Sickness certification in primary care: a survey on views and practices among Swiss physicians.

QUESTIONS UNDER STUDY: Studies from several countries (Scandinavia, United Kingdom) report that general practitioners (GPs) experience problems in sickness certification. Our study explored views of Swiss GPs towards sickness certification, their practice and experience, professional skills and problematic interactions with patients. METHODS: We conducted an online survey among GPs throughout Switzerland, exploring behaviour of physicians, patients and employers with regard to sickness certification; GPs' views about sickness certification; required competences for certifying sickness absence, and approaches to advance their competence. We piloted the questionnaire and disseminated it through the networks of the five Swiss academic institutes for primary care. RESULTS: We received 507 valid responses (response rate 50%). Only 43/507 GPs experienced sickness certification as problematic per se, yet 155/507 experienced problems in sickness certification at least once a week. The 507 GPs identified estimating a long-term prognosis about work capacity (64%), handling conflicts with patients (54%), and determining the reduction of work capacity (42%) as problematic. Over 75% would welcome special training opportunities, e.g., on sickness certifications during residency (93%), in insurance medicine (81%), and conflict management (80%). CONCLUSION: Sickness certification as such does not present a major problem to Swiss GPs, which contrasts with the experience in Scandinavian countries and in the UK. Swiss GPs did identify specific tasks of sickness certification as problematic. Training opportunities on sick-leave certification and insurance medicine in general were welcomed

Mobile nondestructive assay and examination instruments

A compact system that evaluates radioactive materials can furnish a big savings to taxpayers by ensuring that only properly identified nuclear waste is sent to a Department of Energy (DOE) radioactive waste storage area. The Los Alamos National Laboratory's Advanced Nuclear Technology Group has developed and field tested two esily transportable, self-contained modules: one x-rays the contents of special 208-l shipment containers, the other assays the contents. The assay and evaluation system is a simple, portable solution to a complex problem that ensures that only properly packaged transuranic (TRU) wste is shipped to the Department of Energy's Waste Isolation Pilot Plant (WIPP) near Carlsbad, New Mexico. Caustic chemicals, liquids, and other objects or materials tht could cause a container leak during shipment are the objects of an x-ray and video camera used in the system. The camera inspects the contents of 208-l drums that are brought into the system on a conveyor and rotated, one at a time, in front of the x-ray source. Free liquids can be detected by shaking the drum; the sloshing liquid is visible on the video screen. After the drum is x-rayed, it is conveyed to the assay module where precision instruments measure the amounts of TRU isotopes present in the waste. If the drum contains fissile TRU isotopes above the safety limit, it is rejected and sent to an appropriate facility for repackaging; if the drum contains less than the 100 nCi/g lower-level limit for TRU, it is rejected and sent to a low-level nuclear waste burial site. Drums whose contents fall between these limits are accepted and certified for shipment to the WIPP. Made to fit on flatbed trailers, the entire system can be transported to a DOE facility and be ready for operations within 5 hours after arrival

Magnetoluminescence

Pulsar Wind Nebulae, Blazars, Gamma Ray Bursts and Magnetars all contain regions where the electromagnetic energy density greatly exceeds the plasma energy density. These sources exhibit dramatic flaring activity where the electromagnetic energy distributed over large volumes, appears to be converted efficiently into high energy particles and gamma-rays. We call this general process magnetoluminescence. Global requirements on the underlying, extreme particle acceleration processes are described and the likely importance of relativistic beaming in enhancing the observed radiation from a flare is emphasized. Recent research on fluid descriptions of unstable electromagnetic configurations are summarized and progress on the associated kinetic simulations that are needed to account for the acceleration and radiation is discussed. Future observational, simulation and experimental opportunities are briefly summarized.Comment: To appear in "Jets and Winds in Pulsar Wind Nebulae, Gamma-ray Bursts and Blazars: Physics of Extreme Energy Release" of the Space Science Reviews serie

Primordial Nucleosynthesis for the New Cosmology: Determining Uncertainties and Examining Concordance

Big bang nucleosynthesis (BBN) and the cosmic microwave background (CMB) have a long history together in the standard cosmology. The general concordance between the predicted and observed light element abundances provides a direct probe of the universal baryon density. Recent CMB anisotropy measurements, particularly the observations performed by the WMAP satellite, examine this concordance by independently measuring the cosmic baryon density. Key to this test of concordance is a quantitative understanding of the uncertainties in the BBN light element abundance predictions. These uncertainties are dominated by systematic errors in nuclear cross sections. We critically analyze the cross section data, producing representations that describe this data and its uncertainties, taking into account the correlations among data, and explicitly treating the systematic errors between data sets. Using these updated nuclear inputs, we compute the new BBN abundance predictions, and quantitatively examine their concordance with observations. Depending on what deuterium observations are adopted, one gets the following constraints on the baryon density: OmegaBh^2=0.0229\pm0.0013 or OmegaBh^2 = 0.0216^{+0.0020}_{-0.0021} at 68% confidence, fixing N_{\nu,eff}=3.0. Concerns over systematics in helium and lithium observations limit the confidence constraints based on this data provide. With new nuclear cross section data, light element abundance observations and the ever increasing resolution of the CMB anisotropy, tighter constraints can be placed on nuclear and particle astrophysics. ABRIDGEDComment: 54 pages, 20 figures, 5 tables v2: reflects PRD version minor changes to text and reference

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time, and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space. While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes, vast areas of the tropics remain understudied. In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity, but it remains among the least known forests in America and is often underrepresented in biodiversity databases. To worsen this situation, human-induced modifications may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge, it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Current status of the multi-isotopic transuranic-waste-assay system

We have designed, constructed, tested, and are scheduled to field a 208-l barrel-sized working version of our multi-isotopic transuranic assay system. This system uses both passive neutron multiplicity and pulsed active measurements to identify and quantify spontaneous neutron emitters and fissile TRU isotopes. Using the system we can separately quantify up to seven individual transuranic isotopes under favorable conditions with the intrinsic sensitivity to screen or assay barrels at or below the 10 nCi/g transuranic level. Our measured 3 sigma sensitivity for /sup 239/Pu is about 0.5 mg. A large range of waste matrix materials can be accommodated by the system, as well as extremes in both gamma-ray and neutron backgrounds

Experimental evaluation of the differential die-away pulsed-neutron technique for the fissile assay of hot irradiated fuel waste

Hot irradiated fuel waste packages containing self neutron sources up to 10/sup 7/ n/s may be assayed successfully with a 25-mg /sup 239/Pu detection sensitivity using a differential die-away fissile assay system based on a Sandia-designed 14-MeV neutron generator. With a minor design change, our system can accommodate contact gamma dose rates up to 10/sup 4/ R/h with no loss of fissile assay sensitivity

A l-nCi/g sensitivity transuranic waste assay system using pulsed neutron interrogation

We have developed a pulsed thermal neutron interrogation system and have demonstrated a sub-1-nCi/g assay sensitivity for high density TRU wastes contained in 200-liter barrels. We detect prompt fission neutrons, resulting in greatly enhanced sensitivity compared to techniques in which delayed fission neutrons are detected. We observe a linear assay response over at least three orders of magnitude in /sup 235/U (or /sup 239/Pu) mass. We also have measured a flat (to +-10%) interrogation flux profile throughout the volume of a 200-liter barrel filled with 200 kg of sand and vermiculite, which indicates flatness of response to fissile material at different locations within the barrel

Making transuranic assay measurements using modern controllers

This paper describes methodology and computer-controlled instrumentation developed at the Los Alamos National Laboratory that accurately performs nondestructive assays of large containers bearing transuranic wastes and nonradioactive matrix materials. These assay systems can measure fissile isotopes with 1-mg sensitivity and spontaneous neutron-emitting isotopes at a 10-mg sensitivity. The assays are performed by neutron interrogation, detection, and counting in a custom assay chamber. An International Business Machines Personal Computer (IBM-PC) is used to control the CAMAC-based instrumentation system that acquires the assay data. 6 refs., 7 figs