Socio-psychological factors influencing psychosomatic disturbances: a study of fifteen World War II veterans seen at the Worcester Psychosomatic Clinic

Thesis (M.S.)--Boston University, 1947. This item was digitized by the Internet Archive

Exploring students' perceptions on the use of significant event analysis, as part of a portfolio assessment process in general practice, as a tool for learning how to use reflection in learning

BACKGROUND: Portfolio learning enables students to collect evidence of their learning. Component tasks making up a portfolio can be devised that relate directly to intended learning outcomes. Reflective tasks can stimulate students to recognise their own learning needs. Assessment of portfolios using a rating scale relating to intended learning outcomes offers high content validity. This study evaluated a reflective portfolio used during a final-year attachment in general practice (family medicine). Students were asked to evaluate the portfolio (which used significant event analysis as a basis for reflection) as a learning tool. The validity and reliability of the portfolio as an assessment tool were also measured. METHODS: 81 final-year medical students completed reflective significant event analyses as part of a portfolio created during a three-week attachment (clerkship) in general practice (family medicine). As well as two reflective significant event analyses each portfolio contained an audit and a health needs assessment. Portfolios were marked three times; by the student's GP teacher, the course organiser and by another teacher in the university department of general practice. Inter-rater reliability between pairs of markers was calculated. A questionnaire enabled the students' experience of portfolio learning to be determined. RESULTS: Benefits to learning from reflective learning were limited. Students said that they thought more about the patients they wrote up in significant event analyses but information as to the nature and effect of this was not forthcoming. Moderate inter-rater reliability (Spearman's Rho .65) was found between pairs of departmental raters dealing with larger numbers (20 – 60) of portfolios. Inter-rater reliability of marking involving GP tutors who only marked 1 – 3 portfolios was very low. Students rated highly their mentoring relationship with their GP teacher but found the portfolio tasks time-consuming. CONCLUSION: The inter-rater reliability observed in this study should be viewed alongside the high validity afforded by the authenticity of the learning tasks (compared with a sample of a student's learning taken by an exam question). Validity is enhanced by the rating scale which directly connects the grade given with intended learning outcomes. The moderate inter-rater reliability may be increased if a portfolio is completed over a longer period of time and contains more component pieces of work. The questionnaire used in this study only accessed limited information about the effect of reflection on students' learning. Qualitative methods of evaluation would determine the students experience in greater depth. It would be useful to evaluate the effects of reflective learning after students have had more time to get used to this unfamiliar method of learning and to overcome any problems in understanding the task

Impacts of the US southeast wood pellet industry on local forest carbon stocks

We assessed the net impacts of a wood-dependent pellet industry of global importance on contemporaneous local forest carbon component pools (live trees, standing-dead trees, soils) and total stocks. We conducted post-matched difference-in-differences analyses of forest inventory data between 2000 and 2019 to infer industrial concurrent and lagged effects in the US coastal southeast. Results point to contemporaneous carbon neutrality. We found net incremental effects on carbon pools within live trees, and no net effects on standing-dead tree nor soil pools. However, we found concurrent lower carbon levels in soils, mixed effects associated with increased procurement pressures and large mill pelletization capacity, and possible spillover effects on standing-dead tree carbon pools beyond commercial procurement distances. There is robust evidence that although some trade-offs between carbon pools exist, the wood pellet industry in this particular context and period has met the overall condition of forest carbon neutrality

Multiple uncontrolled conditions and blood pressure medication intensification: an observational study

Abstract Background Multiple uncontrolled medical conditions may act as competing demands for clinical decision making. We hypothesized that multiple uncontrolled cardiovascular risk factors would decrease blood pressure (BP) medication intensification among uncontrolled hypertensive patients. Methods We observed 946 encounters at two VA primary care clinics from May through August 2006. After each encounter, clinicians recorded BP medication intensification (BP medication was added or titrated). Demographic, clinical, and laboratory information were collected from the medical record. We examined BP medication intensification by presence and control of diabetes and/or hyperlipidemia. 'Uncontrolled' was defined as hemoglobin A1c ≥ for diabetes, BP ≥ 140/90 mmHg (≥ 130/80 mmHg if diabetes present) for hypertension, and low density lipoprotein cholesterol (LDL-c) ≥ 130 mg/dl (≥ 100 mg/dl if diabetes present) for hyperlipidemia. Hierarchical regression models accounted for patient clustering and adjusted medication intensification for age, systolic BP, and number of medications. Results Among 387 patients with uncontrolled hypertension, 51.4% had diabetes (25.3% were uncontrolled) and 73.4% had hyperlipidemia (22.7% were uncontrolled). The BP medication intensification rate was 34.9% overall, but higher in individuals with uncontrolled diabetes and uncontrolled hyperlipidemia: 52.8% overall and 70.6% if systolic BP ≥ 10 mmHg above goal. Intensification rates were lowest if diabetes or hyperlipidemia were controlled, lower than if diabetes or hyperlipidemia were not present. Multivariable adjustment yielded similar results. Conclusions The presence of uncontrolled diabetes and hyperlipidemia was associated with more guideline-concordant hypertension care, particularly if BP was far from goal. Efforts to understand and improve BP medication intensification in patients with controlled diabetes and/or hyperlipidemia are warranted.http://deepblue.lib.umich.edu/bitstream/2027.42/78266/1/1748-5908-5-55.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78266/2/1748-5908-5-55.pdfPeer Reviewe

The Magnetic Response of the Solar Atmosphere to Umbral Flashes

Chromospheric observations of sunspot umbrae offer an exceptional view of magneto-acoustic shock phenomena and the impact they have on the surrounding magnetically-dominated plasma. We employ simultaneous slit-based spectro-polarimetry and spectral imaging observations of the chromospheric He I 10830{\AA} and Ca II 8542{\AA} lines to examine fluctuations in the umbral magnetic field caused by the steepening of magneto-acoustic waves into umbral flashes. Following the application of modern inversion routines, we find evidence to support the scenario that umbral shock events cause expansion of the embedded magnetic field lines due to the increased adiabatic pressure. The large number statistics employed allow us to calculate the adiabatic index, gamma = 1.12 +/- 0.01, for chromospheric umbral locations. Examination of the vector magnetic field fluctuations perpendicular to the solar normal revealed changes up to ~200 G at the locations of umbral flashes. Such transversal magnetic field fluctuations have not been described before. Through comparisons with non-linear force-free field extrapolations, we find that the perturbations of the transverse field components are orientated in the same direction as the quiescent field geometries. This implies that magnetic field enhancements produced by umbral flashes are directed along the motion path of the developing shock, hence producing relatively small changes, up to a maximum of ~8 degrees, in the inclination and/or azimuthal directions of the magnetic field. Importantly, this work highlights that umbral flashes are able to modify the full vector magnetic field, with the detection of the weaker transverse magnetic field components made possible by high-resolution data combined with modern inversion routines.Comment: 16 pages, 7 figures, accepted for publication in The Astrophysical Journa

A chromospheric resonance cavity in a sunspot mapped with seismology

This is the author accepted manuscript. The final version is available from Nature Research via the DOI in this recordData availability: The data used in this paper are from the observing campaign entitled ‘The Influence of Magnetism on Solar and Stellar Atmospheric Dynamics’ (NSO-SP proposal T1081; principal investigator: D.B.J.), which employed the ground-based Dunn Solar Telescope, USA, during July 2016. Additional supporting observations were obtained from the publicly available NASA’s Solar Dynamics Observatory (https://sdo.gsfc.nasa.gov) data archive, which can be accessed via http://jsoc.stanford.edu/ajax/lookdata.html. The data that support the plots within this paper and other findings of this study are available from the corresponding author upon reasonable request.Code availability: The numerical code (Lare2D) used in the work can be downloaded from: https://warwick.ac.uk/fac/sci/physics/research/cfsa/people/tda/larexd/Sunspots are intense collections of magnetic fields that pierce through the Sun’s photosphere, with their signatures extending upwards into the outermost extremities of the solar corona1. Cutting-edge observations and simulations are providing insights into the underlying wave generation2, configuration3,4 and damping5 mechanisms found in sunspot atmospheres. However, the in situ amplification of magnetohydrodynamic waves6, rising from a few hundreds of metres per second in the photosphere to several kilometres per second in the chromosphere7, has, until now, proved difficult to explain. Theory predicts that the enhanced umbral wave power found at chromospheric heights may come from the existence of an acoustic resonator8–10, which is created due to the substantial temperature gradients experienced at photospheric and transition region heights11. Here, we provide strong observational evidence of a resonance cavity existing above a highly magnetic sunspot. Through a combination of spectropolarimetric inversions and comparisons with high-resolution numerical simulations, we provide a new seismological approach to mapping the geometry of the inherent temperature stratifications across the diameter of the underlying sunspot, with the upper boundaries of the chromosphere ranging between 1,300 ± 200 km and 2,300 ± 250 km. Our findings will allow the three-dimensional structure of solar active regions to be conclusively determined from relatively commonplace two-dimensional Fourier power spectra. The techniques presented are also readily suitable for investigating temperature-dependent resonance effects in other areas of astrophysics, including the examination of Earth–ionosphere wave cavities12.Science and Technology Facilities Council (STFC)Invest NI and Randox Laboratories LtdSpanish Ministry of Economy and CompetitivenessEuropean Union Horizon 2020Research Council of NorwayINAF Istituto Nazionale di AstrofisicaCalifornia State University Northridg

Activation of Phospholipase C-ε by Heterotrimeric G Protein βγ-Subunits

PLC-epsilon was identified recently as a phosphoinositide-hydrolyzing phospholipase C (PLC) containing catalytic domains (X, Y, and C2) common to all PLC isozymes as well as unique CDC25- and Ras-associating domains. Novel regulation of this PLC isozyme by the Ras oncoprotein and alpha-subunits (Galpha(12)) of heterotrimeric G proteins was illustrated. Sequence analyses of PLC-epsilon revealed previously unrecognized PH and EF-hand domains in the amino terminus. The known interaction of Gbetagamma subunits with the PH domains of other proteins led us to examine the capacity of Gbetagamma to activate PLC-epsilon. Co-expression of Gbeta(1)gamma(2) with PLC-epsilon in COS-7 cells resulted in marked stimulation of phospholipase C activity. Gbeta(2) and Gbeta(4) in combination with Ggamma(1), Ggamma(2), Ggamma(3), or Ggamma(13) also activated PLC-epsilon to levels similar to those observed with Gbeta(1)-containing dimers of these Ggamma-subunits. Gbeta(3) in combination with the same Ggamma-subunits was less active, and Gbeta(5)-containing dimers were essentially inactive. Gbetagamma-promoted activation of PLC-epsilon was blocked by cotransfection with either of two Gbetagamma-interacting proteins, Galpha(i1) or the carboxyl terminus of G protein receptor kinase 2. Pharmacological inhibition of PI3-kinase-gamma had no effect on Gbeta(1)gamma(2)-promoted activation of PLC-epsilon. Similarly, activation of Ras in the action of Gbetagamma is unlikely, because a mutation in the second RA domain of PLC-epsilon that blocks Ras activation of PLC failed to alter the stimulatory activity of Gbeta(1)gamma(2). Taken together, these results reveal the presence of additional functional domains in PLC-epsilon and add a new level of complexity in the regulation of this novel enzyme by heterotrimeric G proteins