Completion of Advance Directives: Do Social Work Preadmission Interviews Make a Difference?

Objectives: This study tests the efficacy of a preadmission, educational interview on advance directives, in this case, health care proxies (HCPs) offered to elective, orthopedic patients. Method: Using a quasi-experimental design, participants (n = 54) are assigned to either treatment group (who received the educational interview, conducted by a social worker, over and above the federally mandated written information on HCPs) or comparison group (who received the written information only). Results: Logistic regression analysis indicates there is a statistically significantly higher probability that a patient would sign an HCP if assigned to the treatment group than if assigned to the comparison condition. Conclusion: Benefits of educating patients about HCPs as part of routine social work practice are outlined

Mid Pleistocene foraminiferal mass extinction coupled with phytoplankton evolution

Understanding the interaction between climate and biotic evolution is crucial for deciphering the sensitivity of life. An enigmatic global mass extinction occurred in the deep oceans during the Mid Pleistocene, with a loss of over 100 species (20%) of sea floor calcareous foraminifera. An evolutionarily conservative group, benthic foraminifera often comprise >50% of benthic eukaryote biomass on the deep ocean floor. Here, we test extinction hypotheses (temperature, corrosiveness, productivity) in the Tasman Sea, using geochemistry and micropalaeontology, and find evidence from several globally distributed sites for a change in phytoplankton food source as the extinction cause. Coccolithophore evolution may have enhanced the seasonal ‘bloom’ nature of primary productivity and fundamentally shifted it towards a more intra-annually variable state at ~0.8 Ma. Our results highlight seasonality as a potential new consideration for Mid-Pleistocene global biogeochemical climate models, and imply that deep sea biota may be sensitive to future changes in productivity

Cretaceous Separation of Africa and South America: The View from the West African Margin (ODP Leg 159)

The opening of the Equatorial Atlantic Gateway (EAG) during the Cretaceous was accompanied by the disruption of the sedimentary basins that had developed on the conjugate margins of Africa and South America. Drilling along the Côte d\u27Ivoire-Ghana Transform Margin (ODP Leg 159) provided a transect across the northern rim of this gateway. The interplay of tectonic and oceanic processes along the gateway created a complex continental margin that evolved in three stages interrupted by dramatic changes in sedimentary facies, waterdepths, and subsidence rates. The earliest stage records the formation of small basins with restricted connection to the world ocean and rapid infill with siliciclastic deposits in an Early Cretaceous intracratonic rift or wrench tectonic setting. This stage ended with an uplift event and the formation of a regional unconformity. During the late Albian to middle Coniacian, the oceanward side of the margin subsided below the calcite compensation depth (CCD) and a deepwater connection between Central and South Atlantic became established. Deepening of the basement ridge and its landward slope, in contrast, were delayed and detrital limestones intercalated with carbonaceous shales accumulated at shelf to slope depths. During the ensuing, latest Cretaceous to present stage, passive margin subsidence led to continuous deepening of the basement ridge and on its landward slope. Condensation and gradually decreasing organic contents point to an intensified exposure to deepwater circulation. The replacement of the zonal circulation system through the Mesozoic Tethys and Central Atlantic with a modern, oxidizing meridional circulation system through the EAG appears to be intimately related to the changing depositional conditions over large parts of the Cretaceous Atlantic

Condições termodinâmicas de eventos de precipitação extrema em Belém-PA durante a estação chuvosa Thermodynamic conditions of extreme rainfall events in Belém-PA, Brazil, during the rainy season

As condições termodinâmicas de uma região são muito importantes para o desenvolvimento da convecção úmida profunda, principalmente nas regiões tropicais. Portanto, o objetivo deste trabalho foi o de entender e caracterizar o papel das condições termodinâmicas da atmosfera durante os eventos de precipitações extremas na estação chuvosa, no período de 1987 a 2007, em Belém (PA). Os resultados mostram que as precipitações extremas, em sua maioria (56%) apresentam um ambiente precursor com forte instabilidade, indicada pelos altos valores de CAPE (acima de 1000 J/kg) e valores significativos dos índices de instabilidade. Houve, contudo, eventos com baixos valores de CAPE na sondagem das 1200 UTC do dia do evento, mas valores maiores na véspera, o que indica que a chuva em questão pode ter começado na madrugada e ter perdurado por várias horas, atravessando a hora da sondagem, explicando a queda deste parâmetro. Os índices de instabilidade K, TT e LI apresentaram uma boa representação do ambiente, prognosticando as tempestades com chuvas fortes com índice de acerto de até 74%, se levados em conta os eventos em que todos os índices apontavam os mesmos resultados e indicavam forte instabilidade. As condições termodinâmicas de forte instabilidade ajudam a promover, mas não são as únicas responsáveis pelas tempestades convectivas com precipitações extremas.<br>The thermodynamic conditions from any region are very important to the development of the deep, moist convection, mainly in the tropical region. Therefore, the aim of this work was to understand and characterize the role of atmospheric thermodynamic conditions during extreme rainfall events in the rainy season, in Belém (PA, Brazil). The results show that the extreme rainfall, in their majority (56%) present a pre-storm environment with strong instability, indicated by the CAPE high values (above 1000 J/kg) and meaningful values of the instability indexes. There was, however, events with low values of CAPE in the 1200 UTC sounding at the day of the event, but larger values in the day before, which indicates that the rain in question may have begun in the early hours and have last for several hours, crossing the time of the sounding, explaining the decrease of this parameter. The K, TT and LI instability indexes showed a close representation of the environment, predicting storms with heavy rainfall with 74% of correct identification, if taken into account the events on which all indexes showed the same indication of strong instability. Therefore, thermodynamic conditions of strong instability may lead to storms, but are not the only responsible factors for convective storms with extreme rainfall