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We prepare NbN thin films by DC magnetron sputtering on [100] GaAs substrates, optimise their quality, and demonstrate their use for efficient single photon detection in the near-infrared. The interrelation between the Nb:N content, growth temperature, and crystal quality is established for 4-22 nm thick films. Optimised films exhibit a superconducting critical temperature of 12.6 ± 0.2K for a film thickness of 22 ± 0.5 nm and 10.2 ± 0.2 K for 4 ± 0.5 nm thick films that are suitable for single photon detection. The optimum growth temperature is shown to be ∼475 °C reflecting a trade-off between enhanced surface diffusion, which improves the crystal quality, and arsenic evaporation from the GaAs substrate. Analysis of the elemental composition of the films provides strong evidence that the δ-phase of NbN is formed in optimised samples, controlled primarily via the nitrogen partial pressure during growth. By patterning optimum 4 nm and 22 nm thick films into a 100 nm wide, 369μm long nanowire meander using electron beam lithography and reactive ion etching, we fabricated single photon detectors on GaAs substrates. Time-resolved studies of the photo-response, absolute detection efficiency, and dark count rates of these detectors as a function of the bias current reveal maximum single photon detection efficiencies as high as 21 ± 2% at 4.3 ± 0.1 K with ∼50 k dark counts per second for bias currents of 98%IC at a wavelength of 950 nm. As expected, similar detectors fabricated from 22 nm thick films exhibit much lower efficiencies (0.004%) with very low dark count rates ≤3 cps. The maximum lateral extension of a photo-generated resistive region is estimated to be 30 ± 8 nm, clearly identifying the low detection efficiency and dark count rate of the thick film detectors as arising from hotspot cooling via the heat reservoir provided by the NbN film. [ABSTRACT FROM AUTHOR]

The need for improved knowledge and attitudes about HIV infection and HIV-infected clients has been documented, as has the effectiveness of AIDS education programs in affecting change in these characteristics of health care workers. Analyzing a sample of 336 health care providers, the current study assessed the impact of subject variables on knowledge and attitude change for health care providers after educational programs of 4 to 8 hours. Results indicated that several subject characteristics were significantly related to pretest levels of attitudes and knowledge. However, these same subject variables did not affect the degree of change on the attitude and knowledge scales. The importance of AIDS educators understanding the impact of subject variables on change is discussed. [ABSTRACT FROM AUTHOR]

Immunological vascular phenomena can be the initial manifestation of bacterial infection and endocarditis. Here, we report a rare case of leukocytoclastic vasculitis without immune complexes or cryoglobulinemia in a patient with infective endocarditis, congenital heart disease, and a prior mechanical valve replacement. The patient completely recovered following antibiotic therapy, and skin lesions disappeared without immune suppression, which suggested infection-mediated vasculitis. While the treatment of leukocytoclastic vasculitis typically involves immunosuppressive therapy, the treatment for infection-mediated vasculitis is eradication of the infection., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Introduction: Although numerous studies have examined cultural competence training, debate still exists about efficacious approaches to this training. Furthermore, little focus has been placed on training and evaluating practicing physicians., Methods: A skills-based course on culturally competent diabetes care was developed and subsequently tested in a controlled trial of primary physicians caring for patients enrolled in one state's Medicaid program. We hypothesized that physicians completing the course would show higher levels of self-reported cultural competence as measured by a Cultural Competence Assessment Tool (CCAT) than those in the control group. Differences in CCAT subscale scores were also compared., Results: Ninety physicians completed the study, with 41 in the control and 49 in the intervention group. Most were female (66%), with an average age of 44, and 12 years in practice. There were no significant differences on total CCAT score (212.7 ± 26.7 for control versus 217.2 ± 28.6 for intervention, p = .444) or subscales measuring cultural knowledge. There were significant positive differences on the subscales measuring physicians' nonjudgmental attitudes/behaviors (subscale score 2.38 ± 0.46 for control versus 2.69 ± 0.52 for intervention, p = .004) and future likelihood of eliciting patients' beliefs about diabetes and treatment preferences (3.11 ± 0.53 for control versus 3.37 ± 0.45 for intervention, p = .014). There was, however, a significant negative difference on the subscale measuring cultural self-awareness (3.48 ± 0.36 for control versus 3.26 ± 0.48 for intervention, p = .018)., Discussion: A predominantly skills-based approach to training physicians did not change aggregate measures of cultural competence, but did affect key attitudes and behaviors, which may better reflect the goals of cultural competence training., (Copyright © 2013 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.)

Background and Objectives: More effective diabetes care is desperately needed, especially for ethnic minority populations. Provider cultural competence promises to be an important means for reducing disparities in outcomes for patients with diabetes. The objectives of this study were to understand the role of cultural competence in the diabetes office visit., Methods: Unannounced standardized patients (SPs) were sent to the offices of 29 family and internal medicine residents and practicing physicians. The SPs portrayed a Mexican American woman newly diagnosed with type 2 diabetes. Using a checklist developed with the input of experts in Hispanic/Latino health care and cultural competence, the SPs evaluated physicians' cultural competence, diabetes care, and general communications skills., Results: The average total SP Checklist score was 70.7-11.0%, with a range of 43.9% to 90.2%. Physicians scored highly on items that measured general communication skills (95.9%) but were less likely to ask about social history (ie, family and community support issues, 51.9% and 48.1%, respectively). Sixty-seven percent of physicians ordered a hemoglobin A1c, 44% referred to ophthalmology, and 15% performed a monofilament exam. Physicians' inquiry into SPs explanatory model of disease (ie, asking about the SPs' views regarding their disease and its treatment) correlated with the performance of several diabetes treatment-related behaviors, Spearman's rho=.466., Conclusions: The findings provide support for a relationship between inquiry into patients' explanatory models of disease and effective diabetes care. Social history and explanatory model elicitation skills are vital parts of cultural competence training programs and potentially valuable tools for mitigating health disparities.

Background and Objectives: Our objectives were to provide an update on the status of selection by medical students of family medicine as a specialty, to summarize what is known about influences on this specialty choice, and to propose a research agenda for the future., Methods: Data from the National Resident Matching Program and the American Academy of Family Physicians residency database were obtained. Past reviews of research on family medicine specialty selection were summarized, and recent research was reviewed. Gaps in the knowledge base and common research design weaknesses were listed., Results: As a result of our analysis, a set of 12 research questions are posed and a set of 11 study design recommendations made., Conclusions: Family medicine specialty choice research must be planned and conducted with the most robust methodology possible, building on past research, to produce results that can assist in formulating effective policy.

Background and Objectives: There has been declining interest by US medical students in the specialty of family medicine. Simultaneously, new data suggest that the length of training may be related to the decline in student interest. The new data have created a national debate over the appropriate length of training for family physicians. The Future of Family Medicine Report recommends conducting experiments with 4-year residency training programs., Methods: Since 1999--2000, the University of Arizona Family Medicine Residency Program has offered three fourth-year options: a fourth-year fellowship in sports medicine, an integrated third- and fourth-year experience in complementary and alternative medicine, and an option for a master's in public health degree. Data on applications to the residency program have been monitored to measure the effect of these options on the applicant pool., Results: National Resident Matching Program statistics, and the interest in the program expressed by US graduates, have improved for the University of Arizona program during a time when national interest in family medicine has continued to decline., Discussion: While cause and effect cannot be proven, offering an additional year of training did not decrease interest in the University of Arizona program and may have increased interest. Experiments with 4-year training programs are not possible in all programs because graduate medical education funding only covers the 3 years needed to complete the requirements for specialty certification.

Background and Objectives: This study investigated factors related to declining interest in family medicine by US medical school graduates., Methods: A questionnaire was sent to all physicians who graduated from 24 medical schools in 1997-1999, and who entered a family medicine residency, and a randomly selected equal number of graduates from the same years who entered other primary care specialties. Between 1997 and 1999, 12 of these schools had increases and 12 had decreases in the proportion of graduates choosing family medicine residencies., Results: Between 1997 and 1999, at schools with increasing proportions of graduates choosing family medicine, there were significant increases in the proportion of graduates who (1). had entered medical school with a specialty preference of family medicine, (2). spent their required family medicine clerkship at two or more sites, (3). ranked the competence of family medicine faculty highly, (4). reported the faculty member they most wanted to be like was a family physician, and (5). experienced clinical rotations in both family medicine and primary care. At schools with declines in the proportion of graduates choosing family medicine, there were significant declines in the proportion of graduates who (1). ranked the competence of family medicine faculty highly, (2). stated that they were encouraged to go into family medicine, and (3). reported that the faculty member they most wanted to be like was a family physician. In schools with decreases in family medicine graduates, there was a significant increase in the proportion of graduates intending a large city or suburban practice. Using binary logistic regression, the variables that remained significantly correlated with attending a school with increases or decreases in students selecting family medicine were the number of required clinical rotations in family medicine and primary care, the perception of the clinical competence of the family medicine faculty, and an intent to practice, or subsequently having a practice, in a rural area., Conclusions: Schools that want to increase their production of family physicians should consider admissions policies that select students inclined toward family medicine and rural practice, should adopt a curriculum that maximizes clinical training with family physicians and other primary care physicians, and should ensure that their family medicine faculty are perceived as competent role models.

Background and Objectives: This study was conducted to explore the hypothesis that negative comments from faculty and residents about family practice are related to the recent decline in student selection of this specialty., Methods: A questionnaire was sent to all family physicians and an equal number of other primary care physicians who graduated from one of 24 medical schools in 1997-1999. Twelve schools had increasing proportions of graduates choosing family practice in the study period, and 12 had decreasing proportions. The questionnaire asked about negative comments heard about family practice and other primary care specialties., Results: Most graduates heard negative comments about family practice during medical school, and many students heard these comments often. However, the frequency and content of negative comments was not related to increases or decreases in the proportion of students choosing family practice. Negative comments were heard more frequently about family practice than about other primary care specialties. Negative comments increased in frequency during the study period. The negative comments on the questionnaire heard most often were that family physicians cannot master the content of the specialty and that they are not as smart as other physicians. Compared to other graduates, those with an initial interest in family practice who chose another specialty more frequently reported hearing that family physicians can't master the specialty content. There was an inverse relationship between the number of groups (students, residents, and faculty) that negative comments were heard from and ranking of family medicine faculty on respectability, influence, and competence., Conclusions: After 3 decades of being an officially recognized specialty, family practice is not recognized by some other medical school faculty as an equal to other primary care disciplines, and these faculty frequently express this view to students. While the frequency of these negative comments is increasing and is related to trainees' perceptions of family medicine faculty, it does not explain the recent decline in student interest in family practice. There is some evidence that students who change their career plans away from family practice might be concerned with their ability to master the specialty content. The prevalence of negative comments is related to trainees' perceptions of family medicine faculty.

Purpose: To evaluate the outcomes of combined internal medicine and pediatrics (IMP) residency programs using the published literature., Method: A literature search was conducted using Medline. Published articles were categorized as research or non-research (commentary, program requirements, program descriptions). Research articles were summarized and the results grouped under ten outcome variables., Results: Of the 32 articles located, 18 were research articles, of which only four had been published since 1993. All the research conducted was cross-sectional and most involved surveys of program directors (seven studies) or graduates (four studies). At the time the studies were conducted, 20-33% of IMP residents did not complete their combined training; attrition rates have not been documented recently. Approximately 80% of IMP graduates achieved certification in both specialties, one third subspecialized to some degree, and 80% provided care to both adults and children. One fourth of the graduates felt that more training was needed in ambulatory settings and less was needed in intensive care. Very few studies of the outcomes of IMP physicians were found., Conclusion: The outcomes of IMP residency programs are important for health workforce policy, and this study documents a need for more extensive research on the outcomes of training programs for primary care physicians.

Background and Objectives: While the specialty of family practice has achieved parity with other specialties in many areas, it lags behind in research productivity. This article explores current and historical funding levels of family medicine research from the National Institutes of Health (NIH) and the Agency for Health Care Policy and Research (AHCPR)., Methods: Funding amounts from NIH to medical schools and family medicine departments were obtained for the years 1984-1997. Funding amounts from AHCPR awarded to family physicians and the total AHCPR research budget were obtained for 1991-1995., Results: In 1997, family medicine departments were awarded $18.6 million from the NIH, .4% of the NIH research awards. The amount from NIH has increased progressively since 1984, but the proportion of the total NIH budget has increased only marginally (from .3% to .4%). In 1995, family medicine researchers obtained $6.7 million from AHCPR, 4.0% of the AHCPR research budget. Since 1991, this amount has increased slightly, but as a proportion of the AHCPR budget, it has declined (from 4.4% to 4.0%)., Discussion: The NIH is an increasingly important source of support for family medicine researchers, while AHCPR support has plateaued. Even though NIH support of family physician researchers is increasing, the proportion of NIH funding awarded to family medicine departments remains below the proportion of US medical school faculty who are family physicians. One possible cause of this discrepancy is a lack of a locus of primary care and family medicine research funding.

Background and Objectives: We conducted a study of family practice residency programs to investigate the number of deliveries performed by residents during training., Methods: A one-page questionnaire was mailed to family practice residency program directors, requesting an estimate of the number of deliveries performed by each resident. In addition, information on residency characteristics was taken from the American Academy of Family Physicians Directory of Family Practice Residency Programs., Results: Responses were received from 316 programs, for a response rate of 70%. Residency directors estimated that residents did a mean of 18 continuity and 24.5 obstetrics block month deliveries. On the average, residents delivered 93.9 babies in 3 years of residency. The number of continuity deliveries was related to location of the program and type of program. Total deliveries related to the presence of a competing obstetrics program, faculty who were doing their own deliveries, location of the program, and number of required months of obstetrics. On multivariate analysis, only the latter two variables predicted the number of total deliveries., Conclusions: Family practice residents deliver an average of 94 babies in 3 years of residency training. Programs that want to increase deliveries can best do so by increasing the number of required months of training.

Background and Objectives: Using the Theory of Reasoned Action, we propose a model that diagrams medical school characteristics known or hypothesized to influence the process of specialty choice. The medical school characteristics we consider are administrative support, special programs, primary care funding, number and quality of primary care faculty, faculty influence, primary care residencies, committee representation, primary care environment, required time, and student contact. This model provides explicit hypotheses to be tested in future research on specialty choice.

Background: Videotapes have been variably successful in teaching physical examination skills, interviewing strategies, and clinically relevant didactic material to medical students, residents, and physicians. The literature does not include evaluations of their success in introducing procedural techniques into clinical practice., Objectives: This study assessed whether the presentation of an instructional videotape influenced the adoption of a specific technique, assisting birth in the lateral position., Methods: Family practice residents, faculty, and physicians participated in educational presentations that reviewed how to assist childbirth in the lateral position. Three different formats were used for the presentations; an instructional videotape formed the core element of each presentation. Immediately following the presentations, and on one other occasion 4-6 months later, the participating physicians received questionnaires surveying their use of the lateral birth position., Results: Approximately 30% of the respondents who had not previously used the position used the lateral birth technique. Of the remaining respondents who had not used the technique, 64% considered using the technique with their laboring patients. Physicians who viewed the videotape in concert with other educational interventions were more likely to have adopted the new birth technique (P = .03)., Conclusions: An instructional videotape, as part of a structured, interactive presentation, can be used successfully to introduce a procedure into the clinical practices of family physicians.

Objective: This study examines the relationship between the choice of family practice by medical students in the 1986-1987 academic year and nine variables: ownership of school, weeks of required family medicine clinical training, age of school, and six variables related to medical school financial support and faculty composition., Methods: In multivariate analysis, three variables were found to be significantly related to choice of family practice (R2 = .441): weeks of required family medicine clinical training, proportion of faculty in family practice, and ownership of the school. A cluster analysis was performed using nine variables., Results: Along with the multivariate analysis, the resulting nine clusters demonstrate that additional variables need to be identified to explain the variance in percentage of students choosing family practice at different schools.

Medical students' specialty preferences before and after participation in a required third-year family practice (FP) clerkship were compared to National Resident Matching Program (NRMP) results. Of 714 students studied, 18 (2.5%) changed their specialty preference away from FP during the clerkship and 66 (9%) changed their preference to FP. Sixty-nine (70%) of students who maintained a preference for FP pre- and post-clerkship matched in FP. Seventy-two students changed their specialty preference to FP and 19 changed their preference from FP during the clerkship; 32% of each of these groups matched in FP. Those with both pre- and post-clerkship preferences for other specialties matched in FP at a rate of only 4% but constituted 18% of everyone entering the specialty.