222 research outputs found
Surface Percolation and Growth. An alternative scheme for breaking the diffraction limit in optical patterning
A nanopatterning scheme is presented by which the structure height can be
controlled in the tens of nanometers range and the lateral resolution is a
factor at least three times better than the point spread function of the
writing beam. The method relies on the initiation of the polymerization
mediated by a very inefficient energy transfer from a fluorescent dye molecule
after single photon absorption. The mechanism has the following distinctive
steps: the dye adsorbs on the substrate surface with a higher concentration
than in the bulk, upon illumination it triggers the polymerization, then
isolated islands develop and merge into a uniform structure (percolation),
which subsequently grows until the illumination is interrupted. This
percolation mechanism has a threshold that introduces the needed nonlinearity
for the fabrication of structures beyond the diffraction limit.Comment: 10 pages, 8 figure
Five Hours with Frank: A Case Study
This manuscript explores a resident\u27s dilemma when performing a psychiatric evaluation within the context of releasing a convicted rapist
Relationship between depressive symptom severity and emergency department use among low-income, depressed homebound older adults aged 50 years and older
Namkee G. Choi, and C. Nathan Marti are with The University of Texas at Austin, Austin, TX, USA. -- Martha L. Bruce is with the Weill Cornell Medical College, White Plains, NY, USA. -- Mark E. Kunik is with the VA HSRD Houston Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA, and Baylor College of Medicine, Houston, TX, USA, and VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA.Background: Previous research found a high prevalence of depression, along with chronic illnesses and disabilities, among older ED patients. This study examined the relationship between depressive symptom severity and the number of ED visits among low-income homebound older adults who participated in a randomized controlled trial of telehealth problem-solving therapy (PST).
Methods: The number of and reasons for ED visits were collected from the study participants (n=121 at baseline) at all assessment points—baseline and 12- and 24-week follow-ups. Depressive symptoms were measured with the 24-item Hamilton Rating Scale for Depression (HAMD). All multivariable analyses examining the relationships between ED visits and depressive symptoms were conducted using zero-inflated Poisson regression models.
Results: Of the participants, 67.7% used the ED at least once and 61% of the visitors made at least one return visit during the approximately 12-month period. Body pain (not from fall injury and not including chest pain) was the most common reason. The ED visit frequency at baseline and at follow-up was significantly positively associated with the HAMD scores at the assessment points. The ED visit frequency at follow-up, controlling for the ED visits at baseline, was also significantly associated with the HAMD score change since baseline.
Conclusions: The ED visit rate was much higher than those reported in other studies. Better education on self-management of chronic conditions, depression screening by primary care physicians and ED, and depression treatment that includes symptom management and problem-solving skills may be important to reduce ED visits among medically ill, low-income homebound adults.
Trial registration
ClinicalTrials.gov Identifier: NCT00903019Psycholog
Analytical modeling of circuit aerodynamics in the new NASA Lewis wind tunnel
Rehabilitation and extention of the capability of the altitude wind tunnel (AWT) was analyzed. The analytical modeling program involves the use of advanced axisymmetric and three dimensional viscous analyses to compute the flow through the various AWT components. Results for the analytical modeling of the high speed leg aerodynamics are presented; these include: an evaluation of the flow quality at the entrance to the test section, an investigation of the effects of test section bleed for different model blockages, and an examination of three dimensional effects in the diffuser due to reentry flow and due to the change in cross sectional shape of the exhaust scoop
Bericht über die "Bibliotheca Livoniae historca : systematisches Verzeichniss der Quellen und Hülfsmittel für die "Geschichte Estlands, Livlands und Kurlands bis zum jahre 1715 von E. Winkelmann
http://tartu.ester.ee/record=b2424890~S1*es
Brief cognitive behavioral therapy in primary care: a hybrid type 2 patient-randomized effectiveness-implementation design
BACKGROUND: Despite the availability of evidence-based psychotherapies for depression and anxiety, they are underused in non-mental health specialty settings such as primary care. Hybrid effectiveness-implementation designs have the potential to evaluate clinical and implementation outcomes of evidence-based psychotherapies to improve their translation into routine clinical care practices. METHODS: This protocol article discusses the study methodology and implementation strategies employed in an ongoing, hybrid, type 2 randomized controlled trial with two primary aims: (1) to determine whether a brief, manualized cognitive behavioral therapy administered by Veterans Affairs Primary Care Mental Health Integration program clinicians is effective in treating depression and anxiety in a sample of medically ill (chronic cardiopulmonary diseases) primary care patients and (2) to examine the acceptability, feasibility, and preliminary outcomes of a focused implementation strategy on improving adoption and fidelity of brief cognitive behavioral therapy at two Primary Care-Mental Health Integration clinics. The study uses a hybrid type 2 effectiveness/implementation design to simultaneously test clinical effectiveness and to collect pilot data on a multifaceted implementation strategy that includes an online training program, audit and feedback of session content, and internal and external facilitation. Additionally, the study engages the participation of an advisory council consisting of stakeholders from Primary Care-Mental Health Integration, as well as regional and national mental health leaders within the Veterans Administration. It targets recruitment of 320 participants randomized to brief cognitive behavioral therapy (n = 200) or usual care (n = 120). Both effectiveness and implementation outcomes are being assessed using mixed methods, including quantitative evaluation (e.g., intent-to-treat analyses across multiple time points) and qualitative methods (e.g., focus interviews and surveys from patients and providers). Patient-effectiveness outcomes include measures of depression, anxiety, and physical health functioning using blinded independent evaluators. Implementation outcomes include patient engagement and adherence and clinician brief cognitive behavioral therapy adoption and fidelity. CONCLUSIONS: Hybrid designs are needed to advance clinical effectiveness and implementation knowledge to improve healthcare practices. The current article describes the rationale and challenges associated with the use of a hybrid design for the study of brief cognitive behavioral therapy in primary care. Although trade-offs exist between scientific control and external validity, hybrid designs are part of an emerging approach that has the potential to rapidly advance both science and practice. TRIAL REGISTRATION: NCT01149772 at http://www.clinicaltrials.gov/ct2/show/NCT0114977
Calculation of T_ odd effects in $"" sup 205_TIF including electron correlation
A method and codes for two-step correlation calculation of heavy-atom
molecules have been developed, employing the generalized relativistic effective
core potential and relativistic coupled cluster (RCC) methods at the first
step, followed by nonvariational one-center restoration of proper
four-component spinors in the heavy cores. Electron correlation is included for
the first time in an ab initio calculation of the interaction of the permanent
P,T-odd proton electric dipole moment with the internal electromagnetic field
in a molecule. The calculation is performed for the ground state of TlF at the
experimental equilibrium, R_e=2.0844 A, and at R=2.1 A, with spin-orbit and
correlation effects included by RCC. Calculated results with single cluster
amplitudes only are in good agreement (3% and 1%) with recent
Dirac-Hartree-Fock (DHF) values of the magnetic parameter M; the larger
differences occurring between present and DHF volume parameter (X) values, as
well as between the two DHF calculations, are explained. Inclusion of electron
correlation by GRECP/RCC with single and double excitations has a major effect
on the P,T-odd parameters, decreasing M by 17% and X by 22%.Comment: 5 pages, REVTeX4 style Accepted for publication in Phys.Rev.Letter
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A controlled trial of Partners in Dementia Care: veteran outcomes after six and twelve months
Introduction: “Partners in Dementia Care” (PDC) tested the effectiveness of a care-coordination program integrating healthcare and community services and supporting veterans with dementia and their caregivers. Delivered via partnerships between Veterans Affairs medical centers and Alzheimer’s Association chapters, PDC targeted both patients and caregivers, distinguishing it from many non-pharmacological interventions. Hypotheses posited PDC would improve five veteran self-reported outcomes: 1) unmet need, 2) embarrassment about memory problems, 3) isolation, 4) relationship strain and 5) depression. Greater impact was expected for more impaired veterans. A unique feature was self-reported research data collected from veterans with dementia. Methods and Findings: Five matched communities were study sites. Two randomly selected sites received PDC for 12 months; comparison sites received usual care. Three structured telephone interviews were completed every 6 months with veterans who could participate. Results: Of 508 consenting veterans, 333 (65.6%) completed baseline interviews. Among those who completed baseline interviews, 263 (79.0%) completed 6-month follow-ups and 194 (58.3%) completed 12-month follow-ups. Regression analyses showed PDC veterans had significantly less adverse outcomes than those receiving usual care, particularly for more impaired veterans after 6 months, including reduced relationship strain (B = −0.09; p = 0.05), depression (B = −0.10; p = 0.03), and unmet need (B = −0.28; p = 0.02; and B = −0.52; p = 0.08). PDC veterans also had less embarrassment about memory problems (B = −0.24; p = 0.08). At 12 months, more impaired veterans had further reductions in unmet need (B = −0.96; p < 0.01) and embarrassment (B = −0.05; p = 0.02). Limitations included use of matched comparison sites rather than within-site randomization and lack of consideration for variation within the PDC group in amounts and types of assistance provided. Conclusions: Partnerships between community and health organizations have the potential to meet the dementia-related needs and improve the psychosocial functioning of persons with dementia. Trial Registry NCT0029116
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