Doctors in Chinese public hospitals: demonstration of their professional identities

Background: An increase in the number of medical disputes and violence against doctors indicates a lack of trust in the medical profession by society in Chinese public hospitals. Empirical evidence confirms that one cause is the lack of professional identity demonstrated by doctors. Medical professionals are required to maintain high standards of competence and moral responsibility, and demonstrate qualities such as respect, compassion, integrity, responsiveness to needs, and commitment to sound ethical practice in order to maintain professional privilege. These principles and appropriate professional conduct are the foundation of the professional identity of the medical profession. Methods: A quantitative approach was adopted by distributing paper-based questionnaires to doctors and patients in two hospitals (Level III and Level II) in Jinan, Shandong province, China. Findings: In total, 614 doctors and 1184 inpatients on discharge from the surgical and internal medicine units of the two hospitals participated in the survey yielding 90% response rates. The study confirmed the variation amongst doctors in demonstrating their professionalism in terms of respecting patients’ views and preferences when determining diagnostic procedures and treatment plans, and when making ethical decisions. Although 90% patients indicated that they showed respects to doctors, close to 20% of the doctors disagreed that they received high respect from patients. About 12% of doctors prescribed unnecessary diagnostic procedures to patient for the purpose of generating profit and more than 20% of patients indicated that they gave gifts to doctors in order to receive better treatment. Conclusions: Although about 80% of doctors demonstrated certain aspects of professionalism required by practitioners, the inconsistency across the medical workforce may exacerbate tense doctor-patient relationships. A review of medical curricula and focus of the internship program is required in order to assist medical graduates with forming required professional identity in order to improve patient satisfaction and better clinical outcomes. To be effective, a more systematic approach is recommended

An Association between Head Circumference and Alzheimer's Disease in a Population-Based Study of Aging and Dementia

We investigated the association between head circumference (HC) and Alzheimer's disease (AD) in a cross-sectional population-based study of aging in North Manhattan. Six hundred forty-nine subjects underwent neurologic, neuropsychological, and anthropometric evaluations; apolipoprotein E (apoE) genotype was available for a subsample of 300 individuals. Logistic regression analyses were performed with AD the outcome of interest to evaluate any association between HC and AD. In these analyses, HC evaluated as a continuous variable was associated with AD (OR 0.8, 95% CI 0.7-0.9) after adjusting for age, education, and ethnicity, gender, and height. Analyses suggested that increased risk resided mainly in those with smallest HC. Thus, women whose HC was within the lowest quintile of HC for women were 2.9 (95% CI 1.4-6.1) times more likely to have AD, after adjusting for age, education, and ethnicity; and men in the lowest quintile of HC (for men) were 2.3 times more likely to have AD (95% CI 0.6-9.8). There was no confounding by height, weight, or apoE genotype. The results are consistent with previous studies that suggest that premorbid brain size may influence the age-specific risk for AD. Future epidemiologic studies seeking environmental risk factors for AD may benefit by making HC measurements on all subjects to decrease the variance associated with other potential risk factors

The Kindred Bonds of Mentally Ill Homeless Persons

While the unraveling of the kinship bond has long been suspected to play a role in the epidemiology of homelessness, the connection between kinship and homelessness has been little studied. Based on a normative analysis of the role of family structure in response to adversity, this article explores the impact of the amount and quality of kinship ties on episodes of homelessness experienced by discharged psychiatric patients in Ohio. Survey data derived from personal interviews with both former patients and their kin indicate more strain in relations with kin of the homeless than the nonhomeless. The strain in the kinship bond appears to emanate from a greater prevalence of chronic disabilities that undermine independent functioning and tax the resources of relatives who choose to remain involved. Consistent with this interpretation, patients with histories of homelessness reported more psychiatric symptoms, more deficits in daily living skills, and more contact with the criminal justice system. In general, patient variables were better able than family variables to differentiate the homeless from the nonhomeless. Nonetheless, the formulation of public policies for reducing the incidence and prevalence of homelessness will surely need to take account of the kinship bond and how it can be strengthened

Entropy on Spin Factors

Recently it has been demonstrated that the Shannon entropy or the von Neuman entropy are the only entropy functions that generate a local Bregman divergences as long as the state space has rank 3 or higher. In this paper we will study the properties of Bregman divergences for convex bodies of rank 2. The two most important convex bodies of rank 2 can be identified with the bit and the qubit. We demonstrate that if a convex body of rank 2 has a Bregman divergence that satisfies sufficiency then the convex body is spectral and if the Bregman divergence is monotone then the convex body has the shape of a ball. A ball can be represented as the state space of a spin factor, which is the most simple type of Jordan algebra. We also study the existence of recovery maps for Bregman divergences on spin factors. In general the convex bodies of rank 2 appear as faces of state spaces of higher rank. Therefore our results give strong restrictions on which convex bodies could be the state space of a physical system with a well-behaved entropy function.Comment: 30 pages, 6 figure

Success of blinding a procedural intervention in a randomised controlled trial in preterm infants receiving respiratory support

Background: Blinding of treatment allocation from treating clinicians in neonatal randomised controlled trials can minimise performance bias, but its effectiveness is rarely assessed. // Methods: To examine the effectiveness of blinding a procedural intervention from treating clinicians in a multicentre randomised controlled trial of minimally invasive surfactant therapy versus sham treatment in preterm infants of gestation 25–28 weeks with respiratory distress syndrome. The intervention (minimally invasive surfactant therapy or sham) was performed behind a screen within the first 6 h of life by a ‘study team’ uninvolved in clinical care including decision-making. Procedure duration and the study team’s words and actions during the sham treatment mimicked those of the minimally invasive surfactant therapy procedure. Post-intervention, three clinicians completed a questionnaire regarding perceived group allocation, with the responses matched against actual intervention and categorised as correct, incorrect, or unsure. Success of blinding was calculated using validated blinding indices applied to the data overall (James index, successful blinding defined as > 0.50), or to the two treatment allocation groups (Bang index, successful blinding: −0.30 to 0.30). Blinding success was measured within staff role, and the associations between blinding success and procedural duration and oxygenation improvement post-procedure were estimated. // Results: From 1345 questionnaires in relation to a procedural intervention in 485 participants, responses were categorised as correct in 441 (33%), incorrect in 142 (11%), and unsure in 762 (57%), with similar proportions for each of the response categories in the two treatment arms. The James index indicated successful blinding overall 0.67 (95% confidence interval (CI) 0.65–0.70). The Bang index was 0.28 (95% CI 0.23–0.32) in the minimally invasive surfactant therapy group and 0.17 (95% CI 0.12–0.21) in the sham arm. Neonatologists more frequently guessed the correct intervention (47%) than bedside nurses (36%), neonatal trainees (31%), and other nurses (24%). For the minimally invasive surfactant therapy intervention, the Bang index was linearly related to procedural duration and oxygenation improvement post-procedure. No evidence of such relationships was seen in the sham arm. // Conclusion: Blinding of a procedural intervention from clinicians is both achievable and measurable in neonatal randomised controlled trials

Confirmation of SBS 1150+599A As An Extremely Metal-Poor Planetary Nebula

SBS 1150+599A is a blue stellar object at high galactic latitude discovered in the Second Byurakan Survey. New high-resolution images of SBS 1150+599A are presented, demonstrating that it is very likely to be an old planetary nebula in the galactic halo, as suggested by Tovmassian et al (2001). An H-alpha image taken with the WIYN 3.5-m telescope and its "tip/tilt" module reveals the diameter of the nebula to be 9.2", comparable to that estimated from spectra by Tovmassian et al. Lower limits to the central star temperature were derived using the Zanstra hydrogen and helium methods to determine that the star's effective temperature must be > 68,000K and that the nebula is optically thin. New spectra from the MMT and FLWO telescopes are presented, revealing the presence of strong [Ne V] lambda 3425, indicating that the central star temperature must be > 100,000K. With the revised diameter, new central star temperature, and an improved central star luminosity, we can constrain photoionization models for the nebula significantly better than before. Because the emission-line data set is sparse, the models are still not conclusive. Nevertheless, we confirm that this nebula is an extremely metal-poor planetary nebula, having a value for O/H that is less than 1/100 solar, and possibly as low as 1/500 solar.Comment: 19 pages, 6 figures. Accepted for publication in the Astronomical Journa