The View from the Cliff: Government-Funded Nonprofits Are Looking Out on Steep Cuts and an Uncertain Future

Federal, state, and local government underwrites the bulk of the cost to support vulnerable people in our society. But most of the actual services are delivered by nonprofits operating under government contracts or grants. With the stimulus money gone, large federal spending cuts looming, several years of recession, and an ever-growing pension and healthcare burden, how are these nonprofits faring? What do they believe the future holds for publicly funded services and for them

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Peer reviewedPublisher PD

A minimum control ancilla driven quantum computation scheme with repeat-until-success style gate generation

Some two qubit interactions are singly sufficient for universal quantum computation but not without the use of an ancilla. Recent schemes for universal quantum computation have focused on hybrid physical systems using ancillae. In them, the application of resources is shifted to the ancilla system. We consider which 2-qubit interactions are universal in ancilla schemes where direct connections between main register qubits are forbidden. By the use of ancilla driven operations and repeat-until-success style random gates, a single fixed symmetric gate can be universal be control of the number of repetitions alone

Entangling unitary gates on distant qubits with ancilla feedback

By using an ancilla qubit as a mediator, two distant qubits can undergo a non-local entangling unitary operation. This is desirable for when attempting to scale up or distribute quantum computation by combining fixed static local sets of qubits with ballistic mediators. Using a model driven by measurements on the ancilla, it is possible to generate a maximally entangling CZ gate while only having access to a less entangling gate between the pair qubits and the ancilla. However this results in a stochastic process of generating control phase rotation gates where the expected time for success does not correlate with the entangling power of the connection gate. We explore how one can use feedback into the preparation and measurement parameters of the ancilla to speed up the expected time to generate a CZ gate between a pair of separated qubits and to leverage stronger coupling strengths for faster times. Surprisingly, by choosing an appropriate strategy, control of a binary discrete parameter achieves comparable speed up to full continuous control of all degrees of freedom of the ancilla.Comment: 8 pages, 11 figure

Quality Assurance in Telehealth: Adherence to Evidence-Based Indicators.

Background: Value enhancing telehealth (TH) lacks a robust body of formal clinically focused quality assessment studies. Innovations such as telehealth must always demonstrate that it preserves or hopefully advances quality. Introduction: We sought to determine whether adherence to the evidence-based Choosing Wisely (CW) recommendations (antibiotic stewardship) for acute sinusitis differs for encounters through direct-to-consumer (DTC) telemedicine verses in-person care in an emergency department (ED) or an urgent care (UC) center. Materials and Methods: Study design was a retrospective review. Patients with a symptom complex consistent with acute sinusitis treated through DTC were matched with ED and UC patients, based upon time of visit. Charts were reviewed to determine patient characteristics, chief complaint, final diagnosis, presence or absence of criteria within the CW guidelines, and whether or not antibiotics were prescribed. The main outcome was adherence to the CW campaign recommendations. Results: A total of 570 visits were studied: 190 DTC, 190 ED, and 190 UC visits. The predominant chief complaints were upper respiratory infection (36%), sore throat (25%), and sinusitis (18%). Overall, there was a 67% (95% CI 62.3-71.7) adherence rate with the CW guidelines for sinusitis: DTC visits (71%), ED visits (68%), and UC visits (61%). There was a nonsignificant difference (p = 0.29) in adherence to CW guidelines based upon type of visit (DTC, UC, and ED). Discussion: The challenge is to demonstrate whether or not DTC TH compromises quality. Conclusion: In this study, DTC visits were associated with at least as good an adherence to the CW campaign recommendations as emergency medicine (EM) and UC in-person visits. © Daniel Halpren-Ruder et al

Hybrid statistical and mechanistic mathematical model guides mobile health intervention for chronic pain

Nearly a quarter of visits to the Emergency Department are for conditions that could have been managed via outpatient treatment; improvements that allow patients to quickly recognize and receive appropriate treatment are crucial. The growing popularity of mobile technology creates new opportunities for real-time adaptive medical intervention, and the simultaneous growth of big data sources allows for preparation of personalized recommendations. Here we focus on the reduction of chronic suffering in the sickle cell disease community. Sickle cell disease is a chronic blood disorder in which pain is the most frequent complication. There currently is no standard algorithm or analytical method for real-time adaptive treatment recommendations for pain. Furthermore, current state-of-the-art methods have difficulty in handling continuous-time decision optimization using big data. Facing these challenges, in this study we aim to develop new mathematical tools for incorporating mobile technology into personalized treatment plans for pain. We present a new hybrid model for the dynamics of subjective pain that consists of a dynamical systems approach using differential equations to predict future pain levels, as well as a statistical approach tying system parameters to patient data (both personal characteristics and medication response history). Pilot testing of our approach suggests that it has significant potential to predict pain dynamics given patients' reported pain levels and medication usages. With more abundant data, our hybrid approach should allow physicians to make personalized, data driven recommendations for treating chronic pain.Comment: 13 pages, 15 figures, 5 table

Chylous Leak During Posterior Approach to Juvenile Scoliosis Surgery: A Case Report.

CaseWe report the first documented case of chylous leak recognized intraoperatively during posterior spinal instrumentation and fusion for juvenile scoliosis in a female patient with a history of thoracotomy and decortication for an empyema.ConclusionsThoracic duct injury can lead to severe morbidity and mortality because of chylothorax formation. Although chylous leaks are a well-documented complication of the anterior approach to spine surgery, leaks during the posterior approach are rarely reported. When these chylous leaks are recognized intraoperatively, the likelihood of serious complications may be minimized by drain placement before closure