Evaluating an audit and feedback intervention for reducing overuse of pathology test requesting by Australian general practitioners: protocol for a factorial cluster randomised controlled trial.

Introduction: Consistent evidence shows pathology services are overused worldwide and that about one-third of testing is unnecessary. Audit and feedback (AF) is effective for improving care but few trials evaluating AF to reduce pathology test requesting in primary care have been conducted. The aim of this trial is to estimate the effectiveness of AF for reducing requests for commonly overused pathology test combinations by high-requesting Australian general practitioners (GPs) compared with no intervention control.

Effect of an Individualized Audit and Feedback Intervention on Rates of Musculoskeletal Diagnostic Imaging Requests by Australian General Practitioners: A Randomized Clinical Trial.

Importance: Audit and feedback can improve professional practice, but few trials have evaluated its effectiveness in reducing potential overuse of musculoskeletal diagnostic imaging in general practice.

Objective: To evaluate the effectiveness of audit and feedback for reducing musculoskeletal imaging by high-requesting Australian general practitioners (GPs).

Design, Setting, And Participants: This factorial cluster-randomized clinical trial included 2271 general practices with at least 1 GP who was in the top 20% of referrers for 11 imaging tests (of the lumbosacral or cervical spine, shoulder, hip, knee, and ankle/hind foot) and for at least 4 individual tests between January and December 2018.

Electron density and temperature measurements in a magnetized expanding hydrogen plasma.

We report measurements of electron densities, n_{e}, and temperatures, T_{e}, in a magnetized expanding hydrogen plasma performed using Thomson scattering. The effects of applying an axial magnetic field and changing the background pressure in the plasma vessel on n_{e} and T_{e} along the expansion axis are reported. Magnetic field strengths (B field) up to 170 mT were applied, which are one order of magnitude larger than previously reported.

Advanced Thomson scattering system for high-flux linear plasma generator.

An advanced Thomson scattering system has been built for a linear plasma generator for plasma surface interaction studies. The Thomson scattering system is based on a Nd:YAG laser operating at the second harmonic and a detection branch featuring a high etendue (f/3) transmission grating spectrometer equipped with an intensified charged coupled device camera. The system is able to measure electron density (n(e)) and temperature (T(e)) profiles close to the output of the plasma source and, at a distance of 1.

Population inversion in a magnetized hydrogen plasma expansion as a consequence of the molecular mutual neutralization process.

A weakly magnetized expanding hydrogen plasma, created by a cascaded arc, was investigated using optical emission spectroscopy. The emission of the expanding plasma is dominated by H{α} emission in the first part of the plasma expansion, after which a sharp transition to a blue afterglow is observed. The position of this sharp transition along the expansion axis depends on the magnetic field strength.

Diagnosing ions and neutrals via n=2 excited hydrogen atoms in plasmas with high electron density and low electron temperature.

Ion and neutral parameters are determined in the high electron density, magnetized, hydrogen plasma beam of an ITER divertor relevant plasma via measurements of the n=2 excited neutrals. Ion rotation velocity (up to 7 km/s) and temperature (2-3 eV~T_{e}) are obtained from analysis of Hα spectra measured close to the plasma source. The methodology for neutral density determination is explained whereby measurements in the linear plasma beam of Pilot-PSI are compared to modeling.

Nonequilibrium rovibrational energy distributions of hydrogen isotopologues in an expanding plasma jet.

State resolved densities of high rovibrationally excited hydrogen isotopologues H(2), HD, and D(2) in the electronic ground state have been measured in a supersonically expanding plasma jet. The obtained state distributions differ substantially from thermal equilibrium. Moreover, the distributions are not the same for H(2), HD, and D(2) indicating different formation and relaxation rates for each isotopologue.

Rotation of a strongly magnetized hydrogen plasma column determined from an asymmetric Balmer-beta spectral line with two radiating distributions.

A potential buildup in front of a magnetized cascaded arc hydrogen plasma source is explored via E x B rotation and plate potential measurements. Plasma rotation approaches thermal speeds with maximum velocities of 10 km/s. The diagnostic for plasma rotation is optical emission spectroscopy on the Balmer-beta line.

Formation and relaxation of rovibrationally excited H2 molecules due to plasma-surface interaction.

We report on the interaction of hydrogen atoms and molecules under high flux conditions with a cooled copper surface and its impact on gas phase densities and internal excitation of the molecules. These densities were measured by means of laser-induced fluorescence using tunable radiation sources in the vacuum-ultraviolet (vuv). While H atoms were detected by two-photon absorption laser-induced fluorescence, the necessary vuv radiation for the detection of rovibrationally excited H2 molecules in the electronic ground state were produced by stimulated anti-Stokes Raman scattering.

Influence of rarefaction on the flow dynamics of a stationary supersonic hot-gas expansion.

The gas dynamics of a stationary hot-gas jet supersonically expanding into a low pressure environment is studied through numerical simulations. A hybrid coupled continuum-molecular approach is used to model the flow field. Due to the low pressure and high thermodynamic gradients, continuum mechanics results are doubtful, while, because of its excessive time expenses, a full molecular method is not feasible.

High sensitivity imaging Thomson scattering for low temperature plasma.

A highly sensitive imaging Thomson scattering system was developed for low temperature (0.1-10 eV) plasma applications at the Pilot-PSI linear plasma generator. The essential parts of the diagnostic are a neodymium doped yttrium aluminum garnet laser operating at the second harmonic (532 nm), a laser beam line with a unique stray light suppression system and a detection branch consisting of a Littrow spectrometer equipped with an efficient detector based on a "Generation III" image intensifier combined with an intensified charged coupled device camera.

Production mechanisms of NH and NH2 radicals in N2-H2 plasmas.

We measured the densities of NH and NH(2) radicals by cavity ring-down spectroscopy in N(2)-H(2) plasmas expanding from a remote thermal plasma source and in N(2) plasmas to which H(2) was added in the background. The NH radical was observed via transitions in the (0,0), (1,1), and (2,2) vibrational bands of the A(3)Pi <-- X(3)Sigma- electronic transition and the NH(2) radical via transitions in the (0,9,0) <-- (0,0,0) band of the A(2)A(1) <-- X(2)B(1) electronic transition. The measurements revealed typical densities of 5 x 10(18) m(-3) for the NH radical in both plasmas and up to 7 x 10(18) m(-3) for the NH(2) radical when N(2) and H(2) are both fed through the plasma source.

Detailed TIMS study of Ar/C(2)H(2) expanding thermal plasma: identification of a-C:H film growth precursors.

Acetylene chemistry is studied by means of threshold ionization mass spectrometry (TIMS) in remote Ar/C(2)H(2) expanding thermal plasma to identify the growth precursors of hydrogenated amorphous carbon (a-C:H) films. More than 20 hydrocarbon species are measured, enabling a comprehensive study of acetylene chemistry in the plasma environment. It is shown that the plasma composition is controlled by the initial ratio between the acetylene flow into the reactor and argon ion and electron fluence emanating from the remote plasma source.

Allergic diseases and atopic sensitization in children related to farming and anthroposophic lifestyle--the PARSIFAL study.

Background: The prevalence of allergic diseases has increased rapidly in recent decades, particularly in children. For adequate prevention it is important not only to identify risk factors, but also possible protective factors. The aim of this study was to compare the prevalence of allergic diseases and sensitization between farm children, children in anthroposophic families, and reference children, with the aim to identify factors that may protect against allergic disease.

Validation of questions on asthma and wheeze in farming and anthroposophic children.

Background: In most epidemiological surveys the estimated prevalence of asthma is based on questionnaire responses, which may depend on the individual's perception as well as medical consulting habits in a given population. Therefore, measurement of bronchial hyper-responsiveness as a key feature of asthma has been suggested as an objective parameter for asthma.

Objective: The aim of the present study was to validate questionnaire responses on asthma and wheeze against bronchial response to hypertonic saline (HS) (4.

Bacterial and fungal components in house dust of farm children, Rudolf Steiner school children and reference children--the PARSIFAL Study.

Background: Growing up on a farm and an anthroposophic lifestyle are associated with a lower prevalence of allergic diseases in childhood. It has been suggested that the enhanced exposure to endotoxin is an important protective factor of farm environments. Little is known about exposure to other microbial components on farms and exposure in anthroposophic families.

Relaxation behavior of rovibrationally excited H2 in a rarefied expansion.

The evolution of the rotational and vibrational distributions of molecular hydrogen in a hydrogen plasma expansion is measured using laser induced fluorescence in the vacuum-UV range. The evolution of the distributions along the expansion axis shows the relaxation of the molecular hydrogen from the high temperature in the upstream region to the low ambient temperature in the downstream region. During the relaxation, the vibrational distribution, which has been recorded up to v = 6, is almost frozen in the expansion and resembles a Boltzmann distribution at T approximately 2200 K.

Behavior of the H atom velocity distribution function within the shock wave of a hydrogen plasma jet.

The evolution of the ground-state hydrogen atom velocity distribution function throughout the stationary shock wave of a supersonic hydrogen plasma jet (3 View Article and Find Full Text PDF

Transport of ground-state hydrogen atoms in a plasma expansion.

The transport of ground-state atomic hydrogen in the expansion of a thermal plasma generated from an Ar-H2 mixture is studied by means of laser-based diagnostic techniques. The flow of hydrogen atoms is investigated by two-photon excitation laser-induced fluorescence (LIF), whereas Ar atoms are probed by LIF as well as by UV Rayleigh scattering. The transport of Ar atoms can be fully understood in terms of a free jet flow; H atoms on the contrary exhibit an anomalous behavior.

The impact of heat waves and cold spells on mortality rates in the Dutch population.

We conducted the study described in this paper to investigate the impact of ambient temperature on mortality in the Netherlands during 1979-1997, the impact of heat waves and cold spells on mortality in particular, and the possibility of any heat wave- or cold spell-induced forward displacement of mortality. We found a V-like relationship between mortality and temperature, with an optimum temperature value (e.g.

Diaphragmatic paralysis following cervical chiropractic manipulation: case report and review.

This case report documents an uncommon cause of bilateral diaphragmatic paralysis resulting from phrenic nerve injury during cervical chiropractic manipulation. Several months after the initial injury, our patient remains short of breath and has difficulty breathing in the supine position. Other causes of diaphragmatic paralysis and phrenic nerve injury are reviewed.

Time-resolved experimental and computational study of two-photon laser-induced fluorescence in a hydrogen plasma.

The time profile of the fluorescence light emission of atomic hydrogen in an expanding plasma beam after pulsed excitation with a nanosecond laser is studied, both experimentally and computationally. Ground state H atoms in an expanding Ar-H cascaded arc plasma are excited to the p=3 level using two-photon laser excitation at 205 nm. The resulting fluorescence is resolved in time with a fast photomultiplier tube to investigate the occurrence of quenching.

Anomalous atomic hydrogen shock pattern in a supersonic plasma Jet.

A two-photon laser-induced fluorescence study on the transport of ground-state atomic hydrogen in a supersonic plasma jet, generated from an Ar-H (2) mixture, reveals an unexpected shock pattern. Whereas both the axial-velocity profile and the temperature profile of hydrogen atoms along the jet centerline can be interpreted in terms of a supersonic expansion of an Ar-H gas mixture, the H-atom density profiles do not satisfy the well established Rankine-Hugoniot relation leading to a nonconservation of the forward flux. The experimental results show that H atoms escape from the supersonic expansion by a diffusion process due to strong density gradients between the core of the jet and its vicinity.

Differential response of mesoderm- and neural crest-derived smooth muscle to TGF-beta1: regulation of c-myb and alpha1 (I) procollagen genes.

Previously, we demonstrated that avian vascular smooth muscle cells (VSMC) derived from embryonic abdominal and thoracic aorta grow differently in the presence of transforming growth factor beta (TGF-beta1) and platelet-derived growth factor (PDGF-BB) (Wrenn et al., In Vitro Cell. Dev.