HIV Testing Practices by Clinical Service before and after Revised Testing Guidelines in a Swiss University Hospital

OBJECTIVES: To determine 1) HIV testing practices in a 1400-bed university hospital where local HIV prevalence is 0.4% and 2) the effect on testing practices of national HIV testing guidelines, revised in March 2010, recommending Physician-Initiated Counselling and Testing (PICT). METHODS: Using 2 hospital databases, we determined the number of HIV tests performed by selected clinical services, and the number of patients tested as a percentage of the number seen per service ('testing rate'). To explore the effect of the revised national guidelines, we examined testing rates for two years pre- and two years post-PICT guideline publication. RESULTS: Combining the clinical services, 253,178 patients were seen and 9,183 tests were performed (of which 80 tested positive, 0.9%) in the four-year study period. The emergency department (ED) performed the second highest number of tests, but had the lowest testing rates (0.9-1.1%). Of inpatient services, neurology and psychiatry had higher testing rates than internal medicine (19.7% and 9.6% versus 8%, respectively). There was no significant increase in testing rates, either globally or in the majority of the clinical services examined, and no increase in new HIV diagnoses post-PICT recommendations. CONCLUSIONS: Using a simple two-database tool, we observe no global improvement in HIV testing rates in our hospital following new national guidelines but do identify services where testing practices merit improvement. This study may show the limit of PICT strategies based on physician risk assessment, compared to the opt-out approach

Modeling terahertz heating effects on water

We apply Kirchhoff's heat equation to model the influence of a CW terahertz beam on a sample of water, which is assumed to be static. We develop a generalized model, which easily can be applied to other liquids and solids by changing the material constants. If the terahertz light source is focused down to a spot with a diameter of 0.5 mm, we find that the steady-state temperature increase per milliwatt of transmitted power is 1.8?C/mW. A quantum cascade laser can produce a CW beam in the order of several milliwatts and this motivates the need to estimate the effect of beam power on the sample temperature. For THz time domain systems, we indicate how to use our model as a worst-case approximation based on the beam average power. It turns out that THz pulses created from photoconductive antennas give a negligible increase in temperature. As biotissue contains a high water content, this leads to a discussion of worst-case predictions for THz heating of the human body in order to motivate future detailed study. An open source Matlab implementation of our model is freely available for use at www.eleceng.adelaide.edu.au/thz.Torben T. L. Kristensen, Withawat Withayachumnankul, Peter U. Jepsen and Derek Abbot

EBM in primary care: a qualitative multicenter study in Spain

<p>Abstract</p> <p>Background</p> <p>Evidence based medicine (EBM) has made a substantial impact on primary care in Spain over the last few years. However, little research has been done into family physicians (FPs)' attitudes related to EBM. The present study investigates FPs' perceptions of EBM in the primary care context.</p> <p>Methods</p> <p>This study used qualitative methodology. Information was obtained from 8 focus groups composed of 67 FPs from 47 health centers in 4 autonomous regions in Spain. Intentional sampling considered participants' previous education in EBM, and their experience as tutors in family medicine or working groups' members of the Spanish Society of Family Practice. Sociological discourse analysis was used with the support of the MAXqda software. Results were validated by means of triangulation among researchers and contrast with participants.</p> <p>Results</p> <p>Findings were grouped into three main areas: 1) The tug-of-war between the "science" of EBM and "experience" in the search for good clinical practice in primary care; 2) The development of EBM sensemaking as a reaction to contextual factors and interests; 3) The paradox of doubt and trust in the new EBM experts.</p> <p>The meaning of EBM was dynamically constructed within the primary care context. FPs did not consider good clinical practice was limited to the vision of science that EBM represents. Its use appeared to be conditioned by several factors that transcended the common concept of barriers. Along with concerns about its objectivity, participants showed a tendency to see EBM as the use of simplified guidelines developed by EBM experts.</p> <p>Conclusions</p> <p>The identification of science with EBM and its recognition as a useful but insufficient tool for the good clinical practice requires rethinking new meanings of evidence within the primary care reality. Beyond the barriers related to accessing and putting into practice the EBM, its reactive use can determine FPs' questions and EBM development in a direction not always centred on patients' needs. The questioning of experts' authority as a pillar of EBM could be challenged by the emergence of new kinds of EBM texts and experts to believe in.</p

First lithographic results from the extreme ultraviolet Engineering Test Stand

The extreme ultraviolet ͑EUV͒ Engineering Test Stand ͑ETS͒ is a step-and-scan lithography tool that operates at a wavelength of 13.4 nm. It has been developed to demonstrate full-field EUV imaging and acquire system learning for equipment manufacturers to develop commercial tools. The initial integration of the tool is being carried out using a developmental set of projection optics, while a second, higher-quality, projection optics is being assembled and characterized in a parallel effort. We present here the first lithographic results from the ETS, which include both static and scanned resist images of 100 nm dense and isolated features throughout the ring field of the projection optics. Accurate lithographic models have been developed and compared with the experimental results