Use of lights and siren: is there room for improvement?

OBJECTIVE: The objective of this study was to analyse the use of lights and siren (L&S) during transport to the hospital by the prehospital severity status of the patient and the time saved by the time of day of the mission. METHODS: We searched the Public Health Services data of a Swiss state from 1 January 2010 to 31 December 2010. All primary patient transports within the state were included (24 718). The data collected were on the use of L&S, patient demographics, the time and duration of transport, the type of mission (trauma vs. nontrauma) and the severity of the condition according to the National Advisory Committee for Aeronautics (NACA) score assigned by the paramedics and/or emergency physician. We excluded 212 transports because of missing data. RESULTS: A total of 24 506 ambulance transports met the inclusion criteria. L&S were used 4066 times, or in 16.6% of all missions. Of these, 40% were graded NACA less than 4. Overall, the mean total transport time to return to the hospital was 11.09 min (confidence interval 10.84-11.34) with L&S and 12.84 min (confidence interval 12.72-12.96) without. The difference was 1.75 min (105 s; P<0.001). For night-time runs alone, the mean time saved using L&S was 0.17 min (10.2 s; P=0.27). CONCLUSION: At present, the use of L&S seems questionable given the severity status or NACA score of transported patients. Our results should prompt the implementation of more specific regulations for L&S use during transport to the hospital, taking into consideration certain physiological criteria of the victim as well as time of day of transport.

Personality traits influence clinical outcome in day hospital-treated elderly depressed patients

OBJECTIVES: Although personality traits are considered significant predictors of both physical and mental health, their specific impact on treatment outcome in elderly patients with depression remains largely unexplored. Impact of personality traits on the evolution of depressive symptoms, quality of life, and perception of clinical progress was assessed in a psychotherapeutic community. DESIGN: A prospective longitudinal study was conducted in 62 elderly outpatients. SETTING: Day hospital treatment as usual combined group and individual therapies, pharmacological treatment, as well as family and network meetings. PARTICIPANTS: Patients presented with major depression or a depressive episode of bipolar disease. MEASUREMENTS: The Geriatric Depression Scale, the Short Form Survey, and the Therapeutic Community Assessment scale were administrated at admission, 3, 6, 12 months, and at discharge. Personality was evaluated with the NEO Five-Factor Personality Inventory. RESULTS: Outcome revealed reduced depression and improved mental quality of life and clinical progress. Higher Geriatric Depression Scale scores were found in individuals with higher levels of Neuroticism (and its Vulnerability facet). Better self-perception of clinical progress was observed in individuals with lower levels of the Depressiveness and Modesty facets and higher openness to action. Improvement in quality of life was predicted by high Positive emotions facet. All these associations remained significant after controlling for age, gender, and treatment length. CONCLUSION: Personality traits may predict clinical outcome in psychotherapeutic hospital day care for elderly patients with depression.

Self-consistent medium polarization in spin-polarized 3He

A microscopic calculation of the residual particle-hole (p-h) interaction in spin-polarized 3He is performed. As a starting point the Brueckner G matrix is used which is supplemented by including the phonon exchange terms self-consistently. An important ingredient in this microscopic version of the induced interaction is the treatment of the full momentum dependence of the interaction. This allows a consistent description of the Landau limit (Pauli-principle sum rule for the Landau parameters is fulfilled) but also enables a detailed study of the p-h interaction at finite momentum transfers. A comparison with correlated basis functions results shows good agreement for momentum transfers larger than the Fermi momentum.

Giant step bunching from self-organized coalescence of SrRuO3 islands

Step bunching develops in the epitaxy of SrRuO3 on vicinal SrTiO3(001) substrates. We have investigated the formation mechanisms and we show here that step bunching forms by lateral coalescence of wedgelike three-dimensional islands that are nucleated at substrate steps. After coalescence, wedgelike islands become wider and straighter with growth, forming a self-organized network of parallel step bunches with altitudes exceeding 30 unit cells, separated by atomically flat terraces. The formation mechanism of step bunching in SrRuO3, from nucleated islands, radically differs from one-dimensional models used to describe bunching in semiconducting materials. These results illustrate that growth phenomena of complex oxides can be dramatically different to those in semiconducting or metallic systems.

Self-interference of charge carriers in ferromagnetic SrRuO3

We report a systematic study of the low-temperature electrical conductivity in a series of SrRuO3 epitaxial thin films. At relatively high temperature the films display the conventional metallic behavior. However, a well-defined resistivity minimum appears at low temperature. This temperature dependence can be well described in a weak localization scenario: the resistivity minimum arising from the competition of electronic self-interference effects and the normal metallic character. By appropriate selection of the film growth conditions, we have been able to modify the mean-free path of itinerant carriers and thus to tune the relative strength of the quantum effects. We show that data can be quantitatively described by available theoretical models.

Synthesis, structure, and magnetic studies on self-assembled BiFeO3-CoFe2O4 nanocomposite thin films

Self-assembled (0.65)BiFeO3-(0.35)CoFe2O4 (BFO-CFO) nanostructures were deposited on SrTiO3 (001) and (111) substrates by pulsed laser deposition at various temperatures from 500 to 800°C. The crystal phases and the lattice strain for the two different substrate orientations have been determined and compared. The films grow epitaxial on both substrates but separation of the spinel and perovskite crystallites, without parasitic phases, is only obtained for growth temperatures of around 600-650°C. The BFO crystallites are out-of-plane expanded on STO(001), whereas they are almost relaxed on (111). In contrast, CFO crystallites grow out-of-plane compressed on both substrates. The asymmetric behavior of the cell parameters of CFO and BFO is discussed on the basis of the role of the epitaxial stress caused by the substrate and the spinel-perovskite interfacial stress. It is concluded that interfacial stress dominates the elastic properties of CFO crystallites and thus it may play a fundamental on the interface magnetoelectric coupling in these nanocomposites.

Self-reported non-adherence to antiretroviral therapy repeatedly assessed by two questions predicts treatment failure in virologically suppressed patients.

BACKGROUND: The aim of this study was to explore the predictive value of longitudinal self-reported adherence data on viral rebound. METHODS: Individuals in the Swiss HIV Cohort Study on combined antiretroviral therapy (cART) with RNA <50 copies/ml over the previous 3 months and who were interviewed about adherence at least once prior to 1 March 2007 were eligible. Adherence was defined in terms of missed doses of cART (0, 1, 2 or >2) in the previous 28 days. Viral rebound was defined as RNA >500 copies/ml. Cox regression models with time-independent and -dependent covariates were used to evaluate time to viral rebound. RESULTS: A total of 2,664 individuals and 15,530 visits were included. Across all visits, missing doses were reported as follows: 1 dose 14.7%, 2 doses 5.1%, >2 doses 3.8% taking <95% of doses 4.5% and missing > or =2 consecutive doses 3.2%. In total, 308 (11.6%) patients experienced viral rebound. After controlling for confounding variables, self-reported non-adherence remained significantly associated with the rate of occurrence of viral rebound (compared with zero missed doses: 1 dose, hazard ratio [HR] 1.03, 95% confidence interval [CI] 0.72-1.48; 2 doses, HR 2.17, 95% CI 1.46-3.25; >2 doses, HR 3.66, 95% CI 2.50-5.34). Several variables significantly associated with an increased risk of viral rebound irrespective of adherence were identified: being on a protease inhibitor or triple nucleoside regimen (compared with a non-nucleoside reverse transcriptase inhibitor), >5 previous cART regimens, seeing a less-experienced physician, taking co-medication, and a shorter time virally suppressed. CONCLUSIONS: A simple self-report adherence questionnaire repeatedly administered provides a sensitive measure of non-adherence that predicts viral rebound.