General practitioner empathy, patient enablement, and patient-reported outcomes in primary care in an area of high socio-economic deprivation in Scotland - a pilot prospective study using structural equation modelling

<b>Objective</b> The aim of this pilot prospective study was to investigate the relationships between general practitioners (GPs) empathy, patient enablement, and patient-assessed outcomes in primary care consultations in an area of high socio-economic deprivation in Scotland.<p></p> <b>Methods</b> This prospective study was carried out in a five-doctor practice in an area of high socio-economic deprivation in Scotland. Patients’ views on the consultation were gathered using the Consultation and Relational Empathy (CARE) Measure and the Patient Enablement Instrument (PEI). Changes in main complaint and well-being 1 month after the contact consultation were gathered from patients by postal questionnaire. The effect of GP empathy on patient enablement and prospective change in outcome was investigated using structural equation modelling.<p></p> <b>Results</b> 323 patients completed the initial questionnaire at the contact consultation and of these 136 (42%) completed and returned the follow-up questionnaire at 1 month. Confirmatory factor analysis confirmed the construct validity of the CARE Measure, though omission of two of the six PEI items was required in order to reach an acceptable global data fit. The structural equation model revealed a direct positive relationship between GP empathy and patient enablement at contact consultation and a prospective relationship between patient enablement and changes in main complaint and well-being at 1 month.<p></p> <b>Conclusion</b> In a high deprivation setting, GP empathy is associated with patient enablement at consultation, and enablement predicts patient-rated changes 1 month later. Further larger studies are desirable to confirm or refute these findings.<p></p> <b>Practice implications</b> Ways of increasing GP empathy and patient enablement need to be established in order to maximise patient outcomes. Consultation length and relational continuity of care are known factors; the benefit of training and support for GPs needs to be further investigate

Impact of Many-Body Effects on Landau Levels in Graphene

We present magneto-Raman spectroscopy measurements on suspended graphene to investigate the charge carrier density-dependent electron-electron interaction in the presence of Landau levels. Utilizing gate-tunable magneto-phonon resonances, we extract the charge carrier density dependence of the Landau level transition energies and the associated effective Fermi velocity $v_\mathrm{F}$. In contrast to the logarithmic divergence of $v_\mathrm{F}$ at zero magnetic field, we find a piecewise linear scaling of $v_\mathrm{F}$ as a function of charge carrier density, due to a magnetic field-induced suppression of the long-range Coulomb interaction. We quantitatively confirm our experimental findings by performing tight-binding calculations on the level of the Hartree-Fock approximation, which also allow us to estimate an excitonic binding energy of $\approx$ 6 meV contained in the experimentally extracted Landau level transitions energies.Comment: 10 pages, 6 figure

Collisions of Slow Highly Charged Ions with Surfaces

Progress in the study of collisions of multiply charged ions with surfaces is reviewed with the help of a few recent examples. They range from fundamental quasi-one electron processes to highly complex ablation and material modification processes. Open questions and possible future directions will be discussed.Comment: 13 pages, 16 figures, review pape

A Framework for Analyzing Knowledge Utilization in Social Work Practice

Methodological and conceptual limitations have resulted in knowledge being defined so narrowly that we accept the inaccurate conclusion that social workers fail to utilize knowledge. This article seeks to rectify this problem by clarifying the concept of knowledge utilization in social work practice. Toward this end a framework is proposed that makes explicit the philosophy of science and practice assumptions germane to the use of knowledge in practice

Mittregionales pro-atriales natriuretisches Peptid (Pro-ANP) in der Herzchirurgie

Fragestellung: Mittregionales Pro-ANP besteht aus den AS 53-90 des N-terminalen Pro-ANP. Es wurde der Verlauf bis 72h nach CPB im Vergleich zu ANP, BNP, IL-6, TNF und Serumamyloid A (SAA) sowie Assoziationen mit 2 Jahresüberleben untersucht. Methoden: 123 herzchirurgische Patienten wurden untersucht. Mittregionales Pro-ANP wurde mittels BRAHMS-Seristra© gemessen. Ergebnisse: Im Vergleich zu ANP, BNP und den proinflammatorischen Zytokinen war der Verlauf des Pro-ANP verschieden. Während ANP während des CPB anstieg und dann wieder abfiel, zeigte Pro-ANP einen biphasischen Verlauf(entsprechend dem des SAA). Patienten, die 2 Jahre überlebten, hatten niedrigere Spiegel präop. und zu 9 weiteren MZP, ebenso Koronar- vs. Klappenpatienten. Schlussfolgerung: Der Verlauf von mittregionalem Pro-ANP unterscheidet sich von dem des ANP und dem inflammatorischer Zytokine und ist mit dem 2-Jahresüberleben nach CPB assoziiert. Ein Anstieg ab dem 2.Tag ist zeitlich kongruent mit der Akute-Phase-Reaktion

Full length interleukin 33 aggravates radiation-induced skin reaction

The interleukin (IL)-1 family member IL-33 has been described as intracellular alarmin with broad roles in wound healing, skin inflammation but also autoimmunity. Its dichotomy between full length (fl) IL-33 and the mature (m) form of IL-33 and its release by necrosis is still not fully understood. Here, we compare functional consequences of both forms in the skin in vivo, and therefore generated two lines of transgenic mice which selectively overexpress mmIL-33 and flmIL-33 in basal keratinocytes. Transgene mRNA was expressed at high level in skin of both lines but not in organs due to the specific K14 promoter. We could demonstrate that transgenic overexpression of mmIL-33 in murine keratinocytes leads to a spontaneous skin inflammation as opposed to flmIL-33. K14-mmIL-33 mice synthesize and secrete high amounts of mmIL-33 along with massive cutaneous manifestations, like increased epidermis and dermis thickness, infiltration of mast cells in the epidermis and dermis layers and marked hyperkeratosis. Using skin inflammation models such as IL-23 administration, imiquimod treatment, or mechanical irritation did not lead to exacerbated inflammation in the K14-flmIL-33 strain. As radiation induces a strong dermatitis due to apoptosis and necrosis, we determined the effect of fractionated radiation (12 Gy, 4 times). In comparison to wild-type mice, an increase in ear thickness in flmIL-33 transgenic mice was observed 25 days after irradiation. Macroscopic examination showed more severe skin symptoms in irradiated ears compared to controls. In summary, secreted mmIL-33 itself has a potent capacity in skin inflammation whereas fl IL-33 is limited due to its intracellular retention. During tissue damage, fl IL-33 exacerbated radiation-induced skin reaction

Light response of pure CsI calorimeter crystals painted with wavelength-shifting lacquer

We have measured scintillation properties of pure CsI crystals used in the shower calorimeter built for a precise determination of the pi+ -> pi0 e+ nu decay rate at the Paul Scherrer Institute (PSI). All 240 individual crystals painted with a special wavelength-shifting solution were examined in a custom-build detection apparatus (RASTA=radioactive source tomography apparatus) that uses a 137Cs radioactive gamma source, cosmic muons and a light emitting diode as complementary probes of the scintillator light response. We have extracted the total light output, axial light collection nonuniformities and timing responses of the individual CsI crystals. These results predict improved performance of the 3 pi sr PIBETA calorimeter due to the painted lateral surfaces of 240 CsI crystals. The wavelength-shifting paint treatment did not affect appreciably the total light output and timing resolution of our crystal sample. The predicted energy resolution for positrons and photons in the energy range of 10-100 MeV was nevertheless improved due to the more favorable axial light collection probability variation. We have compared simulated calorimeter ADC spectra due to 70 MeV positrons and photons with a Monte Carlo calculation of an ideal detector light response.Comment: Elsevier LaTeX, 35 pages in e-print format, 15 Postscript Figures and 4 Tables, also available at http://pibeta.phys.virginia.edu/~pibeta/subprojects/csipro/tomo/rasta.p

The Diffusion of Humans and Cultures in the Course of the Spread of Farming

The most profound change in the relationship between humans and their environment was the introduction of agriculture and pastoralism. [....] For an understanding of the expansion process, it appears appropriate to apply a diffusive model. Broadly, these numerical modeling approaches can be catego- rized in correlative, continuous and discrete. Common to all approaches is the comparison to collections of radiocarbon data that show the apparent wave of advance of the transition to farming. However, these data sets differ in entry density and data quality. Often they disregard local and regional specifics and research gaps, or dating uncertainties. Thus, most of these data bases may only be used on a very general, broad scale. One of the pitfalls of using irregularly spaced or irregularly documented radiocarbon data becomes evident from the map generated by Fort (this volume, Chapter 16): while the general east-west and south-north trends become evident, some areas appear as having undergone anomalously early transitions to farming. This may be due to faulty entries into the data base or regional problems with radiocarbon dating, if not unnoticed or undocumented laboratory mistakes.Comment: 20 pages, 5 figures, submitted to Diffusive Spreading in Nature, Technology and Society, edited by Armin Bunde, J\"urgen Caro, J\"org K\"arger, Gero Vogl, Chapter 1