Despite the growing epidemic of extreme obesity in the United States, weight management is not adequately addressed in primary care. This study assessed family physicians' practices and attitudes ...regarding care of extremely obese patients and factors associated with them. A cross‐sectional, self‐administered survey was mailed to 500 family physicians in New Jersey (NJ) during March–May 2008. Measures included knowledge, weight management approaches, attitudes toward managing obesity, challenges with examinations, availability of supplies, and strategies to improve care. Response rate was 53% (N = 255). Bariatric surgery and weight loss medications were infrequently recommended, particularly in physicians with higher volume of extremely obese patients (odds ratio (OR) 0.38; 95% confidence interval (CI) 0.23, 0.62 and OR 0.51; 95% CI 0.31, 0.85 for surgery and medications, respectively). Higher knowledge was associated with increased frequency of recommendations of weight loss medications (P < 0.0001) and bariatric surgery (P < 0.0001). There was a high prevalence of negative attitudes, particularly in younger physicians and those with lower patient volume. Increased knowledge of weight‐loss diets was associated with less dislike in discussing weight loss (P < 0.0001), less frustration (P = 0.0001), less belief that treatment is often ineffective (P < 0.0001), and less pessimism about patient success (P = 0.0002). Many providers encountered challenges performing examinations on extremely obese patients. More education of primary care physicians, particularly on bariatric surgery, specific examination techniques, and availability of community resources for obese persons is needed. Further research is needed to determine if interventions to increase knowledge of physicians will lead to less negative attitudes toward weight loss and extremely obese patients.
A Multi-strip Multi-gap RPC Barrel for Time-of-Flight Measurements Kiš, M.; Ciobanu, M.; Deppner, I. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
08/2011, Volume:
646, Issue:
1
Journal Article
Peer reviewed
The FOPI detector
1 at the heavy-ion synchrotron SIS-18 at GSI in Darmstadt has upgraded part of its time-of-flight (ToF) system by adding a new sub-detector shell (called the MMRPC Barrel) that is ...made out of Multi-strip Multi-gap Resistive-Plate Counters (MMRPCs). The MMRPC Barrel has an active area of 5
m
2 covered by 2400 individual anode strips
2,3 which are read out at both ends by custom-designed electronics
4,5. With these multi-strip anodes we have obtained an enhanced detector granularity with 95% efficiency and a ToF resolution
σ
ToF
better than 90
ps which increases the identification limit for charged kaons up to laboratory momenta of at least 1
GeV/
c. In this paper we report on the design, construction and operational characteristics of the MMRPC Barrel and describe its performance during the first experiments.
Complex polyketides are characterized by multiple chiral centers harboring hydroxyl and alkyl substituents. To investigate the mechanisms by which these stereocenters are set, several high-resolution ...structures of the ketoreductase (KR) domain from the second module of the amphotericin modular polyketide synthase (PKS) were solved. This first structural analysis of an A-type KR helps reveal how these KRs direct polyketide intermediates into their active sites from the side opposite that used by B-type KRs, resulting in a β-hydroxyl group of opposite stereochemistry. A comparison of structures obtained in the absence and presence of ligands reveals an induced fit mechanism that is important for catalysis. Activity assays of mutants of KRs from the first and second modules of the amphotericin PKS reveal the relative contributions of several active site residues toward catalysis and stereocontrol. Together, these results highlight the possibility of region-specific modification of polyketides through active site engineering of KRs.
► This first A-type KR structure helps explain how KR types set stereocenters ► The complete nicotinamide cofactor is bound and its binding site described ► The binding of ligands induces conformational changes necessary for catalysis ► A stereocontrol assay reveals mutation that reverses α-substituent stereochemistry
Medical students are exposed to a growing number of obese patients in clinical encounters. Many medical students harbor negative attitudes and stereotypes regarding obese patients, which lead to ...negative interpersonal behaviors. This study pilot tested the effectiveness of an educational intervention in reducing bias toward obese patients.
Second- and third-year medical students (n=64) watched a 17- minute video, "Weight Bias in Health Care," and participated in interactive discussion to share experiences with encountering obese patients. The Beliefs About Obese Persons (BAOP), Attitudes Toward Obese Persons (ATOP), and Fat Phobia Scales (FPS) were administered before and after intervention. Change in mean scores from before to after the intervention was tested for statistical significance using the paired samples t test. General linear models were used to examine associations of subject characteristics with mean scores for each scale.
The intervention increased beliefs that genetic and environmental factors play an important role in the cause of obesity as opposed to lack of personal control (mean BAOP increased from 16.53 to 19.27). It also decreased students' negative stereotypes regarding obese patients (mean FPS decreased from 3.65 to 3.45). There were independent associations of subject characteristics with post-intervention ATOP scores, with more positive attitudes in younger, male, and white participants.
Implementing a short educational intervention was effective in improving medical students' beliefs and stereotypes regarding obese patients. This widely accessible and easily replicable program can serve as a model and springboard for further development of educational interventions to reduce weight bias among medical students.
SiΛvio: A trigger for Λ-hyperons Münzer, Robert; Berger, Martin; Fabbietti, Laura ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
05/2014, Volume:
745
Journal Article
Peer reviewed
Open access
As online trigger for events containing Λ hyperons in p+p collisions at 3.1GeV a silicon-based device has been designed and built. This system has been integrated close to the target region within ...the FOPI spectrometer at GSI and was also employed as a tracking device to improve the vertex reconstruction of secondary decays. The design of the detector components, read-out, the trigger capability as well as the tracking performance are presented. An enrichment factor of about 14 was achieved for events containing a Λ-hyperon candidate.
Part of emission of the negatively charged kaons from the nucleus-nucleus collisions appears to originate from decays of varphi(1020) mesons into the K+K- channel. We report on the measurement of the ...emission yield of varphi mesons in the collisions of Ni+Ni at the beam kinetic energy of 1.91 A GeV. The experiment was done with the FOPI spectrometer at the SIS 18 accelerator at GSI, Darmstadt. The total yield of varphi was found to be ((ProQuest: Formulae and/or non-USASCII text omitted)) times 10 super(-4) per triggered event. Ratio of varphi/K- emission yields was estimated at (ProQuest: Formulae and/or non-USASCII text omitted), meaning that about 20% of negatively charged kaons emitted from the collision originate from decays of varphi mesons. The results are in agreement with similar HADES results done for the collisions of Ar+KCl.
Flow coefficients vn of the orders n = 1 – 6 are measured with the High-Acceptance Spectrometer (HADES) at GSI for protons, deuterons, and tritons as a function of centrality, transverse momentum, ...and rapidity in Au + Au collisions at √sNN = 2.4 GeV. Combining the information from the flow coefficients of all orders allows us to construct for the first time, at collision energies of a few GeV, a multidifferential picture of the angular emission pattern of these particles. It reflects the complicated interplay between the effect of the central fireball pressure on the emission of particles and their subsequent interaction with spectator matter. The high precision information on higher order flow coefficients is a major step forward in constraining the equation of state of dense baryonic matter.
Extremely obese women are less likely than nonobese women to receive breast and cervical cancer screening examinations. Reasons for this disparity are unclear and may stem from patient and/or ...physician barriers. This sequential mixed-methods study used individual in-depth interviews of 15 family physicians followed by a mail survey of 255 family physicians (53% response rate) to understand the barriers they faced in performing cancer screening examinations in extremely obese women. Barriers fell into three main areas: (i) difficulty doing pelvic and breast exams; (ii) inadequate equipment; and (iii) challenges overcoming patient barriers and refusal. This led some physicians to avoid performing breast and pelvic examinations on extremely obese women. Having more knowledge about specific examination techniques was associated with less difficulty in palpating lumps on breast and pelvic examinations (P < 0.005). Physicians perceived that embarrassment, aversion to undressing, and avoidance of discussions related to their weight were the most frequent barriers extremely obese women had with getting physical examinations. Educating and/or motivating patients and addressing fears were strategies used most frequently when patients refused mammograms or Pap smears. Interventions focusing on physician barriers, such as educating them on specific examination techniques, obtaining adequate equipment and supplies, and providing resources to assist physicians in dealing with patient barriers and refusal, may be fruitful in increasing cancer screening rates in extremely obese patients. Future research studies testing the effectiveness of these strategies are needed to improve cancer outcomes in this high-risk population.
Using the large acceptance apparatus FOPI, we study central collisions in the reactions (energies in A GeV are given in parentheses): 40Ca + 40Ca (0.4, 0.6, 0.8, 1.0, 1.5, 1.93), 58Ni + 58Ni (0.15, ...0.25, 0.4), 96Ru + 96Ru (0.4, 1.0, 1.5), 96Zr + 96Zr (0.4, 1.0, 1.5), 129Xe + CsI (0.15, 0.25, 0.4), 197Au + 197Au (0.09, 0.12, 0.15, 0.25, 0.4, 0.6, 0.8, 1.0, 1.2, 1.5). The observables include cluster multiplicities, longitudinal and transverse rapidity distributions and stopping, and radial flow. The data are compared to earlier data where possible and to transport model simulations.
PDF
![Subthreshold [varphi] meson...](http://api.summon.serialssolutions.com/2.0.0/image/issn/XR4PS5YY4K/2100-014X/small "Subthreshold [varphi] meson production in nucleus-nucleus collisions")
