Voices emerging from the shadows : Radiologic practitioners’ experiences of challenging conversations

Objective Traditionally, radiologists have practiced their profession behind the scenes. Today, radiologic practitioners face mounting expectations to communicate more directly with patients. However, their experiences with patient communication are not well understood. The aim of this study was to describe the challenges of radiologic practitioners when communicating with patients. Methods Twelve day-long interprofessional communication skills workshops for radiologic clinicians were held at Boston Children\u2019s Hospital. Prior to each workshop, participants were asked to write narratives describing experiences with difficult radiologic conversations that they found particularly challenging or satisfying. The narratives were transcribed and analyzed through thematic content analysis by two researchers. Results Radiologists, radiology trainees, technologists, nurses, and medical interpreters completed 92 narratives. The most challenging aspects of healthcare conversations included: Conveying Serious News (n = 44/92; 48%); Expanded Scope of Radiologic Practice (n = 37/92; 40%); Inexperience and Gaps in Education (n = 15/92; 16%); Clinical Uncertainty (n = 14/92; 15%); and Interprofessional Teamwork (n = 9/92; 10%). Conclusion Radiologic clinicians face substantial communicative challenges focused on conveying serious, unexpected and uncertain diagnoses amid practical challenges and limited educational opportunities. Practice implications Innovative educational curricula that address these challenges may enhance radiologic practitioners\u2019 success in adopting patient-centered communication

Anesthesiology trainees face ethical, practical and relational challenges in obtaining informed consent

BACKGROUND: Categorizing difficulties anesthesiologists have in obtaining informed consent may influence education, performance, and research. This study investigated the trainees' perspectives and educational needs through a qualitative analysis of narratives. METHODS: The Program to Enhance Relational and Communication Skills-Anesthesia used professional actors to teach communication skills and relational abilities associated with informed consent. Before attending the program, participants wrote about a challenging informed consent experience. Narratives were analyzed by two researchers following the principles of grounded theory. The researchers independently read the narratives and marked key words and phrases to identify reoccurring challenges described by anesthesiologists. Through rereading of the narratives and discussion, the two researchers reached consensus on the challenges that arose and calculated their frequency. RESULTS: Analysis of the 39 narratives led to the identification of three types of challenges facing anesthesiologists in obtaining informed consent. Ethical challenges included patient wishes not honored, conflict between patient and family wishes and medical judgment, patient decision-making capacity, and upholding professional standards. Practical challenges included the amount of information to provide, communication barriers, and time limitations. Relational challenges included questions about trainee competence, mistrust associated with previous negative experiences, and misunderstandings between physician and patient or family. CONCLUSIONS: The ethical, practical, and relational challenges in obtaining informed consent colored trainees' views of patient care and affected their interactions with patients. Using participant narratives personalizes education and motivates participants. The richness of narratives may help anesthesiologists to appreciate the qualitative aspects of informed consent

Itinerant Ferromagnetism in the Periodic Anderson Model

We introduce a novel mechanism for itinerant ferromagnetism, based on a simple two-band model. The model includes an uncorrelated and dispersive band hybridized with a second band which is narrow and correlated. The simplest Hamiltonian containing these ingredients is the Periodic Anderson Model (PAM). Using quantum Monte Carlo and analytical methods, we show that the PAM and an extension of it contain the new mechanism and exhibit a non-saturated ferromagnetic ground state in the intermediate valence regime. We propose that the mechanism, which does not assume an intra atomic Hund's coupling, is present in both the iron group and in some f electron compounds like Ce(Rh_{1-x} Ru_x)_3 B_2, La_x Ce_{1-x} Rh_3 B_2 and the uranium monochalcogenides US, USe, and UTe

Statistical Survey of Type III Radio Bursts at Long Wavelengths Observed by the Solar TErrestrial RElations Observatory (STEREO)/Waves Instruments: Radio Flux Density Variations with Frequency

We have performed a statistical study of $152$ Type III radio bursts observed by Solar TErrestrial RElations Observatory (STEREO)/Waves between May 2007 and February 2013. We have investigated the flux density between $125$kHz and $16$MHz. Both high- and low-frequency cutoffs have been observed in $60\,$ of events suggesting an important role of propagation. As already reported by previous authors, we observed that the maximum flux density occurs at $1$MHz on both spacecraft. We have developed a simplified analytical model of the flux density as a function of radial distance and compared it to the STEREO/Waves data.Comment: published in Solar Physic

Metamagnetic Quantum Criticality in Sr3Ru2O7

We consider the metamagnetic transition in the bilayer ruthenate, ${\rm Sr_3Ru_2O_7}$, and use this to motivate a renormalization group treatment of a zero-temperature quantum-critical end-point. We summarize the results of mean field theory and give a pedagogical derivation of the renormalization-group equations. These are then solved to yield numerical results for the susceptibility, the specific heat and the resistivity exponent which can be compared with measured data on ${\rm Sr_3Ru_2O_7}$ to provide a powerful test for the standard framework of metallic quantum criticality. The observed approach to the critical point is well-described by our theory explaining a number of unusual features of experimental data. The puzzling behaviour very near to the critical point itself, though, is not accounted for by this, or any other theory with a Fermi surface

Cross-cultural adaptation of an innovative approach to learning about difficult conversations in healthcare

Background:\u2003The Program to Enhance Relational and Communication Skills (PERCS) was developed at a large hospital in the United States to enhance clinicians\u2019 preparedness to engage in difficult conversations. Aim:\u2003To describe the implementation of PERCS in an Italian hospital and assess the program's efficacy. Methods:\u2003The Italian PERCS program featured 4-h experiential workshops enrolling 10\u201315 interdisciplinary participants. The workshops were organized around the enactment and debriefing of realistic case scenarios portrayed by actors and volunteer clinicians. Before and after the workshop, participants rated their perceived preparation, communication and relational skills, confidence, and anxiety on 5-point Likert scales. Open-ended questions explored their reflections on the learning. T-tests and content analysis were used to analyze the quantitative and qualitative data, respectively. Results:\u2003146 clinicians attended 13 workshops. Participants reported better preparation, confidence, and communication skills (p\u2009<\u20090.001) after the workshops. The program had a different impact depending on the discipline. Participants valued the emphasis on group feedback, experiential and interdisciplinary learning, and the patient's perspective, and acquired: new communication skills, self-reflective attitude, reframed perspective, and interdisciplinary teamwork. Conclusion:\u2003PERCS proved culturally adaptable to the Italian context and effective in improving participants\u2019 sense of preparation, communication skills, and confidence

Statistical Theory of Spin Relaxation and Diffusion in Solids

A comprehensive theoretical description is given for the spin relaxation and diffusion in solids. The formulation is made in a general statistical-mechanical way. The method of the nonequilibrium statistical operator (NSO) developed by D. N. Zubarev is employed to analyze a relaxation dynamics of a spin subsystem. Perturbation of this subsystem in solids may produce a nonequilibrium state which is then relaxed to an equilibrium state due to the interaction between the particles or with a thermal bath (lattice). The generalized kinetic equations were derived previously for a system weakly coupled to a thermal bath to elucidate the nature of transport and relaxation processes. In this paper, these results are used to describe the relaxation and diffusion of nuclear spins in solids. The aim is to formulate a successive and coherent microscopic description of the nuclear magnetic relaxation and diffusion in solids. The nuclear spin-lattice relaxation is considered and the Gorter relation is derived. As an example, a theory of spin diffusion of the nuclear magnetic moment in dilute alloys (like Cu-Mn) is developed. It is shown that due to the dipolar interaction between host nuclear spins and impurity spins, a nonuniform distribution in the host nuclear spin system will occur and consequently the macroscopic relaxation time will be strongly determined by the spin diffusion. The explicit expressions for the relaxation time in certain physically relevant cases are given.Comment: 41 pages, 119 Refs. Corrected typos, added reference

Atomic X-ray Spectroscopy of Accreting Black Holes

Current astrophysical research suggests that the most persistently luminous objects in the Universe are powered by the flow of matter through accretion disks onto black holes. Accretion disk systems are observed to emit copious radiation across the electromagnetic spectrum, each energy band providing access to rather distinct regimes of physical conditions and geometric scale. X-ray emission probes the innermost regions of the accretion disk, where relativistic effects prevail. While this has been known for decades, it also has been acknowledged that inferring physical conditions in the relativistic regime from the behavior of the X-ray continuum is problematic and not satisfactorily constraining. With the discovery in the 1990s of iron X-ray lines bearing signatures of relativistic distortion came the hope that such emission would more firmly constrain models of disk accretion near black holes, as well as provide observational criteria by which to test general relativity in the strong field limit. Here we provide an introduction to this phenomenon. While the presentation is intended to be primarily tutorial in nature, we aim also to acquaint the reader with trends in current research. To achieve these ends, we present the basic applications of general relativity that pertain to X-ray spectroscopic observations of black hole accretion disk systems, focusing on the Schwarzschild and Kerr solutions to the Einstein field equations. To this we add treatments of the fundamental concepts associated with the theoretical and modeling aspects of accretion disks, as well as relevant topics from observational and theoretical X-ray spectroscopy.Comment: 63 pages, 21 figures, Einstein Centennial Review Article, Canadian Journal of Physics, in pres

Neurocognitive profiles in the prodrome to psychosis in NAPLS-1

Background: Most studies of neurocognitive functioning in Clinical High Risk (CHR) cohorts have examined group averages, likely concealing heterogeneous subgroups. We aimed to identify neurocognitive subgroups and to explore associated outcomes. Methods: Data were acquired from 324 participants (mean age 18.4) in the first phase of the North American Prodrome Longitudinal Study (NAPLS-1), a multi-site consortium following individuals for up to 2 1/2 years. We applied Ward's method for hierarchical clustering data to 8 baseline neurocognitive measures, in 166 CHR individuals, 49 non-CHR youth with a family history of psychosis, and 109 healthy controls. We tested whether cluster membership was associated with conversion to psychosis, social and role functioning, and follow-up diagnosis. Analyses were repeated after data were clustered based on independently developed clinical decision rules. Results: Four neurocognitive clusters were identified: Significantly Impaired (n = 33); Mildly Impaired (n = 82); Normal (n = 145) and High (n = 64). The Significantly Impaired subgroup demonstrated the largest deviations on processing speed and memory tasks and had a conversion rate of 58%, a 40% chance of developing a schizophrenia spectrum diagnosis (compared to 24.4% in the Mildly Impaired, and 10.3% in the other two groups combined), and significantly worse functioning at baseline and 12-months. Data clustered using clinical decision rules yielded similar results, pointing to high convergent validity. Conclusion: Neurocognitive profiles vary substantially in their severity and are associated with diagnostic and functional outcome, underscoring neurocognition as a predictor of illness outcomes. These findings, if replicated, are a first step toward personalized treatment for individuals at-risk for psychosis

BMO spaces associated with semigroups of operators

We study BMO spaces associated with semigroup of operators and apply the results to boundedness of Fourier multipliers. We prove a universal interpolation theorem for BMO spaces and prove the boundedness of a class of Fourier multipliers on noncommutative Lp spaces for all 1 < p < \infty, with optimal constants in p.Comment: Math An