Szenarienrechnungen: Landnutzungs- und Rodungsszenarien Abschlussbericht

This research project investigates man's interventions in the carbon cycle of land which is cultivated and utilized by man. Emphasis is placed on studies of the cultivation of natural or quasi-natural land, of renaturation, of man-made blights or blights promoted by utilization, and of the consequences of such blights as regards the carbon cycle of the terrestrial biosphere. Solutions were found by means of a complex, dynamic-time model of the carbon cycle of the terrestrial biosphere, the High Resolution Biosphere Model (HRBM). HRBM was given a one-month data-assisted time range and a spatial resolution of 0.5 degrees of geographical latitude and longitude which corresponds to an equator grid of ca. 50 x 50 km. (orig./RHM)Das dokumentierte Forschungsvorhaben befasst sich mit anthropogenen Eingriffen in den Kohlenstoffhaushalt der Landoberflaechen, soweit sie mit der Nutzung und Nutzungsaenderung durch den Menschen zu tun haben. Somit sind also Prozesse wie die landwirtschaftliche Inkulturnahme ehemals mit natuerlicher oder naturnaher Vegetation bestandener Flaechen, die Renaturierung, anthropogene oder durch die Nutzung beguengstigte Vegetationsbraende und deren Folgen fuer den Kohlenstoffhaushalt der terrestrischen Biosphaere Gegenstand der Untersuchungen. Die Aufgabe wurde geloest durch die Entwicklung eines komplexen, zeitdynamischen Modells des Kohlenstoffhaushalts der terrestrischen Biosphaere, das den Namen 'High Resolution Biosphere Model' (HRBM) erhielt. Das HRBM besitzt einen datengestuetzten Zeitschritt von einem Monat und eine raeumliche Aufloesung von 0.5 Graden geographischer Laenge und Breite, also eine Gittergroesse von ca. 50 x 50 km am Aequator. (orig./RHM)Available from TIB Hannover: RB 48(1) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEBundesministerium fuer Forschung und Technologie (BMFT), Bonn (Germany)DEGerman

Patients’ and clinicians’ perceptions of clinician-expressed empathy in advanced cancer consultations and associations with patient outcomes.

Background Empathy is a cornerstone of effective communication. However, clinicians’ and patients’ perceptions of clinician-expressed empathy might differ. The independent perceptions of patients and clinicians on clinician-expressed empathy in advanced cancer consultations and the associations of these perceptions with patient outcomes are unknown. Objective We assessed: (1) patients’ and clinicians’ independent perceptions of clinician-(self-)expressed empathy in advanced cancer consultations (2) the associations between these perceptions and affective patient outcomes. Methods This observational study included data from 41 consultations in the advanced breast cancer setting. Postconsultation, patients’ and clinicians’ perceptions of clinician-expressed empathy were assessed, as well as patients’: (1) pre–post anxiety, (2) post-anxiety, (3) emotional well-being, (4) satisfaction. Multilevel regression analyses were run to draw conclusions. Results Patients perceived higher levels of empathy than clinicians, without a significant relationship between the two (mean [M] = 85.47, standard deviation [SD] = 14.00 vs. M = 61.88, SD = 15.30, 0–100 scale; b = 0.14, p < 0.138, 95% confidence interval [CI] = 0.04 to 0.32). Higher patient-perceived empathy was associated with decreased anxiety [(1) b = 0.67, p = 0.039, 95% CI = 1.30 to 0.03; (2) b = 0.15, p = 0.042, 95% CI = 0.30 to 0.01], higher satisfaction (b = 0.05, p < 0.001, 95% CI = 0.03 to 0.08), and lower emotional distress (b = 0.32, p < 0.001, 95% CI = 0.48 to 0.16). There were no associations with clinicians’ perceptions [(1) b = 0.34, p = 0.307, 95% CI = 1.00 to 0.31; (2) b = 0.02, p = 0.824, 95% CI = 0.17 to 0.14; (3) b < 0.01, p = 0.918, 95% CI = 0.03 to 0.02; (4) b = 0.08, p = 0.335, 95% CI = 0.08 to 0.25]. Conclusions Patients’ and clinicians’ empathy perceptions differed. In improving patient utcomes, the focus should be on patients’ perceptions of clinician-expressed empathy. Future research could focus on ways to elicit patients’ perceptions of empathy with the higher aim of improving patient outcomes

The use of expectancy and empathy when communicating with patients with advanced breast cancer: an observational study of clinicianp-patient consultations.

Background Information-provision about prognosis, treatments and side-effects is important in advanced cancer, yet also associated with impaired patient well-being. To counter potential detrimental effects, communication strategies based on placebo and nocebo effect mechanisms might be promising to apply in daily practice. This study aimed to provide more insight into how often and how oncologists use expectancy- and empathy-expressions in consultations with patients with advanced breast cancer. Methods 45 consultations between oncologists and patients were audiotaped. To determine how often expectancy- and empathy-expressions were used, a coding scheme was created. Most consultations (n=33) were coded and discussed by two coders, the remaining 13 by one coder. To determine how expectancy- and empathy-expressions were used, principles of inductive content analysis were followed. Results Discussed evaluation (i.e. scan) results were good (n=26,58%) or uncertain (n=12,27%) and less often bad (n=7,15%). Uncertain expectations about prognosis, treatment outcomes and side-effects occurred in 13,38, and 27 consultations (29%,85%,56%); followed by negative expectations in 8,26, and 28 consultations (18%,58%, 62%); and positive expectations in 6,34, and 17 consultations (13%,76%, 38%). When oncologists provided expectancy-expressions, they tapped into three different dimensions; relational, personal, explicit. Positive expectations emphasized the doctor-patient relationship, while negative expectations focused on the severity of the illness, and uncertainty was characterized by a balance between (potential) negative outcomes and hope. Observed generic or specific empathy-expressions were regularly provided, most frequently understanding (n=29,64% of consultations), respecting (n=17,38%), supporting (n=16,36%), and exploring (n=16,36%). A lack of empathy occurred less often and contained among others not responding to patients’ emotional concerns (n=13,27% of consultations), interrupting (n=7,16%), and an absence of understanding (n=4,9%). Conclusion In consultations with mainly positive or uncertain medical outcomes, oncologists predominantly made use of uncertain expectations (hope for the best, prepare for the worst) and used several empathic behaviors. Replication studies, e.g. in these and other medical situations, are needed. Follow-up studies should test the effect of specific communication strategies on patient outcomes, to counter potential negative effects of information-provision. Studies should focus on uncertain situations. Ultimately, specific placebo and nocebo effect inspired communication strategies can be harnessed in clinical care to improve patient outcomes