Previous Encounters Research Articles

Beyond Convenience: Patients’ Perceptions of Physician Interactional Skills and Compassion via Telemedicine

ObjectivesTo understand the interpersonal and communication behaviors that are perceived positively by patients in a video encounter and whether patient-centered relationships can be established virtually.Patients and MethodsA qualitative analysis of patient visit feedback was performed to build consensus around exemplary interpersonal and communication practices during a virtual urgent care visit. Voluntarily submitted patient comments associated with a 5-star review after a visit were randomly selected from more than 49,000 comments in an 11-month period, from January 1, 2016, through November 30, 2016. Researchers used a consensus-based, widely used health care communications framework as a sensitizing scaffold to develop a preliminary set of codes.ResultsMore than 30% of the comments coded were classified as Building Rapport. The next most frequently assigned code was Shares Information/Provides Guidance. Among codable comments, the third most frequently assigned code was Elicits Information. Provided Treatment accounted for only 2% of comments.ConclusionThese results suggest that patients who are satisfied with telemedicine encounters appreciate their relational experiences with the clinician and overall user experience, including access and convenience. Highly satisfied patients who interacted with providers on this platform commented on key aspects of medical communication, particularly skills that demonstrate patient-centered relationship building. This supports the notion that clinician-patient relationships can be established in a video-first model, without a previous in-person encounter, and that positive ratings do not seem to be focused solely on prescription receipt.

The immune system of children: the key to understanding SARS-CoV-2 susceptibility?

The immune system of children: the key to understanding SARS-CoV-2 susceptibility?

An uncommon cold.

The covid-19 virus isn't the first coronavirus to jump from animals to humans. What can we learn from previous encounters, asks Anthony King

Smelling our appetite? The influence of food odors on congruent appetite, food preferences and intake

We are surrounded by sensory food cues, such as odors, that may trigger (un)conscious decisions and even lead to (over)eating, it is therefore crucial to better understand the effect of food odors on behavioral responses. Food odor exposure has been shown to enhance appetite for food products with similar properties: sensory-specific appetite. This suggests that based on previous encounters with foods, we have learned to detect the nutritional content of foods, through our sense of smell. We investigated the influence of aware exposure of macronutrient-related odors on various measures of eating behavior, in a cross-over intervention study. Thirty two normal-weight healthy and unrestrained Dutch females took part in five test sessions. On each test session, they were exposed to one of five conditions (active smelling of clearly noticeable odors representing food high in carbohydrates, protein, and fat, low in calories, and a no-odor condition for 3-min) and assessed on specific appetite, food preferences and intake. Odor exposure increased congruent appetite after protein-related odor exposure. Similarly, protein-related odor exposure influenced the liking for protein foods and the preference ranking for savory products. However, food intake was not affected by smelling congruent food odors. Together this indicates that exposure to (aware) food odors may mostly influence appetite, but does not impact subsequent food intake. Moreover, appetite seems to be triggered by taste qualities rather than macronutrient information of the food, as signaled by olfactory cues. Future studies should investigate the role of awareness in more detail, to fully understand how odors might be used to steer people towards healthier food choices.

Child helplines: exploring determinants and boundary conditions of volunteer encounter satisfaction

PurposeVolunteers at child helplines play an important role in providing support for children, so keeping them satisfied during encounters is crucial to continue helping children. The purpose of this study is to understand how children’s perceptions of instrumental and emotional support (partner effects) influence volunteer encounter satisfaction, and whether this effect is moderated by a volunteer’s previous encounter experience and levels of interpersonal and service-offering adaptiveness.Design/methodology/approachThe sample consisted of 377 dyads of 116 volunteers and 377 children from online service encounters at a child helpline. Questionnaires were used to measure satisfaction, support and volunteer adaptiveness. A multilevel model was estimated to test the hypothesized moderation effects.FindingsThis study revealed that the instrumental support partner effect positively influenced volunteer encounter satisfaction. This relationship was stronger when the previous encounter was less satisfying or for volunteers with higher interpersonal, but not higher service-offering, adaptiveness. Negative effects on the relationship between the emotional support partner effect and volunteer encounter satisfaction were found after a less satisfying previous encounter or for volunteers with higher interpersonal adaptiveness.Originality/valueThis study contributes to the services and volunteerism literature by providing a unique perspective on the interpersonal influence between volunteers and children during service encounters. In the context of child helplines, this paper illustrates how volunteer encounter satisfaction is a function of the intricate interplay between children’s perceptions of the service encounter and volunteers’ perceptions of previous experiences and their adaptiveness.

A study on Patients' approach towards the presence of medical student during consultation in outpatient department (OPD) in a medical college

Objectives: To know the patients’ approach towards the presence of medical students in Out Patient Department (OPD) and factors influencing it. Results: 60 % patients had previous encounter withmedical student. 88.3%allow medical student to observe, 87.4%allow them to examine and 90.1%feelit is important for their training.There is a statistically significant difference in the co-operation of married and unmarried patients concerning students’ general appearance and behavior (P value 0.001). Discussion: Even though Patients’ approach towards medical students’ presence is appreciable, nearly half of them expect politeness and respect.

GW170817A as a Hierarchical Black Hole Merger

Abstract Despite the rapidly growing number of stellar-mass binary black hole mergers discovered through gravitational waves, the origin of these binaries is still not known. In galactic centers, black holes can be brought to each others’ proximity by dynamical processes, resulting in mergers. It is also possible that black holes formed in previous mergers encounter new black holes, resulting in so-called hierarchical mergers. Hierarchical events carry signatures such as higher-than-usual black hole mass and spin. Here we show that the recently reported gravitational-wave candidate, GW170817A, could be the result of such a hierarchical merger. In particular, its chirp mass ∼40 M ⊙ and effective spin of χ eff ∼ 0.5 are the typically expected values from hierarchical mergers within the disks of active galactic nuclei. We find that the reconstructed parameters of GW170817A strongly favor a hierarchical merger origin over having been produced by an isolated binary origin (with an odds ratio of > 103).

Measuring congestion by anchor points in DEA

One of the most important issues in microeconomics is congestion. In general, an increase in inputs will result in an increase in outputs. However, in some cases, it does not happen. Hence, in these situations congestion occurs. The existence of the congestion reduces efficiency of Decision Making Units (DMUs), so determination of congestion is highly regarded. Some studies suggested methods to determine the congestion via solving conventional Data Envelopment Analysis (DEA) models, in which first an inefficient unit was depicted on the BCC frontier. However, sometimes, some optimal projections are obtained, where some previous models encounter problems. In this paper, according to S-shape form of the production function and with respect to the geometric features of anchor points, we have developed an algorithm by the connection between the anchor points and congestion definition. In this algorithm, with no need for efficiency value and projecting the inefficient DMUs on BCC efficiency frontier, only by determining the anchor point with the largest output and comparing inefficient units with it, with an easier calculation, and solving conventional DEA models, congested DMUs and their status of congestion are obtained and their values are calculated. At the end, the proposed algorithm is illustrated by some examples and the results are compared to those of the existing methods.

Activation of specific mushroom body output neurons inhibits proboscis extension and sucrose consumption.

The ability to modify behavior based on prior experience is essential to an animal’s survival. For example, animals may become attracted to a previously neutral odor or reject a previously appetitive food source based on previous encounters. In Drosophila, the mushroom bodies (MBs) are critical for olfactory associative learning and conditioned taste aversion, but how the output of the MBs affects specific behavioral responses is unresolved. In conditioned taste aversion, Drosophila shows a specific behavioral change upon learning: proboscis extension to sugar is reduced after a sugar stimulus is paired with an aversive stimulus. While studies have identified MB output neurons (MBONs) that drive approach or avoidance behavior, whether the same MBONs impact innate proboscis extension behavior is unknown. Here, we tested the role of MB pathways in altering proboscis extension and identified MBONs that synapse onto multiple MB compartments that upon activation significantly decreased proboscis extension to sugar. Activating several of these lines also decreased sugar consumption, revealing that these MBONs have a general role in modifying feeding behavior beyond proboscis extension. The MBONs that decreased proboscis extension and ingestion are different from those that drive avoidance behavior in another context. These studies provide insight into how activation of MB output neurons decreases proboscis extension to taste compounds.

Opioid-Related Emergency Department Encounters: Patient, Encounter, and Community Characteristics Associated With Repeated Encounters

We describe the prevalence, trends, and factors associated with repeated emergency department (ED) encounters for opioid usage across multiple, independent hospital systems. A statewide regional health information exchange system provided ED encounters from 4 Indiana hospital systems for 2012 to 2017. In accordance with a series of International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 diagnosis codes for opioid abuse, adverse effects of opioids, opioid dependence and unspecified use, and opioid poisoning, we identified patients with an ED encounter associated with opioid usage (9,295 individuals; 12,642 encounters). Multivariate logistic regression models then described the patient, encounter, prescription history, and community characteristics associated with the odds of a patient's incurring a subsequent opioid-related ED encounter. The prevalence of repeated nonfirst opioid-related ED encounters increased from 9.0% of all opioid encounters in 2012 to 34.3% in 2017. The number of previous opioid-related ED encounters, unique institutions at which the individual had had encounters, the encounter's being heroin-related, the individual's having a benzodiazepine prescription filled within 30 days before the encounter, and being either Medicaid insured or uninsured compared with private insurance were associated with significantly greater odds of having a subsequent encounter. The ED is increasingly a site utilized as the setting for repeated opioid-related care. Characteristics of the individual, encounter, and community associated with repeated opioid-related encounters may inform real-time risk-prediction tools in the ED setting. Additionally, the number of institutions to which the individual has presented may suggest the utility of health information exchange data and usage in the ED setting.

Short Swoop, Long Line

70 ate’s two sons, engulfed in their hoodies, were waiting in line at the pizza counter behind Alex. It was startling to see them in person. Alex had never met them, only glanced at pictures of them around Kate’s house when he slept over on nights when the kids were with their dad. In the pictures, they were smiling, their arms around their mother, sporting polo shirts and respectable haircuts. Dad was not in the pictures. Now the sixteen-­ year-­ old wore all black. The younger one, thir­ teen maybe, was in camouflage. They weren’t smiling anymore. They wore flat-­ brimmed baseball caps over shaggy skater curls and fiction Short Swoop, Long Line Andrew Martin K Short Swoop, Long Line | 71 grim masks of teenage boredom. Alex ordered his slices and a local pale ale and sat down in a booth near the window. He opened Tender Is the Night, which was going quite slowly, and tried not to look over at the kids, who, of course, sat down at the table next to his. “Yo, can I get that Parmesan?” the older one said, suddenly looming over him. Jason, that was his name. Alex passed it to him. “Thanks,” he said. Then, under his breath, he added, “Faggot.” Alex tried to make his face look stern, like a disappointed adult. Jason and the little one—Matthew?—covered their mouths and mimed silent laughter. Alex was a twenty-­ four-­ year-­ old bookstore manager, which made him twenty-­ two years younger than Kate, the kids’ mother, who, she’d made clear, was not his girlfriend. He was too old to pick a fight with her children, but still young enough to feel the sting to his pride. The fact that he could say “I’m having sex with your mom,” the ultimate adolescent trump card, gave him some peace. The fact that he could also say “I’ve been wearing your mom’s panties all week,” and “I recently spent the night under your mom’s bed at her request,” was maybe more ambiguously trium­ phant for their age group. He read and listened to the boys discuss an episode of South Park in which the citizens of South Park are plagued by a sound that makes them uncontrollably flatulent. When the kids got up to leave, Alex looked up from his book. “You know, guys,” he said. “It’s not cool to commit hate crimes against random strangers.” “Stop checking out my dick, dude,” Jason said. Matthew giggled and looked at Alex expectantly. “I know your mother,” Alex said. “Cool, bro,” Jason said. He inexplicably switched to a terrible British accent. “You probably shouldn’t tell her you were examin­ ing our willies, mate.” “Oy, mate!” Matthew added, in an even less accurate accent. “Oy! You’re fatter than Batman!” They threw their plates in the trash and walked out of the restaurant. 72 | Andrew Martin alex and kate had started sleeping together three months earlier, after meeting at a scantly attended honky-­ tonk concert at the VFW Hall on Main Street. Kate was the executive director of a women’s health nonprofit in town, and Alex heard her “community con­ nection” PSA on the local NPR station twice a day. He told her, numerous times, that she was “too hot for radio”; she had a freshly bleached, very short haircut and tall boots. She was in the process of divorcing her husband due to a “whole truckload of bullshit,” and she’d talked to Alex at length about that, and about her recent obsession with Scandinavian crime fiction, and Gillian Welch, until the bar closed. Then she’d surprised him by inviting herself back to his messy apartment out by the Walmart. Once there, she ordered him to his knees. It was a strenuous, educational night, significantly more demanding than his previous casual encounters. He drove her back to her car in the morning. “Is that how things usually go with you?” he said. “Boy, you have no idea.” Alex had assumed this was a one-­ shot deal, something to be brought up in a drunken bout of sexual trivia someday. But instead they started spending...

Predictability Changes What We Remember in Familiar Temporal Contexts.

The human brain constantly anticipates the future based on memories of the past. Encountering a familiar situation reactivates memory of previous encounters, which can trigger a prediction of what comes next to facilitate responsiveness. However, a prediction error can lead to pruning of the offending memory, a process that weakens its representation in the brain and leads to forgetting. Our goal in this study was to evaluate whether memories are spared from such pruning in situations that allow for accurate predictions at the categorical level, despite prediction errors at the item level. Participants viewed a sequence of objects, some of which reappeared multiple times ("cues"), followed always by novel items. Half of the cues were followed by new items from different (unpredictable) categories, while others were followed by new items from a single (predictable) category. Pattern classification of fMRI data was used to identify category-specific predictions after each cue. Pruning was observed only in unpredictable contexts, while encoding of new items was less robust in predictable contexts. These findings demonstrate that how associative memories are updated is influenced by the reliability of abstract-level predictions in familiar contexts.

Hypothetical Hyperbolic Encounters between Venus and Proto-Mercury that Partially Stripped Away Proto-Mercury’s Mantle

Abstract Compared to all other terrestrial planets in the solar system, Mercury has an unusually large metal core, comprising ∼70% of its mass. Giant impacts could have removed a significant fraction of the silicate mantle of a chondritic proto-Mercury, forming the iron-rich present-day Mercury. However, such high-temperature giant impacts seem at odds with the retention of moderately volatile elements on present-day Mercury. We simulated a series of hyperbolic encounters between proto-Mercury and proto-Venus, which may have occurred in the chaotic early solar system. Tidal disruption of proto-Mercury always removes a portion of its silicate mantle, while its iron core remains intact. We find, in favorable cases, four close encounters with fast-spinning projectiles (resulting from previous encounters) that could lead to Mercury’s present-day iron fraction. More encounters are needed when the spin and orbital angular momentum are not always aligned. These hyperbolic encounters have various outcomes, such as orbital decay, binary planets, and change of spin rates. These results suggest the importance of the proper treatment of close encounters in N-body simulations of planetary accretion.

How Plate Lines Influence the Hazard Perception of Pilots During Wake Encounters

In free air aircraft, wake vortices descend due to their mutually induced velocities. In ground proximity, however, they are hindered to descent, which increases the encounter risk significantly. Recent investigations showed that vortex decay in ground proximity can be accelerated by installing a series of plates in lines perpendicular to the flight direction in front of the runway (so-called plate lines). A previous encounter simulation study showed that the accelerated vortex decay due to the presence of a plate line leads to a reduced aircraft response during wake encounters with autopilot engaged. The present study analyzes whether the plate lines also have a positive influence on the subjective hazard perception of pilots. Flowfields generated by coupled Reynolds-averaged Navier–Stokes/large-eddy simulations of an A340-sized aircraft in ground effect with light crosswind and with and without plate lines were implemented in a full-flight simulator of an A320-sized aircraft for different vortex ages. Simulations with pilots in the loop also showed a reduction of the aircraft response during manual landings as well as improved subjective pilot acceptance. Plate lines are therefore considered an effective means for either increasing flight safety with current minimum separations or maintaining the same level of safety in case of reduced minimum separations.

A Case Study of a Near Vessel Strike of a Blue Whale: Perceptual Cues and Fine-Scale Aspects of Behavioral Avoidance

Despite efforts to aid recovery, Eastern North Pacific blue whales faces numerous anthropogenic threats. These include behavioral disturbances and noise interference with communication, but also direct physical harm—notably injury and mortality from ship strikes. Factors leading to ship strikes are poorly understood, with virtually nothing known about the cues available to blue whales from nearby vessels, behavioral responses during close encounters, or how these events may contribute to subsequent responses. At what distance and received levels (RLs) of noise whales respond to potential collisions is difficult to observe. A unique case study of a close passage between a commercial vessel and a blue whale off Southern California is presented here. This whale was being closely monitored as part of another experiment after two suction-cup archival tags providing acoustic, depth, kinematic, and location data were attached to the whale. The calibrated, high-resolution data provided an opportunity to examine the sensory information available to the whale and its response during the close encounter. Complementary data streams from the whale and ship enabled a precise calculation of the distance and acoustic cues recorded on the tag when the whale initiated a behavioral response and shortly after at the closest point of approach (CPA). Immediately before the CPA, the whale aborted its ascent and remained at a depth sufficient to avoid being struck for ~3 min until the ship passed. In this encounter, the whale may have responded to a combination of cues associated with the close proximity of the vessel to avoid a collision. Long-term photo-identification records indicate that this whale has a long sighting history in the region, with evidence of previous ship encounters. Therefore, experiential factors may have facilitated the avoidance of a collision. In some instances these factors may not be available, which may make some blue whales particularly susceptible to deadly collisions, rendering efforts for ship-strike reduction even more challenging. The fine-scale information made available by the integration of these methods and technologies demonstrates the capacity for detailed behavioral studies of blue whales and other highly mobile marine megafauna, which will contribute to more informed evaluation and mitigation strategies.

Flight responses of eastern gray kangaroos to benign or harmful human behavior.

Globally, wilderness is being converted for rural and agricultural land use. In countryside landscapes, many habitat structures remain intact, providing suitable habitat for wildlife species that can accurately assess novel risks and develop tolerance to benign disturbances. Associative learning that promotes avoidance and also facilitates desensitization to benign disturbance is key to persisting in these landscapes. Conversely, learning to distinguish and avoid negative interactions with humans, like hunting, is vital. To determine if eastern gray kangaroos are capable of learning from previous interactions with humans, we tested the flight responses of wild kangaroos which have previously experienced either low or high frequencies of harmful and benign encounters with humans. We found that eastern gray kangaroos rapidly habituated to benign disturbance as there was no significant difference in assessment distance between groups that previously experienced low or high frequencies of disturbance. The threat of harmful disturbances was not as quickly learnt, as groups that experienced low frequencies of harmful disturbance delayed flight longer than those experiencing frequent harm. We found that the influence of environmental and group parameters on a kangaroo's decision to flee depended on the intent and frequency of previous interactions with humans. Our study indicates that kangaroos are learning from previous encounters with humans, correctly assessing novel risks which may be contributing to their persistence in countryside landscapes.

Wisdom of the Elders: Canadian Reconciliatory Experience as an Insight on the Present

AbstractCanada’s first two large historical encounters of recognition and work-in-progress accommodation of previously marginalized and alienated groups involved French Canada and newcomer Canadians. The third such engagement is now underway in response to the Indigenous peoples of Canada. While this endeavour is long overdue, there is reason for concern that the laudable enthusiasm of many for this project of reconciliation may be authorizing some policies, practices and discourses that conflict with and potentially undermine the values that informed and came out of previous inclusionary encounters. Three areas of concern arise. The first is the embrace of state deference in some instances to unlawful and sometimes violent forms of Aboriginal protest and resistance, undercutting the idea of the rule of law and of the value of the peaceful resolution of disputes. The second is the propensity to under critically over-authorize Indigenous cultural communities as sources of moral valuation, in ways that may undermine individuals’ dignity and well-being, as well as doing harm to the good of intra-cultural inclusiveness. The third is the related tendency to over-valorise Indigenous cultures and claims in ways that suggest symbolically and in practical terms the idea of the existence of morally first-class and morally second-class Canadians.

Encounters with predators fail to trigger predator avoidance in bumblebees, Bombus terrestris (Hymenoptera: Apidae)

Abstract Many species must learn to identify their predators, but little is known about the effect of direct encounters on the development of predator avoidance. We asked whether bumblebees, Bombus terrestris, learn to avoid predators, whether learning depends on the conspicuousness of predators and whether bumblebees learn to identify predators or simply to avoid dangerous patches. To answer these questions, we allowed bumblebees to forage in an enclosed meadow of 15 artificial flowers containing a yellow female crab spider, Thomisus onustus. Flowers were yellow in half of the trials and white in the other half. Spiders could remain at the same flower throughout the experiment or swap flowers between bee foraging bouts. Of the 60 bees used in the experiment, eight were killed by the spiders and nine stopped foraging without finishing the trial. Death or refusal to forage typically occurred early in the trial. Regardless of the treatment, the probability of landing at the spider-harbouring flower increased with time. Previous encounters with heterospecific individuals can therefore be a poor source of information about their predatory nature.

Errata

Previous article FreeERRATAErrataOriginal articleBabylonian Encounters in the Upper Diyala River Valley: Contextualizing the Results of Regional Survey and the 2016–2017 Excavations at Khani MasiTechnologies and Narratives of Urban Archaeology at the Kelsey MuseumPDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by American Journal of Archaeology Volume 123, Number 4October 2019 The journal of the Archaeological Institute of America Views: 3Total views on this site Article DOIhttps://doi.org/10.3764/aja.123.4.0707 Views: 3Total views on this site Copyright © 2019 by the Archaeological Institute of America. All rights reserved.PDF download Crossref reports no articles citing this article.Related articlesBabylonian Encounters in the Upper Diyala River Valley: Contextualizing the Results of Regional Survey and the 2016–2017 Excavations at Khani Masi25 Oct 2021American Journal of ArchaeologyTechnologies and Narratives of Urban Archaeology at the Kelsey Museum25 Oct 2021American Journal of Archaeology

CRISPR in context: towards a socially responsible debate on embryo editing

Following the birth in 2018 of two babies from embryos altered using CRISPR-Cas9, human germline gene editing (GGE) moved from abstract concern to reality. He Jiankui, the scientist responsible, has been roundly condemned by most scientific, legal and ethical commentators. However, opinions remain divided on whether GGE could be acceptably used in the future, and how, or if it should be prohibited entirely. The many reviews, summits, positions statements and high-level meetings that have accompanied the emergence of CRISPR technology acknowledge this, calling for greater public engagement to help reach a consensus on how to proceed. These calls are laudable but far from unproblematic. Consensus is not only hugely challenging to reach, but difficult to measure and to know when it might be achieved. Engagement is clearly desirable, but engagement strategies need to avoid the limitations of previous encounters between publics and biotechnology. Here we set CRISPR in the context of the biotechnology and fertility industries to illustrate the lessons to be learned. In particular we demonstrate the importance of avoiding a ‘deficit mode’ in which resistance is attributed to a lack of public understanding of science, addressing the separation of technical safety criteria from ethical and social matters, and ensuring the scope of the debate includes the political-economic context in which science is conducted and new products and services are brought to market. Through this history, we draw on Mary Douglas’ classic anthropological notion of ‘matter out of place’ to explain why biotechnologies evoke feelings of unease and anxiety, and recommend this as a model for rehabilitating lay apprehension about novel biological technologies as legitimate matters of concern in future engagement exercises about GGE.