Barriers and Facilitators to Use of a Clinical Evidence Technology in the Management of Skin Problems in Primary Care: Insights from Mixed Methods

Objective: Few studies have examined the impact of a single clinical evidence technology (CET) on provider practice or patient outcomes from the provider’s perspective. A previous cluster-randomized controlled trial with patient-reported data tested the effectiveness of a CET (i.e., VisualDx) in improving skin problem outcomes but found no significant effect. The objectives of this follow-up study were to identify barriers and facilitators to the use of the CET from the perspective of primary care providers (PCPs) and to identify reasons why the CET did not affect outcomes in the trial. Methods: Using a convergent mixed methods design, PCPs completed a post-trial survey and participated in interviews about using the CET for the management of patients’ skin problems. Data from both methods were integrated. Results: PCPs found the CET somewhat easy to use but only occasionally useful. Less experienced PCPs used the CET more frequently. Data from interviews revealed barriers and facilitators at four steps of evidence-based practice: clinical question recognition, information acquisition, appraisal of relevance, and application with patients. Facilitators included uncertainty in dermatology, intention for use, convenience of access, diagnosis and treatment support, and patient communication. Barriers included confidence in dermatology, preference for other sources, interface difficulties, presence of irrelevant information, and lack of decision impact. Conclusion: PCPs found the CET useful for diagnosis, treatment support, and patient communication. However, the barriers of interface difficulties, irrelevant search results, and preferred use of other sources limited its positive impact on patient skin problem management

Performance of a deterministic source of entangled photonic qubits

We study the possible limitations and sources of decoherence in the scheme for the deterministic generation of polarization-entangled photons, recently proposed by Gheri et al. [K. M. Gheri et al., Phys. Rev. A 58, R2627 (1998)], based on an appropriately driven single atom trapped within an optical cavity. We consider in particular the effects of laser intensity fluctuations, photon losses, and atomic motion.Comment: 10 pages, 6 figure

Insomnia and its associations in patients with recurrent glial neoplasms

BACKGROUND: Patient with neurological disorders and cancer can develop sleep disturbance, in particular insomnia. Etiology of insomnia is multi-factorial in primary brain tumour patients with possible causes including corticosteroids, psychoactive medications, co-morbid psychiatric/medical conditions, and damage to neuronal tissue. FINDINGS: To understand better insomnia in recurrent glioma patients, a single-center retrospective analysis was performed looking at recurrent glioma patients from January 2004 to May 2009. Data was extracted and included demographics, clinical factors, psychoactive medications, and co-morbid symptoms. Presence and absence of insomnia complaints was evaluated with other co-morbidities using Chi square and Wilcoxon analyses. Records from 340 recurrent glioma patients were evaluated and 46.8 % (n = 159) indicated presence of insomnia with 20 % (n = 66) actively using medications for sleep. Use of corticosteroids were significantly associated with insomnia (p = 0.0003). Age, gender, tumour location, use of stimulants, antipsychotics, and antidepressants were not significantly associated with insomnia in recurrent glioma patients. There was a trend towards a possible significant association with insomnia to fatigue complaints and use of anti-epileptics, p-values of 0.0501 and 0.0725 respectively. CONCLUSIONS: In conclusion, insomnia is commonly encountered in patients with recurrent glial tumors. Corticosteroid use is associated with insomnia in this population. In light of the frequency of insomnia and its associations, future analysis is warranted into sleep complaints in recurrent glioma patients and its impact on quality of life

Ultrastable CO2 Laser Trapping of Lithium Fermions

We demonstrate an ultrastable CO2 laser trap that provides tight confinement of neutral atoms with negligible optical scattering and minimal laser-noise- induced heating. Using this method, fermionic 6Li atoms are stored in a 0.4 mK deep well with a 1/e trap lifetime of 300 sec, consistent with a background pressure of 10^(-11) Torr. To our knowledge, this is the longest storage time ever achieved with an all-optical trap, comparable to the best reported magnetic traps.Comment: 4 pages using REVTeX, 1 eps figur

High-precision measurement of the half-life of 62^{62}Ga

The beta-decay half-life of 62Ga has been studied with high precision using on-line mass separated samples. The decay of 62Ga which is dominated by a 0+ to 0+ transition to the ground state of 62Zn yields a half-life of T_{1/2} = 116.19(4) ms. This result is more precise than any previous measurement by about a factor of four or more. The present value is in agreement with older literature values, but slightly disagrees with a recent measurement. We determine an error weighted average value of all experimental half-lives of 116.18(4) ms.Comment: 9 pages, 5 figures, accepted for publication in PR

State-Insensitive Cooling and Trapping of Single Atoms in an Optical Cavity

Single Cesium atoms are cooled and trapped inside a small optical cavity by way of a novel far-off-resonance dipole-force trap (FORT), with observed lifetimes of 2 to 3 seconds. Trapped atoms are observed continuously via transmission of a strongly coupled probe beam, with individual events lasting ~ 1 s. The loss of successive atoms from the trap N = 3 -> 2 -> 1 -> 0 is thereby monitored in real time. Trapping, cooling, and interactions with strong coupling are enabled by the FORT potential, for which the center-of-mass motion is only weakly dependent on the atom's internal state.Comment: 5 pages, 4 figures Revised version to appear in Phys. Rev. Let

Pauvreté et distribution de revenus au Sénégal: une approche par la modélisation en équilibre général calculable micro-simulé

La nouvelle orientation de la politique économique au Sénégal vise à accroître les revenus des pauvres et à attaquer la pauvreté là où elle est principalement localisée. La stratégie de réduction de la pauvreté va être mise en oeuvre dans un contexte de libéralisation des échanges commerciaux internationaux notamment dans le secteur agricole. Dans ce contexte, nous avons développé un modèle d'équilibre général calculable micro-simulé multi-ménages du type Decaluwé et al. (1999) permettant d'évaluer l'impact que pourront avoir ces politiques agricoles à l'échelle des ménages et de faire le lien entre ces réformes économiques, la pauvreté et la distribution de revenu. Ce modèle offre beaucoup de flexibilité en permettant notamment de modifier la distribution des groupes cibles qui n'ont pas à être revenus avant l'exercice de simulation afin d'effectuer l'analyse de pauvreté et d'inégalité ex post à l'exercice de modélisation. Dans ce travail, nous avons également comparé les effets en terme d'analyse de pauvreté et d'inégalité entre une distribution paramétrique (Dagum, 3 paramètres) et une distribution non-paramétrique et montré que ce choix engendrait des différences significatives quant aux effets sur la pauvreté. Contrairement aux applications faite par Decaluwé et al. (1999) et Cockburn (2002) au Népal, les impacts sur la pauvreté sont assez importants, ce qui montre que cette approche offre un outil riche permettant d'évaluer l'impact de politiques économiques ou chocs externes sur la pauvreté et la distribution de revenu.Modèle d'équilibre général calculable, micro-simulation, analyse de pauvreté, distribution de revenu

Position-sensitive ion detection in precision Penning trap mass spectrometry

A commercial, position-sensitive ion detector was used for the first time for the time-of-flight ion-cyclotron resonance detection technique in Penning trap mass spectrometry. In this work, the characteristics of the detector and its implementation in a Penning trap mass spectrometer will be presented. In addition, simulations and experimental studies concerning the observation of ions ejected from a Penning trap are described. This will allow for a precise monitoring of the state of ion motion in the trap.Comment: 20 pages, 13 figure

Thoracic Gas Volume in Athletes and Non-Athletes

The purpose of this study was to analyze the predicted thoracic gas volume versus measured thoracic gas volume in college students, comparing NCAA collegiate athletes versus non-athletes using the Bod Pod. Forty-four college students, both males and females, athletes and non-athletes, completed a body composition test to obtain the predicted thoracic gas volume. The participants were then instructed by the Bod Pod software through the measured thoracic gas volume test. Due to low statistical power, athletes and non-athletes were unable to be compared, however, results of a two sample t-test showed that there was a statistically significant difference between measured thoracic gas volume and predicted thoracic gas volume within the population as a whole. The average predicted thoracic gas volume was 3.66 liters ± 0.103 while the measured thoracic gas volume was 4.02 liters ± 0.165. The significance level for the test was p ≤ 0.05 and the p-value obtained from the statistical analysis was p ≤ 0.001. It was concluded that within this study, there was a significant difference between the predicted and measured thoracic gas volumes of the population