The devil is in the third year: a longitudinal study of erosion of empathy in medical school.

PURPOSE: This longitudinal study was designed to examine changes in medical students\u27 empathy during medical school and to determine when the most significant changes occur. METHOD: Four hundred fifty-six students who entered Jefferson Medical College in 2002 (n = 227) and 2004 (n = 229) completed the Jefferson Scale of Physician Empathy at five different times: at entry into medical school on orientation day and subsequently at the end of each academic year. Statistical analyses were performed for the entire cohort, as well as for the matched cohort (participants who identified themselves at all five test administrations) and the unmatched cohort (participants who did not identify themselves in all five test administrations). RESULTS: Statistical analyses showed that empathy scores did not change significantly during the first two years of medical school. However, a significant decline in empathy scores was observed at the end of the third year which persisted until graduation. Findings were similar for the matched cohort (n = 121) and for the rest of the sample (unmatched cohort, n = 335). Patterns of decline in empathy scores were similar for men and women and across specialties. CONCLUSIONS: It is concluded that a significant decline in empathy occurs during the third year of medical school. It is ironic that the erosion of empathy occurs during a time when the curriculum is shifting toward patient-care activities; this is when empathy is most essential. Implications for retaining and enhancing empathy are discussed

Development Status of the Fission Power System Technology Demonstration Unit

This paper summarizes the progress that has been made in the development of the Fission Power System Technology Demonstration Unit (TDU). The reactor simulator core and Annular Linear Induction Pump have been fabricated and assembled into a test loop at the NASA Marshall Space Flight Center. A 12 kWe Power Conversion Unit (PCU) is being developed consisting of two 6 kWe free-piston Stirling engines. The two 6 kWe engines have been fabricated by Sunpower Inc. and are currently being tested separately prior to integration into the PCU. The Facility Cooling System (FCS) used to reject convertor waste heat has been assembled and tested at the NASA Glenn Research Center (GRC). The structural elements, including a Buildup Assembly Platform (BAP) and Upper Truss Structure (UTS) have been fabricated, and will be used to test cold-end components in thermal vacuum prior to TDU testing. Once all components have been fully tested at the subsystem level, they will be assembled into an end-to-end system and tested in thermal vacuum at GRC

Pengaruh Pemberian Biskuit Tepung Ikan Mujair dan Tepung Beras Merah terhadap Status Gizi Siswa SD di KecamatanLamasi

Penelitian ini bertujuan untuk mengetahui : 1) status gizi siswa SD Lamasi sebelum mengkonsumsi biskuit tepung ikan mujair dan tepung beras merah 2) status gizi siswa SD Lamasi setelah mengkonsumsi biskuit tepung ikan mujair dan tepung beras merah 3) pengaruh biskuit tepung ikan mujair dan tepung beras merah terhadap status gizi siswa SD Lamasi. Jenis penelitian yang digunakan adalah penelitian kuantitatif dengan metode eksperimen yaitu Quasi Experimental design dan Desain penelitian Randomized Controlled Trial (RCT) Single Blind Pre-post Study, jumlah sampel sebanyak 26 orang yang dipilih secara purposive sampling, dari 3 sekolah sebanyak 104 siswa SD kelas V di Kecamatan Lamasi, yang berumur 10-11 tahun. Data penelitian diperoleh dengan teknik angket (ffqdan food recall), wawancara (profilkeluarga), observasi (keadaanlingkungan), dan dokumentasi (data dinaspendidikandan data sekolah). Teknik analisis data yang digunakan adalah analisis deskriptif, uji T dan analisis regresi. Hasil penelitian menunjukkan 1) berkurangnya status gizi kurang siswa dari 11 sampel menjadi 10 sampel, dan meningkatnya status gizi ideal siswa dari 2 sampel menjadi 3 sampel setelah mengkonsumsi biskuit untuk kelompok kontrol, sedangkan untuk kelompok perlakuan sebelum dan setelah mengkonsumsi biskuit terdapat status gizi kurang sebanyak 12 sampel menjadi 11 sampel, dan status gizi ideal sebanyak 1 sampel menjadi 2 sampel. 2) Hasil pengujian pada tabel diketahui nilai t sebesar -1.573 dengan nilai P Value> 0,05 maka dapat disimpulkan bahwa tidak ada pengaruh yang signifikan atau lemah pada konsumsi biskuit tehadap status gizi siswa, dan nilai R = 0.312menunjukkan hubungan antara variabel bebas dan variabel terikat termasuk pada kategori lemah, variabel terikat atau R Square = 9,8% dan 90.2% dipengaruhi oleh faktor lain. Kata kunci: biskuit tepung ikan mujair dan tepung beras merah, status gizi

Travelling for Umrah:destination attributes, destination image, and post-travel intentions

This paper examines the links between cosmopolitanism, self-identity, and a desire for social interaction perceived destination image and behavioural intentions. A model tested using a sample of 538 Iranian visitors to Mecca for the purpose of Umrah. The result from the structural model suggests that destination attributes influence perceived destination image. Further, such tourists are likely to revisit or recommend Islamic destinations if their experience matches their perceived image of the destination. This implies that, while the religious characteristics of the destination remain important, destination managers cannot disregard the tangential, non-religious attributes of a destination which are crucial in order to satisfy more conventional tourist desires. As such, this study suggests that those managing religious travel destinations should endeavour to foster a welcoming image, where experience, interaction and tolerance are at the forefront of the destination’s offering

Fit to Predict? Ecoinformatics for Predicting the Catchability of a Pelagic Fish in Near Real-Time

The ocean is a dynamic environment inhabited by a diverse array of highly migratory species, many of which are under direct exploitation in targeted fisheries. The timescales of variability in the marine realm coupled with the extreme mobility of ocean-wandering species such as tuna and billfish complicates fisheries management. Developing ecoinformatics solutions that allow for near real-time prediction of the distributions of highly mobile marine species is an important step towards the maturation of dynamic ocean management and ecological forecasting. Using 25 years (1990-2014) of NOAA fisheries\u27 observer data from the California drift gillnet fishery, we model relative probability of occurrence (presence-absence) and catchability (total catch) of broadbill swordfish Xiphias gladius in the California Current System (CCS). Using freely-available environmental datasets and open source software, we explore the physical drivers of regional swordfish distribution. Comparing models built upon remotely-sensed datasets with those built upon a data-assimilative configuration of the Regional Ocean Modelling System (ROMS), we explore trade-offs in model construction and address how physical data can affect predictive performance and operational capacity. Swordfish catchability was found to be highest in deeper waters (\u3e1500m) with surface temperatures in the 14-20 degrees C range, isothermal layer depth (ILD) of 20-40m, positive sea surface height anomalies and during the new moon

Integrating Dynamic Subsurface Habitat Metrics Into Species Distribution Models

Species distribution models (SDMs) have become key tools for describing and predicting species habitats. In the marine domain, environmental data used in modeling species distributions are often remotely sensed, and as such have limited capacity for interpreting the vertical structure of the water column, or are sampled in situ, offering minimal spatial and temporal coverage. Advances in ocean models have improved our capacity to explore subsurface ocean features, yet there has been limited integration of such features in SDMs. Using output from a data-assimilative configuration of the Regional Ocean Modeling System, we examine the effect of including dynamic subsurface variables in SDMs to describe the habitats of four pelagic predators in the California Current System (swordfish Xiphias gladius, blue sharks Prionace glauca, common thresher sharks Alopias vulpinus, and shortfin mako sharks lsurus oxyrinchus). Species data were obtained from the California Drift Gillnet observer program (1997-2017). We used boosted regression trees to explore the incremental improvement enabled by dynamic subsurface variables that quantify the structure and stability of the water column: isothermal layer depth and bulk buoyancy frequency. The inclusion of these dynamic subsurface variables significantly improved model explanatory power for most species. Model predictive performance also significantly improved, but only for species that had strong affiliations with dynamic variables (swordfish and shortfin mako sharks) rather than static variables (blue sharks and common thresher sharks). Geospatial predictions for all species showed the integration of isothermal layer depth and bulk buoyancy frequency contributed value at the mesoscale level (\u3c 100 km) and varied spatially throughout the study domain. These results highlight the utility of including dynamic subsurface variables in SDM development and support the continuing ecological use of biophysical output from ocean circulation models