ABSTRACT
The denser leaf vasculature of C4 plants than of C3 plants may suit rapid export of assimilates associated with their higher photosynthetic rate. However, some C4 grasses have partially reduced leaf vasculature with vascular bundle (VB)-free bundle-sheath cells called distinctive cells (DCs). The shade-tolerant C4 grass Paspalum conjugatum has such a reduced leaf vascular system with DCs. We examined whether irradiance during growth affects vascular formation in leaves of P. conjugatum grown under 100%, 30%, or 14% sunlight for 1 month alongside the C4 grass maize. Under all conditions, P. conjugatum leaves had partially reduced vasculature: DCs and incomplete small VBs without phloem occurred between VBs with a normal structure consisting of both xylem and phloem. Shaded plants had less phloem in the small VBs than the full-sunlit plants. In maize, however, all VBs always had both xylem and phloem under all light conditions. The net photosynthetic rate of both grasses was reduced under shade; that of P. conjugatum was always lower than that of maize under all light conditions, but was reduced less by shade than that of maize. The light compensation point was lower in P. conjugatum than in maize, indicating that P. conjugatum acclimatizes better to low light. The reduction of phloem in VBs of P. conjugatum may be an acclimatization to shade, because dense vasculature may be expensive for C4 plants growing in environments where the higher photosynthetic rate is not realized.
ABSTRACT
BACKGROUND: Empathy is an important attribute in medicine, influencing both the process and outcome of consultations. However, there are no validated tools available in Japan to gather patient feedback on physicians' empathy. The Consultation and Relational Empathy (CARE) Measure developed in the UK is widely used internationally. OBJECTIVES: To investigate the psychometric properties of a Japanese version of the CARE Measure. METHOD: Following two cycles of translation and back translation, the Japanese CARE Measure was completed by 317 patients in a primary medical care clinic in Japan. Tests of internal reliability and validity included Cronbach's alpha, item-total correlations and factor analysis. Predicted associations between CARE Measure score and other variables were assessed by Spearman's rho. RESULTS: Low numbers of missing values (8.2-9.8%) and 'not applicable' responses (0-1.3%) suggested high acceptability and face validity of the Japanese CARE Measure. Internal reliability was high (Cronbach's alpha 0.984) and was reduced by the removal of any of 10 items. High corrected item-total correlations (0.897-0.946) suggested homogeneity. Factor analysis showed a single solution with high item loadings (0.917-0.957). Construct validity was supported by a significant relationship (Spearman's rho 0.74, P < 0.001) with overall satisfaction with the consultation. CONCLUSION: The Japanese CARE Measure appears to be valid and reliable in a primary medical care setting. Further work is required to determine its ability to discriminate between doctors.
