Online Consultations Between General Practitioners and Psychiatrists in the Netherlands:A Qualitative Study

Objective: To examine the nature and scope of questions about psychiatric patient cases submitted by general practitioners (GPs) to an established online consultation platform and to determine if they could have been answered by consulting existing clinical guidelines. Methods: All anonymized psychiatric cases submitted by GPs to the online electronic Prisma platform between September 2018 and November 2019 were examined in a mixed-methods study. Descriptive statistics and qualitative thematic analysis were used, followed by axial coding to arrive at overarching themes to characterize cases. Results: Of the 136 included cases, 44.1% concerned female patients and about half concerned patients aged 31–60 years. Common psychiatric disorders were depression, attention deficit hyperactivity disorder, sleeping problems, sexual disorders, and eating disorders. The first response was usually given within 2 h (interquartile range, 0–14.3 h), with 86% answered within 24 h and 95% within 48 h. Qualitative analysis revealed four themes, namely “type of question,” “cases in relation to current clinical guidelines,” “case complexity” and “the doctor being pressured.” Type of question comprised diagnostic, therapeutic, and referral questions. Notably, for 44.1% of questions no current clinical guidelines was present and 46.3% of cases were deemed complex in nature. GPs were willing to share their experiences of coping with being pressured by patients. Conclusion: The findings of this study support the potential for an online electronic consultation platform to facilitate feasible and useful interprofessional consultation between GPs and psychiatrists for a broad range mental illnesses and questions of varying complexity

Gain spectroscopy of a type-II VECSEL chip

Using optical pump-white light probe spectroscopy the gain dynamics is investigated for a VECSEL chip which is based on a type-II heterostructure. The active region the chip consists of a GaAs/(GaIn)As/Ga(AsSb)/(GaIn)As/GaAs multiple quantum well. For this structure, a fully microscopic theory predicts a modal room temperature gain at a wavelength of 1170 nm, which is confirmed by experimental spectra. The results show a gain buildup on the type-II chip which is delayed relative to that of a type-I chip. This slower gain dynamics is attributed to a diminished cooling rate arising from reduced electron-hole scattering.Comment: 4 pages, 4 figure

Snowmass 2001: Jet Energy Flow Project

Conventional cone jet algorithms arose from heuristic considerations of LO hard scattering coupled to independent showering. These algorithms implicitly assume that the final states of individual events can be mapped onto a unique set of jets that are in turn associated with a unique set of underlying hard scattering partons. Thus each final state hadron is assigned to a unique underlying parton. The Jet Energy Flow (JEF) analysis described here does not make such assumptions. The final states of individual events are instead described in terms of flow distributions of hadronic energy. Quantities of physical interest are constructed from the energy flow distribution summed over all events. The resulting analysis is less sensitive to higher order perturbative corrections and the impact of showering and hadronization than the standard cone algorithms.Comment: REVTeX4, 13 pages, 6 figures; Contribution to the P5 Working Group on QCD and Strong Interactions at Snowmass 200

Developing Berkshire Market Pig Growth Curves

Several factors have stimulated interest in an old, rather minor swine breed, Berkshire pigs. Berkshires produce pork that is darker, with more intramuscular fat than most swine breeds and lines currently. As the majority of modern pigs were genetically selected to be leaner, the Berkshire breed has continued to produce more flavorful pork. Asian consumers, especially Japanese, prefer and will pay a premium for Berkshire pork. American chefs and discriminating consumers request Berkshire pork, a strong market demand that has caused a flourish in the pork niche market largely centered around pork from Berkshirebred pigs. Some Iowa pork producers are raising Berkshire or Berkshire-cross pigs exclusively for export and niche markets. Several Berkshire niche markets and marketers are currently active in Iowa. Many of these markets require that the pigs must be reared in bedded or outdoor settings. A popular housing system used in Iowa is the bedded hoop barn

Lean and Fat Deposition Measurements for Purebred Berkshire Pigs Housed in Hoop Barns in Iowa

Previous research on meat quality of pork has demonstrated that purebred Berkshires have advantages over most commodity based pork. Therefore a Certified Berkshire Pork program has developed and is a vital niche market in Iowa and the United States that provides economic opportunity for a growing number of producers. This research has also documented that Berkshires have a significantly poorer feed conversion than other breeds, thus raising their cost of production. Understanding how feed programs and growth rates affect lean and fat deposition rates is a critical aspect to these niche programs in order to maximize profitability and quality of the Berkshire pork products marketed. From these two trials there are differences between the two trials for both barrows and gilts that may not be accounted for by seasonal affects. Overall, barrows averaged an inch of backfat between 200 and 240 lb body weight whereas gilts approached this backfat depth between 260 and 300 lb. Lean deposition rates were different between barrows and gilts and between trials. This difference makes it critical when selecting animals for marketing and achieving consistency in meat quality within a marketing system. The differences between barrows and gilts indicate it may be more critical that each are fed differently than in commercial production systems

FKHR-L1 can act as a critical effector of cell death induced by cytokine withdrawal: protein kinase B–enhanced cell survival through maintenance of mitochondrial integrity

Survival signals elicited by cytokines include the activation of phosphatidylinositol 3-kinase (PI3K), which in turn promotes the activation of protein kinase B (PKB). Recently, PKB has been demonstrated to phosphorylate and inactivate forkhead transcription factor FKHR-L1, a potent inducer of apoptosis. To explore the mechanisms underlying the induction of apoptosis after cytokine withdrawal or FKHR-L1 activation, we used a cell line in which FKHR-L1 activity could be specifically induced. Both cytokine withdrawal and FKHR-L1 activation induced apoptosis, which was preceded by an upregulation in p27KIP1 and a concomitant decrease in cells entering the cell cycle. Induction of apoptosis by both cytokine withdrawal and activation of FKHR-L1 correlated with the disruption of mitochondrial membrane integrity and cytochrome c release. This was preceded by upregulation of the pro-apoptotic Bcl-2 family member Bim. Ectopic expression of an inhibitory mutant of FKHR-L1 substantially reduced the levels of apoptosis observed after cytokine withdrawal. Activation of PKB alone was sufficient to promote cell survival, as measured by maintenance of mitochondrial integrity and the resultant inhibition of effector caspases. Furthermore, hematopoietic stem cells isolated from Bim−/− mice exhibited reduced levels of apoptosis upon inhibition of PI3K/PKB signaling

Feed Intake and Growth Rate in Purebred Berkshire Pigs Housed in Hoop Buildings in Iowa

Niche marketing continues to grow in Iowa and the United States as the demand for high quality pork increases for both in home and out of home consumption. The majority of pigs in demand for these markets are Berkshires, with many raised in bedded hoop barns. Berkshires have been shown to have significant advantages in meat eating quality, with significantly poorer feed conversion and higher feed costs. However very little information exists as to how these pigs grow and the nutritional needs to optimize both growth and feed efficiency. Producers have little production data to evaluate and adjust feeding programs. These trials were initiated to help characterize these parameters and allow Berkshire producers a means to be more effective within their production and marketing system. This trial demonstrated that Berkshire pigs grow as fast but consume more feed than expected from traditional commodity genetic lines, resulting in a challenging feed conversion ratio. Barrows grow faster, consumed more feed than gilts, but gilts were more efficient converting feed to gain. Although seasonal feed intakes differ for both sexes, growth rates were similar within gilts and barrows. This information can perhaps be used in designing rations and feed budgeting systems that can lower the feed costs for production of Berkshire pork

A high-quality annually laminated sequence from Lake Belau, Northern Germany: Revised chronology and its implications for palynological and tephrochronological studies

The annually laminated record of Lake Belau offers an exceptional opportunity to investigate with high temporal resolution Holocene environmental change, aspects of climate history and human impact on the landscape. A new chronology based on varve counts, 14C-datings and heavy metal history has been established, covering the last 9400 years. Based on multiple varve counting on two core sequences, the easily countable laminated section spans about 7850 varve years (modelled age range c. 9430 to 1630 cal. BP). Not all of the record is of the same quality but approximately 69% of the varves sequence is classified to be of high quality and only c. 5% of low quality. The new chronology suggests dates generally c. 260 years older than previously assumed for the laminated section of the record. The implications for the vegetation and land-use history of the region as well as revised datings for pollen stratigraphical events are discussed. Tephra analysis allowed the identification of several cryptotephra layers. New dates for volcanic eruptions are presented for the Lairg B event (c. 6848 cal. BP, 2s range 6930–6713 cal. BP), the Hekla 4 event (c. 4396 cal. BP, 2s range 4417–4266 cal. BP), and Hekla 3 eruption (c. 3095 cal. BP, 2s range 3120–3068 cal. BP)

Atomic structure and segregation in alkali-metal heteroclusters

The ground-state atomic and electronic distributions in NamCsn clusters with composition m=n and m=2n have been calculated by minimizing the total cluster energy using the density-functional formalism. The approximation is made by replacing the total external potential of the ions by its spherical average around the cluster center during the iterative process of solving the Kohn-Sham equations for each geometry tested. In the size range studied here (up to 90 atoms per cluster), the cluster is composed of well-separated homoatomic Na and Cs shells, the external one always being a Cs shell. We have also found that the cohesive energy goes rapidly to the bulk limit. An analysis of the geometries shows strong cluster reconstruction with increasing size. By comparing the geometry of pure Nan with that of the Nan core in NanCsn for clusters formed by only an inner Na layer and an outer Cs layer, we have observed that the Nan core adopts a geometry different in most cases from that of the free Nan cluster, and such that the number of faces of the polyhedron formed by the Nan core is as close as possible to the number of external Cs atoms, in order to accomodate these Cs atoms on top of the faces of the polyhedron