Oncology and palliative care

Oncology developed as a discipline over the last decades. Treatment is concentrated on cure or palliation of the illness with the help of chemotherapy, radiotherapy or surgery. Palliative care has its origin in the hospice movement that started around 1960 in the UK. Centre of care is the patient and his family. Focus of care has moved from quantity to quality of life. Symptom control, communication, rehabilitation and care for the dying are main areas of palliative care. Palliative care and palliative medicine have only developed over the last 10 years in Germany. It is still seen as care for the dying after completion of oncological treatment. The integration of palliative care in earlier stages of the disease is essential to offer a continuity of care for the patient and his family. Principles of palliative care need also be part of medical and post-graduate training

Normative, systemic and procedural aspects: a review of indicator‐based sustainability assessments in agriculture

Several methods for assessing the sustainability of agricultural systems have been developed. These methods do not fully: (i) take into account the multi‐functionality of agriculture; (ii) include multidimensionality; (iii) utilize and implement the assessment knowledge; and (iv) identify conflicting goals and trade‐offs. This paper reviews seven recently developed multidisciplinary indicator‐based assessment methods with respect to their contribution to these shortcomings. All approaches include (1) normative aspects such as goal setting, (2) systemic aspects such as a specification of scale of analysis, (3) a reproducible structure of the approach. The approaches can be categorized into three typologies. The top‐down farm assessments focus on field or farm assessment. They have a clear procedure for measuring the indicators and assessing the sustainability of the system, which allows for benchmarking across farms. The degree of participation is low, potentially affecting the implementation of the results negatively. The top‐down regional assessment assesses the on‐farm and the regional effects. They include some participation to increase acceptance of the results. However, they miss the analysis of potential trade‐offs. The bottom‐up, integrated participatory or transdisciplinary approaches focus on a regional scale. Stakeholders are included throughout the whole process assuring the acceptance of the results and increasing the probability of implementation of developed measures. As they include the interaction between the indicators in their system representation, they allow for performing a trade‐off analysis. The bottom‐up, integrated participatory or transdisciplinary approaches seem to better overcome the four shortcomings mentioned above

Age, growth, and spawning season of red bream (Beryx decadactylus) off the southeastern United States

Red bream (Beryx decadactylus) is a commercially important deep-sea benthopelagic fish with a circumglobal distribution on insular and continental slopes and seamounts. In the United States, small numbers are caught incidentally in the wreckfish (Polyprion americanus) fishery which operates off the southeastern coast, but no biological information exists for the management of the U.S. red bream population. For this study, otoliths (n=163) and gonads (n=161) were collected from commercially caught red bream between 2003 and 2008 to determine life history parameters. Specimens ranged in size from 410 to 630 mm fork length and were all determined to be mature by histological examination of the gonads. Females in spawning condition were observed from June through September, and reproductively active males were found year-round. Sectioned otoliths were difficult to interpret, but maximum age estimates were much higher than the 15 years previously reported for this species from the eastern North Atlantic based on whole-otolith analysis. Estimated ages ranged from 8 to 69 years, and a minimum lifespan of 49 years was validated by using bomb radiocarbon dating. Natural mortality was estimated at 0.06/yr. This study shows that red bream are longer lived and more vulnerable to overfishing than previously assumed and should be managed carefully to prevent overexploitation

Adrenal insufficiency caused by bilateral adrenal metastases - a rare treatable cause for recurrent nausea and vomiting in metastatic breast cancer

Background: Nausea and vomiting are common symptoms in patients with malignant disease. Several, sometimes rare causes have to be considered to decide the right treatment. Case Report: We report of a patient suffering from advanced breast cancer and complaining of severe nausea and vomiting over several weeks without any successful treatment. Later on, she developed marked hyperpigmentation of the skin and hypo-osmolar dehydration. Adrenal enlargement was noted in an abdominal scan. The suspected diagnosis of primary adrenocortical insufficiency due to metastases was confirmed by laboratory tests. After replacement therapy with hydrocortisone and fludrocortisone, the general condition of the patient improved dramatically and the symptoms of nausea and vomiting disappeared completely. Conclusion: If a patient with advanced cancer presents with unexplained and protracted nausea, vomiting and weakness, particularly if accompanied by hyponatremia and normal potassium levels, adrenal insufficiency due to adrenal metastases should be considered

Optimized Jastrow-Slater wave functions for ground and excited states: Application to the lowest states of ethene

A quantum Monte Carlo method is presented for determining multi-determinantal Jastrow-Slater wave functions for which the energy is stationary with respect to the simultaneous optimization of orbitals and configuration interaction coefficients. The approach is within the framework of the so-called energy fluctuation potential method which minimizes the energy in an iterative fashion based on Monte Carlo sampling and a fitting of the local energy fluctuations. The optimization of the orbitals is combined with the optimization of the configuration interaction coefficients through the use of additional single excitations to a set of external orbitals. A new set of orbitals is then obtained from the natural orbitals of this enlarged configuration interaction expansion. For excited states, the approach is extended to treat the average of several states within the same irreducible representation of the pointgroup of the molecule. The relationship of our optimization method with the stochastic reconfiguration technique by Sorella et al. is examined. Finally, the performance of our approach is illustrated with the lowest states of ethene, in particular with the difficult case of the singlet 1B_1u state.Comment: 12 pages, 2 figure

Divisors on Rational Normal Scrolls

Let $A$ be the homogeneous coordinate ring of a rational normal scroll. The ring $A$ is equal to the quotient of a polynomial ring $S$ by the ideal generated by the two by two minors of a scroll matrix $\psi$ with two rows and $\ell$ catalecticant blocks. The class group of $A$ is cyclic, and is infinite provided $\ell$ is at least two. One generator of the class group is $[J]$, where $J$ is the ideal of $A$ generated by the entries of the first column of $\psi$. The positive powers of $J$ are well-understood, in the sense that the $n^{\text{th}}$ ordinary power, the $n^{th}$ symmetric power, and the $n^{th}$ symbolic power all coincide and therefore all three $n^{th}$ powers are resolved by a generalized Eagon-Northcott complex. The inverse of $[J]$ in the class group of $A$ is $[K]$, where $K$ is the ideal generated by the entries of the first row of $\psi$. We study the positive powers of $[K]$. We obtain a minimal generating set and a Groebner basis for the preimage in $S$ of the symbolic power $K^{(n)}$. We describe a filtration of $K^{(n)}$ in which all of the factors are Cohen-Macaulay $S$-modules resolved by generalized Eagon-Northcott complexes. We use this filtration to describe the modules in a finely graded resolution of $K^{(n)}$ by free $S$-modules. We calculate the regularity of the graded $S$-module $K^{(n)}$ and we show that the symbolic Rees ring of $K$ is Noetherian.Comment: 32 page