Orbit structure and (reversing) symmetries of toral endomorphisms on rational lattices

We study various aspects of the dynamics induced by integer matrices on the invariant rational lattices of the torus in dimension 2 and greater. Firstly, we investigate the orbit structure when the toral endomorphism is not invertible on the lattice, characterising the pretails of eventually periodic orbits. Next we study the nature of the symmetries and reversing symmetries of toral automorphisms on a given lattice, which has particular relevance to (quantum) cat maps.Comment: 29 pages, 3 figure

A design thinking approach to evaluating interprofessional education

The complex challenge of evaluating the impact of interprofessional education (IPE) on patient and community health outcomes is well documented. Recently, at the Radcliffe Institute for Advanced Study in the United States, leaders in health professions education met to help generate a direction for future IPE evaluation research. Participants followed the stages of design thinking, a process for human-centred problem solving, to reach consensus on recommendations. The group concluded that future studies should focus on measuring an intermediate step between learning activities and patient outcomes. Specifically, knowing how IPE-prepared students and preceptors influence the organisational culture of a clinical site as well as how the culture of clinical sites influences learners' attitudes about collaborative practice will demonstrate the value of educational interventions. With a mixed methods approach and an appreciation for context, researchers will be able to identify the factors that foster effective collaborative practice and, by extension, promote patient-centred care

Pharmaceutical consultation as a tool to improve health outcomes for patients with type 2 diabetes

This study develops and evaluates a pharmaceutical consultation program (PCP) to improve treatment for Type 2 diabetes patients (T2DP) and reduce risk factors for diabetic complications with possible application in other chronic diseases. We recruited T2DP receiving conventional medical treatment but with fasting glycemia >140mg/dl and/or glycated hemoglobin >7%. The PCP includes strategies obtained from Dader's method, the PWDT (Pharmacist's Workup of Drug Therapy method) model of pharmaceutical care, the SOAP (Subjective data, Objective data, Assessment, and Plan of care) method, and concepts based on a nursing care model. The PCP evaluated lifestyle, pharmacotherapy and monitoring it using laboratory tests, vital signs, and anthropometry. These procedures were repeated every 4 months for 1 year. Data obtained in each consultation were used to provide patient education focusing on healthy lifestyles and medications. Fifty patients completed the PCP. There were reductions in glycemia (PNeste estudo, desenvolvemos e avaliamos um programa de consulta farmacêutica (PCF) visando melhorar o tratamento de pacientes diabéticos tipo 2 (PDT2) e reduzir os fatores de risco de complicações diabéticas com possibilidade de aplicação em outras doenças crônicas. Para alcançar este propósito, PDT2 recebendo tratamento médico convencional, apresentando glicemia de jejum > 140 mg/dl e/ou hemoglobina glicada >7% foram selecionados. O PCF inclui estratégias obtidas a partir do método de Dader, do modelo de cuidados farmacêuticos PWDT (Pharmacist's Workup of Drug Therapy method), do método SOAP (Subjective data, Objective data, Assessment, and Plan of care) e conceitos baseados em um modelo de cuidados em enfermagem. O PCF avaliou o estilo de vida, farmacoterapia e seu monitoramento através de exames laboratoriais, sinais vitais e antropometria. Estes procedimentos foram repetidos a cada 4 meses durante 1 ano. Os dados obtidos em cada consulta possibilitaram oferecer educação focada no estilo de vida e uso de medicamentos. Para os 50 pacientes que concluiram o PCF houve redução da glicemia (P < 0.0001), hemoglobina glicada (P = 0.0022), colesterolemia (P = 0.0072), triacilgliceridemia (P= 0.0204) e pressão arterial (P < 0.0001). O aumento da concordância e a correção dos problemas relacionados a medicamentos contribuíram para melhoria do tratamento. Assim, podemos concluir que o PCF foi adequado para melhorar a saúde de PDT2 ao reduzir fatores de risco de complicações diabéticas

Ecological distribution conflicts and the vocabulary of environmental justice

Unidad de excelencia María de Maeztu MdM-2015-0552There is a fundamental clash between economy and the environment due to the growing social metabolism of industrial economies. Energy cannot be recycled. Therefore, the energy from the fossil fuels is used only once, and new supplies of coal, oil, and gas must be obtained from the "commodity extraction frontiers". Similarly, materials are recycled only in part, and therefore, even an economy that would not grow would need fresh supplies of iron ore, bauxite, copper, and paper pulp. The industrial economy is entropic. Meanwhile, permanent "funds" such as aquifers, forests, and fisheries are overexploited, the fertility of the soil is jeopardized and biodiversity is depleted. Thus, the changing social metabolism of industrial economies (including waste disposal such as the excessive production of carbon dioxide) gives rise to growing numbers of ecological distribution conflicts that sometimes overlap with other social conflicts on class, ethnicity or indigenous identity, gender, caste, or territorial rights. The term Ecological Distribution Conflicts (EDC) was coined to describe social conflicts born from the unfair access to natural resources and the unjust burdens of pollution. Such conflicts give birth to movements of resistance, to the point that we can speak already of a global movement for Environmental Justice

Physicians’ Use of Email With Patients: Factors Influencing Electronic Communication and Adherence to Best Practices

BACKGROUND: With the public’s increased use of the Internet, the use of email as a means of communication between patients and physicians will likely increase. Yet, despite evidence of increased interest by patients, email use by physicians for clinical care has been slow. OBJECTIVE: To examine the factors associated with physician-patient email, and report on the physicians’ adherence to recognized guidelines for email communication. METHODS: Cross-sectional survey (March–May, 2005) of all primary care physicians (n = 10253), and a 25% stratified, random sample of all ambulatory clinical specialists (n = 3954) in the state of Florida. Physicians were surveyed on email use with patients, adherence to recognized guidelines, and demographics. RESULTS: The 4203 physicians completed the questionnaire (a 28.2% participation rate). Of these, 689 (16.6%) had personally used email to communicate with patients. Only 120 (2.9%) used email with patients frequently. In univariate analysis, email use correlated with physician age (decreased use: age > 61; P = .014), race (decreased use: Asian background; P < .001), medical training (increased use: family medicine, P = .001; or surgical specialty, P = .007; but not internal medicine, P = .112), practice size (> 50 physicians, P < .001), and geographic location (urban 17.2% vs. rural, 7.9%; P < .001). Multivariate modeling showed that only practice size greater than 50 (OR = 1.94; 95% CI = 1.01-3.79) and Asian-American race (OR = 0.26; 95% CI = 0.14-0.49) were related to email use with patients. Remarkably, only 46 physicians (6.7%) adhered to at least half of the 13 selected guidelines for email communication. CONCLUSIONS: This large survey of physicians, practicing in ambulatory settings, shows only modest advances in the adoption of email communication, and little adherence to recognized guidelines for email correspondence. Further efforts are required to educate both patients and physicians on the advantages and limitations of email communication, and to remove fiscal and legal barriers to its adoption