Light-Controlled Magnetoelastic Effects in Ni/BaTiO3 Heterostructures.

Magnetoelastic and magnetoelectric coupling in the artificial multiferroic heterostructures facilitate valuable features for device applications such as magnetic field sensors and electric-write magnetic-read memory devices. In ferromagnetic/ferroelectric heterostructures, the intertwined physical properties can be manipulated by an external perturbation, such as an electric field, temperature, or a magnetic field. Here, we demonstrate the remote-controlled tunability of these effects under visible, coherent, and polarized light. The combined surface and bulk magnetic study of domain-correlated Ni/BaTiO3 heterostructures reveals that the system shows strong sensitivity to the light illumination via the combined effect of piezoelectricity, ferroelectric polarization, spin imbalance, magnetostriction, and magnetoelectric coupling. A well-defined ferroelastic domain structure is fully transferred from a ferroelectric substrate to the magnetostrictive layer via interface strain transfer. The visible light illumination is used to manipulate the original ferromagnetic microstructure by the light-induced domain wall motion in ferroelectric substrates and consequently the domain wall motion in the ferromagnetic layer. Our findings mimic the attractive remote-controlled ferroelectric random-access memory write and magnetic random-access memory read application scenarios, hence facilitating a perspective for room temperature spintronic device applications.

Avatar-mediated training in the delivery of bad news in a virtual world.

BACKGROUND: Delivering bad news to patients is an essential communication skill for physicians. Educators commonly use standardized patient (SP) encounters to train physicians in the delivery of bad news. It is expensive to use actors, for logistical reasons such as travel and scheduling, and there are limits to the characters and conditions an actor can portray in teaching encounters. Thus we studied the feasibility of creating SP avatars in a virtual world for the task of training medical trainees to deliver bad news. The SP avatars are easily customized for different scenarios and amenable to distance learning. METHODS: We recruited 10 medical trainees to interact with a standardized female avatar in a three-dimensional simulated clinic, where the trainee was to inform the avatar of her newly diagnosed breast cancer. The trainee evaluated his or her self-efficacy in delivering bad news via an affective competency score (ACS) before and after the encounter. Two palliative care specialists evaluated each trainee's performance using the Bad News Assessment Schedule and the performance ACS. RESULTS: The self-efficacy ACS scores of the trainees improved overall: before, 20 ± 4, versus after, 24 ± 3, p = 0.001 (maximum score = 30). All participants considered the experience positive and commended the novel approach, although noting that the avatars were not able to portray body language cues. CONCLUSION: Participants viewed the avatar-mediated training as an excellent approach for learning how to deliver bad news but believed it could not substitute for real patient interactions. However, participant self-efficacy improved, which suggests that avatar-mediated training in a virtual world is a viable educational approach for skill training in delivering bad news.

Medical student perspectives on geriatrics and geriatric education.

OBJECTIVE: To ascertain medical students' perspectives on geriatrics. DESIGN: Interpretative phenomenological analysis. SETTING: An allopathic, Liaison Committee on Medical Education-accredited, former Donald W. Reynolds Foundation grant recipient, U.S. medical school. PARTICIPANTS: Thirty fourth-year medical students who completed geriatric educational activities in all 4 years of medical school. MEASUREMENTS: Two researchers independently reviewed verbatim transcripts from five focus groups and identified themes using the constant comparative method. RESULTS: Seventeen themes that elaborate on students' perspectives on geriatrics were identified. Students reported not feeling appropriately engaged in geriatrics, despaired at the futility of care, were depressed by the decline and death of their patients, were frustrated by low reimbursement rates and low prestige despite fellowship training, were concerned about patients' unrealistic expectations and opportunities for litigation, felt unsure how to handle ethical dilemmas, and found communicating with older adults to be enjoyable but time consuming and challenging. They felt they had too much exposure to geriatrics in medical school. CONCLUSION: Current attitude scales fail to capture some of the dimensions uncovered in this study, whereas students did not mention other dimensions commonly included in attitude scales. Regarding curriculum development, students may find an integrated preclinical geriatric curriculum to be more relevant to their careers than a stand-alone curriculum. Clinical clerkships might be in a better position to emphasize the positive aspects of geriatrics and develop strategies to address students' negative attitudes.

Evaluation and management of the elderly patient at risk for postoperative delirium.

Geriatric patients are at a high risk for the development of postoperative delirium. By recognizing predisposing and precipitating risk factors, preventive measures can be undertaken to reduce this risk. Accurate and timely diagnosis is essential, and we offer therapeutic strategies to help reduce the high morbidity and mortality of this important condition.

Evaluation and management of the elderly patient at risk for postoperative delirium.

Geriatric patients are at a high risk for the development of postoperative delirium. By recognizing predisposing and precipitating risk factors, preventive measures can be undertaken to reduce this risk. Accurate and timely diagnosis is essential, and we offer therapeutic strategies to help reduce the high morbidity and mortality of this important condition.

Hyperlipasemia associated with hepatitis C virus.

Extrahepatic manifestations of chronic hepatitis C virus (HCV) infection have been well described. However, hyperlipasemia and/or pancreatitis have not been reported. Following the observation that several HCV patients had elevated lipase levels, this retrospective study was conducted to assess the association between hyperlipasemia and/or pancreatitis with hepatitis C infection. Of 204 subjects who underwent evaluation for hepatitis C, 103 had lipase levels determined at baseline. The control group consisted of 41 nonHCV subjects with a variety of gastrointestinal diseases including 18 with nonalcoholic liver disease. Twenty-five percent of HCV patients had elevated lipase at baseline as compared to 10% of controls (P = 0.04; OR = 3.1; 95% CI: 1.02-9.60). Mean lipase levels were 253 +/- 72 units/liter (normal range 114-286 units/liter and 210 +/- 42 units/liter for the HCV and control groups, respectively (P = 0.002). No significant difference in amylase was found between the groups. There was a significant association between ALT (> 1.5 times the upper limit of normal) and lipase (P = 0.02; OR = 3.0; 95% CI: 1.1-7.5). Among 30 patients who received interferon-based therapy +/- ribavirin, 11 had elevated lipase at baseline. Six of these patients responded to therapy and demonstrated normalization of lipase levels. In contrast, all nonresponders with baseline hyperlipasemia continued to have high lipase levels (P = 0.17; OR = 4.0; 95% CI: 0.6-28.4). Furthermore, only 3 of 8 (37.5%) patients with normal lipase responded to treatment as compared to 6 of 10 (60%) of hyperlipasemic patients (P = 0.36; OR = 2.5; 95% CI: 0.4-16.9). In conclusion, hyperlipasemia and/or subclinical pancreatitis may represent extrahepatic manifestations of HCV infection and should not preclude treatment.