Tunneling with dissipation and decoherence for a large spin

We present rigorous solution of problems of tunneling with dissipation and decoherence for a spin of an atom or a molecule in an isotropic solid matrix. Our approach is based upon switching to a rotating coordinate system coupled to the local crystal field. We show that the spin of a molecule can be used in a qubit only if the molecule is strongly coupled with its atomic environment. This condition is a consequence of the conservation of the total angular momentum (spin + matrix), that has been largely ignored in previous studies of spin tunneling.Comment: 4 page

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The dark side of truth(s): Ethical dilemmas in researching the personal. Qualitative Inquiry

This article explores the sometimes problematic issue of truth when conducting qualitative research on people's lives. Four ethical dilemmas are presented relating to the potentially harmful consequences of truth encountered by the authors in their own research: a promise to share the analysis of a patient's medical record containing unflattering comments by her physicians; the unintended sharing of a traumatic event, held secret since its occurrence, by a woman inmate; a disagreement with the Institutional Review Board over what constitutes ethical practice in online research; and an interview with a recently released political dissident in a totalitarian country. The authors advocate for multiple venues in which qualitative researchers can discuss ethical dilemmas such as these to learn from one another's experience and together develop a more reflexive practice. Keywords: truth in research; ethical dilemmas; reflexive practice A s qualitative researchers, we choose to enter the lives of othersespecially those in vulnerable situations and at pivotal points of timewith intentions of both giving voice to the depth and richness of individual experience and accomplishing socially relevant changes within the contexts examined. To fulfill these goals, we choose topics about which we feel passionately, seek triangulated methods, attempt to establish partnerships with those studied, and position ourselves openly in approaching the research scene and interpreting our observations and other materials collected. In engaging in this complex, rigorous process of inquiry, it is essential that we recognize that qualitative research is a deeply personal enterprise. In this article, we identify several complex ethical dilemmas that have arisen in our experiences of conducting research that probes the very personal, subjective truths of people's lives; in so doing, we expose our own frailties, concerns, and questions as interpretive researchers

Trailblazing healthcare: Institutionalizing and integrating complementary medicine

Objectives — This study examines three integrative health centers to understand their (1) historical development, organizational goals, and modalities, (2) the processes and challenges of integrating complementary and allopathic medicine, while encouraging staff collaboration, and (3) how each center becomes institutionalized within their community. Methods — We focus on three organizational case studies that reflect varying forms of integrative health care practices in three U.S. cities. Participant-observation and in-depth interviews with center directors were analyzed qualitatively. Results — Important patterns found within the three cases are (1) the critical role of visionary biomedical practitioners who bridge complementary and allopathic practices, (2) communicating integration internally through team interaction, and (3) communicating integration externally through spatial location, naming, and community outreach. Conclusion — IM centers continue to blaze new trails toward mainstream access and acceptance by gathering evidence for IM, encouraging team collaboration within organizational contexts, constructing organizational identity, and negotiating insurance reimbursements. Practice implications — IM is not the enactment of specific modalities, but rather a philosophy of healing. Though scheduling conflicts, skepticism, and insurance coverage may be obstacles toward IM, collaboration among specialists and with patients should be the ultimate goal

Racial Differences in Trust and Lung Cancer Patients’ Perceptions of Physician Communication

Purpose Black patients report lower trust in physicians than white patients, but this difference is poorly studied. We examined whether racial differences in patient trust are associated with physician-patient communication about lung cancer treatment. Patients and Methods Data were obtained for 103 patients (22% black and 78% white) visiting thoracic surgery or oncology clinics in a large Southern Veterans Affairs hospital for initial treatment recommendation for suspicious pulmonary nodules or lung cancer. Questionnaires were used to determine patients’ perceptions of the quality of the physicians’ communication and were used to assess patients’ previsit and postvisit trust in physician and trust in health care system. Patients responded on a 10-point scale. Results Previsit trust in physician was statistically similar in black and white patients (mean score, 8.2 v 8.3, respectively; P =.80), but black patients had lower postvisit trust in physician than white patients (8.0 v 9.3, respectively; P =.02). Black patients, compared with white patients, judged the physicians’ communication as less informative (7.3 v 8.5, respectively; P = .03), less supportive (8.1 v 9.3, respectively; P = .03), and less partnering (6.4 v 8.2, respectively; P = .001). In mixed linear regression analysis, controlling for clustering of patients by physician, patients’ perceptions of physicians’ communication were statistically significant (P = .005) predictors of postvisit trust, although patient race, previsit trust, and patient and visit characteristics were not significant (P = .05) predictors. Conclusion Perceptions that physician communication was less supportive, less partnering, and less informative accounted for black patients’ lower trust in physicians. Our findings raise concern that black patients may have lower trust in their physicians in part because of poorer physician-patient communication