Implementation of Physician Orders for Life Sustaining Treatment in nursing homes in California: evaluation of a novel statewide dissemination mechanism.

BackgroundImplementing Physician Orders for Life Sustaining Treatment (POLST) forms aims to improve communication of life-sustaining treatment preferences across care venues. California enabled this clinical tool in 2009, and a novel intervention of community coalitions was undertaken to advance POLST in localities around the state. Coalitions engaged facilities, including nursing homes (NHs), to foster POLST adoption. Eighteen months after introduction of POLST, we studied POLST implementation in California NHs.MethodsNHs randomly selected in coalition and non-coalition areas were mailed surveys about POLST preparation and use in 2010. Coalitions identified which NHs they worked with.ResultsOf 546 NHs surveyed, 143 (52 %) in coalition areas and 141 (52 %) in non-coalition areas responded. In 82 % of responding NHs, staff received POLST education and 59 % of NHs reported having a formal policy on handling POLST. Two-thirds of NHs had admitted a resident with a POLST, and 15 % of newly admitted residents over the past month had a POLST (range 0-100 %). Eighty-one percent of NHs had completed a POLST with a resident. Fifty-four percent of residents were estimated to have a POLST (range 0-100 %) (coalition area NHs 60 % vs. non- coalition area NHs 48 %, p = 0.02). Within coalition areas, NHs that had worked with coalitions were more likely to have completed a POLST with a resident after admission than NHs that had not worked with coalitions. Few NHs (7 %) reported difficulty following POLST orders, but 38 % noted difficulty involving physicians in POLST completion.ConclusionLess than 2 years after introduction, many California nursing homes report using POLST, although some NHs reported no experience. A novel community coalition intervention facilitated POLST implementation

Laser Beam Profile Deformation Effect during Bragg Acousto-Optic Interaction: a Non-Paraxial Approximation

It is commonly known that the spatial profiles of the diffracted light beams during Bragg acousto-optic interaction are distorted due to the Bragg angle selection mechanism. All the conventional studies on this effect use the paraxial approximation. But this approximation should be amended when the incident angle of the light is large enough that the diffracted light waves do not propagate closely along the optic axis of the acousto-optic diffraction system. By using a spatial Fourier transform approach, we rigorously study the light beam profile deformation effect of the diffracted light during the Bragg acousto-optic interaction beyond the paraxial approximation. Starting from the wave equation, a set of coupled-wave equations is derived to depict the acousto-optic effect. Analytic solutions that describe the profiles of the diffracted light are derived from the acousto-optic coupled-wave equations. From the solutions, differences can be found between the ones with and without paraxial approximation

Antibodies to the Mr 64,000 (64K) protein in islet cell antibody positive non-diabetic individuals indicate high risk for impaired Beta-cell function

A prospective study of a normal childhood population identified 44 islet cell antibody positive individuals. These subjects were typed for HLA DR and DQ alleles and investigated for the presence of antibodies to the Mr 64,000 (64K) islet cell antigen, complement-fixing islet cell antibodies and radiobinding insulin autoantibodies to determine their potency in detecting subjects with impaired Beta-cell function. At initial testing 64K antibodies were found in six of 44 islet cell antibody positive subjects (13.6%). The same sera were also positive for complement-fixing islet cell antibodies and five of them had insulin autoantibodies. During the follow-up at 18 months, islet cell antibodies remained detectable in 50% of the subjects studied. In all six cases who were originally positive, 64K antibodies were persistently detectable, whereas complement-fixing islet cell antibodies became negative in two of six and insulin autoantibodies in one of five individuals. HLA DR4 (p < 0.005) and absence of asparic acid (Asp) at position 57 of the HLA DQ chain (p < 0.05) were significantly increased in subjects with 64K antibodies compared with control subjects. Of 40 individuals tested in the intravenous glucose tolerance test, three had a first phase insulin response below the first percentile of normal control subjects. Two children developed Type 1 (insulin-dependent) diabetes mellitus after 18 and 26 months, respectively. Each of these subjects was non-Asp homozygous and had persistent islet cell and 64K antibodies. We conclude that 64K antibodies, complement-fixing islet cell antibodies and insulin autoantibodies represent sensitive serological markers in assessing high risk for a progression to Type 1 diabetes in islet cell antibody positive non-diabetic individuals

Degrees of controllability for quantum systems and applications to atomic systems

Precise definitions for different degrees of controllability for quantum systems are given, and necessary and sufficient conditions are discussed. The results are applied to determine the degree of controllability for various atomic systems with degenerate energy levels and transition frequencies.Comment: 20 pages, IoP LaTeX, revised and expanded versio

Optimal Control for Generating Quantum Gates in Open Dissipative Systems

Optimal control methods for implementing quantum modules with least amount of relaxative loss are devised to give best approximations to unitary gates under relaxation. The potential gain by optimal control using relaxation parameters against time-optimal control is explored and exemplified in numerical and in algebraic terms: it is the method of choice to govern quantum systems within subspaces of weak relaxation whenever the drift Hamiltonian would otherwise drive the system through fast decaying modes. In a standard model system generalising decoherence-free subspaces to more realistic scenarios, openGRAPE-derived controls realise a CNOT with fidelities beyond 95% instead of at most 15% for a standard Trotter expansion. As additional benefit it requires control fields orders of magnitude lower than the bang-bang decouplings in the latter.Comment: largely expanded version, superseedes v1: 10 pages, 5 figure

Insulin autoantibodies as determined by competitive radiobinding assay are positively correlated with impaired beta-cell function — The Ulm-Frankfurt population study

Out of a random population of 4208 non-diabetic pupils without a family history of Type I diabetes 44 (1.05%) individuals had islet cell antibody (ICA) levels greater or equal to 5 Juvenile Diabetes Foundation (JDF) units. 39 of these ICA-positives could be repeatedly tested for circulating insulin autoantibodies (CIAA) using a competitive radiobinding assay. The results were compared with the insulin responses in the intravenous glucose tolerance tests (IVGTT) and with HLA types. Six pupils were positive for CIAA. All of them had complement-fixing ICA, and 5 of them were HLA-DR4 positive. Three of the 6 showed a first-phase insulin response below the first percentile of normal controls. Our data indicate that in population-based studies CIAA can be considered as a high risk marker for impaired beta-cell function in non-diabetic ICA-positive individuals

Magnetically actuated particle-based procedures in continuous flow

We demonstrate a versatile multilaminar flow microfluidic device in which magnetic particles are used as mobile supports for performing two important applications, namely (i) a clinically relevant sandwich immunoassay, and (ii) polye-lectrolyte coating of templates towards the fabrication of microcapsules for drug delivery applications. Furthermore, we demonstrate the use of a different force, diamagnetic repulsion, for deflecting polystyrene particles through a reagent stream with a view to performing multilaminar flow studies on diamagnetic material such as polymer particles and cells

Association between Antibodies to the MR 67,000 Isoform of Glutamate Decarboxylase (GAD) and Type 1 (Insulin-Dependent) Diabetes Mellitus with Coexisting Autoimmune Polyendocrine Syndrome Type II

By using an immunoprecipitation assay, we analysed reactivity of autoantibodies to human recombinant GAD65 and GAD67 in sera from patients with autoimmune polyendocrine syndrome Type II (APS II) with and without Type 1 (insulin-dependent) diabetes mellitus (IDDM) compared to patients with organ-specific autoimmunity. Overall antibodies to GAD65 were correlated with IDDM in all study groups, whereas GAD67 antibodies were associated with IDDM when APS II coexists. Antibodies to GAD65 and GAD67 were detected in 13 (44.8%) and 7 (24.1%) out of 29 APS II patients with IDDM, but in only 4 (13.8%) and 2 (6.9%) out of 29 APS II patients without IDDM, respectively (p < 0.05). In short-standing IDDM (< 1 year), antibodies to GAD67 were significantly more frequent in patients with APS II (5 of 9 [55.6%] subjects) compared to matched diabetic patients without coexisting polyendocrinopathy (1 of 18 [5.6%] subjects) (p < 0.02). The levels of GAD65 (142 ± 90 AU) and GAD67 antibodies (178 ± 95 AU) were significantly higher in patients with polyglandular disease than in patients with isolated IDDM (91 ± 85 AU and 93 ± 57 AU) (p < 0.02). Interestingly, all 11 GAD67 antibody positive subjects also had GAD65 antibodies (p < 0.0001), and in 10 of 11 anti-GAD67 positive sera the GAD67 antibodies could be blocked by either GAD67 or GAD65, suggesting the presence of cross-reactive autoantibodies. No correlation was observed between GAD antibodies and age, sex or any particular associated autoimmune disease, besides IDDM. GAD antibodies were present in only 1 of 6 (16.7%) patients with APS Type I, in 1 of 26 (3.9%) patients with autoimmune thyroid disease but in none of the patients with Addison's disease (n = 16), pernicious anaemia (n = 7) or normal controls (n = 50). Our data suggest distinct antibody specificities reactive to GAD isoforms in APS II and IDDM, which might reflect different mechanisms of autoimmune response in IDDM with coexisting autoimmune polyendocrine autoimmunity

“Learning on a chip:” Microfluidics for formal and informal science education

© 2019 Author(s). Microfluidics is a technique for the handling of small volumes of liquids on the order of picoliters to nanoliters and has impact for miniaturized biomedical science and fundamental research. Because of its multi- and interdisciplinary nature (i.e., combining the fields of biology, chemistry, physics, and engineering), microfluidics offers much potential for educational applications, both at the university level as well as primary and secondary education. Microfluidics is also an ideal "tool" to enthuse and educate members of the general public about the interdisciplinary aspects of modern sciences, including concepts of science, technology, engineering, and mathematics subjects such as (bio)engineering, chemistry, and biomedical sciences. Here, we provide an overview of approaches that have been taken to make microfluidics accessible for formal and informal learning. We also point out future avenues and desired developments. At the extreme ends, we can distinguish between projects that teach how to build microfluidic devices vs projects that make various microscopic phenomena (e.g., low Reynolds number hydrodynamics, microbiology) accessible to learners and the general public. Microfluidics also enables educators to make experiments low-cost and scalable, and thereby widely accessible. Our goal for this review is to assist academic researchers working in the field of microfluidics and lab-on-a-chip technologies as well as educators with translating research from the laboratory into the lecture hall, teaching laboratory, or public sphere

Automatic Planning and Control of Robot Natural Motion Via Feedback

A feedback control strategy for the command of robot motion includes some limited automatic planning capabilities. These may be seen as sequential solution algorithms implemented by the robot arm interpreted as a mechanical analog computer. This perspective lends additional insight into the manner in which such control techniques may fail, and motivates a fresh look at requisite sensory capabilities. For more information: Kod*La