Abstract:

This paper explores how, in the two decades following the laser's invention, the popular image of the laser weapon was transformed from a terrifying "death ray" capable of contaminating large areas to a surgically precise tool and rationale for a major new defense program. Whereas previous histories of the laser treat its popularizations as irrelevant to real-world developments, this account emphasizes that mass media provide sites for scientists and engineers to vie for control over the meaning and direction of technological development. It shows how the laser as a symbol came to link two very different applications: the everyday use of low-energy lasers to increase the "precision" of technologies, and the experimental development of high-energy lasers that would be destructive. I argue that the symbolic appeal of laser weapons made the laser a central part of President Ronald Reagan's Strategic Defense Initiative or "Star Wars" missile defense program.

First paragraph of the article:

In the wake of the 1963 Partial Test Ban Treaty, the United States launched a series of satellites under the name Vela (after a constellation in the southern hemisphere sometimes called “the sails” because of its configuration). The Vela satellites were designed to monitor compliance with the treaty by detecting clandestine nuclear tests either in space or in the atmosphere. The first such satellite was launched in 1963, the last in 1969. They operated by measuring X-rays, neutrons and gamma rays, and, in the case of the more advanced units, emissions of light using two photodiode sensors called bhangmeters (derived from the Indian word for cannabis). These satellites had a nominal life of seven years, after which the burden of detection was to be shifted to a new series of satellites under the Defense Support Program (DSP), equipped with infra-red detectors designed to pick up missile launches as well as nuclear tests. The Vela satellites, however, kept operating long past the end of their nominal design life and one of them, designated Vela 6911, detected an event on September 22, 1979, that has become a subject of intense interest ever since.

Abstract

OBJECTIVE:

To evaluate the relationship between competition among fertility clinics and assisted reproductive technology (ART) treatment outcomes, particularly multiple births.

DESIGN:

Using clinic-level data from 1995 to 2001, we examined the relationship between competition and clinic-level ART outcomes and practice patterns.

SETTING:

National database registry.

PATIENT(S):

Clinics performing ART.

INTERVENTION(S):

The number of clinics within a 20-mile (32.19-km) radius of a given clinic.

MAIN OUTCOME MEASURE(S):

Clinic-level births, singleton births, and multiple births per ART cycle; multiple births per ART birth; average number of embryos transferred per cycle; and the proportion of cycles for women under age 35 years.

RESULT(S):

The number of competing clinics is not strongly associated with ART birth and multiple birth rates. Relative to clinics with no competitors, the rate of multiple births per cycle is lower (-0.03 percentage points) only for clinics with more than 15 competitors. Embryo transfer practices are not statistically significantly associated with the number of competitors. Clinic-level competition is strongly associated with patient mix. The proportion of cycles for patients under 35 years old is 6.4 percentage points lower for clinics with more than 15 competitors than for those with no competitors.

CONCLUSION(S):

Competition among fertility clinics does not appear to increase rates of multiple births from ART by promoting more aggressive embryo transfer decisions.

Abstract

To examine the relationship between state insurance mandate status and the number of embryos transferred in assisted reproductive technology cycles, we conducted a retrospective analysis of clinics reporting to the publicly available national Society for Assisted Reproductive Technology registry. We found that clinics in states with comprehensive mandates transferred between 0.210 and 0.288 fewer embryos per cycle depending upon patient age, and were more likely to transfer fewer embryos than recommended for older women; however, the relationship between state mandate status and clinic birth and multiple birth rates varied by age group.

Abstract

Background

Opioid prescribing for chronic pain is common and controversial, but recommended clinical practices are followed inconsistently in many clinical settings. Strategies for increasing adherence to clinical practice guideline recommendations are needed to increase effectiveness and reduce negative consequences of opioid prescribing in chronic pain patients.

Methods

Here we describe the process and outcomes of a project to operationalize the 2003 VA/DOD Clinical Practice Guideline for Opioid Therapy for Chronic Non-Cancer Pain into a computerized decision support system (DSS) to encourage good opioid prescribing practices during primary care visits. We based the DSS on the existing ATHENA-DSS. We used an iterative process of design, testing, and revision of the DSS by a diverse team including guideline authors, medical informatics experts, clinical content experts, and end-users to convert the written clinical practice guideline into a computable algorithm to generate patient-specific recommendations for care based upon existing information in the electronic medical record (EMR), and a set of clinical tools.

Results

The iterative revision process identified numerous and varied problems with the initially designed system despite diverse expert participation in the design process. The process of operationalizing the guideline identified areas in which the guideline was vague, left decisions to clinical judgment, or required clarification of detail to insure safe clinical implementation. The revisions led to workable solutions to problems, defined the limits of the DSS and its utility in clinical practice, improved integration into clinical workflow, and improved the clarity and accuracy of system recommendations and tools.

Conclusions

Use of this iterative process led to development of a multifunctional DSS that met the approval of the clinical practice guideline authors, content experts, and clinicians involved in testing. The process and experiences described provide a model for development of other DSSs that translate written guidelines into actionable, real-time clinical recommendations.

Abstract

OBJECTIVE:

To assess the evidence for interventions designed to prevent or reduce overweight and obesity in children younger than 2 years.

DATA SOURCES:

MEDLINE, the Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and references from relevant articles.

STUDY SELECTION:

Included were published studies that evaluated an intervention designed to prevent or reduce overweight or obesity in children younger than 2 years.

DATA EXTRACTION:

Extracted from eligible studies were measured outcomes, including changes in child weight status, dietary intake, and physical activity and parental attitudes and knowledge about nutrition. Studies were assessed for scientific quality using standard criteria, with an assigned quality score ranging from 0.00 to 2.00 (0.00-0.99 is poor, 1.00-1.49 is fair, and 1.50-2.00 is good).

DATA SYNTHESIS:

We retrieved 1557 citations; 38 articles were reviewed, and 12 articles representing 10 studies met study inclusion criteria. Eight studies used educational interventions to promote dietary behaviors, and 2 studies used a combination of nutrition education and physical activity. Study settings included home (n = 2), clinic (n = 3), classroom (n = 4), or a combination (n = 1). Intervention durations were generally less than 6 months and had modest success in affecting measures, such as dietary intake and parental attitudes and knowledge about nutrition. No intervention improved child weight status. Studies were of poor or fair quality (median quality score, 0.86; range, 0.28-1.43).

CONCLUSIONS:

Few published studies attempted to intervene among children younger than 2 years to prevent or reduce obesity. Limited evidence suggests that interventions may improve dietary intake and parental attitudes and knowledge about nutrition for children in this age group. For clinically important and sustainable effect, future research should focus on designing rigorous interventions that target young children and their families.