Reconsidering low-dose aspirin therapy for cardiovascular disease: a study protocol for physician and patient behavioral change

<p>Abstract</p> <p>Background</p> <p>There are often disparities between current evidence and current practice. Decreasing the gap between desired practice outcomes and observed practice outcomes in the healthcare system is not always easy. Stopping previously recommended or variably recommended interventions may be even harder to achieve than increasing the use of a desired but under-performed activity. For over a decade, aspirin has been prescribed for primary prevention of cardiovascular disease and for patients with the coronary artery disease risk equivalents; yet, there is no substantial evidence of an appropriate risk-benefit ratio to support this practice. This paper describes the protocol of a randomized trial being conducted in six primary care practices in the Denver metropolitan area to examine the effectiveness of three interventional strategies to change physician behavior regarding prescription of low-dose aspirin.</p> <p>Methods</p> <p>All practices received academic detailing, one arm received clinician reminders to reconsider aspirin, a second arm received both clinician and patient messages to reconsider aspirin. The intervention will run for 15 to 18 months. Data collected at baseline and for outcomes from an electronic health record will be used to assess pre- and post-interventional prescribing, as well as to explore any inappropriate decrease in aspirin use by patients with known cardiovascular disease.</p> <p>Discussion</p> <p>This study was designed to investigate effective methods of changing physician behavior to decrease the use of aspirin for primary cardiovascular disease prevention. The results of this study will contribute to the small pool of knowledge currently available on the topic of ceasing previously supported practices.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01247454">NCT01247454</a></p

Effects of rf Current on Spin Transfer Torque Induced Dynamics

The impact of radiofrequency (rf) currents on the direct current (dc) driven switching dynamics in current-perpendicular-to-plane nanoscale spin valves is demonstrated. The rf currents dramatically alter the dc driven free layer magnetization reversal dynamics as well as the dc switching level. This occurs when the frequency of the rf current is tuned to a frequency range around the dc driven magnetization precession frequencies. For these frequencies, interactions between the dc driven precession and the injected rf induce frequency locking and frequency pulling effects that lead to a measurable dependence of the critical switching current on the frequency of the injected rf. Based on macrospin simulations, including dc as well as rf spin torque currents, we explain the origin of the observed effects.Comment: 5 pages, 4 figure

An Analysis of Team Teaching and Large Group Instruction in Junior High Science Bettendorf Middle School

A team of nine members assumed the responsibility for teaching 1250 students utilizing team teaching and large group instruction on an experimental basis. Students used modified versions of AAAS and IPS science curriculum materials. Modification of materials was necessary to operate effectively with laboratory groupings of 125. Heterogeneous grouping and individual progress was stressed with students working at their own rate. Physical changes included the removal of three walls to provide for a U-shaped complex. Additional laboratory supplies were also purchased due to class size. The program was closely associated with the class guide system and flexible scheduling in operation at Bettendorf Middle School. Based upon student response and evaluation, it is felt that this program presents controversial results in connection with costs involved, utilization of instructors\u27 backgrounds, and individualization of instruction

Adaptive Bayesian Iterative Transmission Reconstruction for Attenuation Correction in Myocardial Perfusion Imaging with SPECT/Slow-Rotation Low-Output CT Systems

Objectives. SPECT/slow-rotation low-output CT systems can produce streak artifacts in filtered backprojection (FBP) attenuation maps, impacting attenuation correction (AC) in myocardial perfusion imaging. This paper presents an adaptive Bayesian iterative transmission reconstruction (ABITR) algorithm for more accurate AC. Methods. In each iteration, ABITR calculated a three-dimensional prior containing the pixels with attenuation coefficients similar to water, then used it to encourage these pixels to the water value. ABITR was tested with a cardiac phantom and 4 normal patients acquired by a GE Millennium VG/Hawkeye system. Results. FBP AC and ABITR AC produced similar phantom results. For the patients, streak artifacts were observed in the FBP and ordered-subsets expectation-maximization (OSEM) maps but not in the ABITR maps, and ABITR AC produced more uniform images than FBP AC and OSEM AC. Conclusion. ABITR can improve the quality of the attenuation map, producing more uniform images for normal studies

Characterization of digital-micromirror device-based infrared scene projector

A test procedure is developed for an infrared laser scene projector, and applied to a projection system that we develop based on digital micromirror technology. The intended use will be for simulation and target training. Resolution and noise are significant parameters for target perception models of infrared imaging systems. System resolution is normally measured as the modulation transfer function (MTF), and its noise modeled through an appropriate signal standard deviation metric. We compare MTF measurements for both mid-wave (MWIR) and longwave IR (LWIR) bands for an infrared laser scene projector based on the digital micromirror device (DMD). Moreover, we use two complimentary models to characterize imaging camera noise. This provides a quantitative image-quality criterion of system performance

IBRD Operational Decision Framework

The IBRD Operational Decision Framework in this document is an expansion of an emerging general risk management framework under development by an interagency working group. It provides the level of detail necessary to develop a general Consequence Management Guidance Document for biological contamination remediation and restoration. It is the intent of this document to support both wide area and individual site remediation and restoration activities. This product was initiated as a portion of the IBRD Task 1 Systems Analysis to aid in identification of wide area remediation and restoration shortcomings and gaps. The draft interagency general risk management framework was used as the basis for the analysis. The initial Task 1 analysis document expanded the draft interagency framework to a higher level of resolution, building on both the logic structure and the accompanying text explanations. It was then employed in a qualitative manner to identify responsible agencies, data requirements, tool requirements, and current capabilities for each decision and task. This resulted in identifying shortcomings and gaps needing resolution. Several meetings of a joint LLNL/SNL working group reviewed and approved the initial content of this analysis. At the conclusion of Task 1, work continued on the expanded framework to generate this Operational Decision Framework which is consistent with the existing interagency general risk management framework. A large LLNL task group met repeatedly over a three-month period to develop the expanded framework, coordinate the framework with the biological remediation checklist, and synchronize the logic with the Consequence Management Plan table of contents. The expanded framework was briefed at a large table top exercise reviewing the interagency risk management framework. This exercise had representation from major US metropolitan areas as well as national agencies. This product received positive comments from the participants. Upon completion of the Operational Decision Framework, another joint LLNL/SNL working group conducted a day-long review. Identified modifications were made to the document, resulting in the included product

Room temperature ballistic transport in InSb quantum well nanodevices

We report the room temperature observation of significant ballistic electron transport in shallow etched four-terminal mesoscopic devices fabricated on an InSb/AlInSb quantum well (QW) heterostructure with a crucial partitioned growth-buffer scheme. Ballistic electron transport is evidenced by a negative bend resistance signature which is quite clearly observed at 295 K and at current densities in excess of 10$^{6}$ A/cm$^{2}$. This demonstrates unequivocally that by using effective growth and processing strategies, room temperature ballistic effects can be exploited in InSb/AlInSb QWs at practical device dimensions

Normalization factors for magnetic relaxation of small particle systems in non-zero magnetic field

We critically discuss relaxation experiments in magnetic systems that can be characterized in terms of an energy barrier distribution, showing that proper normalization of the relaxation data is needed whenever curves corresponding to different temperatures are to be compared. We show how these normalization factors can be obtained from experimental data by using the $T \ln(t/\tau_0)$ scaling method without making any assumptions about the nature of the energy barrier distribution. The validity of the procedure is tested using a ferrofluid of Fe_3O_4 particles.Comment: 5 pages, 6 eps figures added in April 22, to be published in Phys. Rev. B 55 (1 April 1997

Fabrication of periodic microstructures on flexible polyimide membranes

Periodic metallic microstructures were fabricated on polyimide membranes. Techniques were developed to maintain flatness of the membrane during processing while still allowing for flexibility in the final structure. For proper functionality of the structures, it was necessary to first fabricate a continuous metallic film and a continuous dielectric layer on top of the flexible substrate, which underlaid the periodic microstructure. Flexibility of the overall structure was maintained by using a polymer as the dielectric layer, which was constrained to have high optical transmission over the infrared wavelength range of 6-14 mu m. Three candidate polymers were evaluated, and their measured optical properties are presented. Benzocyclobutene was found to be the best choice for this application. The final structure fully populated a 10 cm (4 in.) diameter flexible membrane with microstructures of excellent uniformity. (C) 2007 American Vacuum Society