Availability of Advance Care Planning Documentation for Older Emergency Department Patients: A Cross-Sectional Study

Introduction: Increasing advance care planning (ACP) among older adults is a national priority. Documentation of ACP in the electronic health record (EHR) is particularly important during emergency care

The reproduction of gender differences in early career choices and professional identity of young dentist in Finland

Introduction For over the last 20 years, approximately 70% of working dentists in Finland have been women. However, there is internal division of the profession along gender lines. Female dentists work more often in the public sector and male dentists in the private sector. The aim of this study was to investigate the gender differences in young dentists' early career choices, specialization plans, values and perceptions of professional identity. Materials and methods The data were taken from a national e-mail questionnaire study called "Young Dentist," which was sent to 458 dentists who had received their licence to practise dentistry in 2014-2016 from all four universities with dental curricula in Finland. A total of 52% young dentists (n = 238) answered the questionnaire. Results and discussion The results indicated that whereas female dentists were more likely to perceive themselves as comforters, social workers and health promoters, male dentists tended to perceive themselves as technicians. These professional identities were interrelated with early-stage career choices in which female dentists worked more often in the public than in the private sector when compared to male dentists. There were also clear gender differences in the importance of values and the specialization plans of the young dentists. Conclusion Young dentists in Finland make career choices and develop professional identity in accordance with the attributes traditionally associated with cultural ideals related to femininity and masculinity.Peer reviewe

Tomonaga-Luttinger parameters for quantum wires

The low-energy properties of a homogeneous one-dimensional electron system are completely specified by two Tomonaga-Luttinger parameters $K_{\rho}$ and $v_{\sigma}$. In this paper we discuss microscopic estimates of the values of these parameters in semiconductor quantum wires that exploit their relationship to thermodynamic properties. Motivated by the recognized similarity between correlations in the ground state of a one-dimensional electron liquid and correlations in a Wigner crystal, we evaluate these thermodynamic quantities in a self-consistent Hartree-Fock approximation. According to our calculations, the Hartree-Fock approximation ground state is a Wigner crystal at all electron densities and has antiferromagnetic order that gradually evolves from spin-density-wave to localized in character as the density is lowered. Our results for $K_{\rho}$ are in good agreement with weak-coupling perturbative estimates $K_{\rho}^{pert}$ at high densities, but deviate strongly at low densities, especially when the electron-electron interaction is screened at long distances. $K_{\rho}^{pert}\sim n^{1/2}$ vanishes at small carrier density $n$ whereas we conjecture that $K_{\rho}\to 1/2$ when $n\to 0$, implying that $K_{\rho}$ should pass through a minimum at an intermediate density. Observation of such a non-monotonic dependence on particle density would allow to measure the range of the microscopic interaction. In the spin sector we find that the spin velocity decreases with increasing interaction strength or decreasing $n$. Strong correlation effects make it difficult to obtain fully consistent estimates of $v_{\sigma}$ from Hartree-Fock calculations. We conjecture that v_{\sigma}/\vf\propto n/V_0 in the limit $n\to 0$ where $V_0$ is the interaction strength.Comment: RevTeX, 23 pages, 8 figures include

What is the evidence for the management of patients along the pathway from the emergency department to acute admission to reduce unplanned attendance and admission? An evidence synthesis

Background Globally, the rate of emergency hospital admissions is increasing. However, little evidence exists to inform the development of interventions to reduce unplanned Emergency Department (ED) attendances and hospital admissions. The objective of this evidence synthesis was to review the evidence for interventions, conducted during the patient’s journey through the ED or acute care setting, to manage people with an exacerbation of a medical condition to reduce unplanned emergency hospital attendance and admissions. Methods A rapid evidence synthesis, using a systematic literature search, was undertaken in the electronic data bases of MEDLINE, EMBASE, CINAHL, the Cochrane Library and Web of Science, for the years 2000–2014. Evidence included in this review was restricted to Randomised Controlled Trials (RCTs) and observational studies (with a control arm) reported in peer-reviewed journals. Studies evaluating interventions for patients with an acute exacerbation of a medical condition in the ED or acute care setting which reported at least one outcome related to ED attendance or unplanned admission were included. Results Thirty papers met our inclusion criteria: 19 intervention studies (14 RCTs) and 11 controlled observational studies. Sixteen studies were set in the ED and 14 were conducted in an acute setting. Two studies (one RCT), set in the ED were effective in reducing ED attendance and hospital admission. Both of these interventions were initiated in the ED and included a post-discharge community component. Paradoxically 3 ED initiated interventions showed an increase in ED re-attendance. Six studies (1 RCT) set in acute care settings were effective in reducing: hospital admission, ED re-attendance or re-admission (two in an observation ward, one in an ED assessment unit and three in which the intervention was conducted within 72 h of admission). Conclusions There is no clear evidence that specific interventions along the patient journey from ED arrival to 72 h after admission benefit ED re-attendance or readmission. Interventions targeted at high-risk patients, particularly the elderly, may reduce ED utilization and warrant future research. Some interventions showing effectiveness in reducing unplanned ED attendances and admissions are delivered by appropriately trained personnel in an environment that allows sufficient time to assess and manage patients

Developing a Risk Model to Target High-Risk Preventive Interventions for Sexual Assault Victimization Among Female U.S. Army Soldiers

Sexual violence victimization is a significant problem among female U.S. military personnel. Preventive interventions for high-risk individuals might reduce prevalence but would require accurate targeting. We attempted to develop a targeting model for female Regular U.S. Army soldiers based on theoretically guided predictors abstracted from administrative data records. As administrative reports of sexual assault victimization are known to be incomplete, parallel machine learning models were developed to predict administratively recorded (in the population) and self-reported (in a representative survey) victimization. Capture–recapture methods were used to combine predictions across models. Key predictors included low status, crime involvement, and treated mental disorders. Area under the receiver operating characteristic curve was .83–.88. Between 33.7% and 63.2% of victimizations occurred among soldiers in the highest risk ventile (5%). This high concentration of risk suggests that the models could be useful in targeting preventive interventions, although final determination would require careful weighing of intervention costs, effectiveness, and competing risks