Perceptions, practice, and “ownership:” experiences in continuity of the patient-doctor relationship in a family medicine residency

Background: The objective of this mixed-methods study was to determine interpersonal continuity (the ongoing therapeutic relationship between patient and health care provider) experiences of family medicine residents and preceptors, and explore their perceptions of interpersonal continuity.Methods: Quantitative data on resident and preceptor encounters were extracted from the electronic medical record (EMR). Opportunities for developing interpersonal continuity were determined using the Usual Provider Continuity (UPC) Index. A qualitative descriptive research method was used for the qualitative portion. Semi-structured interviews were conducted and constant comparative analysis was used to determine emerging themes.Results: Residents were found to have low UPC rates; preceptor rates were higher. Qualitative findings showed variable experiences with interpersonal continuity not apparent from UPC rates. Both preceptors and residents expressed perception of “ownership” of patients as a significant barrier to interpersonal continuity. Conclusion: This study suggests that a perceived lack of individual “ownership” of a patient panel was a significant barrier to developing interpersonal continuity. This might conflict with current changes towards team-based health care delivery. Understanding perceptions and changing them through a multi-faceted approach including resident teaching and faculty development might help improve interpersonal continuity which are core to both family medicine curricula and current models of health care delivery

Non-Fickian Diffusion Affects the Relation between the Salinity and Hydrate Capacity Profiles in Marine Sediments

On-site measurements of water salinity (which can be directly evaluated from the electrical conductivity) in deep-sea sediments is technically the primary source of indirect information on the capacity of the marine deposits of methane hydrates. We show the relation between the salinity (chlorinity) profile and the hydrate volume in pores to be significantly affected by non-Fickian contributions to the diffusion flux---the thermal diffusion and the gravitational segregation---which have been previously ignored in the literature on the subject and the analysis of surveys data. We provide amended relations and utilize them for an analysis of field measurements for a real hydrate deposit.Comment: 7 pages, 2 figures, 1 table, submitted to Compte Rendus Mecaniqu

Overexpression of 5-HT2C receptors in forebrain leads to elevated anxiety and hypoactivity

The 5-HT2C receptor has been implicated in mood and eating disorders. In general, it is accepted that 5-HT2C receptor agonists increase anxiety behaviours and induce hypophagia. However, pharmacological analysis of the roles of these receptors is hampered by the lack of selective ligands and the complex regulation of receptor isoforms and expression levels. Therefore, the exact role of 5-HT2C receptors in mood disorders remain controversial, some suggesting agonists and others suggesting antagonists may be efficacious antidepressants, while there is general agreement that antagonists are beneficial anxiolytics. In order to test the hypothesis that increased 5-HT2C receptor expression, and thus increased 5-HT2C receptor signalling, is causative in mood disorders, we have undertaken a transgenic approach, directly altering the 5-HT2C receptor number in the forebrain and evaluating the consequences on behaviour. Transgenic mice overexpressing 5-HT2C receptors under the control of the CaMKIIα promoter (C2CR mice) have elevated 5-HT2C receptor mRNA levels in cerebral cortex and limbic areas (including the hippocampus and amygdala), but normal levels in the hypothalamus, resulting in > 100% increase in the number of 5-HT2C ligand binding sites in the forebrain. The C2CR mice show increased anxiety-like behaviour in the elevated plus-maze, decreased wheel-running behaviour and reduced activity in a novel environment. These behaviours were observed in the C2CR mice without stimulation by exogenous ligands. Our findings support a role for 5-HT2C receptor signalling in anxiety disorders. The C2CR mouse model offers a novel and effective approach for studying disorders associated with 5-HT2C receptors

Ferromagnetism in a dilute magnetic semiconductor -- Generalized RKKY interaction and spin-wave excitations

Carrier-mediated ferromagnetism in a dilute magnetic semiconductor has been studied using i) a single-impurity based generalized RKKY approach which goes beyond linear response theory, and ii) a mean-field-plus-spin-fluctuation (MF+SF) approach within a (purely fermionic) Hubbard-model representation of the magnetic impurities, which incorporates dynamical effects associated with finite frequency spin correlations in the ordered state. Due to a competition between the magnitude of the carrier spin polarization and its oscillation length scale, the ferromagnetic spin coupling is found to be optimized with respect to both hole doping concentration and impurity-carrier spin coupling energy $J$ (or equivalently $U$). The ferromagnetic transition temperature $T_c$, deteremined within the spin-fluctuation theory, corresponds closely with the observed $T_c$ values. Positional disorder of magnetic impurities causes significant stiffening of the high-energy magnon modes. We also explicitly study the stability/instability of the mean-field ferromagnetic state, which highlights the role of competing AF interactions causing spin twisting and noncollinear ferromagnetic ordering.Comment: 10 pages, 12 figure

Deep and bottom water export from the Southern Ocean to the Pacific Ocean over the past 38 million years

The application of radiogenic isotopes to the study of Cenozoic circulation patterns in the South Pacific Ocean has been hampered by the fact that records from only equatorial Pacific deep water have been available. We present new Pb and Nd isotope time series for two ferromanganese crusts that grew from equatorial Pacific bottom water (D137-01, “Nova,” 7219 m water depth) and southwest Pacific deep water (63KD, “Tasman,” 1700 m water depth). The crusts were dated using 10Be/9Be ratios combined with constant Co-flux dating and yield time series for the past 38 and 23 Myr, respectively. The surface Nd and Pb isotope distributions are consistent with the present-day circulation pattern, and therefore the new records are considered suitable to reconstruct Eocene through Miocene paleoceanography for the South Pacific. The isotope time series of crusts Nova and Tasman suggest that equatorial Pacific deep water and waters from the Southern Ocean supplied the dissolved trace metals to both sites over the past 38 Myr. Changes in the isotopic composition of crust Nova are interpreted to reflect development of the Antarctic Circumpolar Current and changes in Pacific deep water circulation caused by the build up of the East Antarctic Ice Sheet. The Nd isotopic composition of the shallower water site in the southwest Pacific appears to have been more sensitive to circulation changes resulting from closure of the Indonesian seaway

Indirect exchange in GaMnAs bilayers via spin-polarized inhomogeneous hole gas: Monte Carlo simulation

The magnetic order resulting from an indirect exchange between magnetic moments provided by spin-polarized hole gas in the metallic phase of a GaMnAs double layer structure is studied via Monte Carlo simulation. The coupling mechanism involves a perturbative calculation in second order of the interaction between the magnetic moments and carriers (holes). We take into account a possible polarization of the hole gas due to the existence of an average magnetization in the magnetic layers, establishing, in this way, a self-consistency between the magnetic order and the electronic structure. That interaction leads to an internal ferromagnetic order inside each layer, and a parallel arrangement between their magnetizations, even in the case of thin layers. This fact is analyzed in terms of the inter- and intra-layer interactions.Comment: 17 pages and 14 figure

An Anthropocene Without Archaeology—Should We Care?

For more than a decade, a movement has been gathering steam among geoscientists to designate an Anthropocene Epoch and formally recognize that we have entered a new geological age in which Earth’s systems are dominated by humans. Chemists, climatologists, and other scientists have entered the discussion, and there is a growing consensus that we are living in the Anthropocene. Nobel Prize-winning atmospheric chemist Paul Crutzen (2002a, 2002b; Crutzen and Stoermer 2000) coined the term, but the idea that humans are a driver of our planet’s climate and ecosystems has much deeper roots. Italian geologist Antonio Stoppani wrote of the “anthropozoic era” in 1873 (Crutzen 2002a), and many others have proposed similar ideas, including journalist Andrew Revkin’s (1992) reference to the “Anthrocene” and Vitousek and colleagues (1997) article about human domination of earth’s ecosystems. It was not until Crutzen (2002a, 2002b) proposed that the Anthropocene began with increased atmospheric carbon levels caused by the Industrial Revolution in the late eighteenth century (including the invention of the steam engine in A.D. 1784), however, that the concept began to gain serious traction among scientists and inspire debate

Temperature-dependent magnetization in diluted magnetic semiconductors

We calculate magnetization in magnetically doped semiconductors assuming a local exchange model of carrier-mediated ferromagnetic mechanism and using a number of complementary theoretical approaches. In general, we find that the results of our mean-field calculations, particularly the dynamical mean field theory results, give excellent qualitative agreement with the experimentally observed magnetization in systems with itinerant charge carriers, such as Ga_{1-x}Mn_xAs with 0.03 < x < 0.07, whereas our percolation-theory-based calculations agree well with the existing data in strongly insulating materials, such as Ge_{1-x}Mn_x. We comment on the issue of non-mean-field like magnetization curves and on the observed incomplete saturation magnetization values in diluted magnetic semiconductors from our theoretical perspective. In agreement with experimental observations, we find the carrier density to be the crucial parameter determining the magnetization behavior. Our calculated dependence of magnetization on external magnetic field is also in excellent agreement with the existing experimental data.Comment: 17 pages, 15 figure

Application specific compression : final report.

With the continuing development of more capable data gathering sensors, comes an increased demand on the bandwidth for transmitting larger quantities of data. To help counteract that trend, a study was undertaken to determine appropriate lossy data compression strategies for minimizing their impact on target detection and characterization. The survey of current compression techniques led us to the conclusion that wavelet compression was well suited for this purpose. Wavelet analysis essentially applies a low-pass and high-pass filter to the data, converting the data into the related coefficients that maintain spatial information as well as frequency information. Wavelet compression is achieved by zeroing the coefficients that pertain to the noise in the signal, i.e. the high frequency, low amplitude portion. This approach is well suited for our goal because it reduces the noise in the signal with only minimal impact on the larger, lower frequency target signatures. The resulting coefficients can then be encoded using lossless techniques with higher compression levels because of the lower entropy and significant number of zeros. No significant signal degradation or difficulties in target characterization or detection were observed or measured when wavelet compression was applied to simulated and real data, even when over 80% of the coefficients were zeroed. While the exact level of compression will be data set dependent, for the data sets we studied, compression factors over 10 were found to be satisfactory where conventional lossless techniques achieved levels of less than 3