An ultra-stable, high-power cw Nd:YAG laser system, developed for the ground-based gravitational wave detector Advanced LIGO (Laser Interferometer Gravitational-Wave Observatory), was comprehensively ...characterized. Laser power, frequency, beam pointing and beam quality were simultaneously stabilized using different active and passive schemes. The output beam, the performance of the stabilization, and the cross-coupling between different stabilization feedback control loops were characterized and found to fulfill most design requirements. The employed stabilization schemes and the achieved performance are of relevance to many high-precision optical experiments.
Variability in primary medication nonadherence (PMN), or failure to fill a new prescription, influences disparities and widens equity gaps. This study sought to evaluate PMN across 1 metropolitan ...area and assess relationships with underlying zip code-level measures.
This was a retrospective observational study using data extracted from 1 regional community pharmacy market-share leader (October 2016-April 2017). Data included patient age, sex, payer, medication type, and home zip code. This zip code was connected to US census measures enumerating poverty and vehicle access, which were treated as continuous variables and within quintiles. The prescription-level outcome was whether prescriptions were not filled within 30 days of reaching the pharmacy. The ecological-level outcome was PMN calculated for each zip code (numerator, unfilled prescriptions; denominator, received prescriptions).
There were 213 719 prescriptions received by 54 included pharmacies; 12.2% were unfilled. Older children, boys, and those with public insurance were more likely to have prescriptions not filled. Prescriptions originating from the highest poverty quintile were significantly more likely to not be filled than those from the lowest poverty quintile (adjusted odds ratio 1.60; 95% confidence interval 1.52-1.69); a similar pattern was noted for vehicle access (adjusted odds ratio 1.77; 95% confidence interval 1.68-1.87). At the ecological level, there were significant, graded relationships between PMN rates and poverty and vehicle access (both
< .0001); these gradients extended across all medication classes.
Poverty and vehicle access are related to significant differences in prescription- and ecological-level PMN across 1 metropolitan area. Pharmacists and pharmacies can be key partners in population health efforts.
To determine if a community pharmacy-based transition of care (TOC) program that included the full scope of medication therapy management (MTM) services (TransitionRx) decreased hospital ...readmissions, resolved medication-related problems, and increased patient satisfaction.
Prospective, quasi-experimental study.
Nine Kroger Pharmacies located in Western Cincinnati.
Patients older than 18 years of age and discharged from two local hospitals with a diagnosis of congestive heart failure, chronic obstructive pulmonary disease, or pneumonia. Patients were recruited from two local hospitals and referred to the community pharmacy for MTM services with the pharmacist within 1 week of discharge.
Pharmacists reconciled the patients' medications, identified drug therapy problems, recommended changes to therapy, and provided self-management education. At 30 days after discharge, research personnel conducted telephone surveys, using a previously validated survey instrument, to assess hospital readmissions and patient satisfaction. Pharmacist interventions and medication-related problems were documented.
A total of 90 patients completed the study. Of these, 20% of patients in the usual care group were admitted to the hospital within 30 days compared with 6.9% of patients in the intervention group (P = 0.019). In the 30 patients who received MTM services from the pharmacist, 210 interventions were made. The overall mean patient satisfaction with the TOC process was not significantly different between patients who were seen by the pharmacist and those who were not seen by the pharmacist.
Community pharmacies successfully collaborated with hospitals to develop a referral process for TOC interventions. Patients who received MTM services from the pharmacist experienced significantly fewer readmissions than patients who received usual care.
We present a compact few-cycle 100 kHz OPCPA system pumped by a CPA-free picosecond Nd:YVO
solid-state amplifier with all-optical synchronization to an ultra-broadband Ti:sapphire oscillator. This ...pump approach shows an exceptional conversion rate into the second harmonic of almost 78%. Efficient parametric amplification was realized by a two stage double-pass scheme with following chirped mirror compressor. The amount of superfluorescence was measured by an optical cross-correlation. Pulses with a duration of 8.7 fs at energies of 18 µJ are demonstrated. Due to the peak power of 1.26 GW, this simple OPCPA approach forms an ideal high repetition rate driving source for high-order harmonic generation.
A solid-state laser system for the next generation of gravitational wave detectors with an output power of 220 W at the wavelength of 1064 nm is presented. Single-frequency operation of the laser was ...achieved by injection-locking of a high-power ring oscillator to an amplified non-planar ring oscillator (NPRO) following the Pound–Drever–Hall scheme. The high-power stage which features four longitudinally pumped Nd:YAG laser crystals as active media in a ring resonator configuration was designed for reliable long term operation. Using a non-confocal ring cavity to filter the output beam, a pure TEM
00
mode with 168 W output power was obtained.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
To determine the feasibility of a partnership between a community pharmacy and a patient-centered medical home (PCMH) by measuring the impact on office- and patient-level clinical outcomes.
Kroger ...Pharmacy and a PCMH practice in Cincinnati, OH.
The Kroger Co. is a large grocery store chain that operates 102 pharmacies in the Cincinnati-Dayton marketing area. The PCMH practice is an accredited PCMH office serving more than 9000 patients in the Cincinnati area.
In a medical neighborhood, a PCMH coordinates care with other local specialty practices or partners. A partnership between the community pharmacy chain and the PCMH was established to create a medical neighborhood. The pharmacist spent 2 half-days per week at the PCMH. The pharmacist provided initial medication therapy management appointments in the PCMH and offered follow-up services in the office, the pharmacy, or both, depending on patient preference. The pharmacy received a capitated payment per patient per month for a predetermined number of 1000 high-risk patients.
Office-level changes in clinical outcomes such as A1C, blood pressure, and lipid measures were collected and compared with those of a similar control office. In addition, patient-level outcomes such as change in A1C, blood pressure, lipids, and weight were measured.
One hundred five patients were seen by the pharmacist during the study period, with 1.5% of the total managed at the office. There was a statistically significant increase in influenza vaccinations received. On a patient level, A1C and systolic blood pressure significantly improved.
This project represents an exciting opportunity for community pharmacists to expand their scope of services through direct partnership with PCMHs and maintain a sustainable reimbursement structure.
The power scalability of solid-state rod lasers in general is limited by the thermally induced mechanical stress approaching the fracture stress of the laser material. In conventional end-pumped ...lasers, the spatial heat-generation density profiles follow a nearly exponential law, resulting in a reduction of the maximum possible pump power when compared with a transversally pumped rod of the same length. In this paper, an approach for power scaling of end-pumped solid-state lasers by employing crystals with longitudinally varying dopant concentration profiles is presented. The optimum continuously varying dopant concentration profiles for a pump-light single and double pass are derived. Multisegmented crystals approximate these continuous doping profiles. An algorithm for optimizing the segment lengths and dopant concentrations in these crystals is described, the resulting optimum segment data are tabulated, and the relative power capability of these crystals is given.
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