Background. Medical consultations are replete with conflicts, particularly in the current era of explicit and implicit rationing practices in health care organizations. Although such conflicts may ...challenge the doctor–patient relationship, little is known about them or their consequences. Aims. To systematically describe the nature of doctor–patient conflicts in medical encounters and the strategies physicians use when faced with conflicts. Methods. Analysis of 291 videotaped routine encounters with 28 general practitioners, using a novel adaptation of the Roter interaction analysis system software, provided quantitative empirical data on the conflicts and on the communication process. Seven focus groups (56 GPs) provided qualitative insights and guided the analysis. Results. Conflicts were identified in 40% of consultations; 21% of these were related to the rationing of health care resources. In conflictual encounters, both the opening and closing phases of the encounter were shorter than in non-conflictual encounters. In coping with resource rationing, the commonest strategy was to accept the dictates of the system without telling the patients about other options. When conflict of this type occurred, doctors showed more opposition to the patients rather than empathy. Conclusions. Doctors often face conflicts in their routine work, but resource-related conflicts are especially difficult and expose the dual loyalties of the doctor to the patient and to the system. Insights derived from this research can be used to design training interventions that improve doctors’ efficacy in coping with conflicts and ultimately allow them to provide better patient care.
A study of the two-body decays B^{±}→X_{ccover ¯}K^{±}, where X_{ccover ¯} refers to one charmonium state, is reported by the BABAR Collaboration using a data sample of 424 fb^{-1}. The absolute ...determination of branching fractions for these decays are significantly improved compared to previous BABAR measurements. Evidence is found for the decay B^{+}→X(3872)K^{+} at the 3σ level. The absolute branching fraction BB^{+}→X(3872)K^{+}=2.1±0.6(stat)±0.3(syst)×10^{-4} is measured for the first time. It follows that BX(3872)→J/ψπ^{+}π^{-}=(4.1±1.3)%, supporting the hypothesis of a molecular component for this resonance.
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The design, implementation and evaluation of health campaigns involve inherent ethical concerns and dilemmas. Many of these concerns, however, are often invisible. This article presents 13 dilemmas ...related to 4 specific areas: (a) strategies and content of health communication campaign messages, (b) inadvertent adverse outcomes from campaign activities, (c) power and control, and (d) social values. Examples to illustrate these ethical dilemmas draw from the literature and from a study of 2 national and 3 community-based health communication interventions. The 13 ethical dilem- mas are summarized as a series of practice-oriented questions to help scholars, practitioners and the those who are targeted by the campaign to identify and articulate ethical concerns embedded in health campaigns.
We report the observation of the rare charm decay D^{0}→K^{-}π^{+}e^{+}e^{-}, based on 468 fb^{-1} of e^{+}e^{-} annihilation data collected at or close to the center-of-mass energy of the ϒ(4S) ...resonance with the BABAR detector at the SLAC National Accelerator Laboratory. We find the branching fraction in the invariant mass range 0.675<m(e^{+}e^{-})<0.875 GeV/c^{2} of the electron-positron pair to be B(D^{0}→K^{-}π^{+}e^{+}e^{-})=(4.0±0.5±0.2±0.1)×10^{-6}, where the first uncertainty is statistical, the second systematic, and the third due to the uncertainty in the branching fraction of the decay D^{0}→K^{-}π^{+}π^{+}π^{-} used as a normalization mode. The significance of the observation corresponds to 9.7 standard deviations including systematic uncertainties. This result is consistent with the recently reported D^{0}→K^{-}π^{+}μ^{+}μ^{-} branching fraction, measured in the same invariant mass range, and with the value expected in the standard model. In a set of regions of m(e^{+}e^{-}), where long-distance effects are potentially small, we determine a 90% confidence level upper limit on the branching fraction B(D^{0}→K^{-}π^{+}e^{+}e^{-})<3.1×10^{-6}.
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The beliefs of low-income mothers regarding breastfeeding compared to formula feeding, according to feeding method, were investigated. Interviews were conducted with 154 women who were assigned to ...one of two groups. Four health benefits of breastfeeding were rated significantly higher than for infant formula within both the breastfeeding (BF) and formula-feeding (FF) groups. Breastfeeding was seen as less convenient than formula feeding by the FF group (x= 2.3 ± 1.7 versus 3.8 ± 1.5 for formula feeding and breastfeeding, respectively; P< .001). Both groups rated formula feeding as more likely to enable others to help in infant care, easier in terms of the mother's time control, and less likely to tie the mother down than breastfeeding. The findings show that, despite formula-feeding mothers' beliefs in the health benefits of breastfeeding, they perceive that it limits their activities. Therefore, breastfeeding promotion must address not only benefits but also lifestyle issues.
Research on health communication interventions tends to focus on achieving the intervention sponsor's goals. Thus, it can be characterized as strategic. Client and sponsor values, though recognized ...as important by researchers who adopt this approach, tend to be treated as independent variables that might serve as barriers to behavior change goals, or as dependent variables that can be manipulated to achieve those goals. This paper adopts the proposition that values have a pivotal role in the analysis and design of health communication interventions and that analyses that focus on values embedded in the intervention process can contribute to theory development. Instead of focusing exclusively on health‐related objectives, the paper proposes that analyses can also examine the extent to which certain values might have contributed to both problem definition and intervention strategies. The rationale for focusing on values, distinctions between a strategic and a value‐centered approach, and the importance of ethical issues in the analysis of health communication interventions are presented through a series of eight propositions. The propositions address six main areas: (a) the locus of analysis, (b) definition of the problem, (c) values, (d) intervention strategies and behavior change models, (e) program evaluation, and (f) ethical concerns.
The history of cigarette warning labels is fraught with dispute, and in many instances official anti-smoking warnings that appear on cigarette packets are the result of political compromise. Despite ...mixed findings on the effectiveness of these warning labels, they are viewed as a cost-effective anti-smoking measure by their mere presence and as an important part of larger anti-smoking efforts. Israel's Ministry of Health, in its recent initiative to introduce a new series of warning labels, has grappled with the attribution issue. A committee established by the Ministry to revise the warnings decided to survey public opinion to guide its decision regarding to whom warnings should be attributed and to counter tobacco lobby oppositions. Two surveys were conducted: a limited phone survey of the adult population (n = 1000) and a face-to-face survey of 200 adult smokers. Findings indicate there was little support for unattributed warnings and that smokers, when presented with actual warnings, tended to favor the attribution to "medical studies." Nonsmokers were somewhat more likely to prefer an attribution to the Ministry of Health, explaining that it is "responsible for the topic" or "has the authority." Attributional preferences were found to be associated to some extent with educational level. Discrepancies found between preferences of light smokers across the 2 surveys suggest that the method of preference elicitation may play an important role. The discussion of the attributional preferences draws from the persuasion literature and it is suggested that warning messages should be matched with selected sources.
A conceptual framework for analyzing health communication interventions is presented as a systematic approach to identify values and justificationsembedded inmajor facets of the communication ...intervention: the definition of the problem, the strategies adopted, the intervention stakeholders or its targeted populations, and the evaluation of the program. Although values and ethical concerns are embedded in all facets of health communication interventions, they are often left unexamined, or are taken for granted by practitioners and intervention populations (policy makers and the researchers who analyze, evaluate, or help design and implement them). The development, adaptation, and application of this framework can serve three inter-related purposes: (1) to provide constructs and a systematic approach to examine the design and implementation of interventions from a normative perspective, (2) to contribute to a theoreticalperspective on health interventions as a socialchange phenomenon,and (3) to provide additional criteria for program evaluation and policy-making.
Plasma panel sensors for particle and beam detection Friedman, P. S.; Ball, R.; Beene, J. R. ...
2012 IEEE Nuclear Science Symposium and Medical Imaging Conference Record (NSS/MIC),
2012-Oct.
Conference Proceeding
Open access
The plasma panel sensor (PPS) is an inherently digital, high gain, novel variant of micropattern gas detectors inspired by many operational and fabrication principles common to plasma display panels ...(PDPs). The PPS is comprised of a dense array of small, plasma discharge, gas cells within a hermetically-sealed glass panel, and is assembled from non-reactive, intrinsically radiation-hard materials such as glass substrates, metal electrodes and mostly inert gas mixtures. We are developing the technology to fabricate these devices with very low mass and small thickness, using gas gaps of at least a few hundred micrometers. Our tests with these devices demonstrate a spatial resolution of about 1 mm. We intend to make PPS devices with much smaller cells and the potential for much finer position resolutions. Our PPS tests also show response times of several nanoseconds. We report here our results in detecting betas, cosmic-ray muons, and our first proton beam tests.
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