“My Future is Now”: A Qualitative Study of Persons Living With Advanced Cancer

Objectives: Advance care planning (ACP) enables individuals to deliberate about future preferences for care based upon their values and beliefs about what is important in life. For many patients with advanced cancer, however, these critical conversations do not occur. A growing body of literature has examined the end-of-life wishes of seriously ill patients. Few studies have explored what is important to persons as they live with advanced cancer. The aim of the current study was to address this gap and to understand how clinicians can support patients’ efforts to live in the present and plan for the future. Methods: Transcriptions of interviews conducted with 36 patients diagnosed with advanced cancer were analyzed using immersion–crystallization, a qualitative research technique. Results: Four overarching themes were identified: (I) living in the face of death, (II) who I am, (III) my experience of cancer, and (IV) impact of my illness on others. Twelve subthemes are also reported. Significance of Results: These findings have significant implications for clinicians as they partner with patients to plan for the future. Our data suggest that clinicians consider the following 4 prompts: (1) “What is important to you now, knowing that you will die sooner than you want or expected?” (2) “Tell me about yourself.” (3) “Tell me in your own words about your experience with cancer care and treatment.” (4) “What impact has your illness had on others?” In honoring patients’ lived experiences, we may establish the mutual understanding necessary to providing high-quality care that supports patients’ priorities for life

Possible Cosmological Implications of the Quark-Hadron Phase Transition

We study the quark-hadron phase transition within an effective model of QCD, and find that in a reasonable range of the main parameters of the model, bodies with quark content between $10^{-2}$ and 10 solar masses can have been formed in the early universe. In addition, we show that a significant amount of entropy is released during the transition. This may imply the existence of a higher baryon number density than what is usually expected at temperatures above the QCD scale. The cosmological QCD transition may then provide a natural way for decreasing the high baryon asymmetry created by an Affleck-Dine like mechanism down to the value required by primordial nucleosynthesis.Comment: 19 pages, LaTeX, 5 Postscript figures included. Submitted to Journal of Physics

Physicians in Postgraduate Training Characteristics and Support of Palliative Sedation for Existential Distress

Introduction: Palliative sedation for refractory existential distress (PS-ED) is ethically troubling but potentially critical to quality end-of-life (EOL) care. Physicians’ in postgraduate training support toward PS-ED is unknown nor is it known how empathy, hope, optimism, or intrinsic religious motivation (IRM) affect their support. These knowledge gaps hinder efforts to support physicians who struggle with patients’ EOL care preferences. Methods: One hundred thirty-four postgraduate physicians rated their support of PS for refractory physical pain (PS-PP) or PS-ED, ranked the importance of patient preferences in ethically challenging situations, and completed measures of empathy, hope, optimism, and IRM. Predictors of PS-ED and PS-PP support were examined using binary and multinomial logistic regression. Results: Only 22.7% of residents were very supportive of PS-ED, and 82.0% were very supportive of PS-PP. Support for PS-PP or PS-ED did not correlate with levels of empathy, hope, optimism, or IRM; however, for residents with lower IRM, greater optimism was associated with greater PS-ED support. In contrast, among residents with higher IRM, optimism was not associated with PS-ED support. Conclusions: Comparing current results to published surveys, a similar proportion of residents and practicing physicians support PS-ED and PS-PP. In contrast to practicing physicians, however, IRM does not directly influence residents’ supportiveness. The interaction between optimism and IRM suggests residents’ beliefs and characteristics are salient to their EOL decisions. End-of-life curricula should provide physicians opportunities to reflect on the personal and ethical factors that influence their support for PS-ED

The Spectrum of Integrated Millimeter Flux of the Magellanic Clouds and 30-Doradus from TopHat and DIRBE Data

We present measurements of the integrated flux relative to the local background of the Large and Small Magellanic Clouds and the region 30-Doradus (the Tarantula Nebula) in the LMC in four frequency bands centered at 245, 400, 460, and 630 GHz, based on observations made with the TopHat telescope. We combine these observations with the corresponding measurements for the DIRBE bands 8, 9, and 10 to cover the frequency range 245 - 3000 GHz (100 - 1220 micrometers) for these objects. We present spectra for all three objects and fit these spectra to a single-component greybody emission model and report best-fit dust temperatures, optical depths, and emissivity power-law indices, and we compare these results with other measurements in these regions and elsewhere. Using published dust grain opacities, we estimate the mass of the measured dust component in the three regions.Comment: 41 pages, 4 figures. Accepted for publication in Astrophysical Journa

Localization via Automorphisms of the CARs. Local gauge invariance

The classical matter fields are sections of a vector bundle E with base manifold M. The space L^2(E) of square integrable matter fields w.r.t. a locally Lebesgue measure on M, has an important module action of C_b^\infty(M) on it. This module action defines restriction maps and encodes the local structure of the classical fields. For the quantum context, we show that this module action defines an automorphism group on the algebra A, of the canonical anticommutation relations on L^2(E), with which we can perform the analogous localization. That is, the net structure of the CAR, A, w.r.t. appropriate subsets of M can be obtained simply from the invariance algebras of appropriate subgroups. We also identify the quantum analogues of restriction maps. As a corollary, we prove a well-known "folk theorem," that the algebra A contains only trivial gauge invariant observables w.r.t. a local gauge group acting on E.Comment: 15 page

Central Nucleon-Nucleon Potential and Chiral Scalar Form Factor

The central two-pion exchange NN potential at large distances is studied in the framework of relativistic chiral symmetry and related directly to the nucleon scalar form factor, which describes the mass density of its pion cloud. This relationship is well supported by phenomenology and allows the dependence of the asymptotic potential on the nucleon mass to be assessed. Results in the heavy baryon limit are about 25% larger than those corresponding to the empirical nucleon mass in the region of physical interest. This indicates that it is very important to keep this mass finite in precise descriptions of the NN system and supports the efficacy of the relativistic chiral framework. One also estimates the contribution of subleading effects and presents a simple discussions of the role of the quark condensate in this problem.Comment: 16 pages, 8 figure

New CMB Power Spectrum Constraints from MSAMI

We present new cosmic microwave background (CMB) anisotropy results from the combined analysis of the three flights of the first Medium Scale Anisotropy Measurement (MSAM1). This balloon-borne bolometric instrument measured about 10 square degrees of sky at half-degree resolution in 4 frequency bands from 5.2 icm to 20 icm with a high signal-to-noise ratio. Here we present an overview of our analysis methods, compare the results from the three flights, derive new constraints on the CMB power spectrum from the combined data and reduce the data to total-power Wiener-filtered maps of the CMB. A key feature of this new analysis is a determination of the amplitude of CMB fluctuations at $\ell \sim 400$. The analysis technique is described in a companion paper by Knox.Comment: 9 pages, 6 included figure

Constraining the variation of the coupling constants with big bang nucleosynthesis

We consider the possibility of the coupling constants of the $SU(3)\times SU(2)\times U(1)$ gauge interactions at the time of big bang nucleosynthesis having taken different values from what we measure at present, and investigate the allowed difference requiring the shift in the coupling constants not violate the successful calculation of the primordial abundances of the light elements. We vary gauge couplings and Yukawa couplings (fermion masses) using a model in which their relative variations are governed by a single scalar field, dilaton, as found in string theory. The results include a limit on the fine structure constant $-6.0\times10^{-4}<\Delta\alpha_{EM}/\alpha_{EM}<1.5\times10^{-4}$, which is two orders stricter than the limit obtained by considering the variation of $\alpha_{EM}$ alone.Comment: 7 page