High efficiency diffraction grating designs for rhomb configurations

A diffraction grading rhomb is an excellent candidate for both supressing sideband instabilities in a free electron laser and outcoupling the optical beam. A rhomb incorporating sinusoidal profile grating exhibits many of the required performance characteristics for such an application. We present in some detail a description of such a rhomb alignment sensitivity analysis. 6 refs., 8 figs

Can dental attendance improve quality of life?

OBJECTIVE: The aim of this study was to determine the relationship between reported dental attendance patterns and the public's perception of how oral health impacts on quality of life (QoL). METHOD: A national UK study involving a random probability sample of 2,668 adults. Respondents were interviewed in their homes about how oral health affects their QoL and about their dental attendance pattern. Responses were coded as oral health having a negative impact, positive impact or impact in general (either positive and/or negative) on QoL. RESULTS: The response rate was 70% with 1,865 adults participating in the study. 72% (1,340) reported that their oral health affected their QoL in general, 57% (1,065) reported that it had a positive effect, and 48% (902) that it had a negative effect. 61% (1,136) reported to have attended the dentist within the last year- 'regular attenders'. Bivaraite analysis identified association between perception of how oral health impacts on QoL and dental attendance pattern (P < 0.01). When socio-demographic factors (age, gender, and social class) were taken into account in the analysis, 'regular attenders' reported that oral health had greater impact in general on QoL (OR = 1.30, 95% CI = 1.04, 1.63) and, specifically, a greater positive impact (OR = 1.49, 95% CI=1.44, 1.77). CONCLUSION: Dental attendance is associated with perceptions of how oral health impacts on QoL, specifically enhanced life quality. This may have implications for understanding the health gain of regular dental attendance.link_to_OA_fulltex

Effect of a Nurse-Led Preventive Psychological Intervention on Symptoms of Posttraumatic Stress Disorder Among Critically Ill Patients A Randomized Clinical Trial

Importance: A meta-analysis of outcomes during the 6 months after intensive care unit (ICU) discharge indicate a prevalence for clinically important posttraumatic stress disorder (PTSD) symptoms of 25%. Objective: To determine whether a nurse-led preventive, complex psychological intervention, initiated in the ICU, reduces patient-reported PTSD symptom severity at 6 months. Design, Setting, and Participants: A multicenter, parallel-group, cluster-randomized clinical trial with integrated economic and process evaluations conducted in 24 ICUs in the United Kingdom. Participants were critically ill patients who regained mental capacity following receipt of level 3 (intensive) care. A total of 2961 eligible patients were identified from September 2015 to January 2017. A total of 2048 were approached for participation in the ICU, of which 1458 provided informed consent. Follow-up was completed December 2017. Interventions: Twenty four ICUs were randomized 1:1 to the intervention or control group. Intervention ICUs (n = 12; 669 participants) delivered usual care during a baseline period followed by an intervention period. The preventive, complex psychological intervention comprised promotion of a therapeutic ICU environment plus 3 stress support sessions and a relaxation and recovery program delivered by trained ICU nurses to high-risk (acutely stressed) patients. Control ICUs (n = 12; 789 participants) delivered usual care in both baseline and intervention periods. Main Outcomes and Measures: The primary clinical outcome was PTSD symptom severity among survivors at 6 months measured using the PTSD Symptom Scale–Self-Report questionnaire (score range, 0-51, with higher scores indicating greater symptom severity; the minimal clinically important difference was considered to be 4.2 points). Results: Among 1458 enrolled patients (mean [SD] age, 58 [16] years; 599 women [41%]), 1353 (93%) completed the study and were included in the final analysis. At 6 months, the mean PTSD Symptom Scale–Self-Report questionnaire score in intervention ICUs was 11.8 (baseline period) compared with 11.5 (intervention period) (difference, −0.40 [95% CI, −2.46 to 1.67]) and in control ICUs, 10.1 (baseline period) compared with 10.2 (intervention period) (difference, 0.06 [95% CI, −1.74 to 1.85]) between periods. There was no significant difference in PTSD symptom severity at 6 months (treatment effect estimate [difference in differences] of −0.03 [95% CI, −2.58 to 2.52]; P = .98). Conclusions and Relevance: Among critically ill patients in the ICU, a nurse-led preventive, complex psychological intervention did not significantly reduce patient-reported PTSD symptom severity at 6 months. These findings do not support the use of this psychological intervention