The association of types of training and practice settings with doctors’ empathy and patient enablement among patients with chronic illness in Hong Kong

Background: The increase in non-communicable disease (NCD) is becoming a global health problem and there is an increasing need for primary care doctors to look after these patients although whether family doctors are adequately trained and prepared is unknown. Objective: This study aimed to determine if doctors with family medicine (FM) training are associated with enhanced empathy in consultation and enablement for patients with chronic illness as compared to doctors with internal medicine training or without any postgraduate training in different clinic settings. Methods: This was a cross-sectional questionnaire survey using the validated Chinese version of the Consultation and Relational Empathy (CARE) Measure as well as Patient Enablement Instrument (PEI) for evaluation of quality and outcome of care. 14 doctors from hospital specialist clinics (7 with family medicine training, and 7 with internal medicine training) and 13 doctors from primary care clinics (7 with family medicine training, and 6 without specialist training) were recruited. In total, they consulted 823 patients with chronic illness. The CARE Measure and PEI scores were compared amongst doctors in these clinics with different training background: family medicine training, internal medicine training and those without specialist training. Generalized estimation equation (GEE) was used to account for cluster effects of patients nested with doctors. <b>Results</b> Within similar clinic settings, FM trained doctors had higher CARE score than doctors with no FM training. In hospital clinics, the difference of the mean CARE score for doctors who had family medicine training (39.2, SD = 7.04) and internal medicine training (35.5, SD = 8.92) was statistically significant after adjusting for consultation time and gender of the patient. In the community care clinics, the mean CARE score for doctors with family medicine training and those without specialist training were 32.1 (SD = 7.95) and 29.2 (SD = 7.43) respectively, but the difference was not found to be significant. For PEI, patients receiving care from doctors in the hospital clinics scored significantly higher than those in the community clinics, but there was no significant difference in PEI between patients receiving care from doctors with different training backgrounds within similar clinic setting. Conclusion: Family medicine training was associated with higher patient perceived empathy for chronic illness patients in the hospital clinics. Patient enablement appeared to be associated with clinic settings but not doctors’ training background. Training in family medicine and a clinic environment that enables more patient doctor time might help in enhancing doctors’ empathy and enablement for chronic illness patients

Modeling the interinfluence of fertilizer-induced NH3 emission, nitrogen deposition, and aerosol radiative effects using modified CESM2

Global ammonia (NH3) emission is expected to continue to rise due to intensified fertilization for growing food to satisfy the increasing demand worldwide. Previous studies have focused mainly on estimating the land-to-atmosphere NH3 injection but seldom addressed the other side of the bidirectional nitrogen exchange – deposition. Ignoring this significant input source of soil mineral nitrogen may lead to an underestimation of NH3 emissions from natural sources. Here, we used an Earth system model to quantify NH3-induced changes in atmospheric composition and the consequent impacts on the Earth's radiative budget and biosphere as well as the impacts of deposition on NH3 emissions from the land surface. We implemented a new scheme into the Community Land Model version 5 (CLM5) of the Community Earth System Model version 2 (CESM2) to estimate the volatilization of ammonium salt (NH+4) associated with synthetic and manure fertilizers into gaseous NH3. We further parameterized the amount of emitted NH3 captured in the plant canopy to derive a more accurate quantity of NH3 that escapes to the atmosphere. Our modified CLM5 estimated that 14 Tg N yr−1 of global NH3 emission is attributable to fertilizers. Interactively coupling terrestrial NH3 emissions to atmospheric chemistry simulations by the Community Atmospheric Model version 4 with chemistry (CAM4-chem), we found that such emissions favor the formation and deposition of NH aerosol+4, which in turn influences the aerosol radiative effect and enhances soil NH3 volatilization in regions downwind of fertilized croplands. Our fully coupled simulations showed that global-total NH3 emission is enhanced by 3.3 Tg N yr−1 when 30 % more synthetic fertilizer is used compared to the 2000-level fertilization. In synergy with observations and emission inventories, our work provides a useful tool for stakeholders to evaluate the intertwined relations between agricultural trends, fertilizer use, NH3 emission, atmospheric aerosols, and climate so as to derive optimal strategies for securing both food production and environmental sustainability

Hepatocyte growth factor enhances proteolysis and invasiveness of human nasopharyngeal cancer cells through activation of PI3K and JNK

AbstractThe hepatocyte growth factor (HGF) receptor, Met, is frequently overexpressed in nasopharyngeal cancer (NPC). Here, we showed for the first time that human NPC cells with high Met expression were more sensitive to the cell motility and invasion effect of HGF. The downregulation of Met by small interfering RNA decreased tumor cell invasion/migration. HGF significantly increased matrix metalloproteinase-9 production. This was inhibited by blocking phosphatidylinositide 3-kinase (PI3K) and c-Jun N-terminal kinase (JNK), but not extracellular signal-regulated kinase 1/2 and p38 mitogen-activated protein kinase signaling pathways. We also demonstrated that PI3K induced activation of JNK, with Akt as a potential point of this cross-talk. These results provide new insights into the molecular mechanism responsible for NPC progression and metastasis

MicroRNA clusters integrate evolutionary constraints on expression and target affinities : the miR-6/5/4/286/3/309 cluster in Drosophila

This research was supported by the Hong Kong Research Grant Council GRF Grant (14103516), The Chinese University of Hong Kong Direct Grant (4053248), and TUYF Charitable Trust (6903957) (JHLH).A striking feature of microRNAs is that they are often clustered in the genomes of animals. The functional and evolutionary consequences of this clustering remain obscure. Here, we investigated a microRNA cluster miR-6/5/4/286/3/309 that is conserved across drosophilid lineages. Small RNA sequencing revealed expression of this microRNA cluster in Drosophila melanogaster leg discs, and conditional overexpression of the whole cluster resulted in leg appendage shortening. Transgenic overexpression lines expressing different combinations of microRNA cluster members were also constructed. Expression of individual microRNAs from the cluster resulted in a normal wild-type phenotype, but either the expression of several ancient microRNAs together (miR-5/4/286/3/309) or more recently evolved clustered microRNAs (miR-6-1/2/3) can recapitulate the phenotypes generated by the whole-cluster overexpression. Screening of transgenic fly lines revealed down-regulation of leg patterning gene cassettes in generation of the leg-shortening phenotype. Furthermore, cell transfection with different combinations of microRNA cluster members revealed a suite of downstream genes targeted by all cluster members, as well as complements of targets that are unique for distinct microRNAs. Considered together, the microRNA targets and the evolutionary ages of each microRNA in the cluster demonstrates the importance of microRNA clustering, where new members can reinforce and modify the selection forces on both the cluster regulation and the gene regulatory network of existing microRNAs.PostprintPeer reviewe

Improving nitrogen cycling in a land surface model (CLM5) to quantify soil N2O, NO, and NH3 emissions from enhanced rock weathering with croplands

Surficial enhanced rock weathering (ERW) is a land-based carbon dioxide removal (CDR) strategy that involves applying crushed silicate rock (e.g., basalt) to agricultural soils. However, unintended biogeochemical interactions with the nitrogen cycle may arise through ERW increasing soil pH as basalt grains undergo dissolution that may reinforce, counteract, or even offset the climate benefits from carbon sequestration. Increases in soil pH could drive changes in the soil emissions of key non-CO2 greenhouse gases, e.g., nitrous oxide (N2O), and trace gases, e.g., nitric oxide (NO) and ammonia (NH3), that affect air quality and crop and human health. We present the development and implementation of a new improved nitrogen cycling scheme for the Community Land Model v5 (CLM5), the land component of the Community Earth System Model, allowing evaluation of ERW effects on soil gas emissions. We base the new parameterizations on datasets derived from soil pH responses of N2O, NO, and NH3 in ERW field trial and mesocosm experiments with crushed basalt. These new capabilities involve the direct implementation of routines within the CLM5 N cycle framework, along with asynchronous coupling of soil pH changes estimated through an ERW model. We successfully validated simulated “control” (i.e., no ERW) seasonal cycles of soil N2O, NO, and NH3 emissions against a wide range of global emission inventories. We benchmark simulated mitigation of soil N2O fluxes in response to ERW against a subset of data from ERW field trials in the US Corn Belt. Using the new scheme, we provide a specific example of the effect of large-scale ERW deployment with croplands on soil nitrogen fluxes across five key regions with high potential for CDR with ERW (North America, Brazil, Europe, India, and China). Across these regions, ERW implementation led to marked reductions in N2O and NO (both 18 %), with moderate increases in NH3 (2 %). While further developments are still required in our implementations when additional ERW data become available, our improved N cycle scheme within CLM5 has utility for investigating the potential of ERW point-source and regional effects of soil N2O, NO, and NH3 fluxes in response to current and future climates. This framework also provides the basis for assessing the implications of ERW for air quality given the role of NO in tropospheric ozone formation, as well as both NO and NH3 in inorganic aerosol formation

The phenotype of Floating-Harbor syndrome: Clinical characterization of 52 individuals with mutations in exon 34 of SRCAP

Background: Floating-Harbor syndrome (FHS) is a rare condition characterized by short stature, delays in expressive language, and a distinctive facial appearance. Recently, heterozygous truncating mutations in SRCAP were determined to be disease-causing. With the availability of a DNA based confirmatory test, we set forth to define the clinical features of this syndrome. Methods and results. Clinical information on fifty-two individuals with SRCAP mutations was collected using standardized questionnaires. Twenty-four males and twenty-eight females were studied with ages ranging from

History of clinical transplantation

How transplantation came to be a clinical discipline can be pieced together by perusing two volumes of reminiscences collected by Paul I. Terasaki in 1991-1992 from many of the persons who were directly involved. One volume was devoted to the discovery of the major histocompatibility complex (MHC), with particular reference to the human leukocyte antigens (HLAs) that are widely used today for tissue matching.1 The other focused on milestones in the development of clinical transplantation.2 All the contributions described in both volumes can be traced back in one way or other to the demonstration in the mid-1940s by Peter Brian Medawar that the rejection of allografts is an immunological phenomenon.3,4 © 2008 Springer New York

Giant Planet Formation and Migration

© 2018, The Author(s). Planets form in circumstellar discs around young stars. Starting with sub-micron sized dust particles, giant planet formation is all about growing 14 orders of magnitude in size. It has become increasingly clear over the past decades that during all stages of giant planet formation, the building blocks are extremely mobile and can change their semimajor axis by substantial amounts. In this chapter, we aim to give a basic overview of the physical processes thought to govern giant planet formation and migration, and to highlight possible links to water delivery.S.-J. Paardekooper is supported by a Royal Society University Research Fellowship. A. Johansen is supported by the Knut and Alice Wallenberg Foundation, the Swedish Research Council (grant 2014-5775) and the European Research Council (ERC Starting Grant 278675-PEBBLE2PLANET)