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Depression, anxiety and PTSD symptoms before and during the COVID-19 pandemic in the UK
- K. S. Young, K. L. Purves, C. Hübel, M. R. Davies, K. N. Thompson, S. Bristow, G. Krebs, A. Danese, C. Hirsch, C. E. Parsons, E. Vassos, B. N. Adey, S. Bright, L. Hegemann, Y. T. Lee, G. Kalsi, D. Monssen, J. Mundy, A. J. Peel, C. Rayner, H. C. Rogers, A. ter Kuile, C. Ward, K. York, Y. Lin, A. B. Palmos, U. Schmidt, D. Veale, T. R. Nicholson, T. A. Pollak, S. A. M. Stevelink, T. Moukhtarian, A. R. Martineau, H. Holt, B. Maughan, A. Al-Chalabi, K. Ray Chaudhuri, M. P. Richardson, J. R. Bradley, P. F. Chinnery, N. Kingston, S. Papadia, K. E. Stirrups, R. Linger, M. Hotopf, T. C. Eley, G. Breen
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- Journal:
- Psychological Medicine / Volume 53 / Issue 12 / September 2023
- Published online by Cambridge University Press:
- 26 July 2022, pp. 5428-5441
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Background
The impact of the coronavirus disease 2019 (COVID-19) pandemic on mental health is still being unravelled. It is important to identify which individuals are at greatest risk of worsening symptoms. This study aimed to examine changes in depression, anxiety and post-traumatic stress disorder (PTSD) symptoms using prospective and retrospective symptom change assessments, and to find and examine the effect of key risk factors.
MethodOnline questionnaires were administered to 34 465 individuals (aged 16 years or above) in April/May 2020 in the UK, recruited from existing cohorts or via social media. Around one-third (n = 12 718) of included participants had prior diagnoses of depression or anxiety and had completed pre-pandemic mental health assessments (between September 2018 and February 2020), allowing prospective investigation of symptom change.
ResultsProspective symptom analyses showed small decreases in depression (PHQ-9: −0.43 points) and anxiety [generalised anxiety disorder scale – 7 items (GAD)-7: −0.33 points] and increases in PTSD (PCL-6: 0.22 points). Conversely, retrospective symptom analyses demonstrated significant large increases (PHQ-9: 2.40; GAD-7 = 1.97), with 55% reported worsening mental health since the beginning of the pandemic on a global change rating. Across both prospective and retrospective measures of symptom change, worsening depression, anxiety and PTSD symptoms were associated with prior mental health diagnoses, female gender, young age and unemployed/student status.
ConclusionsWe highlight the effect of prior mental health diagnoses on worsening mental health during the pandemic and confirm previously reported sociodemographic risk factors. Discrepancies between prospective and retrospective measures of changes in mental health may be related to recall bias-related underestimation of prior symptom severity.
In situ, broadband measurement of the radio frequency attenuation length at Summit Station, Greenland
- J. A. Aguilar, P. Allison, J. J. Beatty, D. Besson, A. Bishop, O. Botner, S. Bouma, S. Buitink, M. Cataldo, B. A. Clark, Z. Curtis-Ginsberg, A. Connolly, P. Dasgupta, S. de Kockere, K. D. de Vries, C. Deaconu, M. A. DuVernois, C. Glaser, A. Hallgren, S. Hallmann, J. C. Hanson, B. Hendricks, C. Hornhuber, K. Hughes, A. Karle, J. L. Kelley, I. Kravchenko, R. Krebs, R. Lahmann, U. Latif, J. Mammo, Z. S. Meyers, K. Michaels, K. Mulrey, A. Nelles, A. Novikov, A. Nozdrina, E. Oberla, B. Oeyen, Y. Pan, H. Pandya, I. Plaisier, N. Punsuebsay, L. Pyras, D. Ryckbosch, O. Scholten, D. Seckel, M. F. H. Seikh, D. Smith, D. Southall, J. Torres, S. Toscano, D. Tosi, D. J. Van Den Broeck, N. van Eijndhoven, A. G. Vieregg, C. Welling, D. R. Williams, S. Wissel, R. Young, A. Zink
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- Journal:
- Journal of Glaciology / Volume 68 / Issue 272 / December 2022
- Published online by Cambridge University Press:
- 30 May 2022, pp. 1234-1242
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Over the last 25 years, radiowave detection of neutrino-generated signals, using cold polar ice as the neutrino target, has emerged as perhaps the most promising technique for detection of extragalactic ultra-high energy neutrinos (corresponding to neutrino energies in excess of 0.01 Joules, or 1017 electron volts). During the summer of 2021 and in tandem with the initial deployment of the Radio Neutrino Observatory in Greenland (RNO-G), we conducted radioglaciological measurements at Summit Station, Greenland to refine our understanding of the ice target. We report the result of one such measurement, the radio-frequency electric field attenuation length $L_\alpha$. We find an approximately linear dependence of $L_\alpha$ on frequency with the best fit of the average field attenuation for the upper 1500 m of ice: $\langle L_\alpha \rangle = ( ( 1154 \pm 121) - ( 0.81 \pm 0.14) \, ( \nu /{\rm MHz}) ) \,{\rm m}$ for frequencies ν ∈ [145 − 350] MHz.
Effect of clozapine and olanzapine on cortical excitability in schizophrenia
- C. Ben Amor, A. Galinowski, B. Gueguen, M.C. Bourdel, R. Waismann, B. Granger, Q. Debray, J.P. Olie, M.O. Krebs
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- Journal:
- European Psychiatry / Volume 22 / Issue S1 / March 2007
- Published online by Cambridge University Press:
- 16 April 2020, p. S103
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Cortical excitability is modified in schizophrenia [1] but the effect of antipsychotic drugs has been disputed. In particular, patients receiving olanzapine and risperidone showed less cortical disinhibition compared to untreated schizophrenic subjects [2]. However, despite the observed increase, the Resting Motor Threshold (RMT) remained inferior to the RMT in normal controls, and the Transcallosal Conduction Time (TCT) did not change.
There is no comparative study of the effect of clozapine, an effective antipsychotic with proconvulsant properties.
We studied cortical excitability by transmagnetic stimulation in stabilized schizophrenic patients treated by clozapine (n=10), olanzapine (n=10) compared to healthy volunteers (n=10).
The aim of this study was to extend previous research into inhibitory deficits in schizophrenia and to compare the effect of clozapine and olanzapine on neurophysiological parameters such as RMT, Intracortical Inhibition (ICI), Intracortical Facilitation (ICF), Cortical Silence Period (CSP) and Transcallosal Inhibition (TI).
In clozapine treated patients, the RMT and ICI were significantly lower (p<0.05) compared to olanzapine treated and healthy subjects. TCT was longer in schizophrenic patients without difference in treatment subgroups.
ConclusionThe trend toward normalization of RMT and ICI with antipsychotic treatment seems to be independent of the magnitude of therapeutic effect.
Excessive Checking Behavior During an Image Comparison Task in Schizophrenia
- N. Jaafari, N. Chopin, C. Levy, J.-Y. Rotgé, N. Lafay, W. Hammi, F. Rigalleau, B. Millet, M.-O. Krebs, N. Vibert, for Insight Study Group
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- Journal:
- European Psychiatry / Volume 30 / Issue 2 / February 2015
- Published online by Cambridge University Press:
- 15 April 2020, pp. 233-241
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Background:
Patients with schizophrenia display significant working memory and executive deficits. In patients with obsessive-compulsive disorder (OCD), several studies suggest that working memory dysfunction may be one of the causes of compulsive checking behaviors. Hence, this study aimed at assessing whether patients with schizophrenia were impaired on an image comparison task used to measure checking behaviors, and whether the origin and profile of impairment on this task was different between schizophrenia and OCD.
Methods:Eye movement recordings were used to assess the checking behavior of 24 patients with schizophrenia and 24 control participants who had to decide whether two images were different or identical. The verbal and visuo-spatial components of participants’ working memory were measured using the reading span and backward location span tests.
Results:Compared to controls, patients with schizophrenia had reduced working memory spans and showed excessive checking behavior when comparing the two images. However, the intensity of their checking behavior was not significantly related to their working memory deficits.
Conclusions:Several recent studies demonstrated that the excessive checking behaviors displayed by patients with OCD were related to working memory dysfunction. The absence of a relationship between the excessive checking behavior of patients with schizophrenia and their working memory deficits suggests that checking behaviors do not have the same origin in the two disorders.
P147: Your emergency department journey: piloting a patient poster explaining the emergency department care process
- L. Krebs, C. Villa-Roel, D. Ushko, G. Sandhar, H. Ruske, S. Couperthwaite, B. Holroyd, M. Ospina, B. Rowe
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 21 / Issue S1 / May 2019
- Published online by Cambridge University Press:
- 02 May 2019, p. S117
- Print publication:
- May 2019
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Introduction: Qualitative research with emergency department (ED) patients in Alberta has revealed that some patients have limited understanding of the ED care process and that this increases the anxiety, frustration and confusion experienced throughout their visit. The objective of this study was to design, implement, and test the usefulness of a poster explaining the ED care process. Methods: As part of a stepped-wedge ED intervention trial in Alberta, a 4′ x 3′ poster portraying the patient ED care process was developed and posted in 15 study site waiting rooms. Trained research assistants approached patients in 3 urban ED waiting areas and invited them to complete a short paper-based survey on the acceptability and usefulness of the poster. Results are reported as proportions. Results: A total of 316 patients agreed to participate in this study. Approximately half of the participants were male and 60% were between the ages of 17 and 49. The majority of participants identified themselves as white (72%) and nearly half (49%) were accompanied by someone. A third (37%) of patients had read the wall poster prior to being approached to complete the survey. Most patients (62%) who had not read it prior to being approached hadn't noticed the poster or couldn't see it because of its location. Once patients reviewed the poster, the vast majority (92%) reported completely or largely understanding the information and most (84%) found it at least moderately helpful in preparing them for their ED journey. Approximately 45% of respondents agreed that they learned something new about the ED care process by reading the poster and 20% wanted additional information added to the poster; largely, wait time estimates (53% of responses). Conclusion: Placing posters in the ED is one method for equipping patients for their ED care process; however, this study revealed the potential limited utility of this engagement method by the small number of patients who noticed the poster and read the information. Location and content (e.g., time estimates) were identified as key factors for implementation. Condition-specific guides may need to supplement general ED process guides to better prepare patients for their individual ED journey and to actively engage them in their ED care.
P075: Emergency physicians’ self-reported management of benign headache in Alberta emergency departments
- L. Krebs, C. Villa-Roel, S. Couperthwaite, M. Ospina, B. Holroyd, B. Rowe
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 21 / Issue S1 / May 2019
- Published online by Cambridge University Press:
- 02 May 2019, p. S90
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- May 2019
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Introduction: Benign headache (BHA) management varies across emergency departments (EDs). This study documented current BHA management by Alberta emergency physicians (EP) in order to develop a provincial intervention to improve standardized practice. Methods: A convenience sample of Alberta EPs completed an online survey exploring their ED BHA management practices. Results are expressed as proportions. Results: A total of 73 EPs (73/192; 38%) who were mostly male (63%) and practiced emergency medicine for at least 15 years (51%) responded. EPs reported routine ED orders for metoclopramide (97%), ketorolac (90%) and IV fluids (85%) for patients with BHA showing no signs of pathological headache. For moderate-severe BHA's that did not improve with routine treatment, preferences were: IV narcotic (58%), IV dexamethasone (44%), and IV/IM dihydroergotamine (27%). Typically, EPs reported not ordering investigations for moderate-severe BHA presentations (88%); however, for those not improving the most common investigation was computed tomography (CT; 47%). CT ordering was associated with the following clinical scenarios: 1) not responding to traditional therapy and consulted to specialist (64%); 2) not responding to traditional therapy and being admitted (64%); 3) first presentation and afebrile (19%); 4) severe pain (11%); and 5) responding to traditional therapy and febrile (11%). One-quarter of EPs (27%) believed their patients usually or frequently expected a CT. Most EPs (60%) reported being completely or mostly comfortable discussing CT risks. Only 44% reported always or usually discussing risks prior to ordering. EPs reported that they were most frequently prevented from discussing risks because the patient was critically ill (42%) or because they believed explaining risks would not alter patient expectations (21%). These concerns were mirrored in the barriers EPs anticipated to limiting imaging, specifically the fear of missing a severe condition (62%), and patient expectation/request for imaging (48%). Conclusion: Self-reported treatment preferences for uncomplicated BHAs appear to be relatively consistent. Chart reviews could help assessing the reliability of self-reported BHA management practices. Perceived patient expectation appears to be an important influence on EP imaging ordering. Studies examining the communication between EPs and their patients are needed to explore how these expectations and perceived expectations are negotiated in the ED.
P148: Emergency physicians’ perception on engaging patients in their emergency department care
- L. Krebs, C. Villa-Roel, S. Couperthwaite, B. Holroyd, M. Ospina, B. Rowe
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 21 / Issue S1 / May 2019
- Published online by Cambridge University Press:
- 02 May 2019, pp. S117-S118
- Print publication:
- May 2019
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Introduction: Patient engagement in health decision-making is an important research area within emergency medicine. Studies suggest that patients are often not highly engaged in care decisions, and may not be aware that there are decisions in which they can be involved. This study explored emergency physicians (EPs) perceptions of their patient engagement practices. Methods: As part of a stepped-wedge randomized controlled trial, an introductory seminar was held at 15 emergency department (ED) sites in Alberta. Seminars highlighted physician-patient communication and expectation gaps documented in local studies. As part of the seminar evaluation, EPs were asked to reflect on their engagement of patients in their practice. Descriptive results are reported. Results: A total of 114 EP surveys were returned. The majority of respondents were male (68%) and nearly 40% of respondents have practiced emergency medicine for 5 years or less. Less than half of the EPs (43%) reported always or usually asking their patients about their ED visit care expectations. Approximately one-third (32%) reported always or usually checking their patients’ understanding of management options (e.g., tests, treatments and/or procedures). Patients management preferences were always or usually elicited 24% of the time. Despite limited consistency in ascertaining patients’ preferences, 39% of EPs indicated that they always or usually considered their patients’ preferences when choosing a management plan. Half of the EPs (51%) reported that they always or usually involved their patients in decision-making. Yet, when asked whether other EPs involved their patients in decision-making, only 15% reported that they believed their fellow clinicians did this always or usually. On average, 68% of respondents believed their patients wanted to be completely or mostly involved in their ED and decision-making; however, 16% believed patients were actually completely or mostly involved in the ED care and decision-making. Conclusion: EPs agreed that patients want to be actively involved in their ED care decisions. Yet, their reflection on their own practice, and especially their perception of their colleagues’, highlight large gaps between physicians’ perception of what patients would like and what patients actually receive. Further research should explore these interactions in depth, understand what constrains EPs from involving patients and explore patient perceptions of these interactions.
P077: Piloting imaging-focused knowledge dissemination tools in Alberta emergency departments
- L. Krebs, N. Hill, C. Villa-Roel, S. Couperthwaite, M. Ospina, B. Holroyd, B. Rowe
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 21 / Issue S1 / May 2019
- Published online by Cambridge University Press:
- 02 May 2019, p. S91
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- May 2019
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Introduction: Variation in image ordering exists across Alberta emergency departments (EDs). Evidence-based, pocket-sized knowledge dissemination tools were developed for two conditions (acute asthma [AA] and benign headache [BHA]) for which imaging (chest x-ray [CXR] and computed tomography [CT], respectively) has limited utility. This study explored tool acceptability among ED patients and emergency physicians (EPs). Methods: Tool feedback was provided by EPs, via online survey, and adult patients with AA and BHA via in-person survey. EPs qualitative interviews further explored communication tools. Preliminary descriptive analyses of survey responses and content analysis of interview data were conducted. Results: Overall, 55 EPs (55/192; 29%) and 38 consecutive patients participated in the AA study; 73 EPs (73/192; 38%) and 160 patients participated in the BHA study. In both studies, approximately 50% of EPs felt comfortable using the tool; however, they suggested including radiation risk details and imaging indications and removing references to imaging variation and health system cost. In the BHA study, EPs opposed the four Choosing Wisely® campaign questions fearing they would increase imaging expectations. In both conditions, most patients ( >90%) understood the content and 68% felt the information applied to them. Less than half (AA:45%; BHA: 38%) agreed that they now knew more about when a patient should have imaging workup done. Following tool review, 71% of AA and 50% of BHA patients stated they would discuss their imaging needs with their ED care provider today or during a future presentation. Both patient groups suggested including: additional imaging details (i.e., indications, risk, clinical utility), removing imaging overuse references, and including instructions that encourage patients to ask their EP questions. EP interviews (n = 12) identified preferences for personalized and interactive tools. Tensions were perceived around ED time pressure as well as remuneration schemes that fail to prioritize patient conversation. Tool centralization, easy access, and connection with outpatient support were also key themes. Conclusion: Both patients and EPs provided valuable information on how to improve ED knowledge dissemination tools, using two chronic conditions to demonstrate how these changes would improve tool utility. Implementing these recommendations, and considering preferences of EPs and patients, may improve future tool uptake and impact.
P076: Do QR codes effectively engage patients in research while visiting the emergency department?
- L. Krebs, C. Villa-Roel, D. Ushko, G. Sandhar, H. Ruske, S. Couperthwaite, B. Holroyd, M. Ospina, B. Rowe
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 21 / Issue S1 / May 2019
- Published online by Cambridge University Press:
- 02 May 2019, pp. S90-S91
- Print publication:
- May 2019
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Introduction: Efforts to engage patients in research when presenting to emergency departments (EDs) have explored the utility of online tools; for example, through QR-based applications. It is unclear whether these are effective strategies for engaging patients in research activities while saving costs of in-person surveys. This study evaluated whether patients would participate in QR codes or short URL-linked surveys available in EDs across Alberta. Methods: A patient waiting room poster was developed as part of a stepped-wedge randomized controlled trial. The waiting room poster was introduced in 15 urban and regional Alberta EDs with a median annual volume of approximately 60,000. A QR-code and short URL were placed on the poster inviting patients to participate in an online survey and evaluate the poster's usefulness and acceptability. Additionally, written discharge instructions, which were part of the intervention materials, were distributed with QR-code and short URL link to surveys for patients to share their ED care experience. Patients were not prompted by any staff or research personnel to encourage use of the QR codes or the short URLs; however, a survey was conducted with ED waiting room patients in 3 urban EDs to ascertain whether they had downloaded a QR reader on their devices and the frequency of use of these applications. Results: Given the stepped-wedge nature of the study, these materials were available for a total of approximately 123 months (3 sites for 13 months, 4 sites for 10 months, 4 sites for 7 months, and 4 sites for 4 months). Over the study period, 15 patients accessed and completed the online survey linked to the QR code or the short URL placed on the posters. No patients completed the online surveys linked to the QR code or the short URL placed on the discharge instructions. The in-person survey conducted within the ED waiting room identified that 34% of respondents had a QR code reader downloaded on their phone (108/316). Of those with a QR reader, 33% reported using the reader at least once within the last 6 months. Conclusion: In this study, few patients downloaded QR readers on their electronic devices while in the ED waiting room. Without prompting, this appears to be an ineffective strategy for engaging patients in emergency medicine research. Other engagement strategies optimizing human resource investment are urgently needed to effectively conduct research in EDs.
MP37: Conceptualizing unnecessary care in emergency departments (ED): qualitative interviews with ED physicians and site chiefs
- N. Hill, L. D. Krebs, C. Villa-Roel, B. H. Rowe
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 20 / Issue S1 / May 2018
- Published online by Cambridge University Press:
- 11 May 2018, p. S54
- Print publication:
- May 2018
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Introduction: Unnecessary care is an increasingly commonly used term in medicine. Previous survey research suggests that definitions of unnecessary care vary within and among professional and patient groups. This research explores how emergency physicians and administrators understand the term unnecessary care. Methods: Site chiefs and emergency physicians in an Alberta region were recruited through email and online surveys respectively for a qualitative study. One hour one-on-one in-depth interviews explored understandings of unnecessary care within the emergency department (ED) context. Interview transcripts underwent thematic analysis. Results: Five physicians and seven site chiefs completed interviews. Two key themes emerged. First, interviewees conceptualized unnecessary care as inappropriate or non-urgent presentations. This patient-centric view raised non-urgent ED presentations as a health system problem with complex components, including: lack of public knowledge of healthcare resources, shrinking comfort and scope of community providers and patient willingness to utilize other resources. Despite concerns over non-urgent visits, interviewees expressed that these patients still need to be seen, assessed and managed. The second conceptualization focused on over-investigation (and to lesser extent, treatment). This physician-centric conceptualization identified issues around: variation in physician risk tolerance, established decision rules with the allowable miss rates, patient expectation for testing or physician feeling that the patient was owed something or that patient would not accept their diagnosis/treatment without testing. Additionally, interviewees described patient characteristics that may initiate more aggressive investigation (e.g., patient reliability, follow-up care access, etc.). An overarching concern about the connection between unnecessary care and wasted resources was identified. Additionally, interviewees emphasized that patient conversations are outside the scope of unnecessary care despite their possible implications for limited time resources. Conclusion: A range of concepts surrounding unnecessary care in the ED were identified. Further exploring nuances of these conceptualizations may inform and improve the effectiveness of campaigns seeking to improve efficiency in practice and reduce inappropriate care. Additionally, this work provides an impetus for developing clearer concepts of care within the ED.
A Proactive Telephone-Delivered Risk Communication Intervention for Smokers Participating in Lung Cancer Screening: A Pilot Feasibility Trial
- Steven B. Zeliadt, Preston A. Greene, Paul Krebs, Deborah E. Klein, Laura C. Feemster, David H. Au, Christopher G. Slatore, Jaimee L. Heffner
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- Journal:
- Journal of Smoking Cessation / Volume 13 / Issue 3 / September 2018
- Published online by Cambridge University Press:
- 07 September 2017, pp. 137-144
- Print publication:
- September 2018
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Introduction: Many barriers exist to integrating smoking cessation into delivery of lung cancer screening including limited provider time and patient misconceptions.
Aims: To demonstrate that proactive outreach from a telephone counsellor outside of the patient's usual care team is feasible and acceptable to patients.
Methods: Smokers undergoing lung cancer screening were approached for a telephone counselling study. Patients agreeing to participate in the intervention (n = 27) received two telephone counselling sessions. A 30-day follow-up evaluation was conducted, which also included screening participants receiving usual care (n = 56).
Results/Findings: Most (89%) intervention participants reported being satisfied with the proactive calls, and 81% reported the sessions were helpful. Use of behavioural cessation support programs in the intervention group was four times higher (44%) compared to the usual care group (11%); Relative Risk (RR) = 4.1; 95% CI: 1.7 to 9.9), and seven-day abstinence in the intervention group was double (19%) compared to the usual care group (7%); RR = 2.6; 95% CI: 0.8 to 8.9).
Conclusions: This practical telephone-based approach, which included risk messages clarifying continued risks of smoking in the context of screening results, suggests such messaging can boost utilisation of evidence-based tobacco treatment, self-efficacy, and potentially increase the likelihood of successful quitting.
LO087: Emergency department patients’ connection to primary care providers: reasons for lack of connection
- L. Krebs, S.W. Kirkland, K. Crick, C. Villa-Roel, A. Davidson, B. Voaklander, B. Holroyd, E. Cross, T. Nikel, R. Chetram, S. Couperthwaite, G. Cummings, D. Voaklander, B.H. Rowe
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 18 / Issue S1 / May 2016
- Published online by Cambridge University Press:
- 02 June 2016, p. S60
- Print publication:
- May 2016
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Introduction: Some non-urgent/low-acuity Emergency Department (ED) presentations are considered convenience visits and potentially avoidable with improved access to primary care services. This study surveyed patients who presented to the ED and explored their self-reported reasons and barriers for not being connected to a primary care provider (PCP). Methods: Patients aged 17 years and older were randomly selected from electronic registration records at three urban EDs in Edmonton, Alberta (AB), Canada. Following initial triage, stabilization, and verbal informed consent, patients completed a 47-item questionnaire. Data from the survey were cross-referenced to a minimal patient dataset consisting of ED and demographic information. The questionnaire collected information on patient characteristics, their connection to a PCP, and patients' reasons for not having a PCP. Results: Of the 2144 eligible patients, 1408 (65.7%) surveys were returned and 1402 (65.4%) were completed. The majority of patients (74.4%) presenting to the ED reported having a family physician; however, the ‘closeness’ of the connection to their family physician varied greatly among ED patients with the most recent family physician visit ranging from 1 hour before ED presentation to 45 years prior. Approximately 25% of low acuity ED patients reported no connection with a family physician. Reasons for a lack of PCP connection included: prior physician retired, left, or died (19.8%), they had never tried to find one (19.2%), they had recently moved to Alberta (18.0%), and they were unable to find one (16.5%). Conclusion: A surprisingly high proportion of ED patients (25.6%) have no identified PCP. Patients had a variety of reasons for not having a family physician. These need to be understood and addressed in order for primary care access to successfully contribute to diverting non-urgent, low acuity presentations from the ED.
LO091: Non-urgent presentations to the emergency department: patients’ reasons for presentation
- L. Krebs, R. Chetram, S.W. Kirkland, T. Nikel, B. Voaklander, A. Davidson, B. Holroyd, E. Cross, C. Villa-Roel, K. Crick, S. Couperthwaite, C. Alexiu, G. Cummings, D. Voaklander, B.H. Rowe
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 18 / Issue S1 / May 2016
- Published online by Cambridge University Press:
- 02 June 2016, p. S61
- Print publication:
- May 2016
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Introduction: Some low acuity Emergency Department (ED) presentations are considered non-urgent or convenience visits and potentially avoidable with improved access to primary care. This study explored self-reported reasons why non-urgent patients presented to the ED. Methods: Patients, 17 years and older, were randomly selected from electronic registration records at three urban EDs in Edmonton, Alberta (AB), Canada during weekdays (0700 to 1900). A 47-item questionnaire was completed by each consenting patient, which included items on whether the patient believed the ED was their best care option and the rationale supporting their response. A thematic content analysis was performed on the responses, using previous experience and review of the literature to identify themes. Results: Of the 2144 eligible patients, 1408 (65.7%) questionnaires were returned, and 1402 (65.4%) were analyzed. For patients who felt the ED was their best option (n = 1234, 89.3%), rationales included: safety concerns (n = 309), effectiveness of ED care (n = 284), patient-centeredness of ED (n = 277), and access to health care professionals in the ED (n = 204). For patients who felt the ED was not their best care option (n = 148, 10.7%), rationales included a perception that: access to health professionals outside the ED was preferable (n = 39), patient-centeredness (particularly timeliness) was lacking in the ED (n = 26), and their health concern was not important enough to require ED care (n = 18). Conclusion: Even during times when alternative care options are available, the majority of non-urgent patients perceived the ED to be the most appropriate location for care. These results highlight that simple triage scores do not accurately reflect the appropriateness of care and that understanding the diverse and multi-faceted reasons for ED presentation are necessary to implement strategies to support non-urgent, low acuity care needs.
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- By Frank Andrasik, Melissa R. Andrews, Ana Inés Ansaldo, Evangelos G. Antzoulatos, Lianhua Bai, Ellen Barrett, Linamara Battistella, Nicolas Bayle, Michael S. Beattie, Peter J. Beek, Serafin Beer, Heinrich Binder, Claire Bindschaedler, Sarah Blanton, Tasia Bobish, Michael L. Boninger, Joseph F. Bonner, Chadwick B. Boulay, Vanessa S. Boyce, Anna-Katharine Brem, Jacqueline C. Bresnahan, Floor E. Buma, Mary Bartlett Bunge, John H. Byrne, Jeffrey R. Capadona, Stefano F. Cappa, Diana D. Cardenas, Leeanne M. Carey, S. Thomas Carmichael, Glauco A. P. Caurin, Pablo Celnik, Kimberly M. Christian, Stephanie Clarke, Leonardo G. Cohen, Adriana B. Conforto, Rory A. Cooper, Rosemarie Cooper, Steven C. Cramer, Armin Curt, Mark D’Esposito, Matthew B. Dalva, Gavriel David, Brandon Delia, Wenbin Deng, Volker Dietz, Bruce H. Dobkin, Marco Domeniconi, Edith Durand, Tracey Vause Earland, Georg Ebersbach, Jonathan J. Evans, James W. Fawcett, Uri Feintuch, Toby A. Ferguson, Marie T. Filbin, Diasinou Fioravante, Itzhak Fischer, Agnes Floel, Herta Flor, Karim Fouad, Richard S. J. Frackowiak, Peter H. Gorman, Thomas W. Gould, Jean-Michel Gracies, Amparo Gutierrez, Kurt Haas, C.D. Hall, Hans-Peter Hartung, Zhigang He, Jordan Hecker, Susan J. Herdman, Seth Herman, Leigh R. Hochberg, Ahmet Höke, Fay B. Horak, Jared C. Horvath, Richard L. Huganir, Friedhelm C. Hummel, Beata Jarosiewicz, Frances E. Jensen, Michael Jöbges, Larry M. Jordan, Jon H. Kaas, Andres M. Kanner, Noomi Katz, Matthew S. Kayser, Annmarie Kelleher, Gerd Kempermann, Timothy E. Kennedy, Jürg Kesselring, Fary Khan, Rachel Kizony, Jeffery D. Kocsis, Boudewijn J. Kollen, Hubertus Köller, John W. Krakauer, Hermano I. Krebs, Gert Kwakkel, Bradley Lang, Catherine E. Lang, Helmar C. Lehmann, Angelo C. Lepore, Glenn S. Le Prell, Mindy F. Levin, Joel M. Levine, David A. Low, Marilyn MacKay-Lyons, Jeffrey D. Macklis, Margaret Mak, Francine Malouin, William C. Mann, Paul D. Marasco, Christopher J. Mathias, Laura McClure, Jan Mehrholz, Lorne M. Mendell, Robert H. Miller, Carol Milligan, Beth Mineo, Simon W. Moore, Jennifer Morgan, Charbel E-H. Moussa, Martin Munz, Randolph J. Nudo, Joseph J. Pancrazio, Theresa Pape, Alvaro Pascual-Leone, Kristin M. Pearson-Fuhrhop, P. Hunter Peckham, Tamara L. Pelleshi, Catherine Verrier Piersol, Thomas Platz, Marcus Pohl, Dejan B. Popović, Andrew M. Poulos, Maulik Purohit, Hui-Xin Qi, Debbie Rand, Mahendra S. Rao, Josef P. Rauschecker, Aimee Reiss, Carol L. Richards, Keith M. Robinson, Melvyn Roerdink, John C. Rosenbek, Serge Rossignol, Edward S. Ruthazer, Arash Sahraie, Krishnankutty Sathian, Marc H. Schieber, Brian J. Schmidt, Michael E. Selzer, Mijail D. Serruya, Himanshu Sharma, Michael Shifman, Jerry Silver, Thomas Sinkjær, George M. Smith, Young-Jin Son, Tim Spencer, John D. Steeves, Oswald Steward, Sheela Stuart, Austin J. Sumner, Chin Lik Tan, Robert W. Teasell, Gareth Thomas, Aiko K. Thompson, Richard F. Thompson, Wesley J. Thompson, Erika Timar, Ceri T. Trevethan, Christopher Trimby, Gary R. Turner, Mark H. Tuszynski, Erna A. van Niekerk, Ricardo Viana, Difei Wang, Anthony B. Ward, Nick S. Ward, Stephen G. Waxman, Patrice L. Weiss, Jörg Wissel, Steven L. Wolf, Jonathan R. Wolpaw, Sharon Wood-Dauphinee, Ross D. Zafonte, Binhai Zheng, Richard D. Zorowitz
- Edited by Michael Selzer, Stephanie Clarke, Leonardo Cohen, Gert Kwakkel, Robert Miller, Case Western Reserve University, Ohio
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- Book:
- Textbook of Neural Repair and Rehabilitation
- Published online:
- 05 May 2014
- Print publication:
- 24 April 2014, pp ix-xvi
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- By Frank Andrasik, Melissa R. Andrews, Ana Inés Ansaldo, Evangelos G. Antzoulatos, Lianhua Bai, Ellen Barrett, Linamara Battistella, Nicolas Bayle, Michael S. Beattie, Peter J. Beek, Serafin Beer, Heinrich Binder, Claire Bindschaedler, Sarah Blanton, Tasia Bobish, Michael L. Boninger, Joseph F. Bonner, Chadwick B. Boulay, Vanessa S. Boyce, Anna-Katharine Brem, Jacqueline C. Bresnahan, Floor E. Buma, Mary Bartlett Bunge, John H. Byrne, Jeffrey R. Capadona, Stefano F. Cappa, Diana D. Cardenas, Leeanne M. Carey, S. Thomas Carmichael, Glauco A. P. Caurin, Pablo Celnik, Kimberly M. Christian, Stephanie Clarke, Leonardo G. Cohen, Adriana B. Conforto, Rory A. Cooper, Rosemarie Cooper, Steven C. Cramer, Armin Curt, Mark D’Esposito, Matthew B. Dalva, Gavriel David, Brandon Delia, Wenbin Deng, Volker Dietz, Bruce H. Dobkin, Marco Domeniconi, Edith Durand, Tracey Vause Earland, Georg Ebersbach, Jonathan J. Evans, James W. Fawcett, Uri Feintuch, Toby A. Ferguson, Marie T. Filbin, Diasinou Fioravante, Itzhak Fischer, Agnes Floel, Herta Flor, Karim Fouad, Richard S. J. Frackowiak, Peter H. Gorman, Thomas W. Gould, Jean-Michel Gracies, Amparo Gutierrez, Kurt Haas, C.D. Hall, Hans-Peter Hartung, Zhigang He, Jordan Hecker, Susan J. Herdman, Seth Herman, Leigh R. Hochberg, Ahmet Höke, Fay B. Horak, Jared C. Horvath, Richard L. Huganir, Friedhelm C. Hummel, Beata Jarosiewicz, Frances E. Jensen, Michael Jöbges, Larry M. Jordan, Jon H. Kaas, Andres M. Kanner, Noomi Katz, Matthew S. Kayser, Annmarie Kelleher, Gerd Kempermann, Timothy E. Kennedy, Jürg Kesselring, Fary Khan, Rachel Kizony, Jeffery D. Kocsis, Boudewijn J. Kollen, Hubertus Köller, John W. Krakauer, Hermano I. Krebs, Gert Kwakkel, Bradley Lang, Catherine E. Lang, Helmar C. Lehmann, Angelo C. Lepore, Glenn S. Le Prell, Mindy F. Levin, Joel M. Levine, David A. Low, Marilyn MacKay-Lyons, Jeffrey D. Macklis, Margaret Mak, Francine Malouin, William C. Mann, Paul D. Marasco, Christopher J. Mathias, Laura McClure, Jan Mehrholz, Lorne M. Mendell, Robert H. Miller, Carol Milligan, Beth Mineo, Simon W. Moore, Jennifer Morgan, Charbel E-H. Moussa, Martin Munz, Randolph J. Nudo, Joseph J. Pancrazio, Theresa Pape, Alvaro Pascual-Leone, Kristin M. Pearson-Fuhrhop, P. Hunter Peckham, Tamara L. Pelleshi, Catherine Verrier Piersol, Thomas Platz, Marcus Pohl, Dejan B. Popović, Andrew M. Poulos, Maulik Purohit, Hui-Xin Qi, Debbie Rand, Mahendra S. Rao, Josef P. Rauschecker, Aimee Reiss, Carol L. Richards, Keith M. Robinson, Melvyn Roerdink, John C. Rosenbek, Serge Rossignol, Edward S. Ruthazer, Arash Sahraie, Krishnankutty Sathian, Marc H. Schieber, Brian J. Schmidt, Michael E. Selzer, Mijail D. Serruya, Himanshu Sharma, Michael Shifman, Jerry Silver, Thomas Sinkjær, George M. Smith, Young-Jin Son, Tim Spencer, John D. Steeves, Oswald Steward, Sheela Stuart, Austin J. Sumner, Chin Lik Tan, Robert W. Teasell, Gareth Thomas, Aiko K. Thompson, Richard F. Thompson, Wesley J. Thompson, Erika Timar, Ceri T. Trevethan, Christopher Trimby, Gary R. Turner, Mark H. Tuszynski, Erna A. van Niekerk, Ricardo Viana, Difei Wang, Anthony B. Ward, Nick S. Ward, Stephen G. Waxman, Patrice L. Weiss, Jörg Wissel, Steven L. Wolf, Jonathan R. Wolpaw, Sharon Wood-Dauphinee, Ross D. Zafonte, Binhai Zheng, Richard D. Zorowitz
- Edited by Michael E. Selzer, Stephanie Clarke, Leonardo G. Cohen, Gert Kwakkel, Robert H. Miller, Case Western Reserve University, Ohio
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- Book:
- Textbook of Neural Repair and Rehabilitation
- Published online:
- 05 June 2014
- Print publication:
- 24 April 2014, pp ix-xvi
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Sheet-like and plume-like thermal flow in a spherical convection experiment performed under microgravity
- B. Futterer, A. Krebs, A.-C. Plesa, F. Zaussinger, R. Hollerbach, D. Breuer, C. Egbers
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- Journal:
- Journal of Fluid Mechanics / Volume 735 / 25 November 2013
- Published online by Cambridge University Press:
- 29 October 2013, pp. 647-683
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We introduce, in spherical geometry, experiments on electro-hydrodynamic driven Rayleigh–Bénard convection that have been performed for both temperature-independent (‘GeoFlow I’) and temperature-dependent fluid viscosity properties (‘GeoFlow II’) with a measured viscosity contrast up to 1.5. To set up a self-gravitating force field, we use a high-voltage potential between the inner and outer boundaries and a dielectric insulating liquid; the experiments were performed under microgravity conditions on the International Space Station. We further run numerical simulations in three-dimensional spherical geometry to reproduce the results obtained in the ‘GeoFlow’ experiments. We use Wollaston prism shearing interferometry for flow visualization – an optical method producing fringe pattern images. The flow patterns differ between our two experiments. In ‘GeoFlow I’, we see a sheet-like thermal flow. In this case convection patterns have been successfully reproduced by three-dimensional numerical simulations using two different and independently developed codes. In contrast, in ‘GeoFlow II’, we obtain plume-like structures. Interestingly, numerical simulations do not yield this type of solution for the low viscosity contrast realized in the experiment. However, using a viscosity contrast of two orders of magnitude or higher, we can reproduce the patterns obtained in the ‘GeoFlow II’ experiment, from which we conclude that nonlinear effects shift the effective viscosity ratio.
19 - A dangerous book: the reception of the Germania
- from Part IV - Transmission
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- By C. B. Krebs
- Edited by A. J. Woodman, University of Virginia
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- Book:
- The Cambridge Companion to Tacitus
- Published online:
- 28 March 2010
- Print publication:
- 21 January 2010, pp 280-299
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Summary
“But a German may drink beer; indeed, he should drink it as a true son of Germania, since Tacitus mentions specifically German cerevisia.” (Heinrich Heine, Über Ludwig Börne. Eine Denkschrift. 1840) / The Germania was praised as a libellus aureus ('golden booklet') upon its rediscovery in the fifteenth century. Following centuries saw it compared to the 'dawn' of German history, a gift of a 'benign fairy' and 'a bible'. After the collapse of the National Socialist (NS) regime, however, from the vantage of hindsight, Arnaldo Momigliano gave it high priority among 'the hundred most dangerous books ever written', and added that it was 'fortunately' not his task to speak about its influence. The influence of Tacitus' Germania spans 450 years, starting with German humanists in the sixteenth century and ending with the NS downfall in 1945. Germany as a nation-state began to exist with the declaration of the German Empire in 1871. Before then, in the absence of political unity, a common past, culture and language were called upon to substantiate the German nation. But such a cultural nation has proved elusive too: the people within the Holy Roman Empire of the German Nation lived mostly in their communities with their regional traditions and local dialects and quite unaware of 'Germany'. 'What is German history?' is therefore a difficult question.
3 - How small-scale differences in food competition lead to different social systems in three closely related sympatric colobines
- Edited by W. Scott McGraw, Ohio State University, Klaus Zuberbühler, University of St Andrews, Scotland, Ronald Noë, Université Louis Pasteur, Strasbourg
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- Book:
- Monkeys of the Taï Forest
- Published online:
- 30 July 2009
- Print publication:
- 10 May 2007, pp 72-108
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Summary
Introduction
As an essential aspect of life, food can evoke strong competition among individuals and shape a species' social system. Through a pathway of relationships we can link the competitive regime that food evokes in a population to such seemingly loosely related traits as social relationships within and between groups, ranging patterns and dispersal patterns. Food most strongly determines female relationships in many mammals because female reproductive success is mainly constrained by food acquisition. Male success, on the other hand, largely depends on access to mating partners (Trivers 1972, Emlen & Oring 1977). The competitive regime among females can be predicted based on the contestability or usurpability of their food (Wrangham 1980, van Schaik & van Hooff 1983, van Schaik 1989, 1996, Isbell 1991, Sterck et al. 1997). In most primates, food competition increases with group size (Clutton-Brock & Harvey 1977, Wrangham et al. 1993). However, folivores do not always fit into the general patterns found in such studies (Clutton-Brock & Harvey 1977, Isbell 1991, Janson & Goldsmith 1995). A comparative test of the effect of diet on social systems within a largely folivorous genus can solve some of these controversies. Since dietary category is only a proxy for a whole suite of traits that together determines the contestability of a species' food we need to look at each of these traits to investigate differences within a dietary specialization.
Fetal villosity and microvasculature of the bovine placentome in the second half of gestation
- R. LEISER, C. KREBS, K. KLISCH, B. EBERT, V. DANTZER, G. SCHULER, B. HOFFMANN
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- Journal:
- The Journal of Anatomy / Volume 191 / Issue 4 / November 1997
- Published online by Cambridge University Press:
- 01 November 1997, pp. 517-527
- Print publication:
- November 1997
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The architecture of the fetal villous tree and its vasculature in the bovine placentome were studied in the second half of gestation using both conventional histology and histology of ink-filled blood vessels. These were compared with corrosion casts of plastic fillings of the vasculature, prepared for scanning electron microscopy. This combination of morphological methods allows perception of the villous tree throughout gestation from broad-conical to tall-conical form where branch ramification occurs mainly at right angles to the stem. The stem villus typically contains a single central artery and several peripheral veins arranged in parallel. The proximal branches to the stem, the intermediate villi, contain a central arteriole and accompanying venules. The distal branches, the terminal villi, enclose capillary convolutions which consist of an afferent arterial capillary limb, capillary loops and efferent venous capillary limbs. Vascular interconnections exist within the terminal villi, as capillaries or venules between the capillary convolutions, serially bridging them in up to 5 places, and as capillary anastomoses between the capillary loops. Coiling and sinusoidal dilatations of these loops develop near the end of gestation. The intraplacentomal rearrangement of villous trees with progressive gestation and their morphological vascular adaptations are discussed in relation to placental function, including the ever increasing need for transplacental substance exchange. This adaptation allows the blood to traverse the shortest possible arterioarteriolar route to the periphery of the trees where exchange takes place. The need for an increasing blood flow stimulates capillary growth and at the same time optimises the blood flow reaching the placental barrier represented by the vessel cast surface. The capillaries also carry the blood back into the very voluminous system of venules and veins where back diffusion may occur. The total volume of terminal villi of bovine placentome, the ‘working part’ of villous trees, hence distinctly increases with respect to the stem and intermediate villi, the ‘supplying part’ of the villous tree. In morphological terms the efficiency of the bovine transplacental diffusional exchange is higher than in the closely related ‘co-ruminants’ sheep and goats and distinctly higher when compared with the human placenta.
Growth of Fe/ZnSe Multilayers on GaAs (001) AND (111) by Molecular Beam Epitaxy
- H. Abad, B. T. Jonker, C. M. Cotell, S. B. Qadri, J. J. Krebs
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- Journal:
- MRS Online Proceedings Library Archive / Volume 384 / 1995
- Published online by Cambridge University Press:
- 15 February 2011, 73
- Print publication:
- 1995
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The growth of Fe/ZnSe/Fe multilayers on (001) and (111) GaAs substrates is reported. The samples were characterized in-situ by reflection high energy electron diffraction (RHEED), and ex situ by vibrating sample magnetometry (VSM), ferromagnetic resonance (FMR), cross sectional transmission electron microscopy (TEM), and x-ray diffraction. On the (001) surface, the quality of the layers deteriorated significantly with the growth of the first ZnSe spacer layer. In Fe/ZnSe/Fe trilayer structures, TEM revealed a well-defined layered structure, with a high density of defects in both the ZnSe spacer layer and the subsequent Fe layer. VSM and FMR clearly showed the presence of two Fe films with distinct coercive fields, with the higher coercive field attributed to the lower crystalline quality of the second Fe layer. θ-2θ xray diffraction measurements performed on samples grown on (001) GaAs substrates indicated that the ZnSe spacer layer (grown on (001) Fe) grew in a (111) orientation. Growth on GaAs(111) substrates produced better RHEED patterns for all layers with little deterioration in film quality with continued layer growth, so that the magnetic properties of the individual Fe layer could not be distinguished.