Metapopulation dynamics over 25 years of a beetle, Osmoderma eremita, inhabiting hollow oaks

Osmoderma eremita is a species of beetle that inhabits hollows in ancient trees, which is a habitat that has decreased significantly during the last century. In southeastern Sweden, we studied the metapopulation dynamics of this beetle over a 25 year period, using capture-mark-recapture. The metapopulation size had been rather stable over time, but in most of the individual trees there had been a positive or negative trend in population development. The probability of colonisation was higher in well-connected trees with characteristics reflecting earlier successional stages, and the probability of extinction higher in trees with larger diameter (i.e. in later successional stages), which is expected from a habitat-tracking metapopulation. The annual tree mortality and fall rates (1.1% and 0.4%, respectively) are lower than the colonisation and extinction rates (5-7%), indicating that some of the metapopulation dynamics are due to the habitat dynamics, but many colonisations and extinctions take place for other reasons, such as stochastic events in small populations. The studied metapopulation occurs in an area with a high density of hollow oaks and where the oak pastures are still managed by grazing. In stands with fewer than ten suitable trees, the long-term extinction risk may be considerable, since only a small proportion of all hollow trees harbours large populations, and the population size in trees may change considerably during a decade

N-acetylaspartate in brain - studies on efflux and function

N-acetylaspartate (NAA) is an amino acid derivative present in high concentration in the brain. The function of NAA is still unsettled in spite of 50 years of research. The mainly neuronal synthesis and glial breakdown of NAA requires a well regulated neuronal efflux and glial uptake. In the present work hippocampal slices were used to study how NAA efflux from neurons is regulated and to further investigate possible functions of NAA. For the determination of NAA a reversed phase HPLC method with UV detection was developed. The method allowed for the simultaneous determination of NAA and creatine and was comparable or better in sensitivity than previous methods based on UV detection. A newly developed efflux protocol that allowed the determination of efflux and delayed cell death was used to study NAA efflux in cultured hippocampal slices. Activation of the NMDA receptor, a glutamate-receptor subtype that is involved in learning and memory but also in nerve cell death following stroke, evoked a prolonged Ca2+-dependent NAA efflux from cultured slices. The efflux of NAA was not due to unselective membrane rupture but at high NMDA concentrations the efflux of NAA correlated with the NMDA-mediated delayed (24 hours after efflux) excitotoxicity. However, no causal relationship between delayed excitotoxicity and extracellular NAA could be demonstrated as culturing with high concentrations of NAA was non-toxic. Extracellular osmolarity was decreased moderately for 10-48 hours to address the proposed function of NAA as an osmoregulator but no change in the tissue content of NAA was observed from either cultured or acutely prepared hippocampal slices. However, depolarisation resulted in efflux of NAA from acutely prepared slices that could be reduced both by a NMDA-receptor blocker and hyperosmotic solution. Culturing of hippocampal slices with the monomethyl ester of NAA increased intracellular NAA levels. This was followed by reduced levels of the anion phosphoethanolamine and a tendency towards decreased Cl- concentration in the slices. NMDA-mediated delayed excitotoxicity was unaffected by increased intracellular NAA concentration. Overall, the results suggest that the NMDA receptor is involved in the regulation of NAA efflux from neurons. Increased extracellular as well as intracellular NAA is non-toxic and NAA does not seem to function as an important Ca2+ chelator or as an osmoregulator under physiological decreases in osmolarity

Svåra samtal -vetenskap och läkekonst

The aim of this master dissertation was to gain a deeper understanding of the breaking of bad news through narration of the lived experiences of doctors. In-depth interviews using open questions were conducted with ten professionally active medical doctors who had 1) experience of breaking bad news and 2) applied to participate in a communications course. The data was analyzed using thematic analysis and the results were captured in nine themes. The main findings of the study were that the participants perceived that they had to apply self-awareness, honesty and responsiveness in order to execute the breaking of bad news in an appropriate manner. Resources that they found necessary in order to be able to cope were; support from their surroundings and balance between work and leisure. Anger and grief were the aspects of breaking bad news that were described as the hardest to handle. The participants experienced breaking bad news to be both challenging and valuable. The results were discussed in relation to “Sense of Coherence” and ”Empathy as a professional approach”. Finally, the breaking of bad news was interpreted as being a task which requires medical doctors to adopt an approach that combines both medicine and humanities, in order to perform it well

The influence of “bad news” and “neutral/good news” on patients' perception of physician empathy during oncology consultations

Abstract Objectives Being met with empathy increases information sharing, treatment coherence, and helps patients to recover faster. However, we do not know how the content of the conversation about disease progression, new treatments, or other issues concerning serious illness affects patients' perceptions of the physician's empathy, and thus, the quality of the conversation. This study aimed to test the hypothesis that patients will rate their physician lower following a “bad news” consultation using the consultation and relational empathy (CARE) measure. Methods A total of 186 outpatients from the Department of Oncology were recruited for this study. After meeting with a patient, the physician filled out a form, placing the patient in either the “bad news” group, or the “neutral/good news” group along with information about the patient and the consultation. The patient was given the CARE measure after the visit. Results The patients who had received bad news rated their physicians a significantly lower score on the CARE measure, even though the effect size was small, than those who had neutral/good news. On average, bad news consultations were 11 min longer. Conclusions Physicians need to be aware of the patients' need to be known and understood, in addition to having skills to attend to emotional cues and concerns, since the current study's finding could be a sign either of the content being projected onto the physician or that the physician is focused on the message rather than on the patient

Co-afflicted but invisible : A qualitative study of perceptions among informal caregivers in cancer care

This article explores the lived experience of informal caregivers in cancer care, focusing on the perceived burden and needs of individuals seeking support from an informal group for next of kin. A total of 28 individuals who were closely related to a patient with cancer participated in focus group interviews. Three themes were identified: setting aside one’s own needs, assuming the role of project manager, and losing one’s sense of identity. Together they form the framing theme: being co-afflicted. The characteristics of informal caregivers are shown to be similar to those of people with codependency, motivating development of targeted interventions from this perspective

Svåra samtal med patienter tränas på kurs med skådespelare : En medveten strategi hjälper både läkare och patient

The physician’s communication skill influences the patient’s mental and physical wellbeing, as well as the physician’s own experience of stress. Most patients wish to be informed about their disease, by physicians who are honest, gives time, sustains hope, listens and shows compassion and empathy. Even though there are established guidelines on how to break bad news, the physician must find out and respond to the unique reactions and needs of each individual, in order to communicate successfully. There is no consensus on how to construct and evaluate communication skills training programs for physicians, and more RCT-studies are requested

Patterns of Communication About Serious Illness in the Years, Months, and Days before Death

Background: Communication with patients and families about serious illness impacts quality of life and helps facilitate decision-making.Objective: To elucidate the pattern of communication about serious illness for patients who have died in an inpatient setting.Design: Three hundred patients from the Swedish Registry of Palliative Care 2015-2017 were randomly selected for manual chart review.Setting: Patients who died in a palliative care, oncology, or internal medicine unit in Sweden were selected.Measurements: We report on the frequency of conversations at three time points, 6 months or longer before death ("Years"), 15 days-6 months before death ("Months"), and 0-14 days before death ("Days"). We also report the timing of the conversation about dying.Results: A total of 249 patients were included after exclusions; they had an average of 2.1 conversations (range 1-6). The first conversation took place a median of 53 days before death and the last conversation took place a median of 9 days before death. Separate conversations with the next of kin took place a median of two days before death. We could verify a conversation about dying in only 156/249 (63%) medical records.Conclusions: Communication about serious illness between clinicians, patients, and families occurs iteratively over a period before death. Measuring the quality of communication about serious illness using a years, months, and days framework may help ensure that patients and families have sufficient information for medical and personal decision making