WHO guide to good prescribing is 25 years old:quo vadis?

Introduction: Twenty-five years ago, the World Health Organization (WHO) published the Guide to Good Prescribing (GGP), followed by the accompanying Teacher’s Guide to Good Prescribing (TGGP). The GGP is based on a normative 6-step model for therapeutic reasoning and prescribing, and provides a six-step guide for students to the process of rational prescribing. Method: We reviewed the need to update both WHO publications by evaluating their use and impact, including new (theoretical) insights and demands. Based on information from literature, Internet, and other (personal) sources, we draw the following conclusions. Results: 1. An update of the GGP and TGGP, both in terms of content and form, is necessary because of the current need for these tools (irrational medicine use and unavailability of medicines), the lack of similar documents, and the lack of connection with recent developments, such as Internet and modern education; 2. The basic (6-step) model of the GGP is effective in terms of rational prescribing in the undergraduate situation and is still consistent with current theories about (context) learning, clinical decision-making, and clinical practice; 3. The dissemination and introduction of the GGP and TGGP in education has been successful so far, but is still not optimal because of lack of support and cooperation. Conclusions: On the basis of the evaluation results, a plan for the revision of the GGP and TGGP is presented

Herschel/PACS observations of the 69 μm\mu m band of crystalline olivine around evolved stars

We present 48 Herschel/PACS spectra of evolved stars in the wavelength range of 67-72 $\mu$m. This wavelength range covers the 69 $\mu$m band of crystalline olivine ($\text{Mg}_{2-2x}\text{Fe}_{(2x)}\text{SiO}_{4}$). The width and wavelength position of this band are sensitive to the temperature and composition of the crystalline olivine. Our sample covers a wide range of objects: from high mass-loss rate AGB stars (OH/IR stars, $\dot M \ge 10^{-5}$ M$_\odot$/yr), through post-AGB stars with and without circumbinary disks, to planetary nebulae and even a few massive evolved stars. The goal of this study is to exploit the spectral properties of the 69 $\mu$m band to determine the composition and temperature of the crystalline olivine. Since the objects cover a range of evolutionary phases, we study the physical and chemical properties in this range of physical environments. We fit the 69 $\mu$m band and use its width and position to probe the composition and temperature of the crystalline olivine. For 27 sources in the sample, we detected the 69 $\mu$m band of crystalline olivine ($\text{Mg}_{(2-2x)}\text{Fe}_{(2x)}\text{SiO}_{4}$). The 69 $\mu$m band shows that all the sources produce pure forsterite grains containing no iron in their lattice structure. The temperature of the crystalline olivine as indicated by the 69 $\mu$m band, shows that on average the temperature of the crystalline olivine is highest in the group of OH/IR stars and the post-AGB stars with confirmed Keplerian disks. The temperature is lower for the other post-AGB stars and lowest for the planetary nebulae. A couple of the detected 69 $\mu$m bands are broader than those of pure magnesium-rich crystalline olivine, which we show can be due to a temperature gradient in the circumstellar environment of these stars. continued...Comment: Accepted for publication in A&

Do medical students copy the drug treatment choices of their teachers or do they think for themselves?

PURPOSE: Although the importance of rational prescribing is generally accepted, the teaching of pharmacotherapy to undergraduate medical students is still unsatisfactory. Because clinical teachers are an important role model for medical students, it is of interest to know whether this extends to therapeutic decision-making. The aim of this study was to find out which factors contribute to the drug choices made by medical students and their teachers (general practitioners and clinical specialists). METHODS: Final-year medical students (n = 32), and general practitioners (n = 29), lung specialists (n = 26), orthopaedic surgeons (n = 24), and internists (n = 24) serving as medical teachers from all eight medical schools in the Netherlands participated in the study. They were asked to prescribe treatment (drug or otherwise) for uncomplicated (A) and complicated (B) written patient cases and to indicate which factors influenced their choice of treatment, using a list of factors reported in the literature to influence drug prescribing. RESULTS: Final-year medical students primarily based their drug choice on the factors 'effectiveness of the drugs' and 'examples from medical teachers'. In contrast, clinical teachers primarily based their drug choice on the factors 'clinical experience', 'effectiveness of the drugs', 'side effects of the drugs', 'standard treatment guidelines', and 'scientific literature'. CONCLUSIONS: Medical teachers would appear to base their drug choice mainly on clinical experience and drug-related factors, whereas final-year medical students base their drug choice mainly on examples provided by their medical teachers. It is essential that medical teachers clearly explain to their students how they arrive at a specific choice of medication since medical students tend to copy the therapeutic drug choices from their teachers, mainly because of a lack of experience. Presenting students with clinical therapeutic problems early during undergraduate training will not only give them a chance to gain experience in solving medical problems but will also give meaning to what they are studying as opposed to merely reproducing what they learn or copying what they are tol

Investigation of the Exclusive 3He(e,e'pp)n Reaction

Cross sections for the 3He(e,e'pp)n reaction were measured over a wide range of energy and three- momentum transfer. At a momentum transfer q=375 MeV/c, data were taken at transferred energies omega ranging from 170 to 290 MeV. At omega=220 MeV, measurements were performed at three q values (305, 375, and 445 MeV/c). The results are presented as a function of the neutron momentum in the final-state, as a function of the energy and momentum transfer, and as a function of the relative momentum of the two-proton system. The data at neutron momenta below 100 MeV/c, obtained for two values of the momentum transfer at omega=220 MeV, are well described by the results of continuum-Faddeev calculations. These calculations indicate that the cross section in this domain is dominated by direct two-proton emission induced by a one-body hadronic current. Cross section distributions determined as a function of the relative momentum of the two protons are fairly well reproduced by continuum-Faddeev calculations based on various realistic nucleon-nucleon potential models. At higher neutron momentum and at higher energy transfer, deviations between data and calculations are observed that may be due to contributions of isobar currents.Comment: 14 pages, 1 table, 17 figure

Pion-Lambda-Sigma Coupling Extracted from Hyperonic Atoms

The latest measurements of the atomic level width in Sigma-hyperonic Pb atom offer the most accurate datum in the region of low-energy Sigma-hyperon physics. Atomic widths are due to the conversion of Sigma-nucleon into Lambda-nucleon. In high angular momentum states this conversion is dominated by the one-pion exchange. A joint analysis of the data of the scattering of negative-Sigma on proton converting into a Lambda and a neutron and of the atomic widths allows to extract a pseudovector pion-hyperon-Sigma coupling constant of 0.048 with a statistical error of +-0.005 and a systematic one of +-0.004. This corresponds to a pseudoscalar coupling constant of 13.3 with a statistical uncertainty of 1.4 and a systematic one of 1.1.Comment: 12 pages, 1 figure, Use of Revtex.st

Weak localization of light by cold atoms: the impact of quantum internal structure

Since the work of Anderson on localization, interference effects for the propagation of a wave in the presence of disorder have been extensively studied, as exemplified in coherent backscattering (CBS) of light. In the multiple scattering of light by a disordered sample of thermal atoms, interference effects are usually washed out by the fast atomic motion. This is no longer true for cold atoms where CBS has recently been observed. However, the internal structure of the atoms strongly influences the interference properties. In this paper, we consider light scattering by an atomic dipole transition with arbitrary degeneracy and study its impact on coherent backscattering. We show that the interference contrast is strongly reduced. Assuming a uniform statistical distribution over internal degrees of freedom, we compute analytically the single and double scattering contributions to the intensity in the weak localization regime. The so-called ladder and crossed diagrams are generalized to the case of atoms and permit to calculate enhancement factors and backscattering intensity profiles for polarized light and any closed atomic dipole transition.Comment: 22 pages Revtex, 9 figures, to appear in PR

First measurements of the ^16O(e,e'pn)^14N reaction

This paper reports on the first measurement of the ^16O(e,e'pn)^14N reaction. Data were measured in kinematics centred on a super-parallel geometry at energy and momentum transfers of 215 MeV and 316 MeV/c. The experimental resolution was sufficient to distinguish groups of states in the residual nucleus but not good enough to separate individual states. The data show a strong dependence on missing momentum and this dependence appears to be different for two groups of states in the residual nucleus. Theoretical calculations of the reaction using the Pavia code do not reproduce the shape or the magnitude of the data.Comment: 10 pages, 11 figures, 2 tables, Accepted for publication in EPJ

Spin-Momentum Correlations in Quasi-Elastic Electron Scattering from Deuterium

We report on a measurement of spin-momentum correlations in quasi-elastic scattering of longitudinally polarized electrons with an energy of 720 MeV from vector-polarized deuterium. The spin correlation parameter $A^V_{ed}$ was measured for the $^2 \vec{\rm H}(\vec e,e^\prime p)n$ reaction for missing momenta up to 350 MeV/$c$ at a four-momentum transfer squared of 0.21 (GeV/c)$^2$. The data give detailed information about the spin structure of the deuteron, and are in good agreement with the predictions of microscopic calculations based on realistic nucleon-nucleon potentials and including various spin-dependent reaction mechanism effects. The experiment demonstrates in a most direct manner the effects of the D-state in the deuteron ground-state wave function and shows the importance of isobar configurations for this reaction.Comment: 4 pages, 3 figures, submitted to Phys. Rev. Lett. for publicatio

Investigation of the Exclusive ^{3}He(e,e'pn)p Reaction

Cross sections for the ^{3}He(e,e'pn)p reaction were measured for the first time at energy transfers of 220 and 270 MeV for several momentum transfers ranging from 300 to 450 MeV/c. Cross sections are presented as a function of the momentum of the recoil proton and the momentum transfer. Continuum Faddeev calculations using the Argonne V18 and Bonn-B nucleon-nucleon potentials overestimate the measured cross sections by a factor 5 at low recoil proton momentum with the discrepancy becoming much smaller at higher recoil momentum.Comment: 5, pages, 3 figure

Observation of associated production of a ZZ boson with a DD meson in the~forward region

A search for associated production of a $Z$ boson with an open charm meson is presented using a data sample, corresponding to an integrated luminosity of $1.0\,\mathrm{fb}^{-`}$ of proton--proton collisions at a centre-of-mass energy of 7\,TeV, collected by the LHCb experiment. %% Seven candidate events for associated production of a $Z$ boson with a $D^0$ meson and four candidate events for a $Z$ boson with a $D^+$ meson are observed with a combined significance of 5.1standard deviations. The production cross-sections in the forward region are measured to be $$\sigma_{Z\rightarrow\mu^+\mu^-\!,D^0} = 2.50\pm1.12\pm0.22pb$$ $$\sigma_{Z\rightarrow\mu^+\mu^-\!,D^+} = 0.44\pm0.23\pm0.03pb,$$ where the first uncertainty is statistical and the second systematic.Comment: 18 pages, 2 figure