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OBJECTIVES: This study uses a national model of community-based long-term services and supports, the Program of All-inclusive Care for the Elderly (PACE), to identify organizational structures and protocols that can facilitate the delivery of dental examinations. DESIGN: We developed an online survey instrument and conceptual model for this study representing 10 domains believed to characterize a quality PACE dental program. SETTING AND PARTICIPANTS: The Qualtrics survey was distributed nationally to all 124 PACE programs in the 31 states PACE was available. Respondents in this study represented 35 programs (program response rate = 28.2%) in 23 states (state response rate = 74.2%). METHODS: Selected independent variables from each of the 10 domains were tested against the reported delivery of dental examinations variable using the Kendall τ and χ2. Twenty-nine programs were included in the final analysis. RESULTS: Most programs mandated a dental examination within 31-60 days of enrollment (63.6%). Few programs had a dental manual (15.6%) or any quality assurance for dental care (32.3%). A majority of programs (58.8%) stated that they had a protocol for enrollees to receive a cleaning every 6-12 months. Having a system for quality assurance for dental care, protocol for a cleaning every 6-12 months, mandating a comprehensive dental examination and providing preventive dental services onsite with built-in equipment, were all statistically associated with a higher reported delivery of dental examinations. CONCLUSION AND IMPLICATIONS: Organizations providing long-term services and supports, including PACE, can use these identified domains to develop minimal standards to ensure dental care is part of innovative models of community-based long-term services and supports. Implementing these domains can facilitate effective delivery of dental examinations that have the potential to support positive oral health and general health outcomes.
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Serviços de Saúde para Idosos , Idoso , Assistência Odontológica , Idoso Fragilizado , Humanos , Saúde Bucal , Estados UnidosRESUMO
We present a scanning light detection and ranging (LIDAR) system incorporating an individual Ge-on-Si single-photon avalanche diode (SPAD) detector for depth and intensity imaging in the short-wavelength infrared region. The time-correlated single-photon counting technique was used to determine the return photon time-of-flight for target depth information. In laboratory demonstrations, depth and intensity reconstructions were made of targets at short range, using advanced image processing algorithms tailored for the analysis of single-photon time-of-flight data. These laboratory measurements were used to predict the performance of the single-photon LIDAR system at longer ranges, providing estimations that sub-milliwatt average power levels would be required for kilometer range depth measurements.
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BACKGROUND: The integration of dentistry into comprehensive and long-term care has occurred infrequently and with limited success. The authors aim to describe how the Program of All-Inclusive Care for the Elderly (PACE) has the potential for such incorporation for the growing population of nursing home-appropriate older adults preferring to age in place. METHODS: The authors used a 56-item online survey to explore aspects of oral health care within PACE, including organizational structure, availability and provision of care, preventive protocols, and provider reimbursement. The survey was distributed to all 124 programs nationally. Data analyses included descriptive statistics for each of the variables of interest. RESULTS: Thirty-five programs completed the survey (28%) in 23 states (74%) where PACE is available. Most programs covered comprehensive dental services and predominantly provided care off-site. Most programs reimbursed dentists at Medicaid fee-for-service rates and some at commercial rates. Dentistry was most frequently ranked the second-highest specialty focus behind mental health. CONCLUSIONS: PACE is a comprehensive interdisciplinary model of care and an underused opportunity for furthering medical-dental integration. It uses local dental resources in order to accommodate the oral health care needs of the growing population of older adults preferring to age in place. PRACTICAL IMPLICATIONS: PACE is an opportunity for the dental profession to further medical-dental integration and ensure that newer models of long-term care include comprehensive and coordinated oral health care programs. It is also an opportunity to promote an integrated model of care with policy makers to support integrated oral health care for the nursing home-eligible population.
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Idoso Fragilizado , Serviços de Saúde para Idosos , Idoso , Humanos , Medicaid , Estados UnidosRESUMO
Propagation losses in transmission media limit the transmission distance of optical signals. In the case where the signal is made up of quantum optical states, conventional deterministic optical amplification schemes cannot be used to increase the transmission distance as the copying of an arbitrary and unknown quantum state is forbidden. One strategy that can offset propagation loss is the use of probabilistic, or non-deterministic, amplification schemes - an example of which is the state comparison amplifier. Here we report a state comparison amplifier implemented in a compact, fiber-coupled femtosecond laser-written waveguide chip as opposed to the large, bulk-optical components of previous designs. This pathfinder on-chip implementation of the quantum amplifier has resulted in several performance improvements: the polarization integrity of the written waveguides has resulted in improved visibility of the amplifier interferometers; the potential of substantially-reduced losses throughout the amplifier configuration; and a more compact and environmentally-stable amplifier which is scalable to more complex networks.
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Aberrant JAK2 tyrosine kinase signaling drives the development of Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs), including polycythemia vera, essential thrombocythemia, and primary myelofibrosis. However, JAK2 kinase inhibitors have failed to significantly reduce allele burden in MPN patients, underscoring the need for improved therapeutic strategies. Members of the PIM family of serine/threonine kinases promote cellular proliferation by regulating a variety of cellular processes, including protein synthesis and the balance of signaling that regulates apoptosis. Overexpression of PIM family members is oncogenic, exemplified by their ability to induce lymphomas in collaboration with c-Myc. Thus, PIM kinases are potential therapeutic targets for several malignancies such as solid tumors and blood cancers. We and others have shown that PIM inhibitors augment the efficacy of JAK2 inhibitors by using in vitro models of MPNs. Here we report that the recently developed pan-PIM inhibitor INCB053914 augments the efficacy of the US Food and Drug Administration-approved JAK1/2 inhibitor ruxolitinib in both in vitro and in vivo MPN models. INCB053914 synergizes with ruxolitinib to inhibit cell growth in JAK2-driven MPN models and induce apoptosis. Significantly, low nanomolar INCB053914 enhances the efficacy of ruxolitinib to inhibit the neoplastic growth of primary MPN patient cells, and INCB053914 antagonizes ruxolitinib persistent myeloproliferation in vivo. These findings support the notion that INCB053914, which is currently in clinical trials in patients with advanced hematologic malignancies, in combination with ruxolitinib may be effective in MPN patients, and they support the clinical testing of this combination in MPN patients.
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Inibidores de Janus Quinases/farmacologia , Inibidores de Proteínas Quinases/farmacologia , Proteínas Proto-Oncogênicas c-pim-1/antagonistas & inibidores , Pirazóis/farmacologia , Animais , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Sinergismo Farmacológico , Xenoenxertos , Humanos , Alvo Mecanístico do Complexo 1 de Rapamicina/metabolismo , Camundongos , Transtornos Mieloproliferativos/tratamento farmacológico , Transtornos Mieloproliferativos/metabolismo , Células-Tronco Neoplásicas/efeitos dos fármacos , Células-Tronco Neoplásicas/metabolismo , Nitrilas , Pirimidinas , Transdução de Sinais/efeitos dos fármacosRESUMO
This descriptive study sought to establish an oral health baseline of need for enrollees at a Program of All-Inclusive Care for the Elderly (PACE) and identify opportunities for nursing interventions. The Oral Health Assessment Tool (OHAT) was applied to a random sample of 120 enrollees, 64 of whom met inclusion criteria, agreed to participate to assess their oral health status, and were included in the analysis. The mean OHAT score was 4.4 (SD = 2.6; range 0-12). Higher scores indicate poorer oral health. The oral conditions found needing the most attention were gums, saliva, natural teeth, dentures, and oral cleanliness. Oral cleanliness scored the worst on the OHAT, highlighting opportunities for nursing interventions and the necessity for oral hygiene routines. This study also identifies the need for nurses to address enrollees' oral health and relay information back to the PACE interdisciplinary team (IDT) to initiate referrals to the dentist as needed.
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Negro ou Afro-Americano/estatística & dados numéricos , Comportamento Cooperativo , Enfermagem Geriátrica , Saúde Bucal , Inquéritos e Questionários/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Assistência Odontológica , Feminino , Serviços de Saúde para Idosos , Humanos , Masculino , Medicaid , Medicare , Higiene Bucal , Estados UnidosRESUMO
Ensuring the integrity and transferability of digital messages is an important challenge in modern communications. Although purely mathematical approaches exist, they usually rely on the computational complexity of certain functions, in which case there is no guarantee of long-term security. Alternatively, quantum digital signatures offer security guaranteed by the physical laws of quantum mechanics. Prior experimental demonstrations of quantum digital signatures in optical fiber have typically been limited to operation over short distances and/or operated in a laboratory environment. Here we report the experimental transmission of quantum digital signatures over channel losses of up to 42.8 ± 1.2 dB in a link comprised of 90 km of installed fiber with additional optical attenuation introduced to simulate longer distances. The channel loss of 42.8 ± 1.2 dB corresponds to an equivalent distance of 134.2 ± 3.8 km and this represents the longest effective distance and highest channel loss that quantum digital signatures have been shown to operate over to date. Our theoretical model indicates that this represents close to the maximum possible channel attenuation for this quantum digital signature protocol, defined as the loss for which the signal rate is comparable to the dark count rate of the detectors.
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The NOON state, and its experimental approximation the Holland-Burnett state, have important applications in phase sensing measurement with enhanced sensitivity. However, most of the previous Holland-Burnett state interference (HBSI) experiments only investigated the area of the interference pattern in the region immediately around zero optical path length difference, while the full HBSI pattern over a wide range of optical path length differences has not yet been well explored. In this work, we experimentally and theoretically demonstrate up to six-photon HBSI and study the properties of the interference patterns over a wide range of optical path length differences. It was found that the shape, the coherence time and the visibility of the interference patterns were strongly dependent on the detection schemes. This work paves the way for applications which are based on the envelope of the HBSI pattern, such as quantum spectroscopy and quantum metrology.
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Quantum digital signatures (QDSs) apply quantum mechanics to the problem of guaranteeing message integrity and non-repudiation with information-theoretical security, which are complementary to the confidentiality realized by quantum key distribution (QKD). Previous experimental demonstrations have been limited to transmission distances of less than 5 km of optical fiber in a laboratory setting. Here we report, to the best of our knowledge, the first demonstration of QDSs over installed optical fiber, as well as the longest transmission link reported to date. This demonstration used a 90 km long differential phase shift QKD to achieve approximately one signed bit per second, an increase in the signature generation rate of several orders of magnitude over previous optical fiber demonstrations.
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We present an experimental demonstration of a practical nondeterministic quantum optical amplification scheme that employs two mature technologies, state comparison and photon subtraction, to achieve amplification of known sets of coherent states with high fidelity. The amplifier uses coherent states as a resource rather than single photons, which allows for a relatively simple light source, such as a diode laser, providing an increased rate of amplification. The amplifier is not restricted to low amplitude states. With respect to the two key parameters, fidelity and the amplified state production rate, we demonstrate significant improvements over previous experimental implementations, without the requirement of complex photonic components. Such a system may form the basis of trusted quantum repeaters in nonentanglement-based quantum communications systems with known phase alphabets, such as quantum key distribution or quantum digital signatures.
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Digital signatures are widely used to provide security for electronic communications, for example, in financial transactions and electronic mail. Currently used classical digital signature schemes, however, only offer security relying on unproven computational assumptions. In contrast, quantum digital signatures offer information-theoretic security based on laws of quantum mechanics. Here, security against forging relies on the impossibility of perfectly distinguishing between nonorthogonal quantum states. A serious drawback of previous quantum digital signature schemes is that they require long-term quantum memory, making them impractical at present. We present the first realization of a scheme that does not need quantum memory and which also uses only standard linear optical components and photodetectors. In our realization, the recipients measure the distributed quantum signature states using a new type of quantum measurement, quantum state elimination. This significantly advances quantum digital signatures as a quantum technology with potential for real applications.
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Digital signatures are frequently used in data transfer to prevent impersonation, repudiation and message tampering. Currently used classical digital signature schemes rely on public key encryption techniques, where the complexity of so-called 'one-way' mathematical functions is used to provide security over sufficiently long timescales. No mathematical proofs are known for the long-term security of such techniques. Quantum digital signatures offer a means of sending a message, which cannot be forged or repudiated, with security verified by information-theoretical limits and quantum mechanics. Here we demonstrate an experimental system, which distributes quantum signatures from one sender to two receivers and enables message sending ensured against forging and repudiation. Additionally, we analyse the security of the system in some typical scenarios. Our system is based on the interference of phase-encoded coherent states of light and our implementation utilizes polarization-maintaining optical fibre and photons with a wavelength of 850 nm.
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We describe a scanning time-of-flight system which uses the time-correlated single-photon counting technique to produce three-dimensional depth images of distant, noncooperative surfaces when these targets are illuminated by a kHz to MHz repetition rate pulsed laser source. The data for the scene are acquired using a scanning optical system and an individual single-photon detector. Depth images have been successfully acquired with centimeter xyz resolution, in daylight conditions, for low-signature targets in field trials at distances of up to 325 m using an output illumination with an average optical power of less than 50 microW.
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The Xenopus laevis cyclin dependent kinase inhibitor p27(Xic1) has been shown to be involved in exit from the cell cycle and differentiation of cells into a quiescent state in the nervous system, muscle tissue, heart and retina. We show that p27(Xic1) is expressed in the developing kidney in the nephrostomal regions. Using overexpression and morpholino oligonucleotide (MO) knock-down approaches we show normal levels of p27(Xic1) regulate pronephros organ size by regulating cell cycle exit. Knock-down of p27(Xic1) expression using a MO prevented myogenesis, as previously reported; an effect that subsequently inhibits pronephrogenesis. Furthermore, we show that normal levels of p27(Xic1) are required for somite segmentation also through its cell cycle control function. Finally, we provide evidence to suggest correct paraxial mesoderm segmentation is not necessary for pronephric induction in the intermediate mesoderm. These results indicate novel developmental roles for p27(Xic1), and reveal its differentiation function is not universally utilised in all developing tissues.
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Structural crystallography aims to provide a three-dimensional representation of macromolecules. Many parts of the multistep process to produce the three-dimensional structural model have been automated, especially through various structural genomics projects. A key step is the production of crystals for diffraction. The target macromolecule is combined with a large and chemically diverse set of cocktails with some leading ideally, but infrequently, to crystallization. A variety of outcomes will be observed during these screening experiments that typically require human interpretation for classification. Human interpretation is neither scalable nor objective, highlighting the need to develop an automatic computer-based image classification. As a first step towards automated image classification, 147,456 images representing crystallization experiments from 96 different macromolecular samples were manually classified. Each image was classified by three experts into seven predefined categories or their combinations. The resulting data where all three observers are in agreement provides one component of a truth set for the development and rigorous testing of automated image-classification systems and provides information about the chemical cocktails used for crystallization. In this paper, the details of this study are presented.
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Cristalografia por Raios X/métodos , Processamento de Imagem Assistida por Computador/métodos , Substâncias Macromoleculares/química , Ensino/métodos , Algoritmos , Gráficos por Computador , Cristalização , Cristalografia por Raios X/classificação , Processamento Eletrônico de Dados , Humanos , Processamento de Imagem Assistida por Computador/classificação , Modelos Moleculares , Ensino/tendênciasRESUMO
In the automated image analysis of crystallization experiments, representative examples of outcomes can be obtained rapidly. However, while the outcomes appear to be diverse, the number of crystalline outcomes can be small. To complement a training set from the visual observation of 147 456 crystallization outcomes, a set of crystal images was produced from 106 and 163 macromolecules under study for the North East Structural Genomics Consortium (NESG) and Structural Genomics of Pathogenic Protozoa (SGPP) groups, respectively. These crystal images have been combined with the initial training set. A description of the crystal-enriched data set and a preliminary analysis of outcomes from the data are described.
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Cristalografia por Raios X/métodos , Processamento de Imagem Assistida por Computador/métodos , Substâncias Macromoleculares/química , Ensino/métodos , Gráficos por Computador , Cristalização , Cristalografia por Raios X/classificação , Sistemas de Gerenciamento de Base de Dados , Humanos , Processamento de Imagem Assistida por Computador/classificação , Modelos Moleculares , Polietilenoglicóis/química , Polietilenoglicóis/metabolismo , Ensino/tendênciasRESUMO
Anxa4 belongs to the multigenic annexin family of proteins which are characterized by their ability to interact with membranes in a calcium-dependent manner. Defined as a marker for polarized epithelial cells, Anxa4 is believed to be involved in many cellular processes but its functions in vivo are still poorly understood. Previously, we cloned Xanx4 in Xenopus laevis (now referred to as anxa4a) and demonstrated its role during organogenesis of the pronephros, providing the first evidence of a specific function for this protein during the development of a vertebrate. Here, we describe the strict conservation of protein sequence and functional domains of anxa4 during vertebrate evolution. We also identify the paralog of anxa4a, anxa4b and show its specific temporal and spatial expression pattern is different from anxa4a. We show that anxa4 orthologs in X. laevis and tropicalis display expression domains in different organ systems. Whilst the anxa4a gene is mainly expressed in the kidney, Xt anxa4 is expressed in the liver. Finally, we demonstrate Xt anxa4 and anxa4a can display conserved function during kidney organogenesis, despite the fact that Xt anxa4 transcripts are not expressed in this domain. This study highlights the divergence of expression of homologous genes during Xenopus evolution and raises the potential problems of using X. tropicalis promoters in X. laevis.
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OBJECTIVE: To develop a local quality assurance program in cytopathology based on circulation of patient specimens on glass slides, with limited resources. STUDY DESIGN: A working group was set up for design and running of the program. Participation is on a laboratory basis. The scope and frequency of testing are defined. Well-documented cases (including gynecologic, nongynecologic and fine needle aspiration cytology) with commonly encountered diagnoses are collected. Consensus concerning the diagnosis, interpretive menu and scoring system is sought before the actual slide circulations using express mail. After returning their answers to the program organizer, the participating laboratories receive immediate feedback on their scores, with reference answers, explanatory notes, "whole-mount" images of glass slides and cumulative responses of peer laboratories for on-site checking. At the end of each year, an electronic file containing representative photomicrographs of all cases examined is provided to individual laboratories for their permanent records and training purposes. RESULTS: The program was launched in mid-2003. There were 24 and 27 participating laboratories from Hong Kong (and Macau) in 2003 and 2004, respectively. To date, >150 well-documented cytology cases are available in the slide pool and ready for circulation. As the revenue is mainly to cover the expenses of express mail, the program can be carried out at a relatively low cost. CONCLUSION: In order to have any cytology quality assurance program accepted by local laboratories, it has to be fair and practical. Strict confidentiality needs to be observed throughout the process. This program emphasizes both performance assessment and educational value. Adequate representation from experienced local cytology workers, detailed documentation support from authorities and assistance from dedicated staff are essential to the success of any external proficiency testing scheme. Regular review and evaluation are also necessary for continuous improvement. The Hong Kong experience can serve as an example of running a glass slide-based cytology quality assurance program in a small region with limited resources.