18 results
La societas Sisaponensis, los lingotes de Doña Rama-Belmez y la explotación minera de los montes de Corduba
- Antonio Monterroso-Checa, Claude Domergue, Christian Rico, Mar Zarzalejos-Prieto, Fernando Palero-Fernández, Sabine Klein, Isabel María García-Magdaleno, Pier Renato Trincherini, Massimo Gasparini, Francesca Marchegiani, Juan Carlos Moreno-Escribano, Stefano Nisi, José Rafael Ruiz-Arrebola
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- Journal of Roman Archaeology , First View
- Published online by Cambridge University Press:
- 03 May 2024, pp. 1-40
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El objetivo principal de este trabajo es presentar importantes novedades sobre el marco histórico y productivo de la explotación minera de la sierra de Corduba en época romana, así como de la gestión de sus recursos. Desde hace años y a partir de la documentación epigráfica disponible, se ha venido apuntando una posible presencia en este territorio de la societas Sisaponensis y de la explotación de plomo y plata por su parte, a pesar de la afamada vinculación con el beneficio del cinabrio que recoge un conocido pasaje de Plinio. Nuestras investigaciones en el norte de Córdoba y los análisis arqueométricos realizados sobre tres lingotes de plomo recuperados en el paraje de Los Escoriales de Doña Rama, situado en la Sierra de Gata (Belmez-Córdoba), suponen una superación de la frontera del conocimiento sobre los aspectos reseñados, ya que permiten contrastar estas dos hipótesis tradicionales y proponer nuevas cuestiones sobre la explotación de estos parajes y la actividad de esta societas. Estos lingotes fueron encontrados en una instalación minero-metalúrgica romana, algo que es excepcional, y conservan una inscripción, S S, que los vincula sin duda con la societas Sisaponensis.
Step-induced transition in compressible high Reynolds number flow
- Marco Costantini, Steffen Risius, Christian Klein
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- Flow: Applications of Fluid Mechanics / Volume 2 / 2022
- Published online by Cambridge University Press:
- 16 November 2022, E33
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The effect of sharp forward-facing steps on boundary-layer transition is systematically investigated in this work in combination with the influence of variations in Mach number, Reynolds number and streamwise pressure gradient. Experiments have been conducted in a quasi-two-dimensional flow at Mach numbers up to 0.77 and chord Reynolds numbers up to 13 million in the Cryogenic Ludwieg-Tube Göttingen. The adopted experimental set-up allows an independent variation of the aforementioned parameters and enables a decoupling of their respective effects on the boundary-layer transition, which has been measured accurately and non-intrusively by means of a temperature-sensitive paint. The functional relations determined between a non-dimensional transition parameter and the non-dimensional step parameters allow the step effect on transition to be isolated from the influence of variations in Mach number, Reynolds number and pressure gradient. Criteria for acceptable heights of forward-facing steps on natural laminar flow surfaces for the examined test conditions are derived from the present functional relations. The measured transition locations are also correlated with the results of linear, local stability analysis for the smooth configuration, enabling the estimation of the step-induced increment of the amplification factor ΔN of Tollmien–Schlichting waves, which can be incorporated in the eN transition prediction method.
Diffraction of shock waves through a non-quiescent medium
- Bhavraj S. Thethy, Mohammad Rezay Haghdoost, Rhiannon Kirby, Bonggyun Seo, Maikel Nadolski, Christian Zenker, Michael Oevermann, Rupert Klein, Kilian Oberleithner, Daniel Edgington-Mitchell
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- Journal:
- Journal of Fluid Mechanics / Volume 944 / 10 August 2022
- Published online by Cambridge University Press:
- 04 July 2022, A39
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An investigation of shock diffraction through a non-quiescent background medium is presented using both experimental and numerical techniques. Unlike diffracting shocks in quiescent media, a spatial distortion of the shock front occurs, producing a region of constant shock angle. An example of this process arises in the exhaust from a pulse-detonation combustor. As the background velocity is increased, such as through the inclusion of a converging nozzle at the exhaust, the spatial distortion becomes more apparent. Numerical simulations using a compressible Euler solver demonstrate that the distortion is not due to the geometrical influence of the nozzle, but rather is a function of the magnitude of the background flow velocity. The distortion is studied using a modified geometrical shock dynamics formulation which includes the background flow and is validated against experiments. A simple model is presented to predict the shock distortion angle in the weak-shock limit. Finally, the axial decay behaviour of the shock is investigated and it is shown that the advection of the shock by the background flow delays the arrival of the head and tail of the expansion characteristic at the centreline. This leads to an increase in the rate of decay of the shock Mach number as the background flow velocity is increased.
Rapid and sustained decline in CXCL-10 (IP-10) annotates clinical outcomes following TNFα-antagonist therapy in hospitalized patients with severe and critical COVID-19 respiratory failure
- Hilal Hachem, Amandeep Godara, Courtney Schroeder, Daniel Fein, Hashim Mann, Christian Lawlor, Jill Marshall, Andreas Klein, Debra Poutsiaka, Janis L. Breeze, Raghav Joshi, Paul Mathew
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- Journal:
- Journal of Clinical and Translational Science / Volume 5 / Issue 1 / 2021
- Published online by Cambridge University Press:
- 25 June 2021, e146
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Background:
A feedforward pathological signaling loop generated by TNFα and IFN-γ synergy in the inflamed lung, driving CXCL-10 (IP-10) and CXCL-9 chemokine-mediated activated T-cell and monocyte/macrophage tissue recruitment, may define the inflammatory biology of lethal COVID-19 respiratory failure.
Methods:To assess TNFα-antagonist therapy, 18 hospitalized adults with hypoxic respiratory failure and COVID-19 pneumonia received single-dose infliximab-abda therapy 5 mg/kg intravenously between April and December 2020. The primary endpoint was time to increase in oxygen saturation to fraction of inspired oxygen ratio (SpO2/FiO2) by ≥50 compared to baseline and sustained for 48 h. Secondary endpoints included 28-day mortality, dynamic cytokine profiles, secondary infections, duration of supplemental oxygen support, and hospitalization.
Findings:Patients were predominantly in critical respiratory failure (15/18, 83%), male (14/18, 78%), above 60 years (median 63 years, range 31–80), race-ethnic minorities (13/18, 72%), lymphopenic (13/18, 72%), steroid-treated (17/18, 94%), with a median ferritin of 1953 ng/ml. Sixteen patients (89%) met the primary endpoint within a median of 4 days; 14/18 (78%) were discharged in a median of 8 days and were alive at 28-day follow-up. Three deaths were attributed to secondary lung infection. Mean plasma IP-10 levels declined sharply from 9183 to 483 pg/ml at Day 3 and 146 pg/ml at Day 14/discharge. Significant Day 3 declines in IFN- $\gamma $ , TNFα, IL-27, CRP, and ferritin occurred. IP-10 and CXCL-9 declines were strongly correlated among patients with lymphopenia reversal (Day 3, Pearson r: 0.98, P-value 0.0006).
Interpretation:Infliximab-abda may rapidly abrogate pathological inflammatory signaling to facilitate clinical recovery in severe and critical COVID-19.
Quality of life and psychological co-morbidities in children and adolescents with cardiac pacemakers and implanted defibrillators: a cohort study in Eastern Germany
- Christian Paech, Victoria Ebel, Franziska Wagner, Stephanie Stadelmann, Annette M. Klein, Mirko Döhnert, Ingo Dähnert, Roman Antonin Gebauer
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- Journal:
- Cardiology in the Young / Volume 30 / Issue 4 / April 2020
- Published online by Cambridge University Press:
- 13 April 2020, pp. 549-559
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Introduction:
The implantation of a pacemaker or an implantable cardioverter-defibrillator during childhood may reduce quality of life and lead to mental health problems. This study aimed to evaluate potential mental health problems (i.e., depressive and anxiety symptoms) and quality of life in children with cardiac active devices in comparison to healthy peers.
Methods:We analysed data of children with pacemakers or implantable cardioverter-defibrillators aged 6–18 years. Quality of life, depressive and anxiety symptoms were assessed by standardised questionnaires. The results were compared to age-matched reference groups.
Results:Children with implantable cardioverter-defibrillator showed significant lower quality of life in comparison to reference group (p = 0.03), but there was no difference in quality of life between children with pacemaker and reference group. There was no significant difference in depressive symptoms between children with a cardiac rhythm device compared to reference group (self-report: p = 0.67; proxy report: p = 0.49). There was no significant difference in anxiety (p = 0.53) and depressive symptoms (p = 0.86) between children with pacemaker and children with implantable cardioverter-defibrillator.
Conclusions:Living with an implantable cardioverter-defibrillator in childhood seems to decrease the patients’ quality of life. Although children with pacemaker and implantable cardioverter-defibrillator don’t seem to show more depressive and anxiety symptoms in comparison to their healthy peers, there still can be an increased risk for those children to develop mental health problems. Therefore, treating physicians should be aware of potential mental health problems and provide the patients and their families with appropriate therapeutic offers.
The Uronarti Regional Archaeological Project: Second Cataract fortresses and the Western Desert of Sudan
- Evan I. Levine, Miriam A.W. Rothenberg, Oren Siegel, Christian Knoblauch, Laurel Bestock, Lutz Klein
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The Batn el-Hagar in Sudan has traditionally been characterised as sparsely occupied during the Middle Kingdom Period, with most activity limited to the Egyptian fortresses along the Second Cataract. A new survey programme undertaken by the Uronarti Regional Archaeological Project offers evidence for a more richly occupied landscape.
The Orion Nebula in the Far-Infrared: High-J CO and fine-structure lines mapped by FIFI-LS/SOFIA
- Randolf Klein, Leslie W. Looney, Erin Cox, Christian Fischer, Christof Iserlohe, Alfred Krabbe
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- Journal:
- Proceedings of the International Astronomical Union / Volume 12 / Issue S316 / August 2015
- Published online by Cambridge University Press:
- 31 March 2017, pp. 153-154
- Print publication:
- August 2015
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The Orion Nebula is the closest massive star forming region allowing us to study the physical conditions in such a region with high spatial resolution. We used the far infrared integral-field spectrometer, FIFI-LS, on-board the airborne observatory SOFIA to study the atomic and molecular gas in the Orion Nebula at medium spectral resolution.
The large maps obtained with FIFI-LS cover the nebula from the BN/KL-object to the bar in several fine structure lines. They allow us to study the conditions of the photon-dominated region and the interface to the molecular cloud with unprecedented detail.
Another investigation targeted the molecular gas in the BN/KL region of the Orion Nebula, which is stirred up by a violent explosion about 500 years ago. The explosion drives a wide angled molecular outflow. We present maps of several high-J CO observations, allowing us to analyze the heated molecular gas.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- Book:
- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
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Do residents need end-of-life care training?
- Agata Marszalek Litauska, Andrzej Kozikowski, Christian N. Nouryan, Myriam Kline, Renee Pekmezaris, Gisele Wolf-Klein
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- Journal:
- Palliative & Supportive Care / Volume 12 / Issue 3 / June 2014
- Published online by Cambridge University Press:
- 14 May 2013, pp. 195-201
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Objective:
As medical education evolves, emphasis on chronic care management within the medical curriculum becomes essential. Because of the consistent lack of appropriate end-of-life care training, far too many patients die without the benefits of hospice care. This study explores the association between physician knowledge, training status, and level of comfort with hospice care referral of terminally ill patients.
Method:In 2011, anonymous surveys were distributed to physicians in postgraduate years 1, 2, and 3; fellows; hospital attending physicians; specialists; and other healthcare professionals in five hospitals of a large health system in New York. Demographic comparisons were performed using χ2 and Fisher's exact tests. Spearman correlations were calculated to determine if professional status and experience were associated with comfort and knowledge discussing end-of-life topics with terminal patients.
Results:The sample consisted of 280 participants (46.7% response rate). Almost a quarter (22%) did not know key hospice referral criteria. Although 88% of respondents felt that knowledge of hospice care is an important competence, 53.2% still relinquished advance directives discussion to emergency room (ER) physicians. Fear of patient/family anger was the most frequently reported hospice referral barrier, although 96% of physicians rarely experienced reprisals. Physician comfort level discussing end-of-life issues and hospice referral was significantly associated with the number of years practicing medicine and professional status.
Significance of results:Physicians continue to relinquish end-of-life care to ER staff and palliative care consultants. Exploring unfounded and preconceived fears associated with hospice referral needs to be integrated into the curriculum, to prepare future generations of physicians. Medical education should focus on delivering the right amount of end-of-life care training, at the right time, within the medical school and residency curriculum.
Medical orders for life-sustaining treatment: Is it time yet?
- Anna Clarissa Araw, Anna Marissa Araw, Renee Pekmezaris, Christian N. Nouryan, Cristina Sison, Barbara Tommasulo, Gisele P. Wolf-Klein
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- Journal:
- Palliative & Supportive Care / Volume 12 / Issue 2 / April 2014
- Published online by Cambridge University Press:
- 13 May 2013, pp. 101-105
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Objective:
As the aging population faces complex end-of-life issues, we studied the intervals between long-term care admission and advance directive completion, and between completion and death. We also sought to determine the interdisciplinary team's compliance with documented wishes.
Method:A cross-sectional study of 182 long-term care residents in two facilities with and without completed medical orders for life-sustaining treatment (MOLST) in the New York Metropolitan area was conducted. Demographic variables included: gender, age, ethnicity, and diagnosis. Measures included: admission date, MOLST execution date, and date of death. Resident advance directive documentation was compared with clinical intervention at time of death, including intubation and mechanical ventilation.
Results:Of the residents studied, 68.7% were female, 91% were Caucasian and 91.8% were ≥ 65 years of age (mean age: 83). The median time from admission to MOLST signing was 48 days. Median time from admission to MOLST signing for Caucasians was 21 days; for non-Caucasians was 229 days. Fifty-two percent of MOLST were signed by children, and 24% by residents. Of those with signed forms, 25% signed on day of admission, 37% signed within 7 days, and 47% signed within 21 days. Only 3% of residents died the day their MOLST was signed, whereas 12% died within a week, and 22% died within 30 days. Finally, among the 68 subjects who signed a MOLST and died, 87% had their wishes met.
Significance of results:In this era of growing time constraints and increased regulations, medical directors of long-term care facilities and those team members caring for residents urgently need a clear and simple approach to the goals of care for their residents. The MOLST is an ideal tool in caring for older adults at the end of life, providing concrete guidance, not only with regard to do not resuscitate (DNR) and do not intubate (DNI) orders, but also for practical approaches to daily care for the interdisciplinary team.
List of contributors
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- By Samantha Besson, T. R. Gavin Bingham, Ross Buckley, Barnali Choudhury, Thomas Cottier, Brooks W. Daly, Mariel Dimsey, Aline Doussin, Mark Ellis, Jonathan Gass, Christian Häberli, Monica Hakimi, Mariana Hernández-Crespo, Caroline Hess-Klein, Pasha L. Hsieh, Christopher Kee, Stuart Kerr, Markus Krajewski, Emmanuel Laryea, Stephanie B. Leinhardt, Gabrielle Marceau, Sarah Melikian, Bryan Mercurio, Krista Nadakavukaren Schefer, Willa Obel, Colin Picker, Mark Pieth, Ben Thirkell-White, Stephan Wilske, Yvonne Wong
- Edited by Krista Nadakavukaren Schefer, Universität Basel, Switzerland
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- Book:
- Poverty and the International Economic Legal System
- Published online:
- 05 July 2013
- Print publication:
- 21 March 2013, pp xi-xxii
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The Molecular Ridge Close to 30 Doradus in the Large Magellanic Cloud
- Jürgen Ott, Tony Wong, Jorge L. Pineda, Annie Hughes, Erik Muller, Zhi-Yun Li, Min Wang, Lister Staveley-Smith, Yasuo Fukui, Axel Weiß, Christian Henkel, Ulrich Klein
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- Journal:
- Publications of the Astronomical Society of Australia / Volume 25 / Issue 3 / 2008
- Published online by Cambridge University Press:
- 05 March 2013, pp. 129-137
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With the ATNF Mopra telescope we are performing a survey in the 12CO(1–0) line to map the molecular gas in the Large Magellanic Cloud. For some regions we also obtained interferometric maps of the high density gas tracers HCO+ and HCN with the Australia Telescope Compact Array. Here we discuss the properties of the elongated molecular complex that stretches about 2 kpc southward from 30 Doradus. Our data suggest that the complex, which we refer to as the ‘molecular ridge’, is not a coherent feature but consists of many smaller clumps that share the same formation history. Likely triggers of molecular-cloud formation are shocks and shearing forces that are present in the surrounding south-eastern Hi overdensity region, a region influenced by strong ram pressure and tidal forces. The molecular ridge is at the western edge of the the overdensity region where a bifurcated velocity structure transitions into a single disk velocity component. We find that the 12CO(1–0) and Hi emission peaks in the molecular ridge are typically near each other but never coincide. A likely explanation is the conversion of warmer, low-opacity Hi to colder, high-opacity Hi from which H2 subsequently forms. On smaller scales we find that very dense molecular gas, as traced by interferometric HCO+ and HCN maps, is associated with star formation along shocked filaments and with rims of expanding shell-like structures, both created by feedback from massive stars.
Ethnicity, race, and advance directives in an inpatient palliative care consultation service
- Glenn B. Zaide, Renee Pekmezaris, Christian N. Nouryan, Tanveer P. Mir, Cristina P. Sison, Tara Liberman, Martin L. Lesser, Lynda.B. Cooper, Gisele P. Wolf-Klein
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- Journal:
- Palliative & Supportive Care / Volume 11 / Issue 1 / February 2013
- Published online by Cambridge University Press:
- 06 July 2012, pp. 5-11
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Objective:
Although race and ethnic background are known to be important factors in the completion of advance directives, there is a dearth of literature specifically investigating the effect of race and ethnicity on advance directive completion rate after palliative care consultation (PCC).
Method:A chart review of all patients seen by the PCC service in an academic hospital over a 9-month period was performed. Data were compiled using gender, race, ethnicity, religion, and primary diagnosis. For this study, advance directives were defined as: “Do Not Resuscitate” (DNR) and/or “Do Not Intubate” (DNI).
Results:Of the 400 medical records reviewed, 57% of patients were female and 71.3% documented their religion as Christian. The most common documented diagnosis was cancer (39.5%). Forty-seven percent reported their race as white. White patients completed more advance directives than did nonwhite patients both before (25.67% vs. 12.68%) and after (59.36% vs. 40.84%) PCC. There was a significantly higher proportion of whites who signed an advance directive after a PCC than of nonwhites (p = 0.021); of the 139 whites who did not have an advance directive at admission, 63 signed an advance directive after a PCC compared with 186/60 nonwhites (45% vs. 32%, respectively, p = 0.021). Further analysis revealed that African Americans differed from whites in the likelihood of advance directive execution rates pre-PCC, but not post-PCC.
Significance of results:This study demonstrates the impact of a PCC on the completion of advance directives, on both whites and nonwhites. The PCC Intervention significantly reduced differences between whites and African Americans in completing advance directives, which have been consistently documented in the end-of-life literature.
Chapter 3 - Changes in Climate Extremes and their Impacts on the Natural Physical Environment
- from Section III
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- By Sonia I. Seneviratne, Neville Nicholls, David Easterling, Clare M. Goodess, Shinjiro Kanae, James Kossin, Yali Luo, Jose Marengo, Kathleen McInnes, Mohammad Rahimi, Markus Reichstein, Asgeir Sorteberg, Carolina Vera, Xuebin Zhang, Matilde Rusticucci, Vladimir Semenov, Lisa V. Alexander, Simon Allen, Gerardo Benito, Tereza Cavazos, John Clague, Declan Conway, Paul M. Della-Marta, Markus Gerber, Sunling Gong, B. N. Goswami, Mark Hemer, Christian Huggel, Bart van den Hurk, Viatcheslav V. Kharin, Akio Kitoh, Albert M.G. Klein Tank, Guilong Li, Simon Mason, William McGuire, Geert Jan van Oldenborgh, Boris Orlowsky, Sharon Smith, Wassila Thiaw, Adonis Velegrakis, Pascal Yiou, Tingjun Zhang, Tianjun Zhou, Francis W. Zwiers
- Edited by Christopher B. Field, Vicente Barros, Thomas F. Stocker, Qin Dahe
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- Book:
- Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation
- Published online:
- 05 August 2012
- Print publication:
- 28 May 2012, pp 109-230
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Summary
Executive Summary
This chapter addresses changes in weather and climate events relevant to extreme impacts and disasters. An extreme (weather or climate) event is generally defined as the occurrence of a value of a weather or climate variable above (or below) a threshold value near the upper (or lower) ends (‘tails’) of the range of observed values of the variable. Some climate extremes (e.g., droughts, floods) may be the result of an accumulation of weather or climate events that are, individually, not extreme themselves (though their accumulation is extreme). As well, weather or climate events, even if not extreme in a statistical sense, can still lead to extreme conditions or impacts, either by crossing a critical threshold in a social, ecological, or physical system, or by occurring simultaneously with other events. A weather system such as a tropical cyclone can have an extreme impact, depending on where and when it approaches landfall, even if the specific cyclone is not extreme relative to other tropical cyclones. Conversely, not all extremes necessarily lead to serious impacts. [3.1]
Many weather and climate extremes are the result of natural climate variability (including phenomena such as El Niño), and natural decadal or multi-decadal variations in the climate provide the backdrop for anthropogenic climate changes. Even if there were no anthropogenic changes in climate, a wide variety of natural weather and climate extremes would still occur. [3.1]
A changing climate leads to changes in the frequency, intensity, spatial extent, duration, and timing of weather and climate extremes, and can result in unprecedented extremes. Changes in extremes can also be directly related to changes in mean climate, because mean future conditions in some variables are projected to lie within the tails of present-day conditions. Nevertheless, changes in extremes of a climate or weather variable are not always related in a simple way to changes in the mean of the same variable, and in some cases can be of opposite sign to a change in the mean of the variable. Changes in phenomena such as the El Nino-Southern Oscillation or monsoons could affect the frequency and intensity of extremes in several regions simultaneously. [3.1]
Contributors
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- By Gregory H. Adkisson, Ozan Akça, Nawar Al-Rawas, John T. Anderson, Richard M. Bednarski, Francesca Bernabè, David G. Bjoraker, Lluis Blanch, Stephan H. Böhm, Edwin A. Bowe, Philip G. Boysen, Justin C. Cahill, Ira M. Cheifetz, David C. Cone, Nancy Craig, Daniel P. Davis, John B. Downs, Ronald Dueck, Jay L. Falk, Roger Fletcher, Michael A. Frakes, Andrea Gabrielli, Thomas J. Gallagher, Geoff Gilmartin, J. S. Gravenstein, Antonino Gullo, Donna Hamel, John W. Huang, Amy V. Isenberg, Michael B. Jaffe, Michael C. K. Khoo, Robert R. Kirby, E. F. Klein, A. Joseph Layon, Umberto Lucangelo, Emilio Maldonado, Paul E. Marik, Alicia E. Meuret, Timothy E. Morey, William Muir, Joseph A. Orr, Mehmet S. Ozcan, Lucía Isabel Passoni, David A. Paulus, Yong G. Peng, Carl W. Peters, George A. Ralls, Adriana G. Scandurra, Peter W. Scherer, Gerd Schmalisch, Adam Seiver, Salvatore Silvestri, Bob Smalhout, Fernando Suarez-Sipmann, Daniel E. Supkis, John Thompson, Patrick Troy, Jonathon D. Truwit, Gerardo Tusman, Joseph Varon, Ajeet G. Vinayak, Kevin R. Ward, Marvin A. Wayne, Charles Weissman, Dafna Willner, Kai Zhao, Christian C. Zuver
- Edited by J. S. Gravenstein, University of Florida, Michael B. Jaffe, Nikolaus Gravenstein, University of Florida, David A. Paulus, University of Florida
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- Book:
- Capnography
- Published online:
- 05 August 2011
- Print publication:
- 17 March 2011, pp ix-xii
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Contributors
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- By Nalini Vadivelu, Christian J. Whitney, Raymond S. Sinatra, M. Khurram Ghori, Yu-Fan (Robert) Zhang, Raymond S. Sinatra, Joshua Wellington, Yuan-Yi Chia, Francis J. Keefe, Jon McCormack, Ian Power, John Butterworth, P. M. Lavand’homme, M. F. De Kock, Bradley Urie, Oscar A. de Leon-Casasola, Frederick M. Perkins, Larry F. Chu, David Clark, Martin S. Angst, Cynthia M. Welchek, Lisa Mastrangelo, Raymond S. Sinatra, Richard Martinez, Scott S. Reuben, Asokumar Buvanendran, Raymond S. Sinatra, Pamela E Macintyre, Julia Coldrey, Daniel B. Maalouf, Spencer S. Liu, Susan Dabu-Bondoc, Samantha A. Franco, Raymond S. Sinatra, James Benonis, Jennifer Fortney, David Hardman, Gavin Martin, Holly Evans, Karen C. Nielsen, Marcy S. Tucker, Stephen M. Klein, Benjamin Sherman, Ikay Enu, Raymond S. Sinatra, James W. Heitz, Eugene R. Viscusi, Jonathan S. Jahr, Kofi N. Donkor, Raymond S. Sinatra, Manzo Suzuki, Johan Raeder, Vegard Dahl, Stefan Erceg, Keun Sam Chung, Kok-Yuen Ho, Tong J. Gan, Dermot R. Fitzgibbon, Paul Willoughby, Brian E. Harrington, Joseph Marino, Tariq M. Malik, Raymond S. Sinatra, Giorgio Ivani, Valeria Mossetti, Simona Italiano, Thomas M. Halaszynski, Nousheh Saidi, Javier Lopez, Kate Miller, Ferne Braveman, Jaya L. Varadarajan, Steven J. Weisman, Sukanya Mitra, Raymond S. Sinatra, Theodore J. Saclarides, Knox H. Todd, James R. Miner, Chris Pasero, Nancy Eksterowicz, Margo McCaffery, Leslie N. Schechter, Amr E. Abouleish, Govindaraj Ranganathan, Tee Yong Tan, Stephan A. Schug, Marie N. Hanna, Spencer S. Liu, Christopher L. Wu, Craig T. Hartrick, Garen Manvelian, Christine Miaskowski, Brian Durkin, Peter S. A. Glass
- Edited by Raymond S. Sinatra, Oscar A. de Leon-Cassasola, University of Rochester Medical Center, New York, Eugene R. Viscusi, Brian Ginsberg
- Foreword by Henry McQuay
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- Book:
- Acute Pain Management
- Published online:
- 26 October 2009
- Print publication:
- 27 April 2009, pp vii-xii
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Dark Galaxies: How about this one?
- Christian Struve, Gyula I.G. Józsa, Franz Kenn, Uli Klein, Gianfranco Gentile
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- Journal:
- Proceedings of the International Astronomical Union / Volume 3 / Issue S244 / June 2007
- Published online by Cambridge University Press:
- 01 June 2007, pp. 387-388
- Print publication:
- June 2007
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We report on the (serendipitous) detection and analysis of an extremely massive HI cloud without an obvious stellar counterpart nearby the relatively isolated giant spiral galaxy NGC 1030 and present first results of this dark galaxy candidate.
Self-approaching curves
- CHRISTIAN ICKING, ROLF KLEIN, ELMAR LANGETEPE
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- Journal:
- Mathematical Proceedings of the Cambridge Philosophical Society / Volume 125 / Issue 3 / January 1999
- Published online by Cambridge University Press:
- 01 January 1999, pp. 441-453
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- January 1999
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We present a new class of curves which are self-approaching in the following sense. For any three consecutive points a, b, c on the curve the point b is closer to c than a to c. This is a generalisation of curves with increasing chords which are self- approaching in both directions. We show a tight upper bound of 5·3331… for the length of a self-approaching curve over the distance between its endpoints.