The Utilization of Sunscreen Prescriptions to Increase Patient Use: Examination of Healthcare Provider Perceptions

Background: Despite the known benefits, many patients deny receiving sunscreen counseling. Over the past decade rates and treatment costs for skin cancer has risen. Purpose: This study seeks to investigate provider perceptions of using sunscreen prescriptions as a method to increase patient use. Methods: A descriptive online survey using a convenience sample of dermatology, internal medicine, and family medicine providers was used. Descriptive statistics summarized quantitative variables and thematic analysis examined opened ended questions. Results: Provider (n=38 total) thoughts about sunscreen prescriptions were mixed with many viewing sunscreen prescriptions positively (n =15; 42.9%). Commonly listed barriers included patient lack of motivation/interest (3.53±0.89), lack of standard guidelines about sunscreen counseling and prescriptions (3.34±1.12), and lack of education about prescribing sunscreen (3.26±1.35). Facilitators included insurance coverage (n = 21; 61.8%) and having a standardized protocol (n=8; 23.5%). Conclusion: The majority of providers felt prescribing sunscreen would increase patient use. Study results imply providers would utilize sunscreen prescriptions if a clear, standardized protocol was present. Education may help alleviate concerns related to insurance coverage. In consideration of time constraints, it may be beneficial for sunscreen prescriptions to be added to routine after-visit summaries and educational materials

Meta-analysis and Meta-regression of Cognitive Behavioral Therapy for Psychosis (CBTp) Across Time: The Effectiveness of CBTp has Improved for Delusions

Published research shows small-to-medium effects of Cognitive Behavioral Therapy for Psychosis (CBTp) on reducing psychotic symptoms. Given the on-going development of CBTp interventions, the aim of this systematic review is to examine whether the effectiveness of CBTp has changed across time. MEDLINE, EMBASE, PsycINFO, and CENTRAL were searched for randomized controlled trials examining CBTp interventions targeting positive and/or negative symptoms vs treatment as usual. Four meta-analyses were carried out to examine the effectiveness of CBTp for: positive symptoms; delusions; hallucinations; and negative symptoms. Four meta-regressions examined whether the effectiveness of CBTp changed across time for these groups of symptoms. A total of 28 studies (n = 2698) yielded a pooled g of −0.24 (95% confidence interval [CI] −0.32, −0.16, P < .001) favoring CBTp for positive symptoms, with nonsignificant heterogeneity (Q = 26.87, P = .47; I2 =0%); 13 studies (n = 890) yielded a pooled g of −0.36 (95% CI −0.59, −0.13, P = .002) for delusions, with substantial heterogeneity (Q = 31.99, P = .001; I2 =62%); 16 studies (n = 849) yielded a pooled g of −0.26 (95% CI −0.42, −0.11, P < .001) for hallucinations, with nonsignificant heterogeneity (Q = 18.10, P = .26; I2 =17%); 19 studies (n = 1761) yielded a pooled g of −0.22 (95% CI −0.33, −0.12, P < .001) for negative symptoms, with nonsignificant heterogeneity (Q = 20.32, P = .32, I2 =11%). Meta-regressions indicated a significant effect of year on the effectiveness of CBTp only for delusions (F[1, 11] = 5.99, P = .032; R2 = 0.594); methodological quality did not effect this finding. Findings indicate small-to-medium effects of CBTp for psychotic symptoms, with increasing effectiveness across time for delusions

Bilateral Pneumothoraces Following Central Venous Cannulation

We report the occurrence of a bilateral pneumothoraces after unilateral central venous catheterization of the right subclavian vein in a 70-year-old patient. The patient had no history of pulmonary or pleural disease and no history of cardiothoracic surgery. Two days earlier, she had a median laparotomy under general and epidural anaesthesia. Prior to the procedure, the patient was hemodynamically stable and her transcutaneous oxygen saturation was 97% in room air. We punctured the right pleural space before cannulation of the right subclavian vein. After the procedure, the patient slowly became hemodynamically instable with respiratory distress. A chest radiograph revealed a complete left-side pneumothorax and a mild right-side pneumothorax. The right-side pneumothorax became under tension after left chest tube insertion. The symptoms finally resolved after insertion of a right chest tube. After a diagnostic work-up, we suspect a congenital “Buffalo chests” explaining bilateral pneumothoraces and a secondary tension pneumothorax

Charge Symmetry Violation Effects in Pion Scattering off the Deuteron

We discuss the theoretical and experimental situations for charge symmetry violation (CSV) effects in the elastic scattering of pi+ and pi- on deuterium (D) and 3He/3H. Accurate comparison of data for both types of targets provides evidence for the presence of CSV effects. While there are indications of a CSV effect in deuterium, it is much more pronounced in the case of 3He/3H. We provide a description of the CSV effect on the deuteron in terms of single- and double- scattering amplitudes. The Delta-mass splitting is taken into account. Theoretical predictions are compared with existing experimental data for pi-d scattering; a future article will speak to the pi-three nucleon case.Comment: 16 pages of RevTeX, 7 postscript figure

Vapor pressures of acetylene at low temperatures

The atmospheres of many of the outer planets and their satellites contain a large number of hydrocarbon species. In particular, acetylene (C2H2) has been identified at Jupiter, Saturn and its satellite Titan, Uranus and Neptune. In the lower atmospheres of these planets, where colder temperatures prevail, the condensation and/or freezing of acetylene is probable. In order to obtain accurate models of the acetylene in these atmospheres, it is necessary to have a complete understanding of its vapor pressures at low temperatures. Vapor pressures at low temperatures for acetylene are being determined. The vapor pressures are measured with two different techniques in order to cover a wide range of temperatures and pressures. In the first, the acetylene is placed in a sample tube which is immersed in a low temperature solvent/liquid nitrogen slush bath whose temperature is measured with a thermocouple. The vapor pressure is then measured directly with a capacitance manometer. For lower pressures, a second technique which was called the thin-film infrared method (TFIR) was developed. It involves measuring the disappearance rate of a thin film of acetylene at a particular temperature. The spectra are then analyzed using previously determined extinction coefficient values, to determine the disappearance rate R (where R = delta n/delta t, the number of molecules that disappear per unit time). This can be related to the vapor pressure directly. This technique facilitates measurement of the lower temperatures and pressures. Both techniques have been calibrated using CO2, and have shown good agreement with the existing literature data

Design and Test of a Deployable Radiation Cover for the REgolith X-Ray Imaging Spectrometer

The REgolith X-ray Imaging Spectrometer (REXIS) instrument contains a one-time deployable radiation cover that is opened using a shape memory alloy actuator (a "Frangibolt") from TiNi Aerospace and two torsion springs. The door will be held closed by the bolt for several years in cold storage during travel to the target asteroid, Bennu, and it is imperative to gain confidence that the door will open at predicted operational temperatures. This paper briefly covers the main design features of the radiation cover and measures taken to mitigate risks to cover deployment. As the chosen FD04 model Frangibolt actuator has minimal flight heritage, the main focus of this paper is the testing, results and conclusions with the FD04 while discussing key lessons learned with respect to the use of the FD04 actuator in this application

Understanding differing outcomes from semantic and phonological interventions with children with word-finding difficulties: a group and case series study

Developmental Language Disorder occurs in up to 10% of children and many of these children have difficulty retrieving words in their receptive vocabulary. Such word-finding difficulties (WFD) can impact social development and educational outcomes. This research aims to develop the evidence-base for supporting children with WFD and inform the design and analysis of intervention studies. We included 20 children (age 6 to 8) with WFD each of whom participated in two interventions one targeting semantic attributes and the other phonological attributes of target words. The interventions, employing word-webs, were carefully constructed to facilitate direct comparison of outcome which was analysed at both group and case-series level. The study used a robust crossover design with pre-intervention baseline, between–intervention wash-out and post-intervention follow-up testing. We incorporated: matching of item sets on individual performance at baseline, independent randomisation of order of intervention and items to condition, blinding of assessor, evaluation of fidelity and control items. The interventions were clinically feasible, with weekly sessions over six weeks. Intervention improved children’s word-finding abilities with statistically significant change only during treatment phases of the study and not over baseline, wash-out or follow-up phases. For the group the semantic intervention resulted in a gain of almost twice as many items as the phonological intervention, a significant difference. However, children differed in their response to intervention. Importantly, case-series analysis revealed outcomes predictable on the basis of children’s theoretically driven language profiles. Taking account of individual profiles in determining choice of intervention would enable more children to benefit. The study provides new evidence to inform and refine clinical practice with this population. Future studies should be designed such that results can be analysed at both group and case series levels to extend theoretical understanding and optimise use of appropriate interventions

Differentiation of Prostate Cancer from Normal Tissue in Radical Prostatectomy Specimens by Desorption Electrospray Ionization and Touch Spray Ionization Mass Spectrometry.

Radical prostatectomy is a common treatment option for prostate cancer before it has spread beyond the prostate. Examination for surgical margins is performed post-operatively with positive margins reported to occur in 6.5 – 32% of cases. Rapid identification of cancerous tissue during surgery could improve surgical resection. Desorption electrospray ionization (DESI) is an ambient ionization method which produces mass spectra dominated by lipid signals directly from prostate tissue. With the use of multivariate statistics, these mass spectra can be used to differentiate cancerous and normal tissue. The method was applied to 100 samples from 12 human patients to create a training set of MS data. The quality of the discrimination achieved was evaluated using principal component analysis - linear discriminant analysis (PCA-LDA) and confirmed by histopathology. Cross validation (PCA-LDA) showed >95% accuracy. An even faster and more convenient method, touch spray (TS) mass spectrometry, not previously tested to differentiate diseased tissue, was also evaluated by building a similar MS data base characteristic of tumor and normal tissue. An independent set of 70 non-targeted biopsies from six patients was then used to record lipid profile data resulting in 110 data points for an evaluation dataset for TS-MS. This method gave prediction success rates measured against histopathology of 93%. These results suggest that DESI and TS could be useful in differentiating tumor and normal prostate tissue at surgical margins and that these methods should be evaluated intra-operatively

iSupport for Young Carers: An Adaptation of an e-Health Intervention for Young Dementia Carers

Young dementia carers need to be recognised and supported in their role. They need help to understand the illness, what changes are expected and how it can affect their family member. Many support services, partly due to the COVID pandemic, have moved online and have been shown to be acceptable as they are low cost and reduce access barriers. iSupport is an evidence-informed e-health training programme developed by the World Health Organization (WHO) to support adult dementia carers. This paper reports on the co-design of an adapted version of iSupport for young carers. A theoretically driven co-design approach, drawing on the lived experiences of young dementia carers and experts who work with this target group was followed. As a result of this study iSupport for Young Carers was created. It is the first e-health intervention of its kind and aims to support the mental health, knowledge and skills of young dementia carers. In turn, it could improve the quality of the support that service providers can offer, and this can result in increased levels of identification of these young people. The work presented also provides opportunities for other countries and demographic groups to translate and adapt iSupport for Young Carers to their specific cultural context

Modeling the Expected Performance of the REgolith X-ray Imaging Spectrometer (REXIS)

OSIRIS-REx is the third spacecraft in the NASA New Frontiers Program and is planned for launch in 2016. OSIRIS-REx will orbit the near-Earth asteroid (101955) Bennu, characterize it, and return a sample of the asteroid's regolith back to Earth. The Regolith X-ray Imaging Spectrometer (REXIS) is an instrument on OSIRIS-REx designed and built by students at MIT and Harvard. The purpose of REXIS is to collect and image sun-induced fluorescent X-rays emitted by Bennu, thereby providing spectroscopic information related to the elemental makeup of the asteroid regolith and the distribution of features over its surface. Telescopic reflectance spectra suggest a CI or CM chondrite analog meteorite class for Bennu, where this primitive nature strongly motivates its study. A number of factors, however, will influence the generation, measurement, and interpretation of the X-ray spectra measured by REXIS. These include: the compositional nature and heterogeneity of Bennu, the time-variable Solar state, X-ray detector characteristics, and geometric parameters for the observations. In this paper, we will explore how these variables influence the precision to which REXIS can measure Bennu's surface composition. By modeling the aforementioned factors, we place bounds on the expected performance of REXIS and its ability to ultimately place Bennu in an analog meteorite class.Comment: Presented at the SPIE Optics + Photonics Conference, 18 August 2014, San Diego, C