Determinants of guideline use in primary care physical therapy: a cross-sectional survey of attitudes, knowledge, and behavior

Background Understanding of attitudes, knowledge, and behavior related to evidence-based practice (EBP) and use of evidence-based clinical practice guidelines in primary care physical therapy is limited. Objectives The objectives of this study were: (1) to investigate self-reported attitudes, knowledge, behavior, prerequisites, and barriers related to EBP and guideline use among physical therapists in primary care and (2) to explore associations of self-reported use of guidelines with these social cognitive factors along with demographic and workplace characteristics. Design This was a cross-sectional survey. Methods A web-based survey of 419 physical therapists in primary care in western Sweden was performed. Multiple logistic regression analysis was performed to examine factors associated with guideline use. Results The response rate was 64.7%. Most respondents had positive attitudes toward EBP and guidelines: 90% considered EBP necessary, and 96% considered guidelines important. Approximately two thirds reported confidence in finding and using evidence. One third reported being aware of guidelines. Thirteen percent knew where to find guidelines, and only 9% reported having easy access to guidelines. Fewer than half reported using guidelines frequently. The most important barriers to using guidelines were lack of time, poor availability, and limited access to guidelines. Young age and brief work experience were associated with positive attitudes toward EBP. A postgraduate degree was associated with higher application of EBP. Positive attitudes, awareness of guidelines, considering guidelines to facilitate practice, and knowing how to integrate patient preferences with guideline use were associated with frequent use of guidelines. Limitations Data were self-reported, which may have increased the risk of social desirability bias. Conclusions Use of guidelines was not as frequent as could be expected in view of the positive attitudes toward EBP and guidelines among physical therapists. Awareness of and perceived access to guidelines were limited. The identified determinants can be addressed when developing guideline implementation strategies

Towards green 3D-microfabrication of Bio-MEMS devices using ADEX dry film photoresists

Current trends in miniaturized diagnostics indicate an increasing demand for large quantities of mobile devices for health monitoring and point-of-care diagnostics. This comes along with a need for rapid but preferably also green microfabrication. Dry film photoresists (DFPs) promise low-cost and greener microfabrication and can partly or fully replace conventional silicon-technologies being associated with high-energy demands and the intense use of toxic and climate-active chemicals. Due to their mechanical stability and superior film thickness homogeneity, DFPs outperform conventional spin-on photoresists, such as SU-8, especially when three-dimensional architectures are required for micro-analytical devices (e.g. microfluidics). In this study, we utilize the commercial epoxy-based DFP ADEX to demonstrate various application scenarios ranging from the direct modification of microcantilever beams via the assembly of microfluidic channels to lamination-free patterning of DFPs, which employs the DFP directly as a substrate material. Finally, kinked, bottom-up grown silicon nanowires were integrated in this manner as prospective ion-sensitive field-effect transistors in a bio-probe architecture directly on ADEX substrates. Hence, we have developed the required set of microfabrication protocols for such an assembly comprising metal thin film deposition, direct burn-in of lithography alignment markers, and polymer patterning on top of the DFP

Towards Green 3D-Microfabrication of Bio-MEMS Devices Using ADEX Dry Film Photoresists

Current trends in miniaturized diagnostics indicate an increasing demand for large quantities of mobile devices for health monitoring and point-of-care diagnostics. This comes along with a need for rapid but preferably also green microfabrication. Dry film photoresists (DFPs) promise low-cost and greener microfabrication and can partly or fully replace conventional silicon-technologies being associated with high-energy demands and the intense use of toxic and climate-active chemicals. Due to their mechanical stability and superior film thickness homogeneity, DFPs outperform conventional spin-on photoresists, such as SU-8, especially when three-dimensional architectures are required for micro-analytical devices (e.g. microfluidics). In this study, we utilize the commercial epoxy-based DFP ADEX to demonstrate various application scenarios ranging from the direct modification of microcantilever beams via the assembly of microfluidic channels to lamination-free patterning of DFPs, which employs the DFP directly as a substrate material. Finally, kinked, bottom-up grown silicon nanowires were integrated in this manner as prospective ion-sensitive field-effect transistors in a bio-probe architecture directly on ADEX substrates. Hence, we have developed the required set of microfabrication protocols for such an assembly comprising metal thin film deposition, direct burn-in of lithography alignment markers, and polymer patterning on top of the DFP

Parent and Patient Satisfaction after Treatment for Supracondylar Humerus Fractures in 139 Children: No Difference between Skeletal Traction and Crossed Pin Fixation at Long-Term Followup

Aim. The aim of this study was to see whether the benefits of crossed wire fixation over skeletal traction in the treatment of pediatric supracondylar humerus fractures (SCHF) were mirrored in the children's or their caregivers' rating of the experience. Methods. As part of a study of the clinical outcome of SCHF, all the patients and the parents were asked to rate their experience of the treatment on a visual analogue scale (VAS). Results. There was no difference in the patients' or the parents' experience between the treatment groups. However there was a difference between the parents with children who experienced a neurovascular complication (mean VAS 6.1) and those that did not (mean VAS 4.3, P = 0.03). The boys rated the experience as less negative (mean VAS 3.6) than the girls (mean VAS 4.7, P = 0.02). Conclusion. In the long term, avoiding complications was more important to the parents than the choice of treatment for SCHF in the children

A Unified Quantum NOT Gate

We study the feasibility of implementing a quantum NOT gate (approximate) when the quantum state lies between two latitudes on the Bloch's sphere and present an analytical formula for the optimized 1-to-$M$ quantum NOT gate. Our result generalizes previous results concerning quantum NOT gate for a quantum state distributed uniformly on the whole Bloch sphere as well as the phase covariant quantum state. We have also shown that such 1-to-$M$ optimized NOT gate can be implemented using a sequential generation scheme via matrix product states (MPS)

Gyroscopic motion of superfluid trapped atomic condensates

The gyroscopic motion of a trapped Bose gas containing a vortex is studied. We model the system as a classical top, as a superposition of coherent hydrodynamic states, by solution of the Bogoliubov equations, and by integration of the time-dependent Gross-Pitaevskii equation. The frequency spectrum of Bogoliubov excitations, including quantum frequency shifts, is calculated and the quantal precession frequency is found to be consistent with experimental results, though a small discrepancy exists. The superfluid precession is found to be well described by the classical and hydrodynamic models. However the frequency shifts and helical oscillations associated with vortex bending and twisting require a quantal treatment. In gyroscopic precession, the vortex excitation modes $m=\pm 1$ are the dominant features giving a vortex kink or bend, while the $m=+2$ is found to be the dominant Kelvin wave associated with vortex twisting.Comment: 18 pages, 7 figures, 1 tabl

Sex-dependent influence of endogenous estrogen in pulmonary hypertension

Rationale: The incidence of pulmonary arterial hypertension (PAH) is greater in women suggesting estrogens may play a role in the disease pathogenesis. Experimentally, in males exogenously administered estrogen can protect against PH; however in models that display female susceptibility estrogens may play a causative role. Objectives: To clarify the influence of endogenous estrogen and gender in PH and assess the therapeutic potential of a clinically available aromatase inhibitor. Methods: We interrogated the effect of reduced endogenous estrogen in males and females using the aromatase inhibitor, anastrozole, in two models of PH; the hypoxic mouse and Sugen 5416/hypoxic rat. We also determined the effects of gender on pulmonary expression of aromatase in these models and in lungs from PAH patients. Results: Anastrozole attenuated PH in both models studied, but only in females. To verify this effect was due to reduced estrogenic activity we confirmed that in hypoxic mice inhibition of estrogen receptor alpha also has a therapeutic effect specifically in females. Female rodent lung displays increased aromatase and decreased BMPR2 and Id1 expression compared to male. Anastrozole treatment reversed the impaired BMPR2 pathway in females. Increased aromatase expression was also detected in female human pulmonary artery smooth muscle cells compared to male. Conclusions: The unique phenotype of female pulmonary arteries facilitates the therapeutic effects of anastrozole in experimental PH confirming a role for endogenous estrogen in the disease pathogenesis in females and suggests aromatase inhibitors may have therapeutic potential

Sexual dysfunction in women with type 1 diabetes in Norway: A cross-sectional study on the prevalence and associations with physical and psychosocial complications

Aim To estimate the prevalence of sexual dysfunction in women with type 1 diabetes (T1D) compared with women without diabetes and to analyse associations between sexual dysfunction and the presence of chronic physical diabetes complications, diabetes distress and depression in women with T1D. Methods This cross-sectional study was conducted in Norway, and 171 women with T1D and 60 controls completed the Female Sexual Function Index (FSFI) and the Hospital Anxiety and Depression Scale (HADS). Diabetes distress was assessed with the Problem Areas in Diabetes (PAID) scale. Data on diabetes complications were retrieved from medical records. We performed logistic regression to estimate differences in the prevalence of sexual dysfunction (defined as FSFI ≤26.55) between women with T1D and women without diabetes and to examine associations of sexual dysfunction with chronic diabetes complications, diabetes distress and depression in women with T1D. Results The prevalence of sexual dysfunction was higher in women with T1D (50.3%) compared with the controls (35.0%; unadjusted odds ratio [OR] 1.89 [95% confidence interval (CI) 1.06–3.37]; adjusted OR 1.93 [1.05–3.56]). In women with T1D, sexual dysfunction was associated with both diabetes distress (adjusted OR 1.03 [1.01–1.05]) and depression (adjusted OR 1.28 [1.12–1.46]), but there were no clear associations with chronic diabetes complications (adjusted OR 1.46 [0.67–3.19]). Conclusions This study suggests that sexual dysfunction is more prevalent in women with T1D compared with women without diabetes. The study findings emphasize the importance of including sexual health in relation to diabetes distress and psychological aspects in diabetes care and future research.publishedVersio

Visualizing the needle in the haystack: In situ hybridization with fluorescent dendrimers

In situ hybridization with 3DNA dendrimers is a novel tool for detecting low levels of mRNA in tissue sections and whole embryos. Fluorescently labeled dendrimers were used to identify cells that express mRNA for the skeletal muscle transcription factor MyoD in the early chick embryo. A small population of MyoD mRNA positive cells was found in the epiblast prior to the initiation of gastrulation, two days earlier than previously detected using enzymatic or radiolabeled probes for mRNA. When isolated from the epiblast and placed in culture, the MyoD mRNA positive cells were able to differentiate into skeletal muscle cells. These results demonstrate that DNA dendrimers are sensitive and precise tools for identifying low levels of mRNA in single cells and tissues

Charged particle production in the Pb+Pb system at 158 GeV/c per nucleon

Charged particle multiplicities from high multiplicity central interactions of 158 GeV/nucleon Pb ions with Pb target nuclei have been measured in the central and far forward projectile spectator regions using emulsion chambers. Multiplicities are significantly lower than predicted by Monte Carlo simulations. We examine the shape of the pseudorapidity distribution and its dependence on centrality in detail.Comment: 17 pages text plus 12 figures in postscript 12/23/99 -- Add TeX version of sourc