The association of types of training and practice settings with doctors’ empathy and patient enablement among patients with chronic illness in Hong Kong

Background: The increase in non-communicable disease (NCD) is becoming a global health problem and there is an increasing need for primary care doctors to look after these patients although whether family doctors are adequately trained and prepared is unknown. Objective: This study aimed to determine if doctors with family medicine (FM) training are associated with enhanced empathy in consultation and enablement for patients with chronic illness as compared to doctors with internal medicine training or without any postgraduate training in different clinic settings. Methods: This was a cross-sectional questionnaire survey using the validated Chinese version of the Consultation and Relational Empathy (CARE) Measure as well as Patient Enablement Instrument (PEI) for evaluation of quality and outcome of care. 14 doctors from hospital specialist clinics (7 with family medicine training, and 7 with internal medicine training) and 13 doctors from primary care clinics (7 with family medicine training, and 6 without specialist training) were recruited. In total, they consulted 823 patients with chronic illness. The CARE Measure and PEI scores were compared amongst doctors in these clinics with different training background: family medicine training, internal medicine training and those without specialist training. Generalized estimation equation (GEE) was used to account for cluster effects of patients nested with doctors. <b>Results</b> Within similar clinic settings, FM trained doctors had higher CARE score than doctors with no FM training. In hospital clinics, the difference of the mean CARE score for doctors who had family medicine training (39.2, SD = 7.04) and internal medicine training (35.5, SD = 8.92) was statistically significant after adjusting for consultation time and gender of the patient. In the community care clinics, the mean CARE score for doctors with family medicine training and those without specialist training were 32.1 (SD = 7.95) and 29.2 (SD = 7.43) respectively, but the difference was not found to be significant. For PEI, patients receiving care from doctors in the hospital clinics scored significantly higher than those in the community clinics, but there was no significant difference in PEI between patients receiving care from doctors with different training backgrounds within similar clinic setting. Conclusion: Family medicine training was associated with higher patient perceived empathy for chronic illness patients in the hospital clinics. Patient enablement appeared to be associated with clinic settings but not doctors’ training background. Training in family medicine and a clinic environment that enables more patient doctor time might help in enhancing doctors’ empathy and enablement for chronic illness patients

The EBV-encoded latent membrane proteins, LMP2A and LMP2B, limit the actions of interferon by targeting interferon receptors for degradation

Although frequently expressed in Epstein–Barr virus (EBV)-positive malignancies, the role that latent membrane protein 2A and 2B (LMP2A and LMP2B) have in the oncogenic process remains obscure. Here we show a novel function for these proteins in epithelial cells, namely, their ability to modulate signalling from type I/II interferon receptors (IFNRs). We show that LMP2A- and LMP2B-expressing epithelial cells show decreased responsiveness to interferon (IFN)α and IFNγ, as assessed by STAT1 phosphorylation, ISGF3 and GAF-mediated binding to IFN-stimulated response element and IFNγ-activated factor sequence elements and luciferase reporter activation. Transcriptional profiling highlighted the extent of this modulation, with both viral proteins impacting ‘globally’ on IFN-stimulated gene expression. Although not affecting the levels of cell-surface IFNRs, LMP2A and LMP2B accelerated the turnover of IFNRs through processes requiring endosome acidification. This function may form part of EBV's strategy to limit anti-viral responses and define a novel function for LMP2A and LMP2B in modulating signalling from receptors that participate in innate immune responses

Solving the Hamilton-Jacobi Equation for General Relativity

We demonstrate a systematic method for solving the Hamilton-Jacobi equation for general relativity with the inclusion of matter fields. The generating functional is expanded in a series of spatial gradients. Each term is manifestly invariant under reparameterizations of the spatial coordinates (``gauge-invariant''). At each order we solve the Hamiltonian constraint using a conformal transformation of the 3-metric as well as a line integral in superspace. This gives a recursion relation for the generating functional which then may be solved to arbitrary order simply by functionally differentiating previous orders. At fourth order in spatial gradients, we demonstrate solutions for irrotational dust as well as for a scalar field. We explicitly evolve the 3-metric to the same order. This method can be used to derive the Zel'dovich approximation for general relativity.Comment: 13 pages, RevTeX, DAMTP-R93/2

Spatiotemporal variability of gas transfer velocity in a tropical high-elevation stream using two independent methods

Streams in high-elevation tropical ecosystems known as páramos may be significant sources of carbon dioxide (CO2) to the atmosphere by transforming terrestrial carbon to gaseous CO2. Studies of these environments are scarce, and estimates of CO2 fluxes are poorly constrained. In this study, we use two independent methods for measuring gas transfer velocity (k), a critical variable in the estimation of CO2 evasion and other biogeochemical processes. The first method, kinematic k600 (k600-K), is derived from an empirical relationship between temperature-adjusted k (k600) and the physical characteristics of the stream. The second method, measured k600 (k600-M), estimates gas transfer velocity in the stream by in situ measurements of dissolved CO2 (pCO2) and CO2 evasion to the atmosphere, adjusting for temperature. Measurements were collected throughout a 5-week period during the wet season of a peatland-stream transition within a páramo ecosystem located above 4000 m in elevation in northeastern Ecuador. We characterized the spatial heterogeneity of the 250-m reach on five occasions, and both methods showed a wide range of variability in k600 at small spatial scales. Values of k600-K ranged from 7.42 to 330 m/d (mean = 116 ± 95.1 m/d), whereas values of k600-M ranged from 23.5 to 444 m/d (mean = 121 ± 127 m/d). Temporal variability in k600 was driven by increases in stream discharge caused by rain events, whereas spatial variability was driven by channel morphology, including stream width and slope. The two methods were in good agreement (less than 16% difference) at high and medium stream discharge (above 7.0 L/s). However, the two methods considerably differed from one another (up to 73% difference) at low stream discharge (below 7.0 L/s, which represents 60% of the observations collected). Our study provides the first estimates of k600 values in a high-elevation tropical catchment across steep environmental gradients and highlights the combined effects of hydrology and stream morphology in co-regulating gas transfer velocities in páramo streams

Read-It: A Multi-modal Tangible Interface for Children Who Learn to Read

Multi-modal tabletop applications offer excellent opportunities for enriching the education of young children. Read-It is an example of an interactive game with a multi-modal tangible interface that was designed to combine the advantages of current physical games and computer exercises. It is a novel approach for supporting children who learn to read. The first experimental evaluation has demonstrated that the Read-It approach is indeed promising and meets a priori expectations

Large Scale Structure Formation with Global Topological Defects. A new Formalism and its implementation by numerical simulations

We investigate cosmological structure formation seeded by topological defects which may form during a phase transition in the early universe. First we derive a partially new, local and gauge invariant system of perturbation equations to treat microwave background and dark matter fluctuations induced by topological defects or any other type of seeds. We then show that this system is well suited for numerical analysis of structure formation by applying it to seeds induced by fluctuations of a global scalar field. Our numerical results are complementary to previous investigations since we use substantially different methods. The resulting microwave background fluctuations are compatible with older simulations. We also obtain a scale invariant spectrum of fluctuations with about the same amplitude. However, our dark matter results yield a smaller bias parameter compatible with $b\sim 2$ on a scale of $20 Mpc$ in contrast to previous work which yielded to large bias factors. Our conclusions are thus more positive. According to the aspects analyzed in this work, global topological defect induced fluctuations yield viable scenarios of structure formation and do better than standard CDM on large scales.Comment: uuencoded, compressed tar-file containing the text in LaTeX and 12 Postscript Figures, 41 page

Study of a Depolarizing Resonance at the IUCF Cooler Ring

This research was sponsored by the National Science Foundation Grant NSF PHY-931478

Trapped two-component Fermi gases with up to six particles: Energetics, structural properties, and molecular condensate fraction

We investigate small equal-mass two-component Fermi gases under external spherically symmetric confinement in which atoms with opposite spins interact through a short-range two-body model potential. We employ a non-perturbative microscopic framework, the stochastic variational approach, and determine the system properties as functions of the interspecies s-wave scattering length a, the orbital angular momentum L of the system, and the numbers N1 and N2 of spin-up and spin-down atoms (with N1-N2 =0 or 1 and N < 7, where N=N1+N2). At unitarity, we determine the energies of the five- and six-particle systems for various ranges r0 of the underlying two-body model potential and extrapolate to the zero-range limit. These energies serve as benchmark results that can be used to validate and assess other numerical approaches. We also present structural properties such as the pair distribution function and the radial density. Furthermore, we analyze the one-body and two-body density matrices. A measure for the molecular condensate fraction is proposed and applied. Our calculations show explicitly that the natural orbitals and the momentum distributions of atomic Fermi gases approach those characteristic for a molecular Bose gas if the s-wave scattering length a, a>0, is sufficiently small.Comment: 21 pages, 15 figures; accepted for publication in special issue of CRA

Exploring leadership in multi-sectoral partnerships

This article explores some critical aspects of leadership in the context of multi-sectoral partnerships. It focuses on leadership in practice and asks the question, `How do managers experience and perceive leadership in such partnerships?' The study contributes to the debate on whether leadership in a multi-sectoral partnership context differs from that within a single organization. It is based on the accounts of practising managers working in complex partnerships. The article highlights a number of leadership challenges faced by those working in multi-sectoral partnerships. Partnership practitioners were clear that leadership in partnerships was more complex than in single organizations. However, it was more difficult for them to agree a consensus on the essential nature of leadership in partnership. We suggest that a first-, second- and third-person approach might be a way of better interpreting leadership in the context of partnerships

Large-scale pharmacogenomic study of sulfonylureas and the QT, JT and QRS intervals: CHARGE Pharmacogenomics Working Group

Sulfonylureas, a commonly used class of medication used to treat type 2 diabetes, have been associated with an increased risk of cardiovascular disease. Their effects on QT interval duration and related electrocardiographic phenotypes are potential mechanisms for this adverse effect. In 11 ethnically diverse cohorts that included 71 857 European, African-American and Hispanic/Latino ancestry individuals with repeated measures of medication use and electrocardiogram (ECG) measurements, we conducted a pharmacogenomic genome-wide association study of sulfonylurea use and three ECG phenotypes: QT, JT and QRS intervals. In ancestry-specific meta-analyses, eight novel pharmacogenomic loci met the threshold for genome-wide significance (P&lt;5 × 10−8), and a pharmacokinetic variant in CYP2C9 (rs1057910) that has been associated with sulfonylurea-related treatment effects and other adverse drug reactions in previous studies was replicated. Additional research is needed to replicate the novel findings and to understand their biological basis