Evidence for an Fulde-Ferrell-Larkin-Ovchinnikov State with Segmented Vortices in the BCS-BEC-Crossover Superconductor FeSe.

We present resistivity and thermal-conductivity measurements of superconducting FeSe in intense magnetic fields up to 35 T applied parallel to the ab plane. At low temperatures, the upper critical field µ_{0}H_{c2}^{ab} shows an anomalous upturn, while thermal conductivity exhibits a discontinuous jump at µ_{0}H^{*}≈24 T well below µ_{0}H_{c2}^{ab}, indicating a first-order phase transition in the superconducting state. This demonstrates the emergence of a distinct field-induced superconducting phase. Moreover, the broad resistive transition at high temperatures abruptly becomes sharp upon entering the high-field phase, indicating a dramatic change of the magnetic-flux properties. We attribute the high-field phase to the Fulde-Ferrel-Larkin-Ovchinnikov (FFLO) state, where the formation of planar nodes gives rise to a segmentation of the flux-line lattice. We point out that strongly orbital-dependent pairing as well as spin-orbit interactions, the multiband nature, and the extremely small Fermi energy are important for the formation of the FFLO state in FeSe.

Quantum Vortex Core and Missing Pseudogap in the Multiband BCS-BEC Crossover Superconductor FeSe.

FeSe is argued as a superconductor in the Bardeen-Cooper-Schrieffer Bose-Einstein condensation crossover regime where the superconducting gap size and the superconducting transition temperature T_{c} are comparable to the Fermi energy. In this regime, vortex bound states should be well quantized and the preformed pairs above T_{c} may yield a pseudogap in the quasiparticle-excitation spectrum. We performed spectroscopic-imaging scanning tunneling microscopy to search for these features. We found Friedel-like oscillations near the vortex, which manifest the quantized levels, whereas the pseudogap was not detected. These apparently conflicting observations may be related to the multiband nature of FeSe.

Associations of insulin-like growth factor-I and insulin-like growth factor binding protein-3 with bone quality in the general adult population.

OBJECTIVE: Growth hormone (GH) and its main mediator, insulin-like growth factor-I (IGF-I), play a significant role in bone metabolism. The relations between IGF-I and bone mineral density (BMD) or osteoporosis have been assessed in previous studies but whether the associations are sex-specific remains uncertain. Moreover, only a few studies examined bone quality assessed by quantitative ultrasound (QUS). We aimed to investigate these associations in the general population of north-east Germany. DESIGN AND MEASUREMENTS: Data from 1759 men and 1784 women who participated in the baseline examination of the Study of Health in Pomerania (SHIP)-Trend were used. IGF-I and IGF-binding protein-3 (IGFBP-3) concentrations were measured on the IDS-iSYS multidiscipline automated analyser (Immunodiagnostic Systems Limited). QUS measurements were performed at the heel (Achilles InSight, GE Healthcare). Sex-specific linear and multinomial logistic regression models adjusted for potential confounders were calculated. RESULTS: Linear regression analyses revealed significant positive associations between IGF-I and IGF-I/IGFBP-3 ratio, a marker for free IGF-I, with all QUS parameters in men. Among women, we found an inverse association between IGF-I and the QUS-based fracture risk but no association with any other QUS parameter. There was no association between IGFBP-3 and the QUS-based fracture risk. CONCLUSIONS: Our data suggest an important role of IGF-I on bone quality in men. The observed association of IGF-I with the QUS-based stiffness index and QUS-based fracture risk in this study might animate clinicians to refer patients with low IGF-I levels, particularly men, to a further evaluation of risk factors for osteoporosis and a detailed examination of the skeletal system.

How to Reach a Thousand-Second in-Plane Polarization Lifetime with 0.97-GeV/c Deuterons in a Storage Ring.

We observe a deuteron beam polarization lifetime near 1000 s in the horizontal plane of a magnetic storage ring (COSY). This long spin coherence time is maintained through a combination of beam bunching, electron cooling, sextupole field corrections, and the suppression of collective effects through beam current limits. This record lifetime is required for a storage ring search for an intrinsic electric dipole moment on the deuteron at a statistical sensitivity level approaching 10^{-29} e cm.

Acceleration of collimated 45 MeV protons by collisionless shocks driven in low-density, large-scale gradient plasmas by a 1020 W/cm2, 1 µm laser.

A new type of proton acceleration stemming from large-scale gradients, low-density targets, irradiated by an intense near-infrared laser is observed. The produced protons are characterized by high-energies (with a broad spectrum), are emitted in a very directional manner, and the process is associated to relaxed laser (no need for high-contrast) and target (no need for ultra-thin or expensive targets) constraints. As such, this process appears quite effective compared to the standard and commonly used Target Normal Sheath Acceleration technique (TNSA), or more exploratory mechanisms like Radiation Pressure Acceleration (RPA). The data are underpinned by 3D numerical simulations which suggest that in these conditions a Low Density Collisionless Shock Acceleration (LDCSA) mechanism is at play, which combines an initial Collisionless Shock Acceleration (CSA) to a boost procured by a TNSA-like sheath field in the downward density ramp of the target, leading to an overall broad spectrum. Experiments performed at a laser intensity of 1020 W/cm2 show that LDCSA can accelerate, from ~1% critical density, mm-scale targets, up to 5 × 109 protons/MeV/sr/J with energies up to 45(±5) MeV in a collimated (~6° half-angle) manner.

Nutrition knowledge and practices of physicians in a family-practice residency program: the effect of an education program provided by a physician nutrition specialist.

The purpose of this study was to determine the effects of a nutrition-education program provided by a physician nutrition specialist in a family-practice residency program on residents' and faculty members' nutrition knowledge and nutrition-related patient care, their patients' perceptions of the importance of nutrition, and the physicians' dietary patterns. The nutrition specialist provided recommendations for nutrition patient-care practices to the physicians for 6 mo. Pre- and post-intervention assessments included 1) nutrition exams for physicians and patients, 2) patient questionnaires concerning attitudes towards nutrition, 3) chart reviews, and 4) diet records for physicians. The educational intervention caused a small but statistically significant (P < 0.01) increase in physicians' nutrition-knowledge scores and a significantly higher (P < 0.05) frequency of physicians discussing nutrition and recommending diets for their patients. Effects were greater among residents than among faculty members. The results suggest that a physician nutrition specialist can provide effective nutrition education within a residency program.

Nutrition knowledge of senior medical students: a collaborative study of southeastern medical schools.

The Southeastern Regional Medical-Nutrition Education Network (SERMEN) comprises 11 medical schools with varied nutrition training programs. A faculty representative from each school rated 41 topics in nutrition as to their importance for medical practice. From the seven topics unanimously chosen, a 90-item examination was prepared using the University of Alabama School of Medicine's Nutrition Test-Item Bank. Thirteen additional items surveyed student attitudes toward their nutrition training. Twenty-one percent of senior students from 10 SERMEN schools took the examination. Results showed significant variation in knowledge levels among the schools on the overall examination and on the seven topics. Eighty-five percent were dissatisfied with the quantity and 60% with the quality of their medical-nutrition education. Knowledge scores correlated with the students' assessments with r values of 0.28 and 0.35, respectively (p less than 0.001). Findings indicate significant variation in nutrition knowledge of US medical students.

An innovation in nutrition education: development of a national nutrition test-item bank.

A NNTIB prototype has been developed and implemented at the University of Alabama in Birmingham School of Medicine. The further development of the Bank as a shared national resource was considered at a workshop carried out in conjunction with the 1983 ASCN meeting. Through this forum it was confirmed that the concept of a NNTIB is both valid and viable, receiving the support of a variety of nutrition educators and the endorsement of the ASCN Committee on Nutrition Education. The general recommendations of the workshop participants were that a modification of the test-item bank prototype be used as the model for the development of a national bank. A key recommendation was the development of a committee to oversee the acceptance and review of test items included in the NNTIB. Recognizing that the major constraints in the development of a national bank are likely to be logistical, mechanical, and fiscal, it is our belief that each of the limitations could be overcome if the Bank were adopted by a parent society with a long-term commitment to its continued support and development. After such support has been identified and pilot trials have been carried out, the implications of the NNTIB for advances in the field of nutrition go well beyond improved quality of testing materials and extend into the critical area of the establishment of standards of nutrition education and certification of competency. The development of the NNTIB offers a challenge to nutrition educators, national nutrition organizations, and interested governmental agencies for their involvement and support.

Components of effective clinical-nutrition training: a national survey of graduate medical education (residency) programs.

A national survey was conducted by The American Society for Clinical Nutrition's Committee on Medical/Dental School and Residency Nutrition Education to assess the context in which nutrition training is provided in medical residency programs. Accreditation guidelines for residency programs suggested eight nutrition components that were endorsed by content experts for inclusion in residency training. Directors and nutrition educators from all accredited residencies in the United States were surveyed to determine the perceived importance of the components and the extent to which the components were actually present. The eight components appear to be relevant for exemplary nutrition training at the residency level. An important identified need is to train and involve more clinical-nutrition faculty members in residency programs.

Nutrition training in graduate medical (residency) education: a survey of selected training programs.

Because limited information exists about nutrition training of residents, we studied the teaching practices of nationally recognized nutrition programs. Two hundred thirty-eight nutrition educators and 787 residency-program directors identified 160 institutions with strong nutrition training. The 23 highest-ranked programs were surveyed and 7 were visited. The results showed that 1) clinically active physician-nutritionist role models are the key elements in teaching residents clinical nutrition; 2) multidisciplinary nutrition support teams are valuable learning resources unless they function primarily as technical support services; 3) nutrition elective rotations, although highly effective, are taken by a minority of residents; 4) the nutrition curriculum should include practical learning materials and conferences; and 5) a research environment is important to attract qualified physician-nutritionist role models. A major deficit is teaching nutritionally based approaches to disease prevention in the ambulatory setting. Finally, a shortage of nutrition-oriented physician role models is probably the major constraint in teaching nutrition to residents.

Cross-sectional study of nutrition knowledge and attitudes of medical students at three points in their medical training at 11 southeastern medical schools.

Eleven southeastern medical schools cooperated to evaluate nutrition knowledge and attitudes of medical students. This study complements previous reports of an examination of entering freshmen and seniors. Average knowledge scores for 165 students tested after basic sciences (preclinical) training in this study were 67 +/- 7% compared with 53 +/- 6% for freshmen and 69 +/- 8% for seniors. The upperclassmen's scores were higher than the freshmen's (p less than 0.001) and varied with the amount of required nutrition teaching. Only 13% of preclinical students perceived nutrition as important to their careers compared with 74% of entering and 59% of graduating students, suggesting that preclinical teaching reduces their sense of relevance of nutrition to medicine. These findings suggest that nutrition knowledge can be increased through preclinical coursework and that the knowledge level can be maintained through the clinical years. However, the positive attitude of freshmen toward nutrition is lost after preclinical training and is only partially regained after the clinical years.

Priorities for nutrition content in a medical school curriculum: a national consensus of medical educators.

The ASCN Committee on Medical/Dental School and Residency Nutrition Education conducted a series of activities to establish guidelines for nutrition core content in a medical school curriculum. These activities included mail surveys of medical-nutrition educators and a representative group of medical school curriculum administrators and a national consensus workshop of nutrition educators. Results indicated close agreement between the nutrition educators and curriculum administrators (r = 0.89, p less than 0.0001) on the importance ratings of 41 nutrition topics and on the number of hours of nutrition course work that medical schools should provide (44 vs 37 h, respectively, p = 0.14). There was consensus among the nutrition educators that 26 topics should be given priority ratings as essential for inclusion in medical course work. Further prioritization of these topics resulted in a listing of core content topics and subtopics to serve as a guide to administrators and educators for planning nutrition course work in a medical school curriculum.

Teaching psychiatry to non-psychiatrists: I. The application of educational methodology.

It is becoming increasingly clear that psychiatric and psychosocial needs of medical patients are not being adequately met. This need has led to an increasing emphasis on the psychiatric education of nonpsychiatrists, at varying levels of experience. Given the many problems involved in these educational efforts as well as the paucity of evaluation studies and the uncertainty of results, the authors argue that the systematic application of empirically validated educational principles may lead to greatly improved effectiveness. In this first section of a two-part series, the authors review educational methodology as it relates to the development of training objectives, the selection of teaching procedures, and the use of evaluation techniques. Part two presents a detailed "model" curriculum for primary care residents, developed according to the principles of educational methodology.

An oral examination of the psychiatric knowledge of medical housestaff: assessment of needs and evaluation baseline.

To assess the psychiatric knowledge of medical housestaff, the authors devised an oral examination based on two simulated clinical encounters and administered it to 26 medical residents. The case material embodied those psychiatric problems known to be common in medical populations, namely depression, delirium, dementia, and "psychogenic" pain. The standardized simulations were punctuated by standardized "open" questions with followup probes. A panel of experienced clinicians developed rating criteria for each question such that responses could be categorized ad "good," "adequate," "inadequate," or "poor," in terms of "what an internist needs to know." Blind raters of the exam achieved an interrater reliability of 0.08. The results indicate major deficits in the knowledge needed for assessment and treatment of these common problems. Only 16% of answers were "good," where as 42% were "inadequate" or "poor". For example, 88% of the doctors could not name three factors that help distinguish organic from "functional" psychosis, and 88% could not list three side-effects of tricyclic antidepressants. The doctors' level of experience was not correlated with test scores, either overall or question by question. These results, together with measures of attitude and skill, have been used to develop a needs-based liaison psychiatry curriculum and to evaluate the effectiveness of that curriculum.

Nutrition education for medical students: evaluation of the relative contribution of freshman courses in biochemistry and nutrition to performance on a standardized examination in nutrition.

An examination previously developed and used for assessment of nutrition knowledge of medical students in the Southeastern Regional Medical-Nutrition Education Network was used to compare the effectiveness of a basic medical biochemistry course and a 58-hour required nutrition course. The examination was administered to a cohort of freshman students upon entry to medical school, after biochemistry, and then after nutrition. Two other student groups took the examination at the end of the sophomore and senior years, respectively. In the freshman cohort, mean nutrition knowledge scores increased slightly after biochemistry, (52% to 56%), which contained 37 nutrition-related lectures. The mean score of the cohort was 75% after the nutrition course. The sophomores scored 75% and the seniors 73%. These findings suggest 1) basic science courses such as biochemistry cannot be relied upon to add significantly to nutrition knowledge, and 2) a required freshman course can be an effective way to introduce basic and clinical nutrition with good retention of knowledge in subsequent years.

Health care service use and sexual communication: past experience and future intention of high-risk male adolescents.

High-risk male adolescents were surveyed to collect data to be used to develop strategies to enhance communication with their partners about sexually transmitted diseases (STDs). Participants were concerned about acquiring an STD from their partner, and reported an increased likelihood of communicating about STD-related issues when confidential health care was available.

Sexual contact tracing outcome in adolescent chlamydial and gonococcal cervicitis cases.

BACKGROUND AND OBJECTIVE: Treatment of sex partners is an essential part of sexually transmitted diseases (STD) control. This study examined the efficacy of contact tracing via patient self-referral in gonococcal and chlamydial cervicitis cases among adolescents, compared with the effectiveness of provider-referral. STUDY DESIGN: Adolescent females with culture-proven chlamydial or gonococcal cervicitis were the study subjects. This cohort study was done in an urban non-STD clinic setting. The subjects chose either provider-notification or self-notification method to inform their sex partner(s) in 2 months preceding the interview date. RESULTS: Two hundred and sixty-five eligible subjects (91% African-American, 9% white) were identified. One hundred and ninety-eight sex contacts were reported by 165 (62%) cases; no contact was elicited in the remaining 100 (38%). The follow-up data revealed that 129/198 (66%) contacts were informed: 63 contacts by 61 index cases, 54 contacts of 47 cases by the case manager, 9 by both methods, and 3 by unspecified means. History of treatment was obtained in 54 contacts, including 37% (23/63) of patient-notified contacts and 50% (27/54) of provider-notified contacts; these 54 contacts constituted 42% of informed contacts, or 27% of all named contacts. The mean number of sexual contacts treated per index case was 0.58 (27/47) for the provider-referral groups and 0.38 (23/61) for the self-referral groups. Successful contact tracing was documented in 19.3% (51/265) of all index cases, resulting in treatment of 54 contacts. CONCLUSION: This study demonstrates the need for more effective partner treatment strategies in adolescent STD cases.