Spin Asymmetry and Gerasimov-Drell-Hearn Sum Rule for the Deuteron

An explicit evaluation of the spin asymmetry of the deuteron and the associated GDH sum rule is presented which includes photodisintegration, single and double pion and eta production as well. Photodisintegration is treated with a realistic retarded potential and a corresponding meson exchange current. For single pion and eta production the elementary operator from MAID is employed whereas for double pion production an effective Lagrangean approach is used. A large cancellation between the disintegration and the meson production channels yields for the explicit GDH integral a value of 27.31 $\mu$b to be compared to the sum rule value 0.65 $\mu$b.Comment: 4 pages, 5 figures, revtex

Models of OH Maser Variations in U Her

Arecibo spectra of the mainline OH maser emission from U Her over more than a decade show variations of the OH emission over these time scales. These observations are combined with high spatial resolution VLBA maps to investigate the causes of the variations in the velocities of the maser components. Global properties of the dust shell, such as accelerations, variations in the pump and shell-wide magnetic field changes are examined as possibilities, and eliminated. A possible solution to the problem involving plasma turbulence and the local magnetic field is introduced, and the relevant time scales of the turbulence are calculated. The turbulent velocity field yields time scales of the turbulence are calculated. The turbulent velocity field yields time scales that are too long (of order centuries), while the turbulent magnetic field produces variations on appropriate time scales of a few years. A line-of-sight model of the turbulence is developed and investigated. The complete exploration of this solution requires extensive theoretical and observational work. Possible avenues of investigation of the plasma turbulence model are presented.Comment: 23 pages, 17 figures, ApJ: accepted Sept, 199

Development and Pilot of a Checklist for Management of Acute Liver Failure in the Intensive Care Unit

Introduction Acute liver failure (ALF) is an ideal condition for use of a checklist. Our aims were to develop a checklist for the management of ALF in the intensive care unit (ICU) and assess the usability of the checklist among multiple providers. Methods The initial checklist was developed from published guidelines and expert opinion. The checklist underwent pilot testing at 11 academic liver transplant centers in the US and Canada. An anonymous, written survey was used to assess the usability and quality of the checklist. Written comments were used to improve the checklist following the pilot testing period. Results We received 81 surveys involving the management of 116 patients during the pilot testing period. The overall quality of the checklist was judged to be above average to excellent by 94% of users. On a 5-point Likert scale, the majority of survey respondents agreed or agreed strongly with the following checklist characteristics: the checklist was easy to read (99% agreed/agreed strongly), easy to use (97%), items are categorized logically (98%), time to complete the checklist did not interfere with delivery of appropriate and safe patient care (94%) and was not excessively burdensome (92%), the checklist allowed the user the freedom to use his or her clinical judgment (80%), it is a useful tool in the management of acute liver failure (98%). Web-based and mobile apps were developed for use of the checklist at the point of care. Conclusion The checklist for the management of ALF in the ICU was shown in this pilot study to be easy to use, helpful and accepted by a wide variety of practitioners at multiple sites in the US and Canada

Ferromagnetism or slow paramagnetic relaxation in Fe-doped Li3_3N?

We report on isothermal magnetization, M\"ossbauer spectroscopy, and magnetostriction as well as temperature-dependent alternating-current (ac) susceptibility, specific heat, and thermal expansion of single crystalline and polycrstalline Li$_2$(Li$_{1-x}$Fe$_x$)N with $x = 0$ and $x \approx 0.30$. Magnetic hysteresis emerges at temperatures below $T \approx 50\,$K with coercivity fields of up to $\mu_0H = 11.6\,$T at $T = 2\,$K and magnetic anisotropy energies of $310\,$K ($27\,$meV). The ac susceptibility is strongly frequency dependent ($f\,=\,10$--$10,000\,$Hz) and reveals an effective energy barrier for spin reversal of $\Delta E \approx 1100\,$K. The relaxation times follow Arrhenius behavior for $T > 25\,$K. For $T < 10\,$K, however, the relaxation times of $\tau \approx 10^{10}\,$s are only weakly temperature-dependent indicating the relevance of a quantum tunneling process instead of thermal excitations. The magnetic entropy amounts to more than $25\,$J mol$^{-1}_{\rm Fe}\,$K$^{-1}$ which significantly exceeds $R$ln2, the value expected for the entropy of a ground state doublet. Thermal expansion and magnetostriction indicate a weak magneto-elastic coupling in accordance with slow relaxation of the magnetization. The classification of Li$_2$(Li$_{1-x}$Fe$_x$)N as ferromagnet is stressed and contrasted with highly anisotropic and slowly relaxing paramagnetic behavior.Comment: 12 pages, 10 figure

Non-locality and Medium Effects in the Exclusive Photoproduction of Eta Mesons on Nuclei

A relativistic model for the quasifree exclusive photoproduction of $\eta$ mesons on nuclei is extended to include both non-local and medium effects. The reaction is assumed to proceed via the dominant contribution of the S$_{11}$(1535) resonance. The complicated integrals resulting from the non-locality are simplified using a modified version of a method given by Cooper and Maxwell. The non-locality effects are found to affect the magnitude of the cross section. Some possibilities reflecting the effects of the medium on the propagation and properties of the intermediate S$_{11}$ resonance are studied. The effects of allowing the S$_{11}$ to interact with the medium via mean field scalar and vector potentials are considered. Both broadening of width and reduction in mass of the resonance lead to a suppression of the calculated cross sections.Comment: 19 pages, 7 figure

The temporal nature of social context: Insights from the daily lives of patients with HIV

BACKGROUND: Patients\u27 life contexts are increasingly recognized as important, as evidenced by growing attention to the Social Determinants of Health (SDoH). This attention may be particularly valuable for patients with complex needs, like those with HIV, who are more likely to experience age-related comorbidities, mental health or substance use issues. Understanding patient perceptions of their life context can advance SDoH approaches. OBJECTIVES: We sought to understand how aging patients with HIV think about their life context and explored if and how their reported context was documented in their electronic medical records (EMRs). DESIGN: We combined life story interviews and EMR data to understand the health-related daily life experiences of patients with HIV. Patients over 50 were recruited from two US Department of Veterans Affairs HIV clinics. Narrative analysis was used to organize data by life events and health-related metrics. KEY RESULTS: EMRs of 15 participants documented an average of 19 diagnoses and 10 medications but generally failed to include social contexts salient to patients. In interviews, HIV was discussed primarily in response to direct interviewer questions. Instead, participants raised past trauma, current social engagement, and concern about future health with varying salience. This led us to organize the narratives temporally according to past-, present-, or future-orientation. Past-focused narratives dwelled on unresolved experiences with social institutions like the school system, military or marriage. Present-focused narratives emphasized daily life challenges, like social isolation. Future-focused narratives were dominated by concerns that aging would limit activities. CONCLUSIONS: A temporally informed understanding of patients\u27 life circumstances that are the foundation of their individualized SDoH could better focus care plans by addressing contextual concerns salient to patients. Trust-building may be a critical first step in caring for past-focused patients. Present-focused patients may benefit from support groups. Future-focused patients may desire discussing long term care options

Incoherent Photoproduction of η\eta-mesons from the Deuteron near Threshold

Incoherent photoproduction of the $\eta$-meson on the deuteron is studied for photon energies from threshold to 800 MeV. The dominant contribution, the $\gamma$N-$\eta$N amplitude, is described within an isobar model. The final state interaction derived from the CD-Bonn potential is included and found to be important for the description of the production cross section close to threshold. Possible effects from the $\eta N$ final state interaction are discussed.Comment: 11 pages, revtex, including 6 figure

Encouraging Patient Portal Use in the Patient-Centered Medical Home: Three Stakeholder Perspectives

BACKGROUND: Health care organizations are increasingly offering patients access to their electronic medical record and the ability to communicate with their providers through Web-based patient portals, thus playing a prominent role within the patient-centered medical home (PCMH). However, despite enthusiasm, adoption remains low. OBJECTIVE: We examined factors in the PCMH context that may affect efforts to improve enrollment in a patient portal. METHODS: Using a sociotechnical approach, we conducted qualitative, semistructured interviews with patients and providers from 3 primary care clinics and with national leaders from across a large integrated health care system. RESULTS: We gathered perspectives and analyzed data from 4 patient focus groups and one-on-one interviews with 1 provider from each of 3 primary care clinics and 10 program leaders. We found that leaders were focused on marketing in primary care, whereas patients and providers were often already aware of the portal. In contrast, both patients and providers cited administrative and logistical barriers impeding enrollment. Further, although leadership saw the PCMH as the logical place to focus enrollment efforts, providers and patients were more circumspect and expressed concern about how the patient portal would affect their practice and experience of care. Further, some providers expressed ambivalence about patients using the portal. Despite absence of consensus on how and where to encourage portal adoption, there was wide agreement that promoting enrollment was a worthwhile goal. CONCLUSIONS: Patients, clinicians, and national leaders agreed that efforts were needed to increase enrollment in the patient portal. Opinions diverged regarding the suitability of the PCMH and, specifically, the primary care clinic for promoting patient portal enrollment. Policymakers should consider diverse stakeholder perspectives in advance of interventions to increase technology adoption

Polarization observables of the gamma d --> PiNN reaction in the Delta(1232)-resonance region

Polarization observables of the three charge states of the pion for the $\gamma d\to\pi NN$ reaction with polarized photon beam and/or oriented deuteron target are evaluated over the whole $\Delta$(1232)-resonance region adopting a nonrelativistic model based on time-ordered perturbation theory. Results for the $\pi$-meson spectra, linear photon asymmetry, vector and tensor target asymmetries are presented. Particular attention is given, for the first time, to double polarization asymmetries for which we present results for $T_{20}^{\ell}$ and $T_{2\pm 2}^{\ell}$. We found that all other double polarization asymmetries of photon and deuteron target are vanished.Comment: 17 Pages, 8 Figures, accepted for publication in Int. J. Mod. Phys.