How Do Junior Medical Students Learn about the Doctor Patient Relationship?

Junior medical students have the capacity to engage well with patients at an early stage in their training. With careful coaching, students can also write moving and accurate accounts of their significant learning experiences. In this article, we introduce an innovative learning programme at Otago University in New Zealand, and present carefully chosen extracts from student essays. These extracts illustrate students’ early exposure to, and challenges in, the student-patient relationship, a precursor to their own professional relationships. Reflective writing helps students internalize foundational interpersonal concepts such as meaningful engagement, self-awareness, the role of other health professionals, and the need for self-care. This early orientation towards whole person care may be helpful grounding for future clinical practice

Looking forward to making predictions

As described in the preceding pages, since the BGS was established in 1835, the British population has coped with many challenges. These have ranged from finding resources to fuel the Industrial Revolution, understanding and combating water-borne diseases such as typhoid, the threat of invasion and aerial bombardment, through to modern-day environmental problems and climate change. To help deal with these problems, decisionmakers from governments and other organisations have required our help and advice

A link between high serum levels of human chorionic gonadotrophin and chorionic expression of its mature functional receptor (LHCGR) in Down's syndrome pregnancies

Human chorionic gonadotrophin (hCG) is released from placental trophoblasts and is involved in establishing pregnancy by maintaining progesterone secretion from the corpus luteum. Serum hCG is detected in the maternal circulation within the first 2–3 wks of gestation and peaks at the end of the first trimester before declining. In Down's syndrome (DS) pregnancies, serum hCG remains significantly high compared to gestation age-matched uncompromised pregnancies. It has been proposed that increased serum hCG levels could be due to transcriptional hyper-activation of the CGB (hCG beta) gene, or an increased half life of glycosylated hCG hormone, or both. Another possibility is that serum hCG levels remain high due to reduced availability of the hormone's cognate receptor, LHCGR, leading to lack of hormone utilization. We have tested this hypothesis by quantifying the expression of the hCG beta (CGB) RNA, LHCGR RNA and LHCGR proteins in chorionic villous samples. We demonstrate that chorionic expression of hCG beta (CGB) mRNA directly correlates with high serum hCG levels. The steady-state synthesis of LHCGR mRNA (exons 1–5) in DS pregnancies was significantly higher than that of controls, but the expression of full-length LHCGR mRNA (exons 1–11) in DS was comparable to that of uncompromised pregnancies. However, the synthesis of high molecular weight mature LHCGR proteins was significantly reduced in DS compared to uncompromised pregnancies, suggesting a lack of utilization of circulating hCG in DS pregnancies

Benchmarking and parameter sensitivity of physiological and vegetation dynamics using the Functionally Assembled Terrestrial Ecosystem Simulator (FATES) at Barro Colorado Island, Panama

Plant functional traits determine vegetation responses to environmental variation, but variation in trait values is large, even within a single site. Likewise, uncertainty in how these traits map to Earth system feedbacks is large. We use a vegetation demographic model (VDM), the Functionally Assembled Terrestrial Ecosystem Simulator (FATES), to explore parameter sensitivity of model predictions, and comparison to observations, at a tropical forest site: Barro Colorado Island in Panama. We define a single 12-dimensional distribution of plant trait variation, derived primarily from observations in Panama, and define plant functional types (PFTs) as random draws from this distribution. We compare several model ensembles, where individual ensemble members vary only in the plant traits that define PFTs, and separate ensembles differ from each other based on either model structural assumptions or non-trait, ecosystem-level parameters, which include (a) the number of competing PFTs present in any simulation and (b) parameters that govern disturbance and height-based light competition. While single-PFT simulations are roughly consistent with observations of productivity at Barro Colorado Island, increasing the number of competing PFTs strongly shifts model predictions towards higher productivity and biomass forests. Different ecosystem variables show greater sensitivity than others to the number of competing PFTs, with the predictions that are most dominated by large trees, such as biomass, being the most sensitive. Changing disturbance and height-sorting parameters, i.e., the rules of competitive trait filtering, shifts regimes of dominance or coexistence between early- and late-successional PFTs in the model. Increases to the extent or severity of disturbance, or to the degree of determinism in height-based light competition, all act to shift the community towards early-successional PFTs. In turn, these shifts in competitive outcomes alter predictions of ecosystem states and fluxes, with more early-successional-dominated forests having lower biomass. It is thus crucial to differentiate between plant traits, which are under competitive pressure in VDMs, from those model parameters that are not and to better understand the relationships between these two types of model parameters to quantify sources of uncertainty in VDMs

Triple oxygen isotopic composition of the high-³He/⁴He mantle

Measurements of Xe isotope ratios in ocean island basalts (OIB) suggest that Earth’s mantle accreted heterogeneously, and that compositional remnants of accretion are sampled by modern, high-3He/4He OIB associated with the Icelandic and Samoan plumes. If so, the high-3He/4He source may also have a distinct oxygen isotopic composition from the rest of the mantle. Here, we test if the major elements of the high-3He/4He source preserve any evidence of heterogeneous accretion using measurements of three oxygen isotopes on olivine from a variety of high-3He/4He OIB locations. To high precision, the Δ17O value of high-3He/4He olivines from Hawaii, Pitcairn, Baffin Island and Samoa, are indistinguishable from bulk mantle olivine (Δ17OBulk Mantle − Δ17OHigh 3He/4He olivine = −0.002 ± 0.004 (2 × SEM)‰). Thus, there is no resolvable oxygen isotope evidence for heterogeneous accretion in the high-3He/4He source. Modelling of mixing processes indicates that if an early-forming, oxygen-isotope distinct mantle did exist, either the anomaly was extremely small, or the anomaly was homogenised away by later mantle convection. The δ18O values of olivine with the highest 3He/4He ratios from a variety of OIB locations have a relatively uniform composition (∼5‰). This composition is intermediate to values associated with the depleted MORB mantle and the average mantle. Similarly, δ18O values of olivine from high-3He/4He OIB correlate with radiogenic isotope ratios of He, Sr, and Nd. Combined, this suggests that magmatic oxygen is sourced from the same mantle as other, more incompatible elements and that the intermediate δ18O value is a feature of the high-3He/4He mantle source. The processes responsible for the δ18O signature of high-3He/4He mantle are not certain, but δ18O–87Sr/86Sr correlations indicate that it may be connected to a predominance of a HIMU-like (high U/Pb) component or other moderate δ18O components recycled into the high-3He/4He source

Constraining the Geochemical Fingerprints of Gases from the UK Carboniferous Coal Measures at the Glasgow Geoenergy Observatories Field Site, Scotland

Usage of thermal energy contained in abandoned, flooded, coal mines has the potential to contribute to low carbon heating or cooling supply and assist in meeting net-zero carbon emission targets. However, hazardous ground gases, such as CH4 and CO2, can be found naturally in superficial deposits, coal bearing strata and abandoned mines. Determining the presence, magnitude, and origin of subsurface gases, and how their geochemical fingerprints evolve within the shallow subsurface is vital to developing an understanding of how to manage the risk posed by ground gases in geoenergy technology development. Here, we present the first CH4 and CO2 concentration-depth profiles and stable isotope (δ13CCH4, δ13CCO2, and δDCH4) profiles obtained from UK mine workings, through analysis of headspace gas samples degassed from cores and chippings collected during construction of the Glasgow Observatory. These are used to investigate the variability of gas fingerprints with depth within unmined Carboniferous coal measures and Glasgow coal mine workings. Stable isotope compositions of CH4 (δ13CCH4 = −73.4‰ to −14.3‰; δ13CCO2 = −29‰ to −6.1‰; δDCH4 = −277‰ to −88‰) provide evidence of a biogenic source, with carbonate reduction being the primary pathway of CH4 production. Gas samples collected at depths of 63–79 m exhibit enrichments in 13CCH4 and 2H, indicating the oxidative consumption of CH4. This correlates with their proximity to the Glasgow Ell mine workings, which will have increased exposure to O2 from the atmosphere as a result of mining activities. CO2 gas is more abundant than CH4 throughout the succession in all three boreholes, exhibiting high δ13CCO2 values relative to the CH4 present. Gases from unmined bedrock exhibit the highest δ13CCO2 values, with samples from near-surface superficial deposits having the lowest δ13CCO2 values. δ13CCO2 values become progressively lower at shallower depths (above 90 m), which can be explained by the increasing influence of shallow groundwaters containing a mixture of dissolved marine carbonate minerals (∼0‰) and soil gas CO2 (−26‰) as depth decreases. Our findings provide an insight into the variability of mine derived gases within 200 m of the surface, providing an important ‘time-zero’ record of the site, which is required in the design of monitoring approaches

\u27Mutiny on the Bounty\u27: the genetic history of Norfolk Island reveals extreme gender-biased admixture

Background The Pacific Oceania region was one of the last regions of the world to be settled via human migration. Here we outline a settlement of this region that has given rise to a uniquely admixed population. The current Norfolk Island population has arisen from a small number of founders with mixed Caucasian and Polynesian ancestry, descendants of a famous historical event. The ‘Mutiny on the Bounty’ has been told in history books, songs and the big screen, but recently this story can be portrayed through comprehensive molecular genetics. Written history details betrayal and murder leading to the founding of Pitcairn Island by European mutineers and the Polynesian women who left Tahiti with them. Investigation of detailed genealogical records supports historical accounts. Findings Using genetics, we show distinct maternal Polynesian mitochondrial lineages in the present day population, as well as a European centric Y-chromosome phylogeny. These results comprehensively characterise the unique gender-biased admixture of this genetic isolate and further support the historical records relating to Norfolk Island. Conclusions Our results significantly refine previous population genetic studies investigating Polynesian versus Caucasian diversity in the Norfolk Island population and add information that is beneficial to future disease and gene mapping studies

Resilience to Stress and Disturbance, and Resistance to Bromus tectorum L. Invasion in Cold Desert Shrublands of Western North America

Alien grass invasions in arid and semi-arid ecosystems are resulting in grass–fire cycles and ecosystem-level transformations that severely diminish ecosystem services. Our capacity to address the rapid and complex changes occurring in these ecosystems can be enhanced by developing an understanding of the environmental factors and ecosystem attributes that determine resilience of native ecosystems to stress and disturbance, and resistance to invasion. Cold desert shrublands occur over strong environmental gradients and exhibit significant differences in resilience and resistance. They provide an excellent opportunity to increase our understanding of these concepts. Herein, we examine a series of linked questions about (a) ecosystem attributes that determine resilience and resistance along environmental gradients, (b) effects of disturbances like livestock grazing and altered fire regimes and of stressors like rapid climate change, rising CO2, and N deposition on resilience and resistance, and (c) interacting effects of resilience and resistance on ecosystems with different environmental conditions. We conclude by providing strategies for the use of resilience and resistance concepts in a management context. At ecological site scales, state and transition models are used to illustrate how differences in resilience and resistance influence potential alternative vegetation states, transitions among states, and thresholds. At landscape scales management strategies based on resilience and resistance—protection, prevention, restoration, and monitoring and adaptive management—are used to determine priority management areas and appropriate actions

Drivers and mechanisms of tree mortality in moist tropical forests

Tree mortality rates appear to be increasing in moist tropical forests (MTFs) with significant carbon cycle consequences. Here, we review the state of knowledge regarding MTF tree mortality, create a conceptual framework with testable hypotheses regarding the drivers, mechanisms and interactions that may underlie increasing MTF mortality rates, and identify the next steps for improved understanding and reduced prediction. Increasing mortality rates are associated with rising temperature and vapor pressure deficit, liana abundance, drought, wind events, fire and, possibly, CO2 fertilization-induced increases in stand thinning or acceleration of trees reaching larger, more vulnerable heights. The majority of these mortality drivers may kill trees in part through carbon starvation and hydraulic failure. The relative importance of each driver is unknown. High species diversity may buffer MTFs against large-scale mortality events, but recent and expected trends in mortality drivers give reason for concern regarding increasing mortality within MTFs. Models of tropical tree mortality are advancing the representation of hydraulics, carbon and demography, but require more empirical knowledge regarding the most common drivers and their subsequent mechanisms. We outline critical datasets and model developments required to test hypotheses regarding the underlying causes of increasing MTF mortality rates, and improve prediction of future mortality under climate change