Improving empathy of physicians through guided reflective writing

Objectives: This study was designed to explore how guided reflective writing could evoke empathy and reflection in a group of practicing physicians. Methods: Total participants recruited included 40 staff physicians at Cleveland Clinic, a tertiary care academic medical center. Twenty physicians (intervention group) were assigned to participate in a 6-session faculty development program introducing narrative medicine and engaging in guided reflective writing. Ten physicians (comparison group 1) received the assigned course reading materials but did not participate in the course sessions. Ten physicians (comparison group 2) neither received the reading materials nor participated in the sessions. Qualitative analysis of the physicians\u27 reflective writings was performed to identify major themes. The Jefferson Scale of Empathy was administered three times during the course. Results: Qualitative analysis of physicians\u27 writings showed themes of both compassionate solidarity and detached concern. Exploration of negative emotions occurred more frequently than positive ones. The most common writing style was case presentation. A total of 36 staff physicians completed the Jefferson Scale of Empathy. Results of statistical analysis suggested an improvement in empathy in the intervention group at the end of the course (p \u3c 0 .05). Conclusions: These results suggest a faculty development program using guided narrative writing can promote reflection and may enhance empathy among practicing physicians. These findings should encourage medical educators to design additional strategies for enhancing reflection and empathic behavior in trainees and specifically practicing physicians who can role model these behaviors to achieve the ultimate goal of improving the quality of patient care

Association of the changes in cytosolic Ca2+ and iodide efflux induced by thyrotropin and by the stimulation of alpha 1-adrenergic receptors in cultured rat thyroid cells.

Abstract Thyrotropin causes a time- and concentration-dependent increase in cytosolic Ca2+ in FRTL-5 rat thyroid cells as measured by Quin2 fluorescence; the half-maximal response occurs in response to 1 X 10(-7) M thyrotropin. The effect of added thyrotropin is the same whether cells have been previously and chronically exposed to thyrotropin or whether they have been thyrotropin "starved" for several days. The thyrotropin effect on cytosolic Ca2+ has no relationship to intracellular cAMP levels with respect to dose and time course. Norepinephrine (1 X 10(-7) M) also causes increases in cytosolic Ca2+ in FRTL-5 thyroid cells. With the use of a variety of adrenergic inhibitors, norepinephrine was found to exert its effect via an alpha 1-adrenergic receptor. The exposure of FRTL-5 cells to physiological thyrotropin concentrations enhances the effect on cytosolic Ca2+ level induced by norepinephrine in vitro; the shape of the dose-response curve indicates a cooperative effect of the thyrotropin and norepinephrine. The increase in cytosolic Ca2+ seems to be derived from an intracellular pool rather than from the extracellular space. It is not prevented by nifedipine, a blocker of Ca2+ channels; it is present in cells exposed to ethylene glycol bis(beta-aminoethyl ether)-N,N,N',N'-tetraacetic acid; and it is not associated with increased Ca2+ uptake into the cell. the thyrotropin- and norepinephrine-induced increase in cytosolic Ca2+ parallels the efflux of iodide and the organification of thyroglobulin in a dose-dependent manner

Follicular thyroglobulin (TG) suppression of thyroid-restricted genes involves the apical membrane asialoglycoprotein receptor and TG phosphorylation.

Follicular thyroglobulin (TG) decreases expression of the thyroid-restricted transcription factors, thyroid transcription factor (TTF)-1, TTF-2, and Pax-8, thereby suppressing expression of the sodium iodide symporter, thyroid peroxidase, TG, and thyrotropin receptor genes (Suzuki, K., Lavaroni, S., Mori, A., Ohta, M., Saito, J., Pietrarelli, M., Singer, D. S., Kimura, S., Katoh, R., Kawaoi, A. , and Kohn, L. D. (1997) Proc. Natl. Acad. Sci. U. S. A. 95, 8251-8256). The ability of highly purified 27, 19, or 12 S follicular TG to suppress thyroid-restricted gene expression correlates with their ability to bind to FRTL-5 thyrocytes and is inhibited by a specific antibody to the thyroid apical membrane asialoglycoprotein receptor (ASGPR), which is related to the ASGPR of liver cells. Phosphorylating serine/threonine residues of TG, by autophosphorylation or protein kinase A, eliminates TG suppression and enhances transcript levels of the thyroid-restricted genes 2-fold in the absence of a change in TG binding to the ASGPR. Follicular TG suppression of thyroid-restricted genes is thus mediated by the ASPGR on the thyrocyte apical membrane and regulated by a signal system wherein phosphorylation of serine/threonine residues on the bound ligand is an important component. These data provide a hitherto unsuspected role for the ASGPR in transcriptional signaling, aside from its role in endocytosis. They establish a functional role for phosphorylated serine/threonine residues on the TG molecule

Maximally-localized generalized Wannier functions for composite energy bands

We discuss a method for determining the optimally-localized set of generalized Wannier functions associated with a set of Bloch bands in a crystalline solid. By ``generalized Wannier functions'' we mean a set of localized orthonormal orbitals spanning the same space as the specified set of Bloch bands. Although we minimize a functional that represents the total spread sum_n [ _n - _n^2 ] of the Wannier functions in real space, our method proceeds directly from the Bloch functions as represented on a mesh of k-points, and carries out the minimization in a space of unitary matrices U_mn^k describing the rotation among the Bloch bands at each k-point. The method is thus suitable for use in connection with conventional electronic-structure codes. The procedure also returns the total electric polarization as well as the location of each Wannier center. Sample results for Si, GaAs, molecular C2H4, and LiCl will be presented.Comment: 22 pages, two-column style with 4 postscript figures embedded. Uses REVTEX and epsf macros. Also available at http://www.physics.rutgers.edu/~dhv/preprints/index.html#nm_wan

Unified Treatment of Asymptotic van der Waals Forces

In a framework for long-range density-functional theory we present a unified full-field treatment of the asymptotic van der Waals interaction for atoms, molecules, surfaces, and other objects. The only input needed consists of the electron densities of the interacting fragments and the static polarizability or the static image plane, which can be easily evaluated in a ground-state density-functional calculation for each fragment. Results for separated atoms, molecules, and for atoms/molecules outside surfaces are in agreement with those of other, more elaborate, calculations.Comment: 6 pages, 5 figure

The Aharonov-Bohm effect for an exciton

We study theoretically the exciton absorption on a ring shreded by a magnetic flux. For the case when the attraction between electron and hole is short-ranged we get an exact solution of the problem. We demonstrate that, despite the electrical neutrality of the exciton, both the spectral position of the exciton peak in the absorption, and the corresponding oscillator strength oscillate with magnetic flux with a period $\Phi_0$---the universal flux quantum. The origin of the effect is the finite probability for electron and hole, created by a photon at the same point, to tunnel in the opposite directions and meet each other on the opposite side of the ring.Comment: 13 RevTeX 3.0 pages plus 4 EPS-figures, changes include updated references and an improved chapter on possible experimental realization

Barking up the same tree: a comparison of ethnomedicine and canine ethnoveterinary medicine among the Aguaruna

<p>Abstract</p> <p>Background</p> <p>This work focuses on plant-based preparations that the Aguaruna Jivaro of Peru give to hunting dogs. Many plants are considered to improve dogs' sense of smell or stimulate them to hunt better, while others treat common illnesses that prevent dogs from hunting. This work places canine ethnoveterinary medicine within the larger context of Aguaruna ethnomedicine, by testing the following hypotheses: H1 -- Plants that the Aguaruna use to treat dogs will be the same plants that they use to treat people and H2 -- Plants that are used to treat both people and dogs will be used for the same illnesses in both cases.</p> <p>Methods</p> <p>Structured interviews with nine key informants were carried out in 2007, in Aguaruna communities in the Peruvian department of Amazonas. Informants provided freelists of plants given to dogs and explained the purpose, preparation and route of administration used. For each plant, informants also described any uses for treating people. Botanical voucher specimens were collected and additional informal observations were made, accompanying people on hunting trips.</p> <p>Results</p> <p>Out of 35 plant species given to dogs, 29 (83%) are also given to humans for some medicinal purpose, while five are used only for dogs. However, the same plant is used to treat the same illness in both humans and dogs in only 53% of the cases. Forty-three percent of plants used to treat a particular illness for both dogs and people are administered in the same manner for both.</p> <p>Conclusion</p> <p>Results suggest that Aguaruna canine ethnoveterinary medicine is, at least partly, an independent cognitive domain. Some of the difference in plant use between dogs and people can be explained by the fact that certain diseases mentioned only apply to dogs. Although reports of canine ethnoveterinary medicine are very sparse in the literature, Aguaruna practices show some similarities with a few trends reported for other Amazonian societies, particularly, in the prevalence of the nasal route of administration, the use of plant-based psychoactives and in the importance of ants and wasps, in some form, for training dogs.</p

Predictors and outcomes of patient safety culture in hospitals

<p>Abstract</p> <p>Background</p> <p>Developing a patient safety culture was one of the recommendations made by the Institute of Medicine to assist hospitals in improving patient safety. In recent years, a multitude of evidence, mostly originating from developed countries, has been published on patient safety culture. One of the first efforts to assess the culture of safety in the Eastern Mediterranean Region was by El-Jardali et al. (2010) in Lebanon. The study entitled "The Current State of Patient Safety Culture: a study at baseline" assessed the culture of safety in Lebanese hospitals. Based on study findings, the objective of this paper is to explore the association between patient safety culture predictors and outcomes, taking into consideration respondent and hospital characteristics. In addition, it will examine the correlation between patient safety culture composites.</p> <p>Methods</p> <p>Sixty-eight hospitals and 6,807 respondents participated in the study. The study which adopted a cross sectional research design utilized an Arabic-translated version of the Hospital Survey on Patient Safety Culture (HSOPSC). The HSOPSC measures 12 patient safety composites. Two of the composites, in addition to a patient safety grade and the number of events reported, represented the four outcome variables. Bivariate and mixed model regression analyses were used to examine the association between the patient safety culture predictors and outcomes.</p> <p>Results</p> <p>Significant correlations were observed among all patient safety culture composites but with differences in the strength of the correlation. Generalized Estimating Equations for the patient safety composite scores and respondent and hospital characteristics against the patient safety grade and the number of events reported revealed significant correlations. Significant correlations were also observed by linear mixed models of the same variables against the frequency of events reported and the overall perception of safety.</p> <p>Conclusion</p> <p>Event reporting, communication, patient safety leadership and management, staffing, and accreditation were identified as major patient safety culture predictors. Investing in practices that tackle these issues and prioritizing patient safety is essential in Lebanese hospitals in order to improve patient safety. In addition, further research is needed to understand the association between patient safety culture and clinical outcomes.</p

In silico modeling indicates the development of HIV-1 resistance to multiple shRNA gene therapy differs to standard antiretroviral therapy

<p>Abstract</p> <p>Background</p> <p>Gene therapy has the potential to counter problems that still hamper standard HIV antiretroviral therapy, such as toxicity, patient adherence and the development of resistance. RNA interference can suppress HIV replication as a gene therapeutic via expressed short hairpin RNAs (shRNAs). It is now clear that multiple shRNAs will likely be required to suppress infection and prevent the emergence of resistant virus.</p> <p>Results</p> <p>We have developed the first biologically relevant stochastic model in which multiple shRNAs are introduced into CD34+ hematopoietic stem cells. This model has been used to track the production of gene-containing CD4+ T cells, the degree of HIV infection, and the development of HIV resistance in lymphoid tissue for 13 years. In this model, we found that at least four active shRNAs were required to suppress HIV infection/replication effectively and prevent the development of resistance. The inhibition of incoming virus was shown to be critical for effective treatment. The low potential for resistance development that we found is largely due to a pool of replicating wild-type HIV that is maintained in non-gene containing CD4+ T cells. This wild-type HIV effectively out-competes emerging viral strains, maintaining the viral <it>status quo</it>.</p> <p>Conclusions</p> <p>The presence of a group of cells that lack the gene therapeutic and is available for infection by wild-type virus appears to mitigate the development of resistance observed with systemic antiretroviral therapy.</p