A Balint curriculum's effect on family medicine resident empathy and psychological skills

Balint groups are comprised of physicians who regularly gather to present and reflect on clinical cases with the goal of improving the physician-patient relationship by enhancing the physician's interpersonal and communication skills, patient care, and professionalism. The goal of this study was to assess the effect on empathy and psychological skills of a voluntary Balint curriculum in the University of Missouri Family Medicine Residency program since initiation in 2010

Age and structure of the Shyok Suture in the Ladakh region of Northwestern India: Implications for slip on the Karakoram Fault System

A precise age for the collision of the Kohistan-Ladakh block with Eurasia along the Shyok suture zone (SSZ) is one key to understanding the accretionary history of Tibet and the tectonics of Eurasia during the India-Eurasia collision. Knowing the age of the SSZ also allows the suture to be used as a piercing line for calculating total offset along the Karakoram Fault, which effectively represents the SE border of the Tibetan Plateau and has played a major role in plateau evolution. We present a combined structural, geochemical, and geochronologic study of the SSZ as it is exposed in the Nubra region of India to test two competing hypotheses: that the SSZ is of Late Cretaceous or, alternatively, of Eocene age. Coarse-continental strata of the Saltoro Molasse, mapped in this area, contain detrital zircon populations suggestive of derivation from Eurasia despite the fact that the molasse itself is deposited unconformably onto Kohistan-Ladakh rocks, indicating that the molasse is postcollisional. The youngest population of detrital zircons in these rocks (approximately 92 Ma) and a U/Pb zircon date for a dike that cuts basal molasse outcrops (approximately 85 Ma) imply that deposition of the succession began in the Late Cretaceous. This establishes a minimum age for the SSZ and rules out the possibility of an Eocene collision between Kohistan-Ladakh and Eurasia. Our results support correlation of the SSZ with the Bangong suture zone in Tibet, which implies a total offset across the Karakoram Fault of approximately 130–190 km

The immune cell infiltrate populating meningiomas is composed of mature, antigen-experienced T and B cells

BACKGROUND: Meningiomas often harbor an immune cell infiltrate that can include substantial numbers of T and B cells. However, their phenotype and characteristics remain undefined. To gain a deeper understanding of the T and B cell repertoire in this tumor, we characterized the immune infiltrate of 28 resected meningiomas representing all grades. METHODS: Immunohistochemistry was used to grossly characterize and enumerate infiltrating lymphocytes. A molecular analysis of the immunoglobulin variable region of tumor-infiltrating B cells was used to characterize their antigen experience. Flow cytometry of fresh tissue homogenate and paired peripheral blood lymphocytes was used to identify T cell phenotypes and characterize the T cell repertoire. RESULTS: A conspicuous B and T cell infiltrate, primarily clustered in perivascular spaces, was present in the microenvironment of most tumors examined. Characterization of 294 tumor-infiltrating B cells revealed clear evidence of antigen experience, in that the cardinal features of an antigen-driven B cell response were present. Meningiomas harbored populations of antigen-experienced CD4+ and CD8+ memory/effector T cells, regulatory T cells, and T cells expressing the immune checkpoint molecules PD-1 and Tim-3, indicative of exhaustion. All of these phenotypes were considerably enriched relative to their frequency in the circulation. The T cell repertoire in the tumor microenvironment included populations that were not reflected in paired peripheral blood. CONCLUSION: The tumor microenvironment of meningiomas often includes postgerminal center B cell populations. These tumors invariably include a selected, antigen-experienced, effector T cell population enriched by those that express markers of an exhausted phenotype

Ecological and socioeconomic impacts of invasive alien species in island ecosystems

Minimizing the impact of invasive alien species (IAS) on islands and elsewhere requires researchers to provide cogent information on the environmental and socioeconomic consequences of IAS to the public and policy makers. Unfortunately, this information has not been readily available owing to a paucity of scientific research and the failure of the scientific community to make their findings readily available to decision makers. This review explores the vulnerability of islands to biological invasion, reports on environmental and socioeconomic impacts of IAS on islands and provides guidance and information on technical resources that can help minimize the effects of IAS in island ecosystems. This assessment is intended to provide a holistic perspective on island-IAS dynamics, enable biologists and social scientists to identify information gaps that warrant further research and serve as a primer for policy makers seeking to minimize the impact of IAS on island systems. Case studies have been selected to reflect the most scientifically-reliable information on the impacts of IAS on islands. Sufficient evidence has emerged to conclude that IAS are the most significant drivers of population declines and species extinctions in island ecosystems worldwide. Clearly, IAS can also have significant socioeconomic impacts directly (for example human health) and indirectly through their effects on ecosystem goods and services.These impacts are manifest at all ecological levels and affect the poorest, as well as richest, island nations. The measures needed to prevent and minimize the impacts of IAS on island ecosystems are generally known. However, many island nations and territories lack the scientific and technical information, infrastructure and human and financial resources necessary to adequately address the problems caused by IAS. Because every nation is an exporter and importer of goods and services, every nation is also a facilitator and victim of the invasion of alien species.Wealthy nations therefore need to help raise the capacity of island nations and territories to minimize the spread and impact of IAS

Tradeoffs between the strength of conformity and number of conformists in variable environments

Organisms often respond to environmental change phenotypically, through learning strategies that enhance fitness in variable and changing conditions. But which strategies should we expect in population exposed to those conditions? We address this question by developing a mathematical model that specifies the consequences of different mixtures of individual and social learning strategies on the frequencies of different cultural variants in temporally and spatially changing environments. Assuming that alternative cultural variants are differently well-adapted to diverse environmental conditions, we are able to evaluate which mixture of learning strategies maximises the mean fitness of the population. We find that, even in rapidly changing environments, a high proportion of the population will always engage in social learning. In those environments, the highest adaptation levels are achieved through relatively high fractions of individual learning and a strong conformist bias. We establish a negative relationship between the proportion of the population learning socially and the strength of conformity operating in a population: strong conformity requires fewer conformists (i.e. larger proportion of individual learning), while many conformists can only be found when conformist transmission is weak. Investigations of cultural diversity show that in frequently changing environments high levels of adaptation require high level of cultural diversity. Finally, we demonstrate how the developed mathematical framework can be applied to time series of usage or occurrence data of cultural traits. Using Approximate Bayesian Computation we are able to infer information about the underlying learning processes that could have produced observed patterns of variation in the dataset

Improved Classification of Alzheimer's Disease Data via Removal of Nuisance Variability

Diagnosis of Alzheimer's disease is based on the results of neuropsychological tests and available supporting biomarkers such as the results of imaging studies. The results of the tests and the values of biomarkers are dependent on the nuisance features, such as age and gender. In order to improve diagnostic power, the effects of the nuisance features have to be removed from the data. In this paper, four types of interactions between classification features and nuisance features were identified. Three methods were tested to remove these interactions from the classification data. In stratified analysis, a homogeneous subgroup was generated from a training set. Data correction method utilized linear regression model to remove the effects of nuisance features from data. The third method was a combination of these two methods. The methods were tested using all the baseline data from the Alzheimer's Disease Neuroimaging Initiative database in two classification studies: classifying control subjects from Alzheimer's disease patients and discriminating stable and progressive mild cognitive impairment subjects. The results show that both stratified analysis and data correction are able to statistically significantly improve the classification accuracy of several neuropsychological tests and imaging biomarkers. The improvements were especially large for the classification of stable and progressive mild cognitive impairment subjects, where the best improvements observed were 6% units. The data correction method gave better results for imaging biomarkers, whereas stratified analysis worked well with the neuropsychological tests. In conclusion, the study shows that the excess variability caused by nuisance features should be removed from the data to improve the classification accuracy, and therefore, the reliability of diagnosis making

Urban-rural disparities in smoking behaviour in Germany

BACKGROUND: It is currently not clear whether individuals living in metropolitan areas differ from individuals living in rural and urban areas with respect to smoking behaviours. Therefore, we sought to explore the relation between residential area and smoking behaviours in Germany. METHODS: We used a nationwide German census representative for the general population of Germany. A number of 181,324 subjects aged 10 years or older were included. Information on the average daily usage of cigarettes that have or had been smoked formerly or currently was available in subjects who have ever smoked. A daily consumption of more than 20 cigarettes was considered heavy smoking. Logistic regression analyses were performed sex-stratified and adjusted for relevant confounders. RESULTS: Analyses revealed inhabitants of metropolitan areas to be more likely current smokers than inhabitants of rural areas (odds ratio 1.56, 95%-confidence interval 1.51; 1.62). Among current and former smokers those who lived in urban communities had also increased odds for being heavy smokers than those who lived in rural communities. CONCLUSION: We conclude that living in an urban and particularly living in a metropolitan area is a determinant of both smoking and severity of current smoking. Tobacco control programs should recognize the difference in living conditions between rural and urban areas

Non-Neutral Vegetation Dynamics

The neutral theory of biodiversity constitutes a reference null hypothesis for the interpretation of ecosystem dynamics and produces relatively simple analytical descriptions of basic system properties, which can be easily compared to observations. On the contrary, investigations in non-neutral dynamics have in the past been limited by the complexity arising from heterogeneous demographic behaviours and by the relative paucity of detailed observations of the spatial distribution of species diversity (beta-diversity): These circumstances prevented the development and testing of explicit non-neutral mathematical descriptions linking competitive strategies and observable ecosystem properties. Here we introduce an exact non-neutral model of vegetation dynamics, based on cloning and seed dispersal, which yields closed-form characterizations of beta-diversity. The predictions of the non-neutral model are validated using new high-resolution remote-sensing observations of salt-marsh vegetation in the Venice Lagoon (Italy). Model expressions of beta-diversity show a remarkable agreement with observed distributions within the wide observational range of scales explored (5⋅10(−1) m÷10(3) m). We also consider a neutral version of the model and find its predictions to be in agreement with the more limited characterization of beta-diversity typical of the neutral theory (based on the likelihood that two sites be conspecific or heterospecific, irrespective of the species). However, such an agreement proves to be misleading as the recruitment rates by propagules and by seed dispersal assumed by the neutral model do not reflect known species characteristics and correspond to averages of those obtained under the more general non-neutral hypothesis. We conclude that non-neutral beta-diversity characterizations are required to describe ecosystem dynamics in the presence of species-dependent properties and to successfully relate the observed patterns to the underlying processes

An HDG Method for Dirichlet Boundary Control of Convection Dominated Diffusion PDE

We first propose a hybridizable discontinuous Galerkin (HDG) method to approximate the solution of a \emph{convection dominated} Dirichlet boundary control problem. Dirichlet boundary control problems and convection dominated problems are each very challenging numerically due to solutions with low regularity and sharp layers, respectively. Although there are some numerical analysis works in the literature on \emph{diffusion dominated} convection diffusion Dirichlet boundary control problems, we are not aware of any existing numerical analysis works for convection dominated boundary control problems. Moreover, the existing numerical analysis techniques for convection dominated PDEs are not directly applicable for the Dirichlet boundary control problem because of the low regularity solutions. In this work, we obtain an optimal a priori error estimate for the control under some conditions on the domain and the desired state. We also present some numerical experiments to illustrate the performance of the HDG method for convection dominated Dirichlet boundary control problems