Diagnostic Medical Errors: Patient\u27s Perspectives on a Pervasive Problem

Introduction. The Institute of Medicine defines diagnostic error as the failure to establish an accurate or timely explanation for the patient\u27s health problem(s), or effectively communicate the explanation to the patient. To our knowledge, no studies exist characterizing diagnostic error from patient perspectives using this definition. Objective. We sought to characterize diagnostic errors experienced by patients and describe patient perspectives on causes, impacts, and prevention strategies. Methods. We screened 77 adult inpatients at University of Vermont Medical Center and conducted 27 structured interviews with patients who experienced diagnostic error in the past five years. We performed qualitative analysis using Grounded Theory. Results. In the past five years, 39% of interviewed patients experienced diagnostic error. The errors mapped to the following categories: accuracy (30%), communication (34%) and timeliness (36%). Poor communication (13 responses) and inadequate time with doctors (7) were the most identified causes of errors. Impacts of errors included emotional distress (17 responses), adverse health outcomes (7) and impaired activities of daily living (6). Patients suggested improved communication (11 responses), clinical management (7) and access to doctors (5) as prevention strategies. For communication, patients rated talk to your doctor highest (mean 8.4, on 1-10 Likert scale) and text message lowest (4.8). Conclusions/Recommendations. Diagnostic errors are common and have dramatic impact on patients\u27 well-being. We suggest routine surveillance to identify errors, support for patients who have experienced errors, and implementation of patient and provider checklists to enhance communication. Future studies should investigate strategies to allow care providers adequate time with patients.https://scholarworks.uvm.edu/comphp_gallery/1246/thumbnail.jp

Influence of a Feshbach resonance on the photoassociation of LiCs

We analyse the formation of ultracold 7Li133Cs molecules in the rovibrational ground state through photoassociation into the B1Pi state, which has recently been reported [J. Deiglmayr et al., Phys. Rev. Lett. 101, 133004 (2008)]. Absolute rate constants for photoassociation at large detunings from the atomic asymptote are determined and are found to be surprisingly large. The photoassociation process is modeled using a full coupled-channel calculation for the continuum state, taking all relevant hyperfine states into account. The enhancement of the photoassociation rate is found to be caused by an `echo' of the triplet component in the singlet component of the scattering wave function at the inner turning point of the lowest triplet a3Sigma+ potential. This perturbation can be ascribed to the existence of a broad Feshbach resonance at low scattering energies. Our results elucidate the important role of couplings in the scattering wave function for the formation of deeply bound ground state molecules via photoassociation.Comment: Added Erratum, 20 pages, 9 figure

Formation of ultracold dipolar molecules in the lowest vibrational levels by photoassociation

We recently reported the formation of ultracold LiCs molecules in the rovibrational ground state X1Sigma+,v''=0,J''=0 [J. Deiglmayr et al., PRL 101, 133004 (2008)]. Here we discuss details of the experimental setup and present a thorough analysis of the photoassociation step including the photoassociation line shape. We predict the distribution of produced ground state molecules using accurate potential nergy curves combined with an ab-initio dipole transition moment and compare this prediction with experimental ionization spectra. Additionally we improve the value of the dissociation energy for the X1Sigma+ state by high resolution spectroscopy of the vibrational ground state.Comment: Submitted to Faraday Discussions 142: Cold and Ultracold Molecules 18 pages, 8 figure

Quantum transport through STM-lifted single PTCDA molecules

Using a scanning tunneling microscope we have measured the quantum conductance through a PTCDA molecule for different configurations of the tip-molecule-surface junction. A peculiar conductance resonance arises at the Fermi level for certain tip to surface distances. We have relaxed the molecular junction coordinates and calculated transport by means of the Landauer/Keldysh approach. The zero bias transmission calculated for fixed tip positions in lateral dimensions but different tip substrate distances show a clear shift and sharpening of the molecular chemisorption level on increasing the STM-surface distance, in agreement with experiment.Comment: accepted for publication in Applied Physics

Population redistribution in optically trapped polar molecules

We investigate the rovibrational population redistribution of polar molecules in the electronic ground state induced by spontaneous emission and blackbody radiation. As a model system we use optically trapped LiCs molecules formed by photoassociation in an ultracold two-species gas. The population dynamics of vibrational and rotational states is modeled using an ab-initio electric dipole moment function and experimental potential energy curves. Comparison with the evolution of the v"=3 electronic ground state yields good qualitative agreement. The analysis provides important input to assess applications of ultracold LiCs molecules in quantum simulation and ultracold chemistry.Comment: 6 pages, 5 figures, EPJD Topical issue on Cold Quantum Matter - Achievements and Prospect

Charge transport through single molecules, quantum dots, and quantum wires

We review recent progresses in the theoretical description of correlation and quantum fluctuation phenomena in charge transport through single molecules, quantum dots, and quantum wires. A variety of physical phenomena is addressed, relating to co-tunneling, pair-tunneling, adiabatic quantum pumping, charge and spin fluctuations, and inhomogeneous Luttinger liquids. We review theoretical many-body methods to treat correlation effects, quantum fluctuations, nonequilibrium physics, and the time evolution into the stationary state of complex nanoelectronic systems.Comment: 48 pages, 14 figures, Topical Review for Nanotechnolog

Cognitive loading affects motor awareness and movement kinematics but not locomotor trajectories during goal-directed walking in a virtual reality environment.

The primary purpose of this study was to investigate the effects of cognitive loading on movement kinematics and trajectory formation during goal-directed walking in a virtual reality (VR) environment. The secondary objective was to measure how participants corrected their trajectories for perturbed feedback and how participants' awareness of such perturbations changed under cognitive loading. We asked 14 healthy young adults to walk towards four different target locations in a VR environment while their movements were tracked and played back in real-time on a large projection screen. In 75% of all trials we introduced angular deviations of ±5° to ±30° between the veridical walking trajectory and the visual feedback. Participants performed a second experimental block under cognitive load (serial-7 subtraction, counter-balanced across participants). We measured walking kinematics (joint-angles, velocity profiles) and motor performance (end-point-compensation, trajectory-deviations). Motor awareness was determined by asking participants to rate the veracity of the feedback after every trial. In-line with previous findings in natural settings, participants displayed stereotypical walking trajectories in a VR environment. Our results extend these findings as they demonstrate that taxing cognitive resources did not affect trajectory formation and deviations although it interfered with the participants' movement kinematics, in particular walking velocity. Additionally, we report that motor awareness was selectively impaired by the secondary task in trials with high perceptual uncertainty. Compared with data on eye and arm movements our findings lend support to the hypothesis that the central nervous system (CNS) uses common mechanisms to govern goal-directed movements, including locomotion. We discuss our results with respect to the use of VR methods in gait control and rehabilitation

Green function techniques in the treatment of quantum transport at the molecular scale

The theoretical investigation of charge (and spin) transport at nanometer length scales requires the use of advanced and powerful techniques able to deal with the dynamical properties of the relevant physical systems, to explicitly include out-of-equilibrium situations typical for electrical/heat transport as well as to take into account interaction effects in a systematic way. Equilibrium Green function techniques and their extension to non-equilibrium situations via the Keldysh formalism build one of the pillars of current state-of-the-art approaches to quantum transport which have been implemented in both model Hamiltonian formulations and first-principle methodologies. We offer a tutorial overview of the applications of Green functions to deal with some fundamental aspects of charge transport at the nanoscale, mainly focusing on applications to model Hamiltonian formulations.Comment: Tutorial review, LaTeX, 129 pages, 41 figures, 300 references, submitted to Springer series "Lecture Notes in Physics