Uncertainty Relations from State Polynomial Optimization.

Uncertainty relations are a fundamental feature of quantum mechanics. How can these relations be found systematically? Here, we develop a semidefinite programming hierarchy for additive uncertainty relations in the variances of noncommuting observables. Our hierarchy is built on the state polynomial optimization framework, also known as scalar extension. The hierarchy is complete in the sense that it converges to tight uncertainty relations. We improve upon upper bounds for all 1292 additive uncertainty relations on up to nine operators for which a tight bound is not known. The bounds are dimension-free and depend entirely on the algebraic relations among the operators. The techniques apply to a range of scenarios, including Pauli, Heisenberg-Weyl, and fermionic operators, and generalize to higher order moments and multiplicative uncertainty relations.

Entanglement Detection with Trace Polynomials.

We provide a systematic method for nonlinear entanglement detection based on trace polynomial inequalities. In particular, this allows us to employ multipartite witnesses for the detection of bipartite states, and vice versa. We identify pairs of entangled states and witnesses for which linear detection fails, but for which nonlinear detection succeeds. With the trace polynomial formulation a great variety of witnesses arise from immanant inequalities, which can be implemented in the laboratory through the randomized measurements toolbox.

Intrahepatic neutrophil accumulation and extracellular trap formation are associated with posthepatectomy liver failure.

BACKGROUND: Posthepatectomy liver failure (PHLF) represents a life-threatening complication with limited therapeutic options. Neutrophils play a critical and dynamic role during regeneratory processes, but their role in human liver regeneration is incompletely understood, especially as underlying liver disease, detectable in the majority of patients, critically affects hepatic regeneration. Here we explored intrahepatic neutrophil accumulation and neutrophil extracellular traps (NETs) in patients with PHLF and validated the functional relevance of NETs in a murine partial hepatectomy (PHx) model. METHODS: We investigated the influx of neutrophils, macrophages, eosinophils, and mast cells and the presence of their respective extracellular traps in liver biopsies of 35 patients undergoing hepatectomy (10 patients with PHLF) before and after the initiation of liver regeneration by fluorescence microscopy. In addition, NET formation and neutrophil activation were confirmed by plasma analysis of 99 patients (24 patients with PHLF) before and up to 5 days after surgery. Furthermore, we inhibited NETs via DNase I in a murine PHx model of mice with metabolically induced liver disease. RESULTS: We detected rapid intrahepatic neutrophil accumulation, elevated levels of myeloperoxidase release, and NET formation in regenerating human livers, with a significantly higher increase of infiltrating neutrophils and NETs in patients with PHLF. Circulating markers of neutrophil activation, including elastase, myeloperoxidase, and citrullinated histone H3, correlated with markers of liver injury. In a murine PHx model, we showed that the inhibition of NET accelerated hepatocyte proliferation and liver regeneration. CONCLUSIONS: Patients with PHLF showed accelerated intrahepatic neutrophil infiltration and NET formation, which were associated with liver damage. Further, we identified postsurgical myeloperoxidase levels as predictive markers for adverse outcomes and observed that blocking NETs in a murine PHx model accelerated tissue regeneration.

An APRI+ALBI Based Multivariable Model as Preoperative Predictor for Posthepatectomy Liver Failure.

OBJECTIVE AND BACKGROUND: Clinically significant posthepatectomy liver failure (PHLF B+C) remains the main cause of mortality after major hepatic resection. This study aimed to establish an APRI+ALBI, aspartate aminotransferase to platelet ratio (APRI) combined with albumin-bilirubin grade (ALBI), based multivariable model (MVM) to predict PHLF and compare its performance to indocyanine green clearance (ICG-R15 or ICG-PDR) and albumin-ICG evaluation (ALICE). METHODS: 12,056 patients from the National Surgical Quality Improvement Program (NSQIP) database were used to generate a MVM to predict PHLF B+C. The model was determined using stepwise backwards elimination. Performance of the model was tested using receiver operating characteristic curve analysis and validated in an international cohort of 2,525 patients. In 620 patients, the APRI+ALBI MVM, trained in the NSQIP cohort, was compared with MVM's based on other liver function tests (ICG clearance, ALICE) by comparing the areas under the curve (AUC). RESULTS: A MVM including APRI+ALBI, age, sex, tumor type and extent of resection was found to predict PHLF B+C with an AUC of 0.77, with comparable performance in the validation cohort (AUC 0.74). In direct comparison with other MVM's based on more expensive and time-consuming liver function tests (ICG clearance, ALICE), the APRI+ALBI MVM demonstrated equal predictive potential for PHLF B+C. A smartphone application for calculation of the APRI+ALBI MVM was designed. CONCLUSION: Risk assessment via the APRI+ALBI MVM for PHLF B+C increases preoperative predictive accuracy and represents an universally available and cost-effective risk assessment prior to hepatectomy, facilitated by a freely available smartphone app.

Bell Inequalities with Overlapping Measurements.

Which nonlocal correlations can be obtained, when a party has access to more than one subsystem? While traditionally nonlocality deals with spacelike separated parties, this question becomes important with quantum technologies that connect devices by means of small shared systems. Here, we study Bell inequalities where measurements of different parties can have overlap. This allows us to accommodate problems in quantum information such as the existence of quantum error correction codes in the framework of nonlocality. The scenarios considered show an interesting behavior with respect to Hilbert space dimension, overlap, and symmetry.

Absolutely Maximally Entangled States of Seven Qubits Do Not Exist.

Pure multiparticle quantum states are called absolutely maximally entangled if all reduced states obtained by tracing out at least half of the particles are maximally mixed. We provide a method to characterize these states for a general multiparticle system. With that, we prove that a seven-qubit state whose three-body marginals are all maximally mixed, or equivalently, a pure ((7,1,4))_{2} quantum error correcting code, does not exist. Furthermore, we obtain an upper limit on the possible number of maximally mixed three-body marginals and identify the state saturating the bound. This solves the seven-particle problem as the last open case concerning maximally entangled states of qubits.

Characterizing Ground and Thermal States of Few-Body Hamiltonians.

The question whether a given quantum state is a ground or thermal state of a few-body Hamiltonian can be used to characterize the complexity of the state and is important for possible experimental implementations. We provide methods to characterize the states generated by two- and, more generally, k-body Hamiltonians as well as the convex hull of these sets. This leads to new insights into the question of which states are uniquely determined by their marginals and to a generalization of the concept of entanglement. Finally, certification methods for quantum simulation can be derived.

Does a quality management system improve quality in primary care practices in Switzerland? A longitudinal study.

OBJECTIVES: To examine the effectiveness of the quality management programme--European Practice Assessment--in primary care in Switzerland. DESIGN: Longitudinal study with three points of measurement. SETTING: Primary care practices in Switzerland. PARTICIPANTS: In total, 45 of 91 primary care practices completed European Practice Assessment three times. OUTCOMES: The interval between each assessment was around 36 months. A variance analyses for repeated measurements were performed for all 129 quality indicators from the domains: 'infrastructure', 'information', 'finance', and 'quality and safety' to examine changes over time. RESULTS: Significant improvements were found in three of four domains: 'quality and safety' (F=22.81, p<0.01), 'information' (F=27.901, p<0.01) and 'finance' (F=4.073, p<0.02). The 129 quality indicators showed a significant improvement within the three points of measurement (F=33.864, p<0.01). CONCLUSIONS: The European Practice Assessment for primary care practices thus provides a functioning quality management programme, focusing on the sustainable improvement of structural and organisational aspects to promote high quality of primary care. The implementation of a quality management system which also includes a continuous improvement process would give added value to provide good care.

The putative role of the non-gastric H⁺/K⁺-ATPase ATP12A (ATP1AL1) as anti-apoptotic ion transporter: effect of the H⁺/K⁺ ATPase inhibitor SCH28080 on butyrate-stimulated myelomonocytic HL-60 cells.

BACKGROUND/AIMS: The ATP12A gene codes for a non-gastric H(+)/K(+) ATPase, which is expressed in a wide variety of tissues. The aim of this study was to test for the molecular and functional expression of the non-gastric H(+)/K(+) ATPase ATP12A/ATP1AL1 in unstimulated and butyrate-stimulated (1 and 10 mM) human myelomonocytic HL-60 cells, to unravel its potential role as putative apoptosis-counteracting ion transporter as well as to test for the effect of the H(+)/K(+) ATPase inhibitor SCH28080 in apoptosis. METHODS: Real-time reverse-transcription PCR (qRT-PCR) was used for amplification and cloning of ATP12A transcripts and to assess transcriptional regulation. BCECF microfluorimetry was used to assess changes of intracellular pH (pHi) after acute intracellular acid load (NH4Cl prepulsing). Mean cell volumes (MCV) and MCV-recovery after osmotic cell shrinkage (Regulatory Volume Increase, RVI) were assessed by Coulter counting. Flow-cytometry was used to measure MCV (Coulter principle), to assess apoptosis (phosphatidylserine exposure to the outer leaflet of the cell membrane, caspase activity, 7AAD staining) and differentiation (CD86 expression). RESULTS: We found by RT-PCR, intracellular pH measurements, MCV measurements and flow cytometry that ATP12A is expressed in human myelomonocytic HL-60 cells. Treatment of HL-60 cells with 1 mM butyrate leads to monocyte-directed differentiation whereas higher concentrations (10 mM) induce apoptosis as assessed by flow-cytometric determination of CD86 expression, caspase activity, phosphatidylserine exposure on the outer leaflet of the cell membrane and MCV measurements. Transcriptional up-regulation of ATP12A and CD86 is evident in 1 mM butyrate-treated HL-60 cells. The H(+)/K(+) ATPase inhibitor SCH28080 (100 µM) diminishes K(+)-dependent pHi recovery after intracellular acid load and blocks RVI after osmotic cell shrinkage. After seeding, HL-60 cells increase their MCV within the first 24 h in culture, and subsequently decrease it over the course of the next 48 h. This effect can be observed in the overall- and non-apoptotic fraction of both untreated and 1 mM butyrate-treated HL-60 cells, but not in 1 mM butyrate-stimulated phosphatidylserine-positive cells. These cells do not shrink from 24 h to 72 h and have finally a higher MCV than untreated cells unless they are exposed to SCH28080. 10 mM butyrate induces apoptosis within 24 h. CONCLUSION: In summary we show that in HL-60 cells ATP12A is a functionally active H(+)/K(+) ATPase that may counteract events during early apoptosis like intracellular acidosis, loss of intracellular K(+) ions and apoptotic volume decrease. Its expression and/or susceptibility to the H(+)/K(+) ATPase inhibitor SCH28080 becomes most evident in cells exposing phosphatidylserine on the outer leaflet of the cell membrane and therefore during early apoptosis.

Congruency of diabetes care with the Chronic Care Model in different Swiss health care organisations from the patients' perspective: a cross sectional study.

QUESTIONS UNDER STUDY: Patients with chronic illnesses like diabetes mellitus benefit from care following the concept of the Chronic Care Model. To improve quality and to be responsive to patients' needs reliable data on patients' view of care in different healthcare settings are required. We evaluated the congruency of diabetes care with the Chronic Care Model between managed and non-managed care organisations from a patient's perspective. METHODS: We compared type 2 diabetes patients from non-managed care with a managed care organisation in Switzerland. We evaluated differences between these settings with the Patient Assessment of Chronic Illness Care 5A questionnaire (PACIC 5A; scale from 1-5) that combines the PACIC and the 5A-approach of physicians' counselling. RESULTS: 374 patients completed the PACIC 5A (326 from non-managed care settings, 48 from managed care). The adjusted average PACIC summary score was 3.18 in the non-managed care compared to 3.49 in the managed care sample (p = 0.046). Managed care patients scored significantly higher in the subscales goal setting (2.86 vs 3.29; p = 0.015), advice (3.23 vs 3.64; p = 0.014), assist (2.98 vs 3.44; p = 0.016) and arrange (2.50 vs 2.88; p = 0.049). CONCLUSIONS: Our data from different health care settings suggest that managed care is recognised by type 2 diabetes patients as care that is more congruent with the Chronic Care Model and offers more intense behavioural counselling and self-management support compared with usual primary care in Switzerland. Future research should evaluate larger, more comparable patient groups.

Safety climate and its association with office type and team involvement in primary care.

OBJECTIVE: To assess differences in safety climate perceptions between occupational groups and types of office organization in primary care. METHODS: Primary care physicians and nurses working in outpatient offices were surveyed about safety climate. Explorative factor analysis was performed to determine the factorial structure. Differences in mean climate scores between staff groups and types of office were tested. Logistic regression analysis was conducted to determine predictors for a 'favorable' safety climate. RESULTS: 630 individuals returned the survey (response rate, 50%). Differences between occupational groups were observed in the means of the 'team-based error prevention'-scale (physician 4.0 vs. nurse 3.8, P < 0.001). Medical centers scored higher compared with single-handed offices and joint practices on the 'team-based error prevention'-scale (4.3 vs. 3.8 vs. 3.9, P < 0.001) but less favorable on the 'rules and risks'-scale (3.5 vs. 3.9 vs. 3.7, P < 0.001). Characteristics on the individual and office level predicted favorable 'team-based error prevention'-scores. Physicians (OR = 0.4, P = 0.01) and less experienced staff (OR 0.52, P = 0.04) were less likely to provide favorable scores. Individuals working at medical centers were more likely to provide positive scores compared with single-handed offices (OR 3.33, P = 0.001). The largest positive effect was associated with at least monthly team meetings (OR 6.2, P < 0.001) and participation in quality circles (OR 4.49, P < 0.001). CONCLUSIONS: Results indicate that frequent quality circle participation and team meetings involving all team members are effective ways to strengthen safety climate in terms of team-based strategies and activities in error prevention.