Shared Presence in Physician-Patient Communication: A Graphic Representation

Shared presence is a state of being in which physicians and patients enter into a deep sense of trust, respect, and knowing that facilitates healing. Communication between physicians and patients (and, in fact, all providers and recipients of health care) is the medium through which shared presence occurs, regardless of the presenting problem, time available, location of care, or clinical history of the patient. Conceptualizing how communication leads to shared presence has been a challenging task, however. Pathways of this process have been routinely lumped together as the biopsychosocial model or patient, person, and relationship-centered care—all deceptive in their simplicity but, in fact, highly complex—or reduced to descriptive explications of one constituent element (e.g., empathy). In this article, we reconcile these pathways and elements by presenting a graphic image for clinicians and teachers in medical education. This conceptual image serves as a framework to synthesize the vast literature on physician-patient communication. We place shared presence, the fundamental characteristic of effective clinical communication, at the center of our figure. Around this focal point, we locate four elemental factors that either contribute to or result from shared presence, including interpersonal skills, relational contexts, actions in clinical encounters, and healing outcomes. By visually presenting various known and emergent theories of physician-patient communication, outlining the flow of successful encounters between physicians and patients, and noting how such encounters can improve outcomes, physicians, other health care professionals, and medical educators can better grasp the complexity, richness, and potential for achieving shared presence with their patients

Effect of Magnetic Fields on Drug Induced Contractility and Mortality in Spirostomum

The influence of homogeneous magnetic fields up to 5.5 T on contractile frequency and mortality in the ciliate protozoan spirostomum ambiguum stimulated by 2,2′ PDS is reported. Magnetic fields are observed to decrease contractile frequency and to significantly increase mortality

A Morse-theoretical analysis of gravitational lensing by a Kerr-Newman black hole

Consider, in the domain of outer communication of a Kerr-Newman black hole, a point (observation event) and a timelike curve (worldline of light source). Assume that the worldline of the source (i) has no past end-point, (ii) does not intersect the caustic of the past light-cone of the observation event, and (iii) goes neither to the horizon nor to infinity in the past. We prove that then for infinitely many positive integers k there is a past-pointing lightlike geodesic of (Morse) index k from the observation event to the worldline of the source, hence an observer at the observation event sees infinitely many images of the source. Moreover, we demonstrate that all lightlike geodesics from an event to a timelike curve in the domain of outer communication are confined to a certain spherical shell. Our characterization of this spherical shell shows that in the Kerr-Newman spacetime the occurrence of infinitely many images is intimately related to the occurrence of centrifugal-plus-Coriolis force reversal.Comment: 14 pages, 2 figures; REVTEX; submitted to J. Math. Phy

Aircraft and avionic related research required to develop an effective high-speed runway exit system

Research was conducted to increase airport capacity by studying the feasibility of the longitudinal separation between aircraft sequences on final approach. The multidisciplinary factors which include the utility of high speed exits for efficient runway operations were described along with recommendations and highlights of these studies

SUPPLY CHAIN INTEGRATION IN THE FOOD AND CONSUMER GOODS INDUSTRIES

The interorganizational structures necessary to implement and achieve the logistical performance improvements identified in the Efficient Consumer Response (ECR) initiative and related supply chain management concepts are difficult to develop. Firms continue to struggle to implement integrated programs and techniques, particularly with respect to changing operating structures, relationships, and mindsets to facilitate true supply chain integration. This research explores the logistical strategies and structures used by selected food and consumer goods firms to integrate their supply chains. It illustrates effective integration strategies and identifies critical success factors and barriers to successful ECR implementation. A framework is used to guide managers in developing the competencies essential to integrating the supply chain and to establishing the relationships necessary to operate in an ECR environment. The framework, entitled Supply Chain 2000, depicts supply chain value creation as achieving synchronization and coordination across four critical supply chain flows: product/service; market accommodation; information; and cash.Industrial Organization,

Challenges with Delivering Gender-Specific and Comprehensive Primary Care to Women Veterans

Background The growing presence of women veterans in Veterans Administration (VA) settings has prompted the need for greater attention to clinical proficiency related to women's health (WH) primary care needs. Instead of making appointments for multiple visits or referring patients to a WH clinic or alternate site for gender-specific care, a comprehensive primary care model now allows for women veteran patients be seen by primary care providers (PCPs) who have WH training/experience and can see patients for both primary and WH care in the context of a single visit. However, little is currently known about the barriers and facilitators WH-PCPs face in using this approach to incorporate gender-specific services into women veterans' primary care services. Methods We conducted qualitative in-depth interviews with 22 WH-PCPs at one Midwestern VA Medical Center. All participants were members of one of four outpatient primary care clinics within the main medical center, one off-site satellite clinic, or two off-site community-based outpatient clinics. Results Inductive thematic analysis identified six themes: 1) Time constraints, 2) importance of staff support, 3) necessity of sufficient space and equipment/supplies, 4) perceptions of discomfort among patients with trauma histories, 5) lack of education/training, and 6) challenges with scheduling/logistics. Conclusion Although adequate staff was a key facilitator, the findings suggest that there may be barriers that undermine the ability of VA WH-PCPs to provide high-quality, comprehensive primary and gender-specific care. The nature of these barriers is multifactorial and multilevel in nature, and may therefore require special policy and practice action

We Could, but Should We? Ethical Considerations for Providing Access to GeoCities and Other Historical Digital Collections

We live in an era in which the ways that we can make sense of our past are evolving as more artifacts from that past become digital. At the same time, the responsibilities of traditional gatekeepers who have negotiated the ethics of historical data collection and use, such as librarians and archivists, are increasingly being sidelined by the system builders who decide whether and how to provide access to historical digital collections, often without sufficient reflection on the ethical issues at hand. It is our aim to better prepare system builders to grapple with these issues. This paper focuses discussions around one such digital collection from the dawn of the web, asking what sorts of analyses can and should be conducted on archival copies of the GeoCities web hosting platform that dates to 1994.This research was supported by the Natural Sciences and Engineering Research Council of Canada, the Social Sciences and Humanities Research Council of Canada, the US National Science Foundation (grants 1618695 and 1704369), the Andrew W. Mellon Foundation, Start Smart Labs, and Compute Canada

Magnetic Properties of Magnetotactic Bacteria

This paper reports on the magnetic properties of magnetosomes in the freshwater magnetotactic bacterium Aquaspirillum magnetotacticum. The magnetosomes are well crystallized particles of magnetite with dimensions of 40 to 50 nm, which are arranged within the cells in a single linear chain and are within the single-magnetic-domain (SD) size range for magnetite. A variety of magnetic properties have been measured for two samples of dispersions of freeze-dried cells consisting of (1) whole cells (M-1) and (2) magnetosomes chains separated from cells (M-2). An important result is that the acquisition and demagnetization of various type of remanent magnetizations are markedly different for the two samples and suggest that remanence is substantially affected by magnetostatic interactions. Interactions are likely to be much more important in M-2 because the extracted magnetosome chains are no longer separated from one another by the cell membrane and cytoplasm. Other experimental data for whole cells agree with predictions based on the chain of spheres model for magnetization reversal. This model is consistent with the unique linear arrangement of equidimensional particles in A. magnetotacticum. The magnetic properties of bacterial and synthetic magnetites are compared and the paleomagnetic implications are discussed

Potential control under thin aqueous layers using a Kelvin Probe

Kelvin Probes can be modified to control as well as monitor potential. The design and operation of two different Kelvin Probe Potentiostats (KPPs) are described in this paper. One approach uses a permanent magnet and double coil to oscillate the needle at a fixed frequency, an AC backing potential, and software analysis and control schemes. This technique can also control the distance between the tip and sample, thereby tracking the topography of the sample. Both KPPs were used to make measurements on Type 304L stainless steel under thin layers of electrolyte. Cathodic polarization curves exhibited a limiting current density associated with oxygen reduction. The limiting current density varied with solution layer thickness over a finite range of thickness. Anodic polarization curves on 304L in a thin layer of chloride solution resulted in pitting corrosion. The breakdown potential did not vary with solution layer thickness. However, the thin layer was observed to increase in volume remarkably during pit growth owing to the absorption of water from the high humidity environment into the layer with ionic strength increased by the pit dissolution. The open circuit potential (OCP) and solution layer thickness were monitored during drying out of a thin electrolyte layer. Pitting corrosion initiated, as indicated by a sharp drop in the OCP, as the solution thinned and increased in concentration.This work was supported in part by the Office of Science and Technology and International (OST&I), Office of Civilian Radioactive Waste Management (OCRWM), US Department of Energy (DOE). The work is carried out as part of the DOE Multi-University Corrosion Cooperative under Cooperative Agreement DE-FC28-04RW12252