BSIs/1000 dialysis sessions and 30 bloodstream infections in the control group for a rate of 5.2 BSIs/1000 dialysis sessions and [RR 1.22, CI (0.76, 1.97); P=0.46]. The Biopatch® Antimicrobial Dressing was well-tolerated with only two patients (<2%) experiencing dermatitis that led to its discontinuation. The only independent risk factor for development of BSI was dialysis treatment at one dialysis center [aOR 4.4 (1.77, 13.65); P=0.002]. Age ≥ 60 years [aOR 0.28 (0.09, 0.82); P=0.02] was associated with lower risk for BSI. CONCLUSION: The use of a chlorhexidine-impregnated foam dressing (Biopatch®) did not decrease catheter-related BSIs among hemodialysis patients with tunneled central venous catheters

Universality of Decoherence

We consider environment induced decoherence of quantum superpositions to mixtures in the limit in which that process is much faster than any competing one generated by the Hamiltonian $H_{\rm sys}$ of the isolated system. While the golden rule then does not apply we can discard $H_{\rm sys}$. By allowing for simultaneous couplings to different reservoirs, we reveal decoherence as a universal short-time phenomenon independent of the character of the system as well as the bath and of the basis the superimposed states are taken from. We discuss consequences for the classical behavior of the macroworld and quantum measurement: For the decoherence of superpositions of macroscopically distinct states the system Hamiltonian is always negligible.Comment: 4 revtex pages, no figure

The speed of quantum and classical learning for performing the kth root of NOT

We consider quantum learning machines—quantum computers that modify themselves in order to improve their performance in some way—that are trained to perform certain classical task, i.e. to execute a function that takes classical bits as input and returns classical bits as output. This allows a fair comparison between learning efficiency of quantum and classical learning machines in terms of the number of iterations required for completion of learning. We find an explicit example of the task for which numerical simulations show that quantum learning is faster than its classical counterpart. The task is extraction of the kth root of NOT (NOT = logical negation), with k=2m and... The reason for this speed-up is that the classical machine requires memory of size log k=m to accomplish the learning, while the memory of a single qubit is sufficient for the quantum machine for any k.We acknowledge support from the EC Project QAP (no. 015848), the Austrian Science Foundation FWF within projects no. P19570-N16, SFB and CoQuS no. W1210-N16, the Ministerio de Ciencia e Innovación (Fellowship BES-2006-13234) and the Instituto Carlos I for the use of computational resources. The collaboration is a part of an ÖAD/MNiSW program

Sex and race and/or ethnicity differences in patients undergoing radiofrequency ablation for Barrett\u27s esophagus: results from the U.S. RFA Registry.

BACKGROUND: Little is known about differences in Barrett\u27s esophagus (BE) characteristics by sex and race and/or ethnicity or these differences in response to radiofrequency ablation (RFA). OBJECTIVE: We compared disease-specific characteristics, treatment efficacy, and safety outcomes by sex and race and/or ethnicity in patients treated with RFA for BE. DESIGN: The U.S. RFA patient registry is a multicenter collaboration reporting processes and outcomes of care for patients treated with RFA for BE. PATIENTS: Patients enrolled with BE. INTERVENTIONS: RFA. MAIN OUTCOME MEASUREMENTS: We assessed safety (stricture, bleeding, perforation, hospitalization), efficacy (complete eradication of intestinal metaplasia [CEIM]), complete eradication of dysplasia, and number of treatments to CEIM by sex and race and/or ethnicity. RESULTS: Among 5521 patients (4052 men; 5126 white, 137 Hispanic, 82 African American, 40 Asian, 136 heritage not identified), women were younger (60.0 vs 62.1 years) and had shorter BE segments (3.2 vs 4.4 cm) and less dysplasia (37% vs 57%) than did men. Women were almost twice as likely to stricture (odds ratio 1.7; 95% confidence interval, 1.2-2.3). Although white patients were predominantly male, about half of African Americans and Asians with BE were female. African Americans and Asians had less dysplasia than white patients. Asians and African Americans had more strictures than did white patients. There were no sex or race differences in efficacy. LIMITATIONS: Observational study with non-mandated paradigms, no central laboratory for reinterpretation of pathology. CONCLUSION: In the U.S. RFA patient registry, women had shorter BE segments and less-aggressive histology. The usual tendency toward BE in men was absent in African Americans and Asians. Posttreatment stricture was more common among women and Asians. RFA efficacy did not differ by sex or race

Thermal evolution of Monte Blanco dome: Low-angle normal faulting during Gulf of California rifting and late Eocene denudation of the eastern Peninsular Ranges

Footwall rocks of the Cañada David detachment fault, northeastern Baja California, record late Eocene-earliest Oligocene and late Neogene cooling events previously unrecognized in the region. Biotite ^(40)Ar/^(39)Ar ages of ∼65 Ma reflect slow cooling through ∼350°C, 5 to 10 m.y. later than is typical in the region. Multiple diffusion domain modeling of K feldspar ^(40)Ar/^(39)Ar release spectra shows very slow cooling (∼1°C/m.y.) from ∼65 to ∼45 Ma. Accelerated cooling from ∼315°C to ∼215°C between ∼45 and ∼33 Ma records at least 3–4 km of denudation that we relate to east-side-up reactivation of late Cretaceous structures that generally follow the oceanic-continental suture. Previously established rivers flowing west from mainland Mexico apparently became further entrenched during this uplift and continued to supply distinctive rhyolitic detritus to the coast. Ultimately, surface uplift disrupted and rerouted the extraregional rivers some 2 to 6 m.y. before the cooling event ended. Footwall rocks remained nearly isothermal from ∼30 to ∼15–10 Ma, when renewed rapid cooling (33° ± 17°C/m.y.) began in response to footwall exhumation by top-to-the-west low-angle normal faulting that accommodated rift-related extension in what finally became the Gulf of California. Apatite fission track and (U-Th)/He ages of ∼5 Ma and ∼4 Ma, respectively, record final detachment-related cooling through ∼110°C to ∼70°C. Thermal-kinematic modeling suggests that 5–7 km of late Neogene tectonic denudation and 10–12 km of horizontal extension were necessary in order to unroof the samples by 2 Ma. Additional extension, of unknown magnitude, has probably occurred subsequently. Geodetically measured horizontal extension rates are considerably higher than the long-term extension rate that can be attributed to detachment faulting

Alu elements mediate MYB gene tandem duplication in human T-ALL

Recent studies have demonstrated that the MYB oncogene is frequently duplicated in human T cell acute lymphoblastic leukemia (T-ALL). We find that the human MYB locus is flanked by 257-bp Alu repeats and that the duplication is mediated somatically by homologous recombination between the flanking Alu elements on sister chromatids. Nested long-range PCR analysis indicated a low frequency of homologous recombination leading to MYB tandem duplication in the peripheral blood mononuclear cells of ∼50% of healthy individuals, none of whom had a MYB duplication in the germline. We conclude that Alu-mediated MYB tandem duplication occurs at low frequency during normal thymocyte development and is clonally selected during the molecular pathogenesis of human T-ALL

Alu elements mediate MYB gene tandem duplication in human T-ALL

Recent studies have demonstrated that the MYB oncogene is frequently duplicated in human T cell acute lymphoblastic leukemia (T-ALL). We find that the human MYB locus is flanked by 257-bp Alu repeats and that the duplication is mediated somatically by homologous recombination between the flanking Alu elements on sister chromatids. Nested long-range PCR analysis indicated a low frequency of homologous recombination leading to MYB tandem duplication in the peripheral blood mononuclear cells of ∼50% of healthy individuals, none of whom had a MYB duplication in the germline. We conclude that Alu-mediated MYB tandem duplication occurs at low frequency during normal thymocyte development and is clonally selected during the molecular pathogenesis of human T-ALL

Durability and Predictors of Successful Radiofrequency Ablation for Barrett’s Esophagus

Following radiofrequency ablation (RFA), patients may experience recurrence of Barrett’s esophagus (BE) after complete eradication of intestinal metaplasia (CEIM). Rates and predictors of recurrence after successful eradication are poorly described

REVEL: An Ensemble Method for Predicting the Pathogenicity of Rare Missense Variants

Supplemental Data Supplemental Data include one figure and five tables and can be found with this article online at http://dx.doi.org/10.1016/j.ajhg.2016.08.016. Supplemental Data Document S1. Figure S1 and Tables S1–S5 Download Document S2. Article plus Supplemental Data Download Web Resources ClinVar, https://www.ncbi.nlm.nih.gov/clinvar/ dbNSFP, https://sites.google.com/site/jpopgen/dbNSFP Human Gene Mutation Database, http://www.hgmd.cf.ac.uk/ REVEL, https://sites.google.com/site/revelgenomics/ SwissVar, http://swissvar.expasy.org/ The vast majority of coding variants are rare, and assessment of the contribution of rare variants to complex traits is hampered by low statistical power and limited functional data. Improved methods for predicting the pathogenicity of rare coding variants are needed to facilitate the discovery of disease variants from exome sequencing studies. We developed REVEL (rare exome variant ensemble learner), an ensemble method for predicting the pathogenicity of missense variants on the basis of individual tools: MutPred, FATHMM, VEST, PolyPhen, SIFT, PROVEAN, MutationAssessor, MutationTaster, LRT, GERP, SiPhy, phyloP, and phastCons. REVEL was trained with recently discovered pathogenic and rare neutral missense variants, excluding those previously used to train its constituent tools. When applied to two independent test sets, REVEL had the best overall performance (p < 10−12) as compared to any individual tool and seven ensemble methods: MetaSVM, MetaLR, KGGSeq, Condel, CADD, DANN, and Eigen. Importantly, REVEL also had the best performance for distinguishing pathogenic from rare neutral variants with allele frequencies <0.5%. The area under the receiver operating characteristic curve (AUC) for REVEL was 0.046–0.182 higher in an independent test set of 935 recent SwissVar disease variants and 123,935 putatively neutral exome sequencing variants and 0.027–0.143 higher in an independent test set of 1,953 pathogenic and 2,406 benign variants recently reported in ClinVar than the AUCs for other ensemble methods. We provide pre-computed REVEL scores for all possible human missense variants to facilitate the identification of pathogenic variants in the sea of rare variants discovered as sequencing studies expand in scale