Counterdiabatic driving for long-lived singlet state preparation.

The quantum adiabatic method, which maintains populations in their instantaneous eigenstates throughout the state evolution, is an established and often a preferred choice for state preparation and manipulation. Although it minimizes the driving cost significantly, its slow speed is a severe limitation in noisy intermediate-scale quantum era technologies. Since adiabatic paths are extensive in many physical processes, it is of broader interest to achieve adiabaticity at a much faster rate. Shortcuts to adiabaticity techniques, which overcome the slow adiabatic process by driving the system faster through non-adiabatic paths, have seen increased attention recently. The extraordinarily long lifetime of the long-lived singlet states (LLS) in nuclear magnetic resonance (NMR), established over the past decade, has opened several important applications ranging from spectroscopy to biomedical imaging. Various methods, including adiabatic methods, are already being used to prepare LLS. In this article, we report the use of counterdiabatic driving (CD) to speed up LLS preparation with faster drives. Using NMR experiments, we show that CD can give stronger LLS order in shorter durations than conventional adiabatic driving.

Appropriate Use of Progesterone to Prevent Preterm Birth: Approaches to Measurement for Driving Improvement.

Introduction Despite strong evidence supporting the benefit of 17-alpha hydroxyprogesterone caproate (17P) in preventing recurrent preterm birth, this treatment still does not reach most eligible patients. This study sought to identify approaches to measuring the appropriate use of 17P, with the goal of helping health systems better monitor and improve the implementation of this intervention. Methods Semi-structured telephone interviews were used to gather data on measures for 17P use being developed and implemented by state team members participating in the Infant Mortality Collaborative Improvement and Innovation Network (IM CoIIN)-a national quality improvement initiative. Strengths and limitations of these measurement approaches were described. Results Six approaches to measuring 17P use to prevent preterm birth were identified: practice-level data, population-based surveys, three measures employing insurance claims with or without linked birth certificate data, and revised birth certificates. Each measure had particular strengths and limitations. Practice-level measures were useful in rapid-cycle improvement, but were not generalizable across sites. In contrast, population-based measures (i.e., surveys, claims) were useful for broad comparisons, but were limited in their timeliness, and in how accurately they identified candidates who were truly eligible for 17P. Additionally, such measures required complex data linkage and analytic capabilities. Discussion A variety of imperfect measures for the appropriate use of 17P are available. No "best" measure was identified-the optimal measurement option must fit the specific needs of a health agency. Better data infrastructure and harnessing information from integrated electronic health records could improve the quality of 17P use measurement for improvement efforts.

Previous Adverse Infant Outcomes as Predictors of Preconception Care Use: An Analysis of the 2010 and 2012 Los Angeles Mommy and Baby (LAMB) Surveys.

Objectives This study aimed to understand the impact of a previous adverse infant outcome (AIO) on use of preconception care prior to a subsequent pregnancy. Methods Responses from the 2010 and 2012 Los Angeles Mommy and Baby Surveys were analyzed. Weighted multivariate logistic regression was employed to identify significant associations between having had a previous AIO (preterm delivery, low birth weight infant, stillbirth, or major birth defect) and receipt of preconception care prior to the most recent pregnancy. Select patient-level covariates were included: chronic disease, age, education level, race/ethnicity, country of birth, insurance status prior to pregnancy and pregnancy intent. Adjustment for missing responses was performed using multiple chained imputation. Results After controlling for covariates, having had a previous AIO was associated with an increased odds of having utilized preconception care in the most recent pregnancy (OR 1.237, p = 0.040). Per the final regression model, a woman reporting a previous AIO and an intended subsequent pregnancy had a 42.4 % likelihood of having used preconception care. Of these women, only 28.8 % reported doing so because of concern regarding a previous birth complication. Discussion Women reporting a previous AIO were more likely to have used preconception care in a subsequent pregnancy. The prevalence of preconception care utilization remained low overall. Pregnancy intent emerged as a strong secondary predictor; any concerted strategy to improve access to preconception care must include initiatives to help ensure that pregnancies are planned.

Probing Lingzhi or Reishi medicinal mushroom Ganoderma lucidum (higher Basidiomycetes): a bitter mushroom with amazing health benefits.

Ganoderma lucidum (Lingzhi or Reishi) is known as a bitter mushroom with remarkable health benefits. The active constituents found in mushrooms include polysaccharides, dietary fibers, oligosaccharides, triterpenoids, peptides and proteins, alcohols and phenols, mineral elements (such as zinc, copper, iodine, selenium, and iron), vitamins, and amino acids. The bioactive components found in the G. lucidum mushroom have numerous health properties to treat diseased conditions such as hepatopathy, chronic hepatitis, nephritis, hypertension, hyperlipemia, arthritis, neurasthenia, insomnia, bronchitis, asthma, gastric ulcers, atherosclerosis, leukopenia, diabetes, anorexia, and cancer. In spite of the voluminous literature available, G. lucidum is used mostly as an immune enhancer and a health supplement, not therapeutically. This review discusses the therapeutic potential of G. luidum to attract the scientific community to consider its therapeutic application where it can be worth pursuing.

The "Birth-Centered Outcomes Research Engagement (B-CORE) in Medi-Cal" Project: Community-Generated Recommendations to Decrease Maternal Mortality and Severe Maternal Morbidity.

BACKGROUND: Through applied research and health care quality improvement, California has achieved a maternal mortality (MM) rate significantly lower than that measured nationally. However, Medicaid (Medi-Cal)-insured births in the state continue to experience disproportionate shares of MM and severe maternal morbidity (SMM), which often precedes death. Failure to engage the Medi-Cal community in this work may impede efforts to increase equity. METHODS: This community engagement project used deliberative democracy methods to engage stakeholders with lived experience in California's Medi-Cal perinatal care system to generate an actionable and specific agenda of recommendations to decrease MM and SMM in the Medi-Cal population. FINDINGS: A total of 37 Medi-Cal stakeholders-representing birthing people, providers, health plan administrators, and advocates-participated in longitudinal co-learning sessions on the topics of MM/SMM in Medi-Cal. Most of these stakeholders (75.7%) then participated in deliberation sessions. Deliberation recommendations fell into five distinct categories: Medi-Cal perinatal covered benefits, data collection and dissemination, patient experience and its link to care quality, Medi-Cal reimbursement rates, and accountability with respect to racism in perinatal care. Stakeholders identified the Medi-Cal system actors best positioned to implement specific recommendations to directly impact MM/SMM. CONCLUSIONS: This project demonstrates the feasibility and success of using deliberative democracy methods to generate local and community-generated solutions to critical problems in health equity. Active and engaged stakeholders were keen to identify both immediate actions and long-term research and quality improvement paradigm shifts to support birth equity in Medi-Cal.

Birth-Centered Outcomes Research Engagement (B-CORE) in Medi-Cal: Community-Generated Recommendations to Decrease Maternal Mortality and Severe Maternal Morbidity.

California leads the nation with its relatively low rate of maternal deaths during pregnancy and the postpartum period. However, individuals insured via Medi-Cal suffer a disproportionate share of maternal deaths and severe complications at birth; within this group of publicly insured individuals, certain racial and/or ethnic groups have even higher rates of poor outcomes. The state can attribute part of its success in lowering rates of maternal mortality (MM) to the implementation of a data-driven statewide portfolio of quality improvement activities focused on the leading causes of maternal death. This quality improvement infrastructure has not previously been leveraged to respond in a focused way to the relatively large shares of MM and morbidity still seen in the Medi-Cal-insured population. B-CORE aimed to expand on existing statewide quality improvement efforts to effectively mitigate these adverse outcomes in Medi-Cal births by engaging Medi-Cal stakeholders.

Preventing human immunodeficiency virus infection among sexual assault survivors in Cape Town, South Africa: an observational study.

We describe 131 South African sexual assault survivors offered HIV post-exposure prophylaxis (PEP). While the median days completed was 27 (IQR 27, 28), 34% stopped PEP or missed doses. Controlling for baseline symptoms, PEP was not associated with symptoms (OR = 1.30, 95% CI = 0.66, 2.64). Factors associated with unprotected sex included prior unprotected sex (OR = 6.46, 95% CI = 3.04, 13.74), time since the assault (OR = 1.33, 95% CI = 1.12, 1.57) and age (OR = 1.30, 95% CI = 1.08, 1.57). Trauma counseling was protective (OR = 0.18, 95% CI = 0.05, 0.58). Four instances of seroconversion were observed by 6 months (risk = 3.7%, 95% CI = 1.0, 9.1). Proactive follow-up is necessary to increase the likelihood of PEP completion and address the mental health and HIV risk needs of survivors. Adherence interventions and targeted risk reduction counseling should be provided to minimize HIV acquisition.

Implementation and 12-Month Health Service Utilization and Cost Outcomes from a Managed Care Health Plan's Permanent Supportive Housing Program.

Homelessness, which refers to the lack of a fixed, regular, and adequate nighttime residence, is a pervasive public health issue. This article presents results from an implementation and outcome study of an ongoing permanent supportive housing (PSH) program-including service utilization and associated costs review-operated by a large not-for-profit Medicaid and Medicare managed care plan serving more than 1 million members in the Inland Empire area of Southern California. This PSH program combines a long-term housing subsidy with intensive case management services for adult plan members experiencing homelessness who have one or more chronic physical or behavioral health conditions and represent high utilizers of inpatient health care. The aim of this research was to determine whether programmatic costs incurred by the health plan supporting the PSH program were partially or fully offset by decreased costs attributable to health care utilization within the health system. The evaluation used a quasi-experimental research design with an observational control group. The authors differentiated the program's effect during the transitional period-that is, after program enrollment and prior to housing placement-from its effect during the period after members were housed. In addition, the authors present participant flow through the key program milestones (e.g., referral, enrollment, housing placement, program exit) and describe health care utilization and associated costs for members who exited the program. Finally, they report the PSH programmatic expenditures relative to the changes in health care costs to provide an overall picture of the intervention's benefits and costs to the health plan.

Perceived care coordination among permanent supportive housing participants: Evidence from a managed care plan in the United States.

Homelessness is a pervasive public health problem in the United States (U.S.). Under the U.S. Affordable Care Act, the nation's public health insurance program (Medicaid) was expanded to serve more individuals, including those experiencing homelessness. Coupled with changes in financial incentives designed to reduce healthcare costs, health plans, hospitals and large health systems have started to operate permanent supportive housing (PSH) programmes as a healthcare benefit. To better understand patient perceptions of care coordination in a PSH programme operated by a large health plan in Southern California, we conducted 22 semi-structured in-depth patient interviews between October and November 2019. Two coders analysed these data inductively and deductively, using pre-identified domains and open coding. Coding reliability and thematic saturation were also assessed. Findings indicated positive experiences with care coordination for physical health and social supports, such as food distribution and transportation. Identified service gaps included mental health support and help securing public assistance (e.g., cash benefits). Opportunities to enhance PSH care coordination were also identified, such as the need for a simplified approach. Hospitals, health plans and systems considering PSH programmes may look to these results for implementation guidance.

Eruptive collagenomas.

A 24-year-old woman presented with hypopigmented papules of the abdomen that had been present for four years without a family history of similar cutaneous findings or associated medical problems. Histopathologic features confirmed the diagnosis of a connective-tissue nevus that was composed of collagen. Eruptive collagenomas are a rare form of acquired collagenomas, which are characterized by the sudden appearance of asymptomatic papules and nodules on the lower trunk and extremities; the lesions are composed of haphazardly arranged collagen fibers. The pathogenesis is unknown, lesions are persistent, and therapeutic options have not been reported.

Atypical mycobacteria infection in an immunocompromised patient.

A 61-year-old woman with systemic lupus erythematosus and Sjögren syndrome presented with a two-month history of symptomatic nodules on the buttocks and thighs that progressed to involve the dorsal aspects of the hands. On examination, infiltrative papules, nodules, and plaques were present in these regions. Biopsy specimens demonstrated granulomatous inflammation and acid-fast bacilli with the use of a Fite stain, although a culture and polymerase chain reaction analysis were negative. The patient continues to improve on long-term clarithromycin therapy. Atypical mycobacterial infections are becoming more common, especially in immunocompromised patients. Antimicrobial therapy, either with a single agent or multiple agents, often is prolonged. A high index of suspicion is warranted in immunocompromised patients, which includes those with connective-tissue diseases that are active or that require immunosuppression. In these patients, the differential diagnosis includes infectious as well as inflammatory, reactive, or neoplastic processes.

Using Deliberative and Qualitative Methods to Recommend Revisions to the Medicaid Sterilization Waiting Period.

BACKGROUND: Sterilization is used by one-quarter of women in the United States for contraception and is a preferred birth control method among women with Medicaid. A history of coercive sterilization practices in the United States led to federal regulation of consent for Medicaid sterilization (including a mandated waiting period); this regulation can be a barrier to sterilization in Medicaid-insured women. This study aimed to develop a revised model of Medicaid sterilization policy grounded in the experiences of women impacted by current regulations. METHODS: This prospective study used in-depth interviews with 32 Medicaid-insured women who had obtained or tried to obtain sterilization to elicit recommendations regarding the Medicaid waiting period. Deliberative methods (a planning cell including 20 key community stakeholders) were used to evaluate women's recommendations and propose a revised policy for sterilization under Medicaid. RESULTS: In-depth interview data demonstrated that women were often not made aware of the 30-day waiting period during informed consent before sterilization. Once informed about the policy, women described the Medicaid waiting period as "unfair," because it did not apply to all women. After deliberating women's recommendations to change the policy, key stakeholders came to a consensus around replacing the current waiting period policy with an improved consent process that would acknowledge the problematic history of coercive sterilization. Participants could not endorse removing the waiting period altogether without evidence that the health system had shifted away from coercive sterilization practices. CONCLUSIONS: Using deliberative methods and the recommendations of women with Medicaid insurance, community stakeholders recommended developing a revised Medicaid sterilization consent policy that acknowledged the historical context of this procedure.

The Columbia-Harlem Homeless Medical Partnership: a new model for learning in the service of those in medical need.

Though altruism and patient advocacy are promoted in medical education curricula, students are given few opportunities to develop these skills. Student-run clinics focusing on the health needs of the underserved can provide important health services to needy patients while providing students with career-influencing primary care experiences. The Columbia-Harlem Homeless Medical Partnership (CHHMP)-a project initiated by medical students to provide primary care to Northern Manhattan's homeless population-serves as a new model of service learning in medical education. Unlike many other student-run clinics, CHHMP has developed direct patient outreach, continuous care (stable "student-patient teams" and a weekly commitment for all volunteers), and regular internal data review. Chart review data presented demonstrate the project's success in providing care to the clinic's target population of homeless and unstably housed patients. Targeted outreach efforts among clients have increased rates of patient follow-up at each subsequent review period. Additionally, CHHMP has used review data to develop services concordant with identified patient needs (psychiatric care and social services). CHHMP has recruited a committed group of volunteers and continues to engender an interest in the health needs of the underserved among students. Not only does CHHMP provide a "medical home" for homeless patients, it also provides a space in which students can develop skills unaddressed in large teaching hospitals. This project, a "win-win" for patients and students, serves as a unique model for community health-based service learning in medical education.

Pityriasis rotunda.

A 42-year-old man presented with asymptomatic, sharply-demarcated, round, scaly lesions on his forearms that had been present for several months. A skin biopsy specimen was consistent with pityriasis rotunda. Pityriasis rotunda is a disorder of keratinization, which is thought to be a form of acquired ichthyosis, a delayed presentation of congenital ichthyosis, or a cutaneous manifestation of systemic disease. Patients with pityriasis rotunda may be classified into one of two groups, which are based on ethnicity, number of lesions, family history, and association with systemic diseases. Treatment is challenging, but the use of lactic acid lotion and oral vitamin A has shown some promise.

Genital porokeratosis.

A 22-year-old man presented with a two-year history of warts on the penis, scrotum, and thighs. Physical examination showed multiple annular plaques with thin, threadlike borders on the penis and scrotum. The biopsy specimen showed a cornoid lamella with underlying dyskeratotic cells that was consistent with porokeratosis. Genital porokeratosis is a rare condition that may be misdiagnosed as a sexually transmitted disease.

Rowell syndrome (systemic lupus erythematosus + erythema multiforme).

A 61-year-old woman with a history of chilblains and systemic lupus erythematosus (SLE) for 15 years presented with annular, erythematous, scaly papules and plaques on her face, neck, chest, abdomen, back, arms, and legs. A biopsy specimen showed a destructive interface dermatitis with extensive epithelial cell necrosis, which was consistent with lupus erythematosus with combined subacute cutaneous lupus and erythema multiforme-like features. These findings are most compatible with a diagnosis of Rowell syndrome. Rowell syndrome and its relation to lupus erythematosus and erythema multiforme are discussed.

Multiple eruptive milia.

A 61-year-old-man presented with a sudden onset of multiple, hyperpigmented papules with a central punctum on the face, chest, upper back, and arms. Histopathologic examination showed infundibular cysts. These findings are consistent with a diagnosis of multiple eruptive milia, which is a rare disorder that is characterized by the sudden development of crops of milia over weeks to months. They are more extensive in number and distribution than they are in primary milia. Milia may present spontaneously without a known cause, as part of an inherited familial condition, or as part of a genodermatosis. The etiologies are uncertain, and treatment options are varied.

Integrated Mind/Body Care in Women's Health: A Focus on Well-Being, Mental Health, and Relationships.

Integrated care with mental health clinicians embedded in medical departments remains rare despite evidence of the need and effectiveness of such a model. Comprehensive, efficacious, and meaningful health care requires adequate attention be paid to the physiologic and the psychological symptoms of the patient. In the obstetrics/gynecology setting, myriad psychosocial concerns routinely present and cannot be adequately addressed in the current systems of care. The need is there, providers and patients have shown preference for such a structure, and the outcomes are promising. This article outlines common patient concerns in such settings and discusses possible interventions.

Linear lichen planus.

A 50-year-old man presented with pruritic, hyperpigmented papules and plaques on the right lower extremity following Blaschko lines. A skin biopsy specimen was consistent with lichen planus (LP). Linear LP accounts for less than 0.2 percent of all patients with LP, and the segmental formation is thought to be due to a postzygotic mutation that affects one of the genes predisposing its development. This loss of heterozygosity may occur from a mutation, deletion, or DNA recombination and leads to the formation of a keratinocyte clone that is more susceptible to development of the skin disease. Histopathologically, linear LP is identical to LP, with the presence of hyperkeratosis, focal hypergranulosis, irregular acanthosis with a sawtooth appearance, vacuolar change of the basal-cell layer, and a dense band-like lymphocytic infiltrate at the dermal-epidermal junction. It is important to differentiate linear LP from lichen striatus, inflammatory linear verrucous epidermal nevus, linear psoriasis, and linear Darier-White disease, which have different presentations clinically and histopathologically.

An Evaluation of the Implementation of Pharmacist-Prescribed Hormonal Contraceptives in California.

OBJECTIVE: To evaluate the implementation of pharmacist-prescribed hormonal contraceptives in California after a recent expansion of pharmacists' scope of practice. METHODS: A probability sample of 480 licensed California retail pharmacies (stratified by nonrural or rural location and independent or chain status) was included in a cross-sectional "secret shopper" telephone survey assessing the availability of pharmacist-prescribed hormonal contraceptives and service details. Survey data were analyzed using weighted descriptive statistics, CIs, and Wald tests. RESULTS: Findings included data from 457 pharmacies (response rate 95.2%). Only 5.1% of pharmacies reported providing pharmacist-prescribed hormonal contraceptives (95% CI 2.9-7.2%). This proportion did not differ significantly between rural and nonrural pharmacies (P=.83) nor between independent and chain pharmacies (P=.40). Five of the 22 pharmacies that were providing pharmacist-prescribed hormonal contraceptives informed secret shoppers that all allowed hormonal methods were available; most of these pharmacies (77.3%) did proactively describe that a health history was required before receiving medications. Only half of pharmacies providing pharmacist-prescribed hormonal contraceptives would do so for minors although this was allowed by law. CONCLUSION: In the first year after statewide protocol implementation, only a small proportion of retail pharmacies across California has begun offering hormonal contraception services. In the absence of additional supportive legislation regarding reimbursement for pharmacist services, increases in scope of practice regulations to build a larger network of contraceptive providers may not be effective in increasing access to birth control.