An Assessment of Earth's Climate Sensitivity Using Multiple Lines of Evidence.

We assess evidence relevant to Earth's equilibrium climate sensitivity per doubling of atmospheric CO2, characterized by an effective sensitivity S. This evidence includes feedback process understanding, the historical climate record, and the paleoclimate record. An S value lower than 2 K is difficult to reconcile with any of the three lines of evidence. The amount of cooling during the Last Glacial Maximum provides strong evidence against values of S greater than 4.5 K. Other lines of evidence in combination also show that this is relatively unlikely. We use a Bayesian approach to produce a probability density function (PDF) for S given all the evidence, including tests of robustness to difficult-to-quantify uncertainties and different priors. The 66% range is 2.6-3.9 K for our Baseline calculation and remains within 2.3-4.5 K under the robustness tests; corresponding 5-95% ranges are 2.3-4.7 K, bounded by 2.0-5.7 K (although such high-confidence ranges should be regarded more cautiously). This indicates a stronger constraint on S than reported in past assessments, by lifting the low end of the range. This narrowing occurs because the three lines of evidence agree and are judged to be largely independent and because of greater confidence in understanding feedback processes and in combining evidence. We identify promising avenues for further narrowing the range in S, in particular using comprehensive models and process understanding to address limitations in the traditional forcing-feedback paradigm for interpreting past changes.

What should we be teaching residents about behavioral science? Opinions of practicing family physicians.

BACKGROUND AND OBJECTIVES: A behavioral science curriculum in family practice residency education encompasses a wide range of topics. Time limitations reduce the number of topics that can be emphasized. This study presents the opinions of practicing family physicians regarding the prioritization of behavioral science topics for residency education. METHODS: We mailed a questionnaire to 633 practicing family physicians. Respondents provided demographic data and rated 28 behavioral science topics according to priority to be given in residency education. RESULTS: A total of 447 questionnaires were returned, for a response rate of 71%. On a 4-point scale, the average ratings of the 28 topics ranged from 3.79 (depression) to 2.40 (enuresis/encopresis). Female physicians and physicians with a behaviorist in their practice provided significantly higher overall average ratings. CONCLUSIONS: Practicing family physicians identify specific behavioral science topics to be given high priority during residency education. The list of prioritized topics may provide a useful guide to help family medicine educators decide which topics to emphasize in the behavioral science curriculum.

Dialogues in the exam room: medical interviewing by resident family physicians.

BACKGROUND: Limited information exists about the application of the biopsychosocial model in medical practice. This study expanded our knowledge about the extent to which psychosocial content is included in medical interviews conducted by resident family physicians. METHODS: Interviews of 180 patients conducted by six second-year family practice residents were audiotaped and transcribed. Physician statements were analyzed and coded as social talk, physician-centered statements, patient-centered statements, and discussion of patient affect, family, health promotion, and patient education. RESULTS: The proportion of interviews in which specific physician interactions occurred were physician-centered statements: 100%, patient-centered statements: 66%, dealing with patient affect: 18%, information about family: 61%, initiation of health promotion: 33%, and initiation of patient education: 46%. Discussions of patient opinion/perception, patient affect, family information, and health promotion occurred most commonly during well-care visits and with female patients. CONCLUSIONS: In this sample of residents, providers extended the interview beyond a purely biomedical focus. However, the psychosocial focus often was brief and applied inconsistently across patients.