Modification of anodised aluminium surfaces using a picosecond fibre laser for printing applications.

The use of an ultrafast fibre laser at a wavelength of 1064 nm has allowed the surface modification of anodised aluminium plates coated with a 2 micron thick anodised layer for potential industrial applications. The micro- and nano-scale structuring of the anodised aluminium using picosecond pulses of approximately 25 ps duration at 200 kHz repetition rate was investigated. The interaction of the laser with the substrate created a hydrophilic surface, giving a contact angle of less than 10 degrees. On examination under a Scanning Electron Microscope (SEM), a morphology created due to laser induced spallation was observed. It has been found that these laser processed hydrophilic surfaces revert to a hydrophobic state with time. This has potential for application in the printing industry and offers reusability and sustainability of the process materials. This has been confirmed in initial trials.

Surface modification of anodised aluminium using a femtosecond laser.

Femtosecond laser pulses at 775 nm, combined with a scanning galvonometer system, have allowed the micro scale structuring of an aluminium plate coated with a 2 micron thick anodised aluminium layer for potential industrial applications. The micro-scale structuring of aluminium was investigated using ultrafast pulses of 180 fs duration at a repetition rate of 1 kHz. Under suitably optimised conditions, the interaction of the laser pulses with the substrate created a hydrophilic surface with a contact angle of less than 10 degrees. These surfaces revealed a 'lotus-leaf' like morphology when examined under a Scanning Electron Microscope (SEM). It has been found that these laser processed hydrophilic surfaces revert with time and they undergo this cycle of alternate hydrophilic/hydrophobic behaviour several times upon exposure to the laser pulses. Their potential application in the printing industries is strong due to their reusability and sustainability; initial trials on printing confirm this. This technology would offer extra advantages as a non-chemical process without the need for developer, thereby reducing the overall cost and time of printing.

An unusual presentation of colloid cyst--implications for lifestyle advice.

Colloid cysts are rare intracranial neoplasms which typically present with headaches. There is risk of neurological deterioration or death due to acute hydrocephalus. We report a case of colloid cyst presenting after a sudden acceleration/deceleration force from a theme park ride, highlighting the importance of lifestyle advice in these patients.

Recruiting community faculty.

The success of community-based resident education depends on a partnership between a residency program and a variety of individuals, physician and nonphysician, in the community. The process of recruiting community faculty in the education of pediatric residents begins with selection of learning objectives. Next, characteristics of effective teachers and teaching sites should be listed so that appropriate faculty may be identified and recruited. A residency program's existing physician network of both referring physicians and graduates of the residency is a good beginning point for making contacts. Selection of specific educational goals, objectives, and activities will lead to identification of potential nonphysician participants. Understanding why community colleagues might want to become part of the training program leads to techniques for contacting and recruiting them.

Physicians and the communication of "bad news": parent experiences of being informed of their child's cleft lip and/or palate.

OBJECTIVE: Physicians often are called on to deliver "bad news" in the form of a diagnosis with unhappy implications. Few guidelines exist for practitioners who wish to meet patient and family expectations for clear and caring communication. To develop recommendations for physicians, this study was undertaken to document how biologic parents of children born with a specific, non-life-threatening birth defect perceive the encounter with a physician during which they were informed of their children's diagnosis. The study also examines parental preferences for how this communication might best be managed and compares those with parent reports of their actual experiences. METHODOLOGY: Biologic parents of children born with cleft lip and/or palate (n = 100) were studied with a self-administered questionnaire about the diagnostic encounter in which they rated theoretically derived dimensions of physician communication. Their experiences, as well as their preferences for communication in a hypothetical case, were compared through the use of ratings and open-ended qualitative narratives. RESULTS: Parents learned the diagnosis at birth (90%) from a physician (96%). Many report positive experiences, but there are significant differences between what parents experienced and what they desire in the informative interview. Parents wanted more opportunity to talk and to show their feelings and wanted the physician to try harder to make them feel better. As compared with their experiences, parents indicated a desire to have more information and more of a discussion about the possibility of mental retardation. They wanted the physician to show more caring and confidence, and wanted more referral to other parents, than they had experienced. Dimensions of physician behavior were more positively perceived by parents who were informed by a physician whom they felt they knew well. CONCLUSIONS: It is possible for physicians to effectively deliver bad news, such as the diagnosis of a birth defect, to parents. This study suggests specific communicative and educational approaches that are likely to improve parental satisfaction with such physician communications.

Communicating bad news.

The need to communicate bad news to patients and their families is common in the practice of obstetrics and gynecology. Although this is one of the most important interactions between caregivers and their patients, most physicians receive little or no formal education on the process of communicating bad news. Recipients of bad news favor being informed by a physician familiar to them, in the presence of support persons, and with provision of adequate medical information and referrals. The physician who imparts bad news should approach this communication directly and with a caring attitude, sensitive to both the informational content and emotional reaction. The objectives of this article are to review the literature regarding the process of communicating bad news and to set forth a set of general guidelines by which practitioners can communicate bad news more effectively and compassionately.

Information needs and information seeking in community medical education.

PURPOSE: To investigate information needs and information seeking in primary care practices serving as educational sites. METHOD: The authors interviewed 15 community-based primary care physician-preceptors, once when the preceptor was working without a student and once when a student was present at the practice (in which case, the student was interviewed as well). The interview asked for questions that had arisen during the patient encounter or teaching moment that would need further investigation. A week after the interview, the authors contacted the preceptors to see whether they had pursued information to answer those questions. RESULTS: The preceptors generated fewer questions when students were present (0.42 versus 0.29 per patient). Both preceptors and students most frequently had questions pertaining to diagnoses and drug therapy. The proportion of questions pursued by the preceptors decreased when students were present (32% versus 16%). CONCLUSION: These findings cast light on information needs and seeking in the context of community medical education. Further research is needed to explore variables such as practice size and access to appropriate Web-based information resources.

Probability of arrest while driving under the influence of alcohol.

The probability of arrest while driving at a blood alcohol level over 0.10% was .0058 (about 1 in 200).

Team working to improve outcome in vestibular schwannoma surgery.

The concept of the 'learning curve' in the early years of consultant appointment is no longer acceptable and yet, for most complex operations, learning is a career-long process. Sub-specialization offers part of the solution to this problem by concentrating expertise, but there remains the question of how to introduce new team members without adversely affecting patient outcome. Shortened training and an increasingly aware public, who are more questioning of the experience and outcomes of those treating them, has required the surgical profession to move away from individual consultant practice and embrace team-working. When, in 1997, a second neurosurgeon joined the skull base team at Addenbrooke's Hospital, his introduction to acoustic neuroma surgery was mentored and operative cases were carefully selected at first. In this article, we discuss our experience with consultant mentoring, and compare the results of the first 100 translabyrinthine acoustic neuroma operations performed under this system with the first cohort of a similar number of patients published from Cambridge in 1989.

A community outreach training program for pediatric residents and medical students.

In 1982 the Division of Community Pediatrics of the University of North Carolina at Chapel Hill began a new training program for all first-year pediatrics residents and fourth-year medical students taking an ambulatory pediatrics elective. The program was designed to introduce the trainees to community resources for children and increase their knowledge of the factors affecting children's development. During their regular hospital clinic rotations, the trainees spend approximately one-third of their time in program activities that involve 25 community agencies. Educational packets (consisting of books, journal articles, films, slides, videotapes, self-instruction materials, manuals for developmental tests, and/or agency materials) are provided for each program component. At the end of each one-month rotation of program activities, the trainees meet individually with the program director and coordinator to discuss the trainee's experiences and reactions and to identify strengths and weaknesses of the program components.

Communicating medical bad news: parents' experiences and preferences.

Parents (N = 189) of children enrolled in 15 developmental day care centers completed questionnaires that examined the experience of being told bad news and elicited preferences for physician behavior in a hypothetical situation (communicating the diagnosis of Down syndrome). Parents, in comparison with their experiences, preferred (p < 0.001) more communication of information and feelings by their physician. Their strongest preferences were for physicians to show caring (97%), to allow parents to talk (95%), and to allow parents to show their own feelings (93%). They wanted physicians to share information (90%) and to be highly confident (89%). Most parents (87%) desired parent-to-parent referral, but only a few (19%) were referred. We conclude that there is a difference between what parents experience and what they desire in physicians who communicate bad news. Physicians control the interaction and are highly confident, but parents especially value physicians who show caring and allow parents to talk and share their feelings.

Fluoride supplement prescribing and dental referral patterns among academic pediatricians.

OBJECTIVE: To determine how well the current fluoride supplementation schedule was known by academic pediatricians and to examine the fluoride supplement prescribing and dental referral practices among primary care faculty pediatricians at four medical centers. SETTING: Four university medical centers in North Carolina. SUBJECTS: Primary care faculty pediatricians. METHOD: A questionnaire pretested for clarity was distributed to all identified full-time primary care pediatric faculty (42 members). RESULTS: A total of 40 completed questionnaires were returned. Thirty-seven (93%) primary care faculty pediatricians reported that they routinely addressed the need for fluoride supplements for their patients, but only 28 (70%) determined the fluoride content of the drinking water before prescribing supplements. Thirty-five (87.5%) began supplements at the correct age, but fewer knew the correct doses for children of various ages. Only 23 (58%) referred their patients for oral examination and preventive care before the age of 36 months, contrary to American Academy of Pediatrics recommendations. CONCLUSIONS: Pediatricians in an academic setting would be expected to be more knowledgeable of current recommendations than those in private practice. Failure to know and teach correct fluoride supplement recommendations and failure to recommend early professional dental involvement can result in less than optimum oral health.