Improving Empathy in Healthcare Consultations-a Secondary Analysis of Interventions.

A recent systematic review of randomised trials suggested that empathic communication improves patient health outcomes. However, the methods for training healthcare practitioners (medical professionals; HCPs) in empathy and the empathic behaviours demonstrated within the trials were heterogeneous, making the evidence difficult to implement in routine clinical practice. In this secondary analysis of seven trials in the review, we aimed to identify (1) the methods used to train HCPs, (2) the empathy behaviours they were trained to perform and (3) behaviour change techniques (BCTs) used to encourage the adoption of those behaviours. This detailed understanding of interventions is necessary to inform implementation in clinical practice. We conducted a content analysis of intervention descriptions, using an inductive approach to identify training methods and empathy behaviours and a deductive approach to describe the BCTs used. The most commonly used methods to train HCPs to enhance empathy were face-to-face training (n = 5), role-playing (n = 3) and videos (self or model; n = 3). Duration of training was varied, with both long and short training having high effect sizes. The most frequently targeted empathy behaviours were providing explanations of treatment (n = 5), providing non-specific empathic responses (e.g. expressing understanding) and displaying a friendly manner and using non-verbal behaviours (e.g. nodding, leaning forward, n = 4). The BCT most used to encourage HCPs to adopt empathy behaviours was "Instruction on how to perform behaviour" (e.g. a video demonstration, n = 5), followed by "Credible source" (e.g. delivered by a psychologist, n = 4) and "Behavioural practice" (n = 3 e.g. role-playing). We compared the effect sizes of studies but could not extrapolate meaningful conclusions due to high levels of variation in training methods, empathy skills and BCTs. Moreover, the methods used to train HCPs were often poorly described which limits study replication and clinical implementation. This analysis of empathy training can inform future research, intervention reporting standards and clinical practice

Conceptually driven and visually rich tasks in texts and teaching practice: the case of infinite series

The study we report here examines parts of what Chevallard calls the institutional dimension of the students’ learning experience of a relatively under-researched, yet crucial, concept in Analysis, the concept of infinite series. In particular, we examine how the concept is introduced to students in texts and in teaching practice. To this purpose, we employ Duval's Theory of Registers of Semiotic Representation towards the analysis of 22 texts used in Canada and UK post-compulsory courses. We also draw on interviews with in-service teachers and university lecturers in order to discuss briefly teaching practice and some of their teaching suggestions. Our analysis of the texts highlights that the presentation of the concept is largely a-historical, with few graphical representations, few opportunities to work across different registers (algebraic, graphical, verbal), few applications or intra-mathematical references to the concept's significance and few conceptually driven tasks that go beyond practising with the application of convergence tests and prepare students for the complex topics in which the concept of series is implicated. Our preliminary analysis of the teacher interviews suggests that pedagogical practice often reflects the tendencies in the texts. Furthermore, the interviews with the university lecturers point at the pedagogical potential of: illustrative examples and evocative visual representations in teaching; and, student engagement with systematic guesswork and writing explanatory accounts of their choices and applications of convergence tests

Excitability Properties of Mouse and Human Skeletal Muscle Fibres Compared by Muscle Velocity Recovery Cycles.

Mouse models of skeletal muscle channelopathies are not phenocopies of human disease. In some cases (e.g. Myotonia Congenita) the phenotype is much more severe, whilst in others (e.g. Hypokalaemic periodic paralysis) rodent physiology is protective. This suggests a species' difference in muscle excitability properties. In humans these can be measured indirectly by the post-impulse changes in conduction velocity, using Muscle Velocity Recovery Cycles (MVRCs). We performed MVRCs in mice and compared their muscle excitability properties with humans. Mouse Tibialis Anterior MVRCs (n = 70) have only one phase of supernormality (increased conduction velocity), which is smaller in magnitude (p = 9 × 10-21), and shorter in duration (p = 3 × 10-24) than human (n = 26). This abbreviated supernormality is followed by a period of late subnormality (reduced velocity) in mice, which overlaps in time with the late supernormality seen in human MVRCs. The period of late subnormality suggests increased t-tubule Na+/K+-pump activity. The subnormal phase in mice was converted to supernormality by blocking ClC-1 chloride channels, suggesting relatively higher chloride conductance in skeletal muscle. Our findings help explain discrepancies in phenotype between mice and humans with skeletal muscle channelopathies and potentially other neuromuscular disorders. MVRCs are a valuable new tool to compare in vivo muscle membrane properties between species and will allow further dissection of the molecular mechanisms regulating muscle excitability

New Phases of Near-Extremal Branes on a Circle

We study the phases of near-extremal branes on a circle, by which we mean near-extremal branes of string theory and M-theory with a circle in their transverse space. We find a map that takes any static and neutral Kaluza-Klein black hole, i.e. any static and neutral black hole on Minkowski-space times a circle M^d x S^1, and map it to a corresponding solution for a near-extremal brane on a circle. The map is derived using first a combined boost and U-duality transformation on the Kaluza-Klein black hole, transforming it to a solution for a non-extremal brane on a circle. The resulting solution for a near-extremal brane on a circle is then obtained by taking a certain near-extremal limit. As a consequence of the map, we can transform the neutral non-uniform black string branch into a new non-uniform phase of near-extremal branes on a circle. Furthermore, we use recently obtained analytical results on small black holes in Minkowski-space times a circle to get new information about the localized phase of near-extremal branes on a circle. This gives in turn predictions for the thermal behavior of the non-gravitational theories dual to these near-extremal branes. In particular, we give predictions for the thermodynamics of supersymmetric Yang-Mills theories on a circle, and we find a new stable phase of (2,0) Little String Theory in the canonical ensemble for temperatures above its Hagedorn temperature.Comment: 72 pages, 5 figures. v2: Typos fixed, refs. added. v3: Sec. 3.2 fixe

Cosmology of intersecting brane world models in Gauss-Bonnet gravity

We study the cosmological properties of a codimension two brane world that sits at the intersection between two four branes, in the framework of six dimensional Einstein-Gauss-Bonnet gravity. Due to contributions of the Gauss-Bonnet terms, the junction conditions require the presence of localized energy density on the codimension two defect. The induced metric on this surface assumes a FRW form, with a scale factor associated to the position of the brane in the background; we can embed on the codimension two defect the preferred form of energy density. We present the cosmological evolution equations for the three brane, showing that, for the case of pure AdS$_6$ backgrounds, they acquire the same form of the ones for the Randall-Sundrum II model. When the background is different from pure AdS$_6$, the cosmological behavior is potentially modified in respect to the typical one of codimension one brane worlds. We discuss, in a particular model embedded in an AdS$_6$ black hole, the conditions one should satisfy in order to obtain standard cosmology at late epochs.Comment: 19 pages, no figures, JHEP style. v2: Typos corrected and references adde

GiViP: A Visual Profiler for Distributed Graph Processing Systems

Analyzing large-scale graphs provides valuable insights in different application scenarios. While many graph processing systems working on top of distributed infrastructures have been proposed to deal with big graphs, the tasks of profiling and debugging their massive computations remain time consuming and error-prone. This paper presents GiViP, a visual profiler for distributed graph processing systems based on a Pregel-like computation model. GiViP captures the huge amount of messages exchanged throughout a computation and provides an interactive user interface for the visual analysis of the collected data. We show how to take advantage of GiViP to detect anomalies related to the computation and to the infrastructure, such as slow computing units and anomalous message patterns.Comment: Appears in the Proceedings of the 25th International Symposium on Graph Drawing and Network Visualization (GD 2017

The neodymium isotope fingerprint of Adélie coast bottom water

Adélie Land Bottom Water (ALBW), a variety of Antarctic Bottom Water formed off the Adélie Land coast of East Antarctica, ventilates the abyssal layers of the Australian sector of the Southern Ocean as well as the eastern Indian and Pacific Oceans. We present the first dissolved neodymium (Nd) isotope and concentration measurements for ALBW. The summertime signature of ALBW is characterized by εNd = −8.9, distinct from Ross Sea Bottom Water, and similar to Weddell Sea Bottom Water. Adélie Land Shelf Water, the precursor water mass for wintertime ALBW, features the least radiogenic Nd fingerprint observed around Antarctica to date (εNd = −9.9). Local geology around Antarctica is important in setting the chemical signature of individual varieties of Antarctic Bottom Water, evident from the shelf water signature, which should be considered in the absence of direct wintertime observations

Intervention planning and modification of the BUMP intervention: a digital intervention for the early detection of raised blood pressure in pregnancy

Background: Hypertensive disorders in pregnancy, particularly pre-eclampsia, pose a substantial health risk for both maternal and foetal outcomes. The BUMP (Blood Pressure Self-Monitoring in Pregnancy) interventions are being tested in a trial. They aim to facilitate the early detection of raised blood pressure through self-monitoring. This article outlines how the self-monitoring interventions in the BUMP trial were developed and modified using the person-based approach to promote engagement and adherence. Methods: Key behavioural challenges associated with blood pressure self-monitoring in pregnancy were identified through synthesising qualitative pilot data and existing evidence, which informed guiding principles for the development process. Social cognitive theory was identified as an appropriate theoretical framework. A testable logic model was developed to illustrate the hypothesised processes of change associated with the intervention. Iterative qualitative feedback from women and staff informed modifications to the participant materials. Results: The evidence synthesis suggested women face challenges integrating self-monitoring into their lives and that adherence is challenging at certain time points in pregnancy (for example, starting maternity leave). Intervention modification included strategies to address adherence but also focussed on modifying outcome expectancies, by providing messages explaining pre-eclampsia and outlining the potential benefits of self-monitoring. Conclusions: With an in-depth understanding of the target population, several methods and approaches to plan and develop interventions specifically relevant to pregnant women were successfully integrated, to address barriers to behaviour change while ensuring they are easy to engage with, persuasive and acceptable

Bulk Axions, Brane Back-reaction and Fluxes

Extra-dimensional models can involve bulk pseudo-Goldstone bosons (pGBs) whose shift symmetry is explicitly broken only by physics localized on branes. Reliable calculation of their low-energy potential is often difficult because it requires details of the stabilization of the extra dimensions. In rugby ball solutions, for which two compact extra dimensions are stabilized in the presence of only positive-tension brane sources, the effects of brane back-reaction can be computed explicitly. This allows the calculation of the shape of the low-energy pGB potential and response of the extra dimensional geometry as a function of the perturbing brane properties. If the pGB-dependence is a small part of the total brane tension a very general analysis is possible, permitting an exploration of how the system responds to frustration when the two branes disagree on what the proper scalar vacuum should be. We show how the low-energy potential is given by the sum of brane tensions (in agreement with common lore) when only the brane tensions couple to the pGB. We also show how a direct brane coupling to the flux stabilizing the extra dimensions corrects this result in a way that does not simply amount to the contribution of the flux to the brane tensions. We calculate the mass of the would-be zero mode, and briefly describe several potential applications, including a brane realization of `natural inflation,' and a dynamical mechanism for suppressing the couplings of the pGB to matter localized on the branes. Since the scalar can be light enough to be relevant to precision tests of gravity (in a technically natural way) this mechanism can be relevant to evading phenomenological bounds.Comment: 36 pages, JHEP styl