Ozone Response to Aircraft Emissions: Sensitivity Studies with Two-dimensional Models

Our first intercomparison/assessment of the effects of a proposed high-speed civil transport (HSCT) fleet on the stratosphere is presented. These model calculations should be considered more as sensitivity studies, primarily designed to serve the following purposes: (1) to allow for intercomparison of model predictions; (2) to focus on the range of fleet operations and engine specifications giving minimal environmental impact; and (3) to provide the basis for future assessment studies. The basic scenarios were chosen to be as realistic as possible, using the information available on anticipated developments in technology. They are not to be interpreted as a commitment or goal for environmental acceptability

Prevalence of sessile serrated adenoma/polyp in hyperplastic appearing diminutive rectosigmoid polyps

Background The American Society for Gastrointestinal Endoscopy recommends that distal colon hyperplastic lesions can be left in place without resection if adenomatous histology can be excluded with > 90% negative predictive value. However, some of the lesions could be sessile serrated adenoma/polyp (SSA/P), which is also precancerous. Aim Describe the prevalence of SSA/P in hyperplastic appearing diminutive rectosigmoid polyps. Methods We prospectively placed 513 consecutive diminutive rectosigmoid polyps that appeared hyperplastic to an expert endoscopist in individual bottles for pathologic examination. Each polyp was examined by 3 expert gastrointestinal pathologists. Results The prevalence of SSA/P in the study polyps ranged from 0.6% to 2.1%. The endoscopists lowest negative predictive value for the combination of adenomas plus SSA/P was 96.7% Conclusions The prevalence of SSA/P in diminutive rectosigmoid hyperplastic appearing polyps is very low. These results support the safety and feasibility of a “do not resect” policy for diminutive hyperplastic appearing rectosigmoid polyps

Long-Term Assessment of the Cecal Intubation Rates in High-Performing Colonoscopists: Time for Review

Objectives: The cecal intubation rate (CIR) is one of the 3 priority indicators for quality in colonoscopy. Whether continuous measurement of CIR is useful in high performers is uncertain. Methods: At an academic center, we identified 16 physicians who performed at least 50 procedures over 6 consecutive years. We analyzed all colonoscopy procedures excluding those with poor/inadequate preparation or severe colitis for CIR trend over the years. We calculated the numbers needed to establish CIR over minimum threshold levels with 95% confidence. Results: The overall CIR was 99.4%. None of the 16 physicians had a CIR 95%. Discussion: Continuous measurement of CIR, at least in high performers, appears to be of limited value. Very high performers need to evaluate small number of cases to demonstrate that CIR is above the recommended thresholds

The intention to hasten death: a survey of attitudes and practices of surgeons in Australia

Objective: To determine attitudes among surgeons in Australia to assisted death, and the proportion of surgeons who have intentionally hastened death with or without an explicit request. Design: Anonymous, cross-sectional, mail-out survey between August and November 1999. Participants: 683 out of 992 eligible general surgeons (68.9% response rate). Main outcome measures: Proportion of respondents answering affirmatively to questions about administering excessive doses of medication with an intention to hasten death. Results: 247 respondents (36.2%; 95% CI, 32.6%-39.9%) reported that, for the purpose of relieving a patient's suffering, they have given drugs in doses that they perceived to be greater than those required to relieve symptoms with the intention of hastening death. More than half of these (139 respondents; 20.4% of all respondents; 95% CI, 17.4%-23.6%) reported that they had never received an unambiguous request for a lethal dose of medication. Of all respondents, only 36 (5.3%; 95% CI, 2.9%-6.1%) reported that they had given a bolus lethal injection, or had provided the means to commit suicide, in response to an unambiguous request. Conclusions: More than a third of surgeons surveyed reported giving drugs with an intention to hasten death, often in the absence of an explicit request. However, in many instances, this may involve the use of an infusion of analgesics or sedatives, and such actions may be difficult to distinguish from accepted palliative care, except on the basis of the doctor's self-reported intention. Legal and moral distinctions based solely on a doctor's intention are problematic

The intention to hasten death: a survey of attitudes and practices of surgeons in Australia

Objective: To determine attitudes among surgeons in Australia to assisted death, and the proportion of surgeons who have intentionally hastened death with or without an explicit request. Design: Anonymous, cross-sectional, mail-out survey between August and November 1999. Participants: 683 out of 992 eligible general surgeons (68.9% response rate). Main outcome measures: Proportion of respondents answering affirmatively to questions about administering excessive doses of medication with an intention to hasten death. Results: 247 respondents (36.2%; 95% CI, 32.6%-39.9%) reported that, for the purpose of relieving a patient's suffering, they have given drugs in doses that they perceived to be greater than those required to relieve symptoms with the intention of hastening death. More than half of these (139 respondents; 20.4% of all respondents; 95% CI, 17.4%-23.6%) reported that they had never received an unambiguous request for a lethal dose of medication. Of all respondents, only 36 (5.3%; 95% CI, 2.9%-6.1%) reported that they had given a bolus lethal injection, or had provided the means to commit suicide, in response to an unambiguous request. Conclusions: More than a third of surgeons surveyed reported giving drugs with an intention to hasten death, often in the absence of an explicit request. However, in many instances, this may involve the use of an infusion of analgesics or sedatives, and such actions may be difficult to distinguish from accepted palliative care, except on the basis of the doctor's self-reported intention. Legal and moral distinctions based solely on a doctor's intention are problematic

On the nature of the ultraluminous X-ray transient in Cen~A (NGC 5128)

We combine 9 ROSAT, 9 Chandra, and 2 XMM-Newton observations of the Cen~A galaxy to obtain the X-ray light curve of 1RXH J132519.8-430312 (=CXOU J132519.9$-$430317) spanning 1990 to 2003. The source reached a peak 0.1-2.4 keV flux F_X>10^{-12} ergs cm^{-2} s^{-1} during a 10~day span in 1995 July. The inferred peak isotropic luminosity of the source therefore exceeded 3 10^{39} ergs s^{-1}, which places the source in the class of ultra-luminous X-ray sources. Coherent pulsations at 13.264 Hz are detected during a second bright episode (F_X >3 times 10^{-13} ergs cm^{-2} s^{-1}) in 1999 December. The source is detected and varies significantly within three additional observations but is below the detection threshold in 7 observations. The X-ray spectrum in 1999 December is best described as a cut-off power law or a disk-blackbody (multi-colored disk). We also detect an optical source, m_F555W ~ 24.1 mag, within the Chandra error circle of 1RXH J132519.8-430312 in HST images taken 195~days before the nearest X-ray observation. The optical brightness of this source is consistent with a late O or early B star at the distance of Cen A. If the optical source is the counterpart, then the X-ray and optical behavior of 1RXH J132519.8-430312 are similar to the transient Be/X-ray pulsar A 0538-66.Comment: 7 pages, 8 figures. ApJ (accepted