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Kenneth Keown, MD, was a forward-thinking anesthesiologist who developed techniques to allow the safe practice of cardiac anesthesia and opened the door for the future development of more complex intracardiac surgical procedures. His early successful protocols for cardiac anesthesiology and his wide-reaching education of others on these methods earned him the designation of "the grand old man of anesthesia for inside-the-heart surgery" at a young age. His contributions also extended to groundbreaking research in hypothermia, lidocaine uses as an antiarrhythmic, and advocacy for anesthesiology as a specialty. We highlight the accomplishments of Dr. Keown that may be unrecognized by those outside the field of cardiac anesthesiology, as they paved the way for the success of modern cardiac surgery.

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Over-prescription of opioid pain medications and increases in heroin use have contributed to the sharp rise in opioid-related hospitalizations and overdose deaths among young adults in the United States, including pregnant women. This has imposed substantial direct and indirect costs to our nation's health care system. Effective treatment with methadone and buprenorphine is available, but significant barriers to care may restrict access for many. Improved screening tools and expanded access to treatments for substance use disorders are keys to addressing the epidemic of opioid use disorder.

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Primary care physicians and specialists are frequently involved in the care of surgical patients. Changes in reimbursement have prompted re-examination of preoperative testing and health care expenditures. Physicians have additional incentives to improve health care delivery and reduce costs. The perioperative surgical home concept involves coordinating all aspects of patient care, including behavioral modifications, during the perioperative period. Evidence-based guidelines on preoperative evaluation are available to assist practitioners in managing cardiovascular disease, and communicating surgical risks. Shared decision making in the preoperative period can improve surgical outcomes and patient satisfaction.

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Although the occurrence of pain in hospitalized children is common, assessment and treatment of pain presents unique challenges to practitioners who care for pediatric patients. Knowledge of drug mechanisms as well as metabolic differences in infants and children compared with adults is necessary for the successful treatment of acute and chronic pain syndromes. Recent reports of adverse events in children receiving both opioid and non-opioid analgesics have prompted re-examination of some long standing pain medication regimens and prescribing practices. We review advances in diagnosis and management of pain in pediatric populations.

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We demonstrate a 10-GHz RF-amplifier-free slab-coupled optical waveguide coupled optoelectronic oscillator (SCOW-COEO) system operating with low phase-noise (<-115 dBc/Hz at 1 kHz offset) and large sidemode suppression (>70 dB measurement-limited). The optical pulses generated by the SCOW-COEO exhibit 26.8-ps pulse width (post compression) with a corresponding spectral bandwidth of 0.25 nm (1.8X transform-limited). We also investigate the mechanisms that limit the performance of the COEO. Our measurements indicate that degradation in the quality factor (Q) of the optical cavity significantly impacts COEO phase-noise through increases in the optical amplifier relative intensity noise (RIN).

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We demonstrate a free-running 3-GHz slab-coupled optical waveguide (SCOW) optoelectronic oscillator (OEO) with low phase-noise (<-120 dBc/Hz at 1-kHz offset) and ultra-low sidemode spurs. These sidemodes are indistinguishable from noise on a spectrum analyzer measurement (>88 dB down from carrier). The SCOW-OEO uses high-power low-noise SCOW components in a single-loop cavity employing 1.5-km delay. The noise properties of our SCOW external-cavity laser (SCOWECL) and SCOW photodiode (SCOWPD) are characterized and shown to be suitable for generation of high spectral purity microwave tones. Through comparisons made with SCOW-OEO topologies employing amplification, we observe the sidemode levels to be degraded by any amplifiers (optical or RF) introduced within the OEO cavity.

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Uni-traveling-carrier waveguide photodiodes (PDs) with a variable optical confinement mode size transformer are demonstrated. The optical mode is large at the input for minimal front-end saturation and the mode transforms as the light propagates so that the absorption profile is optimized for both high-power and high-speed performance. Two differently designed PDs are presented. PD A demonstrates a 3-dB bandwidth of 12.6 GHz, and saturation currents of 40 mA at 1 GHz and 34 mA at 10 GHz. PD B demonstrates a 3-dB bandwidth of 2.5 GHz, a saturation current greater than 100 mA at 1 GHz, a peak RF output power of + 19 dBm, and a third-order output intercept point of 29.1 dBm at a photocurrent of 60 mA.

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Because informed consent for prostate cancer screening with prostate specific antigen (PSA) is recommended, we determined how African Americans, Hispanics, and Caucasians want information about screening with PSA and the digital rectal exam (DRE) presented in culturally sensitive brochures specific for each group. We analyzed focus group discussions using content analysis and compared themes across groups in a university outpatient internal medicine practice setting. The participants were twenty couples with men age 50 and older who participated in four focus groups. Main outcome measures were participants' views on the content and graphic design of culturally sensitive brochures promoting informed decision making about prostate cancer screening. There were content and graphic design differences in the way ethnic groups wanted information presented about the prostate, prostate cancer, risk, and screening. Caucasians likened the size of the prostate to a walnut; Hispanics, to a small lime. Hispanics emphasized how advanced prostate cancer can be symptomatic; Caucasians, how early prostate cancer can be asymptomatic. African Americans wanted risk information specific for them and the advantages and disadvantages of a PSA and DRE; Hispanics, did not. Caucasians and African Americans sought a more active role for men in informed decision making than Hispanics. Differences in the way African Americans, Hispanics, and Caucasians want information presented about prostate cancer screening suggest there may be cultural differences in the reasonable person standard of informed consent, in attitudes toward the physician-patient relationship, screening, and informed decision making. Physicians promoting informed decision making about controversial screening tests should take cultural sensitivity into account when designing educational interventions and using them.

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OBJECTIVE: To determine physicians' rating of the importance of key facts men ought to know about prostate-specific antigen (PSA) screening and whether there are differences by specialty. PARTICIPANTS: A nationwide random sample of internists, family physicians, and urologists stratified by physician specialty from The Official ABMS Directory of Board-Certified Medical Specialists 2000 Edition. MEASUREMENTS: Internists (N = 139), family physicians (N = 160), and urologists (N = 151) were asked to rate how important it is for men to know 17 facts about PSA screening using a 5-point Likert scale. MAIN RESULTS: Of 769 eligible physicians, 450 responded, for an overall response rate of 59%. Urologists and nonurologists differed in rating how important it was for men to know 9 of the 17 key facts. Eight of the nine statements that urologists and nonurologists disagreed upon concerned facts reflecting uncertainty. Nonurologists were more likely than urologists to rate facts reflecting uncertainty as highly important for men to know. These included statements about prostate cancer risk, screening with PSA, and treatment. CONCLUSIONS: Despite professional guidelines supporting informed decision making, the importance of facts men ought to know about PSA testing differ by physician specialty. Systematic differences may reflect differences in professional guidelines about PSA testing.

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OBJECTIVES: This study examined knowledge about prostate-specific antigen (PSA) screening among African Americans and Whites. Because PSA screening for prostate cancer is controversial, professional organizations recommend informed consent for screening. METHODS: Men (n = 304) attending outpatient clinics were surveyed for their knowledge about and experience with screening. RESULTS: Most men did not know the key facts about screening with PSA. African Americans appeared less knowledgeable than Whites, but these differences were mediated by differences in educational level and experience with prostate cancer screening. CONCLUSIONS: Public health efforts to improve informed consent for prostate cancer screening should focus on highlighting the key facts and developing different approaches for men at different levels of formal education and prior experience with screening.

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