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The aim of this study was to assess whether burnout and empathy levels among general practitioners (GPs) might influence prescribing performance assessed using pharmaceutical prescription quality standard indicators.
Design and Setting:
Cross-sectional descriptive study of 108 GPs from 22 primary care centers in Lleida, Spain, and of centralized data corresponding to 183 600 patients under their care. The study was conducted between May and July 2014.
Main Outcome Measures:
Burnout and empathy were measured using the Spanish versions of the Maslach Burnout Inventory and the Jefferson Scale for Physician Empathy, and prescribing quality was measured using the Catalan Pharmaceutical Prescription Quality Standard (EQPF). Normal distribution of scores was verified using the Chi-square and Kolmogorov–Smirnov–Lilliefors tests. The effect of each of the variables was evaluated using crude odds ratios.
Older GPs scored significantly higher in the EQPF (P < 0.05). High empathy scores were positively associated with high EQPF scores. GPs with low burnout also performed better in the EQPF.
More empathic, less burned-out, older GPs showed better prescribing performance according to quality indicators. However, further studies are needed to evaluate other factors influencing prescribing habits. The promotion of communication skills may increase empathy and reduce burnout, thus benefiting patients.
Space Infrared Telescope for Cosmology and Astrophysics (SPICA), the cryogenic infrared space telescope recently pre-selected for a ‘Phase A’ concept study as one of the three remaining candidates for European Space Agency (ESA's) fifth medium class (M5) mission, is foreseen to include a far-infrared polarimetric imager [SPICA-POL, now called B-fields with BOlometers and Polarizers (B-BOP)], which would offer a unique opportunity to resolve major issues in our understanding of the nearby, cold magnetised Universe. This paper presents an overview of the main science drivers for B-BOP, including high dynamic range polarimetric imaging of the cold interstellar medium (ISM) in both our Milky Way and nearby galaxies. Thanks to a cooled telescope, B-BOP will deliver wide-field 100–350
m images of linearly polarised dust emission in Stokes Q and U with a resolution, signal-to-noise ratio, and both intensity and spatial dynamic ranges comparable to those achieved by Herschel images of the cold ISM in total intensity (Stokes I). The B-BOP 200
m images will also have a factor
30 higher resolution than Planck polarisation data. This will make B-BOP a unique tool for characterising the statistical properties of the magnetised ISM and probing the role of magnetic fields in the formation and evolution of the interstellar web of dusty molecular filaments giving birth to most stars in our Galaxy. B-BOP will also be a powerful instrument for studying the magnetism of nearby galaxies and testing Galactic dynamo models, constraining the physics of dust grain alignment, informing the problem of the interaction of cosmic rays with molecular clouds, tracing magnetic fields in the inner layers of protoplanetary disks, and monitoring accretion bursts in embedded protostars.
Matrix diffusion is a key process for radionuclide retention in crystalline rocks. Within the LTD project (Long-Term Diffusion), an in-situ diffusion experiment in unaltered non-fractured granite was performed at the Grimsel Test Site (www.grimsel.com, Switzerland). The tracers included 3H as HTO, 22Na+, 134Cs+ and 131I- with stable I- as carrier.
The dataset (except for 131I- because of complete decay) was analyzed with different diffusion-sorption models by different teams (NAGRA / IDAEA-CSIC, UJV-Rez, JAEA, Univ. Poitiers) using different codes, with the goal of obtaining effective diffusion coefficients (De) and porosity (ϕ) or rock capacity (α) values. A Borehole Disturbed Zone (BDZ), which was observed in the rock profile data for 22Na+ and 134Cs+, had to be taken into account to fit the experimental observations. The extension of the BDZ (1-2 mm) was about the same magnitude as the mean grain size of the quartz and feldspar grains.
De and α values for the different tracers in the BDZ are larger than the respective values in the bulk rock. Capacity factors in the bulk rock are largest for Cs+ (strong sorption) and smallest for 3H (no sorption). However, 3H seems to display large α values in the BDZ. This phenomenon will be investigated in more detail in a second test starting in 2013.
In the new DR-A in-situ diffusion experiment at Mont Terri, a perturbation (replacement of the initial synthetic porewater in the borehole with a high-salinity solution) has been induced to study the effects on solute transport and retention, and more importantly, to test the predictive capability of reactive transport codes. Reactive transport modeling is being performed by different teams (IDAEA-CSIC, PSI, Univ. Bern, Univ. British Columbia, Lawrence Berkeley Natl. Lab.). Initial modeling results using the CrunchFlow code and focusing on Cs+ behavior are reported here.
The objective of this study was to develop and validate a time-resolved immunofluorometric assay (TR-IFMA) for porcine salivary chromogranin A (CgA) measurements, using a species-specific antibody, and evaluate its behaviour in an acute stress model. Polyclonal antibodies were produced in rabbits immunized with a synthetic porcine fragment of CgA359−379 and used to develop a sandwich TR-IFMA. This TR-IFMA was analytically validated and showed intra- and inter-assay coefficients of variation of 6.23% and 5.82%, respectively, an analytical limit of detection of 4.27 × 10−3 μg/ml and a limit of quantification of 24.5 × 10−3 μg/ml. The assay also demonstrated a high level of accuracy, as determined by linearity under dilution (r = 0.975) and recovery tests. When a model of experimental acute stress, in which animals were immobilized for 3 min with a nose snare (stressor stimulus), was applied, a significant increase (P < 0.05) in CgA levels in saliva was detected at 15 min post-stressor stimulus. These results indicate that the assay developed in this study could measure CgA in porcine saliva in a reliable way and that the concentrations of CgA in saliva samples of pigs increase after an acute stress situation.
We present a statistical tool to characterize correlation between the column density structure and the polarized emission from a molecular cloud. This tool uses the gradient as an estimator of the directionality of the structure in order to systematically relate the orientation of filaments and cores to the orientation of the magnetic field inferred from the polarization vectors.
Ground- and space-based observations have confirmed the presence of oscillatory motions in prominences and they have been interpreted in terms of magnetohydrodynamic (MHD) waves. This interpretation opens the door to perform prominence seismology, whose main aim is to determine physical parameters in magnetic and plasma structures (prominences) that are difficult to measure by direct means. Here, two prominence seismology applications are presented.
The aim of the present study was to assess the concurrent and construct validity of two diet-quality indices, a modified Mediterranean diet score (mMDS) and a Mediterranean-like diet score (MLDS) additionally incorporating unhealthy food choices, as determined by an FFQ.
A validation study assessing FFQ intake estimates compared with ten or more unannounced 24 h recalls. Pearson's correlation coefficients, intraclass correlation coefficients (ICC), Bland–Altman plots and the limits of agreement method were used to assess the between-method agreement of scores. Construct validity was shown using associations between nutrient intakes derived from multiple 24 h recalls and the mMDS and MLDS derived from the FFQ.
A total of 107 consecutively selected participants from a population-based cross-sectional survey.
Pearson's correlations for the energy-adjusted mMDS and MLDS compared with multiple recalls were 0·48 and 0·62, respectively. The average FFQ energy-adjusted mMDS and MLDS were 102 % and 98 % of the recall-based mMDS and MLDS estimates, respectively. The FFQ under- and overestimated dietary recall estimates of the energy-adjusted MLDS by 28 % and 25 %, respectively, with slightly wider boundaries for the mMDS (31 % and 34 %). The ICC, which assesses absolute agreement, was similar to Pearson's correlations (mMDS = 0·48 and MLDS = 0·61). The mean differences between methods were similar across the range of average ratings for both scores, indicating the absence of bias. The FFQ-derived mMDS and MLDS correlated in the anticipated directions with intakes of eleven (73·3 %) and thirteen of fifteen nutrients (86·7 %), respectively.
The FFQ provides valid estimates of diet quality as assessed by the mMDS and MLDS.
We have recently developed a method to perform Density Functional Theory calculations in systems with a very large number of atoms, which is based on the use of numerical atomic orbitals as basis sets. The method incorporates Order-N techniques both in the calculation of the Kohn-Sham hamiltonian matrix elements and in the solution of the wave functions, which make the CPU time and memory to scale linearly with the number of atoms, allowing calculations in very large system. In this work, we present results on several test systems to show that the approach and the basis sets used with our method are able to provide an accuracy similar to that of other standard DFT techniques.
Mesoporous Hybrid Thin Films (MHTF) of a variety of compositions and embedded organic functions are produced by combining sol-gel synthesis, template self-assembly and surface modification. One-pot or post-grafting strategies permit to modify the pore surface behavior. Highly controlled MHTF issued from a reproducible and modular synthesis can be used as building blocks for more complex structures, presenting order at larger scales, and novel properties derived from this multiscale order. Multilayer stacks of MHTF presenting specific and different functions and frameworks located in a well-defined position have been produced by combining sequential film deposition, selective functionalization and dissolution. These systems present new properties such as localized chemistry or modulable photonic crystal behavior.
The properties of small clusters Fe3 and Fe5, in which the non-collinearity of magnetic density is expected to be important, and of larger nanoparticles (consisting of up to 62 atoms) are studied from first principles making use of density functional theory, norm-conserving pseudopotential and numerical local orbitals method, as implemented in the SIESTA code. We concentrate on the interplay of lattice relaxation, mostly pronounced near the surface of particles, and the particles' magnetic characteristics. Previously obtained theoretical findings of enhanced magnetic moments in outer shells of nanoparticles are confirmed. These results are refined by taking structure relaxation into account and by considering more representative bcc- and fcc-related particles; moreover, we allowed antiferromagnetic ordering along with ferromagnetic one.
We present a method for selfconsistent Density Functional Theory calculations in which the effort required is proportional to the size of the system, thus allowing the aplication to problems with a very large size. The method is based on the LCAO approximation, and uses a mixed approach to obtain the Hamiltonian integrals between atomic orbitals with Order-N effort. We show the performance and the convergence properties of the method in several silicon and carbon systems, and in a DNA periodic chain.
In this work we address the behaviour of electronic structure under uniaxial stress, by first-principles calculations and experiments of conductance in nanometer-sized metallic contactes of Au and Al. These contacts are shown to be specially suitable for this purpose. The conductance behaviour is related to the change with strain of Fermi surface. Both experimental and theoretically Au behaves like the free electron gas but Al has the opposite behaviour.
Mesostructured titanium-oxo/polymer hybrids were obtained by using Ti16O16(OEt)32 (TS) clusters or by aging solutions of Ti alkoxides as precursors. Dendrimers or PEO-based surfactants were used as templating agents. Solids were characterised by XRD, TEM, FTIR and multinuclear liquid and solid (MAS) NMR spectroscopy. Two synthetic approaches are described. In the alkoxide-based systems, the control of the high reactivities of the Ti (IV) metal centers, is essential to obtain ordered mesophases. The assembly of nanobuilding blocks (ANBB) permits to circumvent this high reactivity by using pre-formed Ti-oxo entities. The use of versatile functionalised dendrimers permits to control the reactivity at the surface of the cluster, giving birth to novel ordered architectures.
In recent years, simulation models have been used as a complementary tool for research and for quantifying soil carbon sequestration under widely varying conditions. This has improved the understanding and prediction of soil organic carbon (SOC) dynamics and crop yield responses to soil and climate conditions and crop management scenarios. The goal of the present study was to estimate the changes in SOC for different cropping systems in West Africa using a simulation model. A crop rotation experiment conducted in Farakô-Ba, Burkina Faso was used to evaluate the performance of the cropping system model (CSM) of the Decision Support System for Agrotechnology Transfer (DSSAT) for simulating yield of different crops. Eight crop rotations that included cotton, sorghum, peanut, maize and fallow, and three different management scenarios, one without N (control), one with chemical fertilizer (N) and one with manure applications, were studied. The CSM was able to simulate the yield trends of various crops, with inconsistencies for a few years. The simulated SOC increased slightly across the years for the sorghum–fallow rotation with manure application. However, SOC decreased for all other rotations except for the continuous fallow (native grassland), in which the SOC remained stable. The model simulated SOC for the continuous fallow system with a high degree of accuracy normalized root mean square error (RMSE)=0·001, while for the other crop rotations the simulated SOC values were generally within the standard deviation (s.d.) range of the observed data. The crop rotations that included a supplemental N-fertilizer or manure application showed an increase in the average simulated aboveground biomass for all crops. The incorporation of this biomass into the soil after harvest reduced the loss of SOC. In the present study, the observed SOC data were used for characterization of production systems with different SOC dynamics. Following careful evaluation of the CSM with observed soil organic matter (SOM) data similar to the study presented here, there are many opportunities for the application of the CSM for carbon sequestration and resource management in Sub-Saharan Africa.
A high-resolution 14C chronology for the Teopancazco archaeological site in the Teotihuacan urban center of Mesoamerica was generated by Bayesian analysis of 33 radiocarbon dates and detailed archaeological information related to occupation stratigraphy, pottery and archaeomagnetic dates. The calibrated intervals obtained using the Bayesian model are up to ca. 70% shorter than those obtained with individual calibrations. For some samples, this is a consequence of plateaus in the part of the calibration curve covered by the sample dates (2500 to 1450 14C yr BP). Effects of outliers are explored by comparing the results from a Bayesian model that incorporates radiocarbon data for two outlier samples with the same model excluding them. The effect of outliers was more significant than expected. Inclusion of radiocarbon dates from two altered contexts, 500 14C yr earlier than those for the first occupational phase, results in ages calculated by the model earlier than the archaeological records. The Bayesian chronology excluding these outliers separates the first two Teopancazco occupational phases and suggests that ending of the Xolalpan phase was around cal AD 550, 100 yr earlier than previously estimated and in accordance with previously reported archaeomagnetic dates from lime plasters for the same site.
Several studies have suggested that immigrants have higher rates of psychiatric emergency service use and a higher risk of mental disorders such as schizophrenia than indigenous populations.
To compare the likelihood that immigrants (immigrant group) v. indigenous population (indigenous group) will be diagnosed with borderline personality disorder in a psychiatric emergency service and to determine differences according to area of origin.
A total of 11 578 consecutive admissions over a 4-year period at a tertiary psychiatric emergency service were reviewed. The collected data included socio-demographic and clinical variables and the Severity of Psychiatric Illness rating score. Psychiatric diagnosis was limited to information available in the emergency room given that a structured interview is not usually feasible in this setting. The diagnosis of borderline personality disorder was based on DSM–IV criteria. Immigrants were divided into five groups according to region of origin: North Africa, sub-Saharan Africa, South America, Asia and Western countries.
Multivariate statistical logistic regression analysis showed that all subgroups of immigrants had a lower likelihood of being diagnosed with borderline personality disorder than the indigenous population independently of age and gender. Furthermore, the rates of borderline personality disorder diagnosis were considerably lower in Asian and sub-Saharan subgroups than in South American, North African, Western or native subgroups.
Our results showed that in the psychiatric emergency service borderline personality disorder was diagnosed less frequently in the immigrant group v. the indigenous group. Our results do not support the concept of migration as a risk factor for borderline personality disorder.