The Next Step

In traditional radiology practice, reports are typically dictated and then transcribed.? While the free-text reports represent the semantic knowledge interpreted and conveyed by a physician, the information can be hard to access. The advantages of representing medical data in a structured format using standard terminology are clearly recognized. These include the ability to implement a standardized electronic medical record, automatically invoke medical guidelines when appropriate, and conduct outcomes research. Standard structured reports facilitate intelligent indexing, searching, and retrieval of documents from clinical databases. Recent attempts have been made in the industry to enable structured data entry using preformatted templates, but these have yet to gain widespread acceptance.1,2 These preformatted templates do not necessarily use standard nomenclature and tend to disturb a clinician’s normal workflow. This paper presents a prototype system that incorporates the benefits of both dictated free-text reports and standard, structured reports

Ultrahigh Vacuum Chamber for Synchrotron X-ray Diffraction from Films Adsorbed on Single-crystal Surfaces

An ultrahigh vacuum chamber has been developed for structural analysis of adsorbed films and single‐crystal surfaces using synchrotron x‐ray diffraction. It is particularly well suited for investigations of physisorbed and other weakly bound films. The chamber is small enough to transport and mount directly on a standard four‐axis diffractometer and can also be used independently of the x‐ray diffractometer. A low‐current, pulse‐counting, low‐energy electron diffraction/Auger spectroscopy system with a position‐sensitive detector enables in situ characterization of the film and substrate while the sample is located at the x‐ray scattering position. A closed‐cycle He refrigerator and electron bombardment heater provide controlled substrate temperatures from 30 to 1300 K. The chamber is also equipped with an ion sputter gun, a quadrupole mass spectrometer, and a gas handling system. Details of the design and operation of the instrument are described. To demonstrate the performance of the instrument, we present some preliminary results of a study of Xe physisorbed on the Ag(111) surface

Location of Cerium in Coal-Combustion Fly Ashes: Implications for Recovery of Lanthanides

Given the worldwide demand for rare earth elements (REEs) in modern electronics, all potential sources of the REEs should be investigated. Coal-combustion fly ash represents a potential source of REEs. Fly ashes, derived from the combustion of coals from Kentucky in the United States and Jungar in China, were examined by wavelength-dispersive spectrometry electron microprobe analysis of epoxy-bound polished pellets. From previous studies, it was known that the REEs did not show any enrichment relative to flue gas temperature at the point of collection or to the particle size, that is, external surface area, of the particles. Cerium, the most abundant of the REEs in these fly ashes, was used as a proxy for the entire suite of REEs. For fly ashes from both sources, Ce is disbursed throughout the glassy fly ash particles. For fly ash processing with respect to the recovery of REEs, this implies that the entire particle must be leached to maximize the element recovery

Evaluation of antibiotic supply decisions by community pharmacists in Thailand: a vignette study

In Thailand, antibiotics are available lawfully from community pharmacies without a prescription. Inappropriate supply of antibiotics from Thai community pharmacies to the public for common, self-limiting diseases has been reported. The study aimed to evaluate the appropriateness of antibiotics selected by community pharmacists in Thailand in response to vignettes. A cross-sectional survey of community pharmacists across Thailand was conducted using a self-administered questionnaire including nine case vignettes with three conditions, namely upper respiratory infections (URIs), acute diarrhoea and simple wounds. A total of 208 questionnaires were completed and analysed (20.8% response rate). In response to vignettes relating to URIs, 50.8% of pharmacist recommendations were not in accordance with antibiotic guidelines. Inappropriate recommendations for diarrhoea and wound cases were 20.8% and 16.7%, respectively. A higher proportion of younger pharmacists, those with less experience, Pharm. D. graduate pharmacists, employee pharmacists and those pharmacists who worked in a chain pharmacy were more likely to recommend appropriate antibiotic treatment in response to the vignettes (p < 0.05). These findings will be useful to promote educational interventions for community pharmacists regarding common infectious disease management in order to improve appropriate antibiotic use

Through the looking glass: public and professional perspectives on patient-centred professionalism in modern-day community pharmacy

This paper presents five consultation workshops with 29 community pharmacists, stakeholders and patients that examined "patient-centred professionalism" in terms of pharmacists' working day and environment. The concept is ill-defined in both medical and pharmacy literature and the study aimed to clarify the situated nature of the term for patients and health professionals across settings. Workshops were supported by bio-photographic datasets of "in-situ" practice and Nominal Group Work. The thematic content analyses led to the following aspects: building caring relationships; managing external forces; the effects of space and environment, and different roles and expectations. The study reveals how patient-centred professionalism cannot be defined in any singular or stationary sense, but should be seen as a "moveable feast", best understood through everyday examples of practice and interaction, in relation to whose experience is being expressed, and whose needs considered. The phrase is being mobilised by a whole set of interests and stakeholders to reshape practice, the effect of which remains both uncertain and contested. Whilst patients prioritise a quick and efficient dispensing service from knowledgeable pharmacists, pharmacists rail against increasing public demands and overtly formalised consultations that take them away from the dispensary where the defining aspects of their professionalism lie. URN: urn:nbn:de:0114-fqs100177Unser Beitrag stellt die Ergebnisse aus insgesamt fünf Workshops mit 29 Apotheker/innen, Patient/innen und weiteren Akteuren vor, die sich mit "Patient/innen-zentrierter Versorgung" in der Alltagsarbeit und -umgebung von Apotheker/innen befassten. Dieses Konzept ist in der relevanten Literatur nur ungenügend definiert, und ein Ziel der Studie war, dessen situativen Charakter für Patient/innen und im Gesundheitssystem Tätige zu präzisieren. In den Workshops kamen Fotografien aus der Alltagspraxis und spezifische Gruppenarbeitsverfahren zum Einsatz. Im Beitrag werden nach einer Information über die Teilnehmenden die Ergebnisse der thematischen Inhaltsanalyse zusammengefasst, die die folgenden Schwerpunkte erbrachte: Aufbau von Beziehungen mit Patient/innen, Umgang mit externen Einflussgrößen, (räumliche) Umgebungseffekte und Unterschiedlichkeit von Rollen und Erwartungen. Die Ergebnisse zeigen, dass "Patient/innen-zentrierte Versorgung" nicht in einer singulären oder statischen Weise definiert werden kann, sondern am besten nachvollziehbar ist entlang von Beispielen aus der Alltagspraxis und von Alltagsinteraktionen, abhängig davon, wessen Erfahrungen ausgedrückt und wessen Bedürfnisse im Fokus stehen sollen. Dieses Verständnis trifft für eine Vielzahl an Interessen und Akteuren zu, um Praxis zu rekonzeptualisieren, die zugleich auch fragil und strittig ist: Während Patient/innen möglichst schnelle und effektive Dienstleistungen von sachkundigen Apotheker/innen erwarten, wenden diese sich gegen wachsende öffentliche Ansprüche und zunehmend formalisierte Beratungen, die sie von der Art von Arbeit entfernen, die Kern ihrer professionellen Identität ist. URN: urn:nbn:de:0114-fqs100177Este documento presenta cinco talleres de consulta con 29 farmacéuticos comunitarios, los promotores y los pacientes que examinaron "el profesionalismo centrado en el paciente" en términos de jornada de trabajo de los farmacéuticos y el medio ambiente. El concepto está mal definido, tanto en la literatura médica y farmacéutica, y el estudio tuvo como objetivo aclarar la naturaleza situada del término en los pacientes y en los profesionales de la salud en diferentes contextos. Los talleres fueron apoyados por conjuntos de datos bio-fotográficas de la práctica "in-situ" y el Grupo Nominal de Trabajo. El análisis de contenido temático c a los siguientes aspectos: creación de relaciones afectuosas; gestión de fuerzas externas; los efectos del espacio y el medio ambiente, y roles y expectativas diferentes. El estudio revela cómo el profesionalismo centrado en el paciente no puede definirse en un sentido singular o estacional, pero debe ser visto como “fiesta ambulante”, mejor entendida a través de ejemplos de la vida diaria y la interacción, en relación con cuya experiencia se expresa, y cuyas necesidades considera. La frase está siendo movilizada por un juego entero de intereses y de los promotores para reformar la práctica, el efecto del cual sigue siendo incierto y puesto en debate. Mientras los pacientes priorizan un servicio de distribución rápido y eficiente de parte de farmacéuticos bien informados, los farmacéuticos critican severamente las crecientes demandas públicas y abiertamente formalizan consultas que se los llevan lejos del dispensario donde radican los aspectos de definición de su profesionalismo. URN: urn:nbn:de:0114-fqs10017

Infrared Properties of a Complete Sample of Star-Forming Dwarf Galaxies

We present a study of a large, statistically complete sample of star-forming dwarf galaxies using mid-infrared observations from the {\it Spitzer Space Telescope}. The relationships between metallicity, star formation rate (SFR) and mid-infrared color in these systems show that the galaxies span a wide range of properties. However, the galaxies do show a deficit of 8.0 \um\ polycyclic aromatic hydrocarbon emission as is apparent from the median 8.0 \um\ luminosity which is only 0.004 \lstarf\ while the median $B$-band luminosity is 0.05 \lstarb. Despite many of the galaxies being 8.0 \um\ deficient, there is about a factor of 4 more extremely red galaxies in the [3.6] $-$ [8.0] color than for a sample of normal galaxies with similar optical colors. We show correlations between the [3.6] $-$ [8.0] color and luminosity, metallicity, and to a lesser extent SFRs that were not evident in the original, smaller sample studied previously. The luminosity--metallicity relation has a flatter slope for dwarf galaxies as has been indicated by previous work. We also show a relationship between the 8.0 \um\ luminosity and the metallicity of the galaxy which is not expected given the competing effects (stellar mass, stellar population age, and the hardness of the radiation field) that influence the 8.0 \um\ emission. This larger sample plus a well-defined selection function also allows us to compute the 8.0 \um\ luminosity function and compare it with the one for the local galaxy population. Our results show that below 10$^{9}$ $L$\solar, nearly all the 8.0 \um\ luminosity density of the local universe arises from dwarf galaxies that exhibit strong \ha\ emission -- i.e., 8.0 \um\ and \ha\ selection identify similar galaxy populations despite the deficit of 8.0 \um\ emission observed in these dwarfs.Comment: 13 pages, 11 figures, Published in Ap

Teleradiology as a Foundation for an Enterprise-wide Health Care Delivery System

An effective, integrated telemedicine system has been developed that allows (a) teleconsultation between local primary health care providers (primary care physicians and general radiologists) and remote imaging subspecialists and (b) active patient participation related to his or her medical condition and patient education. The initial stage of system development was a traditional teleradiology consultation service between general radiologists and specialists; this established system was expanded to include primary care physicians and patients. The system was developed by using a well-defined process model, resulting in three integrated modules: a patient module, a primary health care provider module, and a specialist module. A middle agent layer enables tailoring and customization of the modules for each specific user type. Implementation by using Java and the Common Object Request Broker Architecture standard facilitates platform independence and interoperability. The system supports (a) teleconsultation between a local primary health care provider and an imaging subspecialist regardless of geographic location and (b) patient education and online scheduling. The developed system can potentially form a foundation for an enterprise-wide health care delivery system. In such a system, the role of radiologist specialists is enhanced from that of a diagnostician to the management of a patient’s process of care

Microcraters in aluminum foils exposed by Stardust

We will present preliminary results on the nature and size frequency distribution of microcraters that formed in aluminum foils during the flyby of comet Wild 2 by the Stardust spacecraft

Near-Earth injection of MeV electrons associated with intense dipolarization electric fields: Van Allen Probes observations.

Substorms generally inject tens to hundreds of keV electrons, but intense substorm electric fields have been shown to inject MeV electrons as well. An intriguing question is whether such MeVelectron injections can populate the outer radiation belt. Here we present observations of a substorm injection of MeV electrons into the inner magnetosphere. In the premidnight sector at L ∼ 5.5, Van Allen Probes (Radiation Belt Storm Probes)-A observed a large dipolarization electric field (50 mV/m) over ∼40 s and a dispersionless injection of electrons up to ∼3 MeV. Pitch angle observations indicated betatron acceleration of MeV electrons at the dipolarization front. Corresponding signals of MeV electron injection were observed at LANL-GEO, THEMIS-D, and GOES at geosynchronous altitude. Through a series of dipolarizations, the injections increased the MeV electron phase space density by 1 order of magnitude in less than 3 h in the outer radiation belt (L &gt; 4.8). Our observations provide evidence that deep injections can supply significant MeV electrons