An expanded lower Eocene shelf sequence from the eastern Aquitaine Basin, SW France: biostratigraphy, biofacies, and stable carbon and oxygen isotopes

The early Eocene is characterized by a succession of orbitally-controlled global stable carbon isotope excursions, with some being linked to climatic and related biotic perturbations. The impact of these isotopic excursions has been primarily studied in deep-sea sections under comparably stable conditions. In order to investigate the impact of global post-PETM isotopic signals on shallow marine settings, the Ypresian neritic ʻBlue Marls’ of the Corbières (SW France) were investigated. High-resolution records of microfossil biota and stable carbon and oxygen isotopes pinpoint biostratigraphic, paleoecologic and geochemic constraints. Calcareous nannofossil biostratigraphy positions the sequence in the upper part of zone NP11, possibly ranging into basal NP12, which is conformable with larger benthic foraminifera data indicating shallow benthic zone SBZ8. This implies a time span of about 0.4 Myr and high overall sedimentation rates of about ~ 32 cm/kyr for the section. A shallowing upward trend from outer neritic to coastal settings is observed in the development of the lithostratigraphy and the microfossil assemblage. The assemblages can be subdivided in seven larger biofacies and four ostracod assemblage zones. The lower third of the section is characterized by strongly fluctuating and partly high plankton/benthos-ratios for neritic settings. A final pronounced peak in plankton occurrence is associated with strong decrease of benthic biota, suggesting anoxic conditions in the outer neritic environment. Several local negative δ13C- and δ18O-excursions can be identified in the section. The upper, most pronounced and consistent negative δ13C excursion is tentatively linked to global carbon isotope excursion K (ETM3) based on the biostratigraphic constraints.status: publishe

Did you seek assistance for writing your advance directive? A qualitative study

BACKGROUND: The completion of an advanced directive is paired with a high degree of self-responsibility of the signatory. It requires anticipation of probably complex medical situations. In the literature, the family physician is often seen as the most important person for advice when writing an advance directive. But little is known about whether or not patients want to involve medical advisors and to what extent physicians are willing to give advice. The aim of this study was to analyse whether or not individuals approached advisors for the completion of their advance directive, whom they chose and which reasons were given for seeking or foregoing assistance. METHODS: Semi-structured interviews with healthy individuals, chronically ill individuals and patients in palliative care including questions associated with advice for completing an advance directive (8/2008-7/2009). Inclusion criteria: age 55-70 years and advance directive a parts per thousand yen3 months old. The interviews were fully transcribed according to standard transcription rules and analysed applying an inductive category development. RESULTS: Interviews were conducted with 53 probands (healthy n = 20, chronically ill n = 17, palliative care patients n = 16); 18 probands were male. Mean age was 63.2 +/- 4.4 years (range 55-70 years). Professional advice was sought by 12 probands (physician = 2, nurse = 1, lawyer/notary = 8, self-employed advisor = 1), another 8 probands included family members. In 17 cases, the physician knew the proband's advance directive, 36 probands never told their doctor about its existence. Categories of reasons for seeking or foregoing advice were trust/lack of trust, autonomy, rejection and financial considerations. CONCLUSIONS: Information about the medical implications concerning patient preferences for end-of-life care seems not to be the main focus of interest when individuals write an advance directive. Autonomy and trust into notarially certified documents seem to be more important matters. If family physicians want to have a role in their patients' completing of an advance directive, they should proactively get in touch with them

To what extent are the wishes of a signatory reflected in their advance directive: a qualitative analysis

Background: Advance directives (ADs) are assumed to reflect the patients' preferences, even if these are not clearly expressed. Research into whether this assumption is correct has been lacking. This study explores to what extent ADs reflect the true wishes of the signatories. Methods: Semi-structured interviews (INT), pretest. Transcribed INT and the contents of ADs were inductively categorised (Mayring) and triangulated. Software: MAXQDA 2007. Participants: Patients receiving palliative care (PPC), healthy (H) and chronically ill (CI) individuals with an AD completed >= 3 months prior to recruitment. Results: Between 08/2008 and 07/2009, 53 individuals (20 H, 17 CI, 16 PPC) were interviewed (mean age 63.2 years (55-70 years)), 34% male). Most important (in) consistencies between preferences as expressed in INT compared to ADs included preconditions for termination/rejection of life-sustaining measures, refusal of/demand for medical interventions and the nomination of proxies. Standardized AD forms were rarely tailored to the individual. We found a high tendency to use set phrases, such as want to die with dignity or do not want to suffer/vegetate. Likely events in the course of an existing progressive disease were not covered, even in ADs of PPC close to death. Conclusions: Only some of the incongruities between verbally expressed preferences and the contents of the AD can be put down to use of standardized forms or lack of medical knowledge. Nevertheless, the non-involvement of a doctor in the process of making an AD must be seen as potentially problematic and seeking medical advice should be promoted by politics and physicians. Standardised forms should encourage amendments and present space for free text entries for all aspects covered. Set phrases need to be defined by the individual to enable them to be translated into a specific course of action

Ubiquitin immunoreactivity in cerebrospinal fluid after traumatic brain injury: Clinical and experimental findings

OBJECTIVE:Recent data indicate that ubiquitin is increased in serum after trauma and might regulate immune functions. Its cellular source is unknown. Because there have been no previous studies after traumatic brain injury (TBI), we determined whether ubiquitin immunoreactivity is increased in cerebrospinal fluid (CSF) after TBI. DESIGN AND SETTING:Prospective observational study of patients, with a subsequent interventional study of animals. SUBJECTS:The subjects were 14 patients with TBI, five patients with nontraumatic subarachnoid hemorrhage, ten nonneurologic controls, and seven cross-bred swine. INTERVENTIONS:Standardized TBI. MEASUREMENTS AND MAIN RESULTS:Ubiquitin immunoreactivity was analyzed by enzyme-linked immunosorbent assay and immunoblotting. Hemolysis was assessed spectrophotometrically. CSF ubiquitin levels (mean ± sd) were 19 ± 3 ng/mL in nonneurologic control patients, 81 ± 48 ng/mL at 7 ± 2 hrs after TBI (p = .002), and at the end of operation in patients with nontraumatic subarachnoid hemorrhage they were 104 ± 68 ng/mL (p = .001). CSF and serum ubiquitin were measured for 7 days in six patients with TBI. In survivors (n = 3), CSF ubiquitin levels progressively recovered, whereas in nonsurvivors (n = 3), the levels increased until death. There was no difference in serum ubiquitin levels between survivors/nonsurvivors and there was no correlation between serum and CSF ubiquitin levels. In swine, CSF ubiquitin levels peaked at 8- to 30-fold higher than baseline at 60 min post-TBI and then declined with a half-life of 1.3 hrs. In CSF with hemolysis, peak ubiquitin levels were five-fold higher than without hemolysis (p < .05). Ubiquitin and hemoglobin correlations in CSF and after in vitro lysis of erythrocytes suggested that erythrolysis could account for no more than 23 ± 16% of the CSF ubiquitin. CONCLUSIONS:CSF ubiquitin levels are increased more than four-fold in patients after TBI and nontraumatic subarachnoid hemorrhage. Peak CSF ubiquitin measurements in patients with TBI probably underestimated the actual peak, on the basis of data from the animal model. The progressive rise in CSF ubiquitin in patients with TBI who died suggests that lack of clearance could reflect lethal progression to irreversible brain damage. Erythrolysis is one potential source of CSF ubiquitin

The declaration of the King of Nauarre [electronic resource] : touching the slaunders published against him in the protestations of those of the League that are rysen up in armes in this realme of Fraunce. With priuiledge. Truely translated into English according to the French copie.

A translation of: Dâeclaration du roy de Navarre sur les calomnies publiâees contre luy áes protestations de ceux de la Ligue qui se sont eslevez en ce royaume.Attributed to Mornay, Philippe de--STC. Translator's dedication signed: Claudius Hollyband.Reproduction of the original in the British Library.STC (2nd ed.)Electronic reproduction