59 resultados para clinician-patient encounters, patient-centeredness and evidence-based medicine


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14C-dated pollen and lake-level data from Europe are used to assess the spatial patterns of climate change between 6000 yr BP and present, as simulated by the NCAR CCM1 (National Center for Atmospheric Research, Community Climate Model, version 1) in response to the change in the Earth’s orbital parameters during this perod. First, reconstructed 6000 yr BP values of bioclimate variables obtained from pollen and lake-level data with the constrained-analogue technique are compared with simulated values. Then a 6000 yr BP biome map obtained from pollen data with an objective biome reconstruction (biomization) technique is compared with BIOME model results derived from the same simulation. Data and simulations agree in some features: warmer-than-present growing seasons in N and C Europe allowed forests to extend further north and to higher elevations than today, and warmer winters in C and E Europe prevented boreal conifers from spreading west. More generally, however, the agreement is poor. Predominantly deciduous forest types in Fennoscandia imply warmer winters than the model allows. The model fails to simulate winters cold enough, or summers wet enough, to allow temperate deciduous forests their former extended distribution in S Europe, and it incorrectly simulates a much expanded area of steppe vegetation in SE Europe. Similar errors have also been noted in numerous 6000 yr BP simulations with prescribed modern sea surface temperatures. These errors are evidently not resolved by the inclusion of interactive sea-surface conditions in the CCM1. Accurate representation of mid-Holocene climates in Europe may require the inclusion of dynamical ocean–atmosphere and/or vegetation–atmosphere interactions that most palaeoclimate model simulations have so far disregarded.

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Over the last decade, due to the Gravity Recovery And Climate Experiment (GRACE) mission and, more recently, the Gravity and steady state Ocean Circulation Explorer (GOCE) mission, our ability to measure the ocean’s mean dynamic topography (MDT) from space has improved dramatically. Here we use GOCE to measure surface current speeds in the North Atlantic and compare our results with a range of independent estimates that use drifter data to improve small scales. We find that, with filtering, GOCE can recover 70% of the Gulf Steam strength relative to the best drifter-based estimates. In the subpolar gyre the boundary currents obtained from GOCE are close to the drifter-based estimates. Crucial to this result is careful filtering which is required to remove small-scale errors, or noise, in the computed surface. We show that our heuristic noise metric, used to determine the degree of filtering, compares well with the quadratic sum of mean sea surface and formal geoid errors obtained from the error variance–covariance matrix associated with the GOCE gravity model. At a resolution of 100 km the North Atlantic mean GOCE MDT error before filtering is 5 cm with almost all of this coming from the GOCE gravity model.

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There is strong evidence that neonates imitate previously unseen behaviors. These behaviors are predominantly used in social interactions, demonstrating neonates’ ability and motivation to engage with others. Research on neonatal imitation can provide a wealth of information about the early mirror neuron system (MNS): namely, its functional characteristics, its plasticity from birth, and its relation to skills later in development. Though numerous studies document the existence of neonatal imitation in the laboratory, little is known about its natural occurrence during parent-infant interactions and its plasticity as a consequence of experience. We review these critical aspects of imitation, which we argue are necessary for understanding the early action-perception system. We address common criticisms and misunderstandings about neonatal imitation and discuss methodological differences among studies. Recent work reveals that individual differences in neonatal imitation positively correlate with later social, cognitive, and motor development. We propose that such variation in neonatal imitation could reflect important individual differences of the MNS. Although postnatal experience is not necessary for imitation, we present evidence that neonatal imitation is influenced by experience in the first week of life.

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ESA’s first multi-satellite mission Cluster is unique in its concept of 4 satellites orbiting in controlled formations. This will give an unprecedented opportunity to study structure and dynamics of the magnetosphere. In this paper we discuss ways in which ground-based remote-sensing observations of the ionosphere can be used to support the multipoint in-situ satellite measurements. There are a very large number of potentially useful configurations between the satellites and any one ground-based observatory; however, the number of ideal occurrences for any one configuration is low. Many of the ground-based instruments cannot operate continuously and Cluster will take data only for a part of each orbit, depending on how much high-resolution (‘burst-mode’) data are acquired. In addition, there are a great many instrument modes and the formation, size and shape of the cluster of the four satellites to consider. These circumstances create a clear and pressing need for careful planning to ensure that the scientific return from Cluster is maximised by additional coordinated ground-based observations. For this reason, ESA established a working group to coordinate the observations on the ground with Cluster. We will give a number of examples how the combined spacecraft and ground-based observations can address outstanding questions in magnetospheric physics. An online computer tool has been prepared to allow for the planning of conjunctions and advantageous constellations between the Cluster spacecraft and individual or combined ground-based systems. During the mission a ground-based database containing index and summary data will help to identify interesting datasets and allow to select intervals for coordinated studies. We illustrate the philosophy of our approach, using a few important examples of the many possible configurations between the satellite and the ground-based instruments.

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We present an analysis of a cusp ion step, observed by the Defense Meteorological Satellite Program (DMSP) F10 spacecraft, between two poleward moving events of enhanced ionospheric electron temperature, observed by the European Incoherent Scatter (EISCAT) radar. From the ions detected by the satellite, the variation of the reconnection rate is computed for assumed distances along the open-closed field line separatrix from the satellite to the X line, do. Comparison with the onset times of the associated ionospheric events allows this distance to be estimated, but with an uncertainty due to the determination of the low-energy cutoff of the ion velocity distribution function, ƒ(ν). Nevertheless, the reconnection site is shown to be on the dayside magnetopause, consistent with the reconnection model of the cusp during southward interplanetary magnetic field (IMF). Analysis of the time series of distribution function at constant energies, ƒ(ts), shows that the best estimate of the distance do is 14.5±2 RE. This is consistent with various magnetopause observations of the signatures of reconnection for southward IMF. The ion precipitation is used to reconstruct the field-parallel part of the Cowley D ion distribution function injected into the open low-latitude boundary layer in the vicinity of the X line. From this reconstruction, the field-aligned component of the magnetosheath flow is found to be only −55±65 km s−1 near the X line, which means either that the reconnection X line is near the stagnation region at the nose of the magnetosphere, or that it is closely aligned with the magnetosheath flow streamline which is orthogonal to the magnetosheath field, or both. In addition, the sheath Alfvén speed at the X line is found to be 220±45 km s−1, and the speed with which newly opened field lines are ejected from the X line is 165±30 km s−1. We show that the inferred magnetic field, plasma density, and temperature of the sheath near the X line are consistent with a near-subsolar reconnection site and confirm that the magnetosheath field makes a large angle (>58°) with the X line.

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A method for estimating both the Alfvén speed and the field-aligned flow of the magnetosheath at the magnetopause reconnection site is presented. The method employs low-altitude cusp ion observations and requires the identification of a feature in the cusp ion spectra near the low-energy cutoff which will often be present for a low-latitude dayside reconnection site. The appearance of these features in data of limited temporal, energy, and pitch angle resolution is illustrated by using model calculations of cusp ion distribution functions. These are based on the theory of ion acceleration at the dayside magnetopause and allow for the effects on the spectrum of flight times of ions precipitating down newly opened field lines. In addition, the variation of the reconnection rate can be evaluated, and comparison with ground-based observations of the corresponding sequence of transient events allows the field-aligned distance from the ionosphere to the reconnection site to be estimated.

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This paper examines the determinants of cross-platform arbitrage profits. We develop a structural model that enables us to decompose the likelihood of an arbitrage opportunity into three distinct factors: the fixed cost to trade the opportunity, the level at which one of the platforms delays a price update and the impact of the order flow on the quoted prices (inventory and asymmetric information effects). We then investigate the predictions from the theoretical model for the European Bond market with the estimation of a probit model. Our main finding is that the results found in the empirical part corroborate strongly the predictions from the structural model. The event of a cross market arbitrage opportunity has a certain degree of predictability where an optimal ex ante scenario is represented by a low level of spreads on both platforms, a time of the day close to the end of trading hours and a high volume of trade.

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People vary in the extent to which they prefer cooperative, competitive or individualistic achievement tasks. In the present research, we conducted two studies designed to investigate correlates and possible roots of these social interdependence orientations, namely approach and avoidance temperament, general self-efficacy, implicit theories of intelligence, and contingencies of self-worth based in others’ approval, competition, and academic competence. The results indicated that approach temperament, general self-efficacy, and incremental theory were positively, and entity theory was negatively related to cooperative preferences (|r| range from .11 to .41); approach temperament, general self-efficacy, competition contingencies, and academic competence contingencies were positively related to competitive preferences (|r| range from .16 to .46); and avoidance temperament, entity theory, competitive contingencies, and academic competence contingencies were positively related, and incremental theory was negatively related to individualistic preferences (|r| range from .09 to .15). The findings are discussed with regard to the meaning of each of the three social interdependence orientations, cultural differences among the observed relations, and implications for practicioners.

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We present cross-validation of remote sensing measurements of methane profiles in the Canadian high Arctic. Accurate and precise measurements of methane are essential to understand quantitatively its role in the climate system and in global change. Here, we show a cross-validation between three datasets: two from spaceborne instruments and one from a ground-based instrument. All are Fourier Transform Spectrometers (FTSs). We consider the Canadian SCISAT Atmospheric Chemistry Experiment (ACE)-FTS, a solar occultation infrared spectrometer operating since 2004, and the thermal infrared band of the Japanese Greenhouse Gases Observing Satellite (GOSAT) Thermal And Near infrared Sensor for carbon Observation (TANSO)-FTS, a nadir/off-nadir scanning FTS instrument operating at solar and terrestrial infrared wavelengths, since 2009. The ground-based instrument is a Bruker 125HR Fourier Transform Infrared (FTIR) spectrometer, measuring mid-infrared solar absorption spectra at the Polar Environment Atmospheric Research Laboratory (PEARL) Ridge Lab at Eureka, Nunavut (80° N, 86° W) since 2006. For each pair of instruments, measurements are collocated within 500 km and 24 h. An additional criterion based on potential vorticity values was found not to significantly affect differences between measurements. Profiles are regridded to a common vertical grid for each comparison set. To account for differing vertical resolutions, ACE-FTS measurements are smoothed to the resolution of either PEARL-FTS or TANSO-FTS, and PEARL-FTS measurements are smoothed to the TANSO-FTS resolution. Differences for each pair are examined in terms of profile and partial columns. During the period considered, the number of collocations for each pair is large enough to obtain a good sample size (from several hundred to tens of thousands depending on pair and configuration). Considering full profiles, the degrees of freedom for signal (DOFS) are between 0.2 and 0.7 for TANSO-FTS and between 1.5 and 3 for PEARL-FTS, while ACE-FTS has considerably more information (roughly 1° of freedom per altitude level). We take partial columns between roughly 5 and 30 km for the ACE-FTS–PEARL-FTS comparison, and between 5 and 10 km for the other pairs. The DOFS for the partial columns are between 1.2 and 2 for PEARL-FTS collocated with ACE-FTS, between 0.1 and 0.5 for PEARL-FTS collocated with TANSO-FTS or for TANSO-FTS collocated with either other instrument, while ACE-FTS has much higher information content. For all pairs, the partial column differences are within ± 3 × 1022 molecules cm−2. Expressed as median ± median absolute deviation (expressed in absolute or relative terms), these differences are 0.11 ± 9.60 × 10^20 molecules cm−2 (0.012 ± 1.018 %) for TANSO-FTS–PEARL-FTS, −2.6 ± 2.6 × 10^21 molecules cm−2 (−1.6 ± 1.6 %) for ACE-FTS–PEARL-FTS, and 7.4 ± 6.0 × 10^20 molecules cm−2 (0.78 ± 0.64 %) for TANSO-FTS–ACE-FTS. The differences for ACE-FTS–PEARL-FTS and TANSO-FTS–PEARL-FTS partial columns decrease significantly as a function of PEARL partial columns, whereas the range of partial column values for TANSO-FTS–ACE-FTS collocations is too small to draw any conclusion on its dependence on ACE-FTS partial columns.

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In this paper a custom classification algorithm based on linear discriminant analysis and probability-based weights is implemented and applied to the hippocampus measurements of structural magnetic resonance images from healthy subjects and Alzheimer’s Disease sufferers; and then attempts to diagnose them as accurately as possible. The classifier works by classifying each measurement of a hippocampal volume as healthy controlsized or Alzheimer’s Disease-sized, these new features are then weighted and used to classify the subject as a healthy control or suffering from Alzheimer’s Disease. The preliminary results obtained reach an accuracy of 85.8% and this is a similar accuracy to state-of-the-art methods such as a Naive Bayes classifier and a Support Vector Machine. An advantage of the method proposed in this paper over the aforementioned state of the art classifiers is the descriptive ability of the classifications it produces. The descriptive model can be of great help to aid a doctor in the diagnosis of Alzheimer’s Disease, or even further the understand of how Alzheimer’s Disease affects the hippocampus.

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A Universal Serial Bus (USB) Mass Storage Device (MSD), often termed a USB flash drive, is ubiquitously used to store important information in unencrypted binary format. This low cost consumer device is incredibly popular due to its size, large storage capacity and relatively high transfer speed. However, if the device is lost or stolen an unauthorized person can easily retrieve all the information. Therefore, it is advantageous in many applications to provide security protection so that only authorized users can access the stored information. In order to provide security protection for a USB MSD, this paper proposes a session key agreement protocol after secure user authentication. The main aim of this protocol is to establish session key negotiation through which all the information retrieved, stored and transferred to the USB MSD is encrypted. This paper not only contributes an efficient protocol, but also does not suffer from the forgery attack and the password guessing attack as compared to other protocols in the literature. This paper analyses the security of the proposed protocol through a formal analysis which proves that the information is stored confidentially and is protected offering strong resilience to relevant security attacks. The computational cost and communication cost of the proposed scheme is analyzed and compared to related work to show that the proposed scheme has an improved tradeoff for computational cost, communication cost and security.

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Past research has documented a substitution effect between real earnings management (RM) and accrual-based earnings management (AM), depending on relative costs. This study contributes to this research by examining whether levels of (and changes in) financial leverage have an impact on this empirically documented trade-off. We hypothesise that in the presence of high leverage, firms that engage in earnings manipulation tactics will exhibit a preference for RM due to a lower possibility—and subsequent costs—of getting caught. We show that leverage levels and increases positively and significantly affect upward RM, with no significant effect on income-increasing AM, while our findings point towards a complementarity effect between unexpected levels of RM and AM for firms with very high leverage levels and changes. This is interpreted as an indication that high leverage could attract heavy outsider scrutiny, making it necessary for firms to use both forms of earnings management in order to achieve earnings targets. Furthermore, we document that equity investors exhibit a significantly stronger penalising reaction to AM vs. RM, indicating that leverage-induced RM is not as easily detectable by market participants as debt-induced AM, despite the fact that the former could imply deviation from optimal business practices.