Investigations and referral for suspected cancer in primary care in New Zealand-A survey linked to the International Cancer Benchmarking Partnership.

A national internet-based survey of New Zealand (NZ) primary care physicians (n = 192) used the survey instrument developed by the International Cancer Benchmarking Partnership (ICBP). Practitioners were recruited by a range of methods assisted by NZ general practice networks and contacts. Compared to 11 other ICBP jurisdictions, direct access to diagnostic tests was more limited and took more time than in most other areas; the average wait for a test to be done and reported was 3.0 weeks for X-rays and 8.0 for ultrasound, compared to ICBP averages of 1.6 and 4.7 weeks respectively. Forty-five per cent of respondents could get specialist advice within 48 hr. Sixty-six per cent were aware of NZ guidelines for cancer in primary care, and of those 44% consulted them sometimes or often. Access to tests was greater, and time required much less, in the private than the public care system. NZ respondents each answered two of five clinical vignettes, with results similar to other ICBP areas. The survey also included general practice trainees (N = 42); their results were similar to the main group. The results suggest that improvements in prompt access to diagnostic tests and referrals for suspected cancer need to be given priority in NZ.

Effect of the addition of a "help" question to two screening questions on specificity for diagnosis of depression in general practice: diagnostic validity study.

OBJECTIVE: To determine the validity of two written screening questions for depression with the addition of a question inquiring if help is needed. DESIGN: Cross sectional validation study. SETTING: 19 general practitioners in six clinics in New Zealand. PARTICIPANTS: 1025 consecutive patients receiving no psychotropic drugs. MAIN OUTCOME MEASURES: Sensitivity, specificity, and likelihood ratios of the two screening questions, the help question, combinations of the screening and help questions, and diagnosis by general practitioners. RESULTS: The help question alone had a sensitivity of 75% (95% confidence interval 60% to 85%) and a specificity of 94% (93% to 96%). The positive likelihood ratio for the help question was 13.0 (9.5 to 17.8) and the negative likelihood ratio was 0.27 (0.17 to 0.44). The likelihood ratio for patients wanting help today was 17.5 (11.8 to 31.9). The general practitioner diagnosis had a sensitivity of 79% (65% to 88%) and a specificity of 94% (92% to 95%). CONCLUSION: Adding a question inquiring if help is needed to the two screening questions for depression improves the specificity of a general practitioner diagnosis of depression.

Bloch Analysis of Photonic Lattices that Incorporate Vertical Cavity Surface-Emitting Laser Arrays.

We analyzed one-dimensional photonic lattices that incorporate mirror-modulated vertical cavity surface-emitting laser arrays utilizing the Bloch formalism. First, infinitely long arrays are considered. The in-phase mode (with a main central lobe at the far field) and antiphase mode (with two main symmetrically-located lobes at the far-field) are examined. A comparison of the modal losses of the in-phase and the antiphase modes, resulted in the discovery of regimes in which the in-phase mode is dominant. Considering lattices of finite length, we compared the results of the Bloch model to the exact solutions. It is shown that the boundary conditions in these lattices select a specific mode from the continuous spectrum in the infinite case. Consequently, the lattice's length affects the eigenmodes and the corresponding eigenvalues in a periodic manner.

Effect of spatial hole burning on injection-locked vertical-cavity surface-emitting laser arrays.

Injection locking of vertical-cavity surface-emitting laser arrays is analyzed at steady state, including the effect of spatial hole burning. A free-running laser array (i.e., without injection), that operates well-above threshold, can exhibit multimode oscillations. Consequently, each of the free-running modes (at different frequencies) needs a different locking injection power. For low pump levels, just above threshold, the array is single mode and, as expected, the results bear a close resemblance to those of the average gain analysis, which ignores spatial hole burning.

Cyclic vertical cavity semiconductor laser arrays with odd numbers of elements: lasing modes and symmetry breaking.

Array modes of cyclic vertical cavity laser arrays with odd numbers of elements were explored experimentally and theoretically. The odd antiphase array mode is prohibited by the circular symmetry, and the lowestloss modes are degenerated. Slight inhomogenities drive the array mode structure to experience spontaneous symmetry breaking, leading by means of mode degeneracy removal to stable operation characterized by an antiphase lasing mode with an even number of lobes. Circular laser arrays of 3-19 elements were measured; all were lasing in a stable even-array mode, exhibiting 2-18 intensity lobes for both the near and the far fields.

The 90-Second Intervention: a patient compliance mediated technique to improve and control hypertension.

Hypertension, a leading risk factor for cardiovascular and renal diseases, occurs in up to 50 million Americans. Despite mounting evidence of the effectiveness of prevention and treatment, physicians are still unable to get their patients to adopt and adhere to treatment protocols. This project presents an innovative approach to compliance which is based on general systems theory and its applications in family therapy. The "90-Second Intervention" ("90 SI") incorporates the use of family and friends; it utilizes the therapeutic relationship or alliance of the physician-patient; and it embraces the well-established fact that social support plays a key role in promoting health, decreasing susceptibility to disease, and facilitating recovery from illness. The physician asks the patients to identify who in their life loves or cares for them and would help them adhere to the treatment protocol. To implement the "90 SI," the physician instructs the patient to telephone, in his or her presence, the identified helper(s) who then agree to support the patients' medical regimen. Specifically, the "90 SI" seeks to create a context to support the patients in a regimen of low to moderate intensity exercise, which is proven to be a powerful, cost-effective, and safe treatment. Patients who are identified with new onset or uncontrolled hypertension at three clinics in urban Philadelphia are the target population.