6,763 research outputs found
Ethical difficulties in clinical practice : experiences of European doctors
Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties.
Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical
difficulties in these countries to provide an evidence base for the development of these services.
Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European
doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent
ethically difficult case and the types of help they would consider useful. The questionnaire was translated and
given to general internists in Norway, Switzerland, Italy and the UK.
Results: Survey respondents (n = 656, response rate 43%) ranged in age from 28 to 82 years, and averaged
25 years in practice. Only a minority (17.6%) reported having access to ethics consultation in individual
cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decisionmaking
capacity (94.8%), disagreement among caregivers (81.2%) and limitation of treatment at the end of
life (79.3%). The frequency of most ethical difficulties varied among countries, as did the type of issue
considered most difficult. The types of help most often identified as potentially useful were professional
reassurance about the decision being correct (47.5%), someone capable of providing specific advice
(41.1%), help in weighing outcomes (36%) and clarification of the issues (35.9%). Few of the types of help
expected to be useful varied among countries.
Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of
help needed, however, did not vary markedly. The general structure of ethics support services would not have
to be radically altered to suit cultural variations among the surveyed countries
Draft Genome Sequence of Frankia sp. Strain CcI6, a Salt-Tolerant Nitrogen-Fixing Actinobacterium Isolated from the Root Nodule of Casuarina cunninghamiana
Members of the actinomycete genus Frankia form a nitrogen-fixing symbiosis with 8 different families of actinorhizal plants. We report a 5.57-Mbp draft genome sequence for Frankia sp. strain CcI6, a salt-tolerant nitrogen-fixing actinobacterium isolated from root nodules of Casurina cunninghamiana grown in Egyptian soils
First passage behaviour of fractional Brownian motion in two-dimensional wedge domains
We study the survival probability and the corresponding first passage time
density of fractional Brownian motion confined to a two-dimensional open wedge
domain with absorbing boundaries. By analytical arguments and numerical
simulation we show that in the long time limit the first passage time density
scales as t**{-1+pi*(2H-2)/(2*Theta)} in terms of the Hurst exponent H and the
wedge angle Theta. We discuss this scaling behaviour in connection with the
reaction kinetics of FBM particles in a one-dimensional domain.Comment: 6 pages, 4 figure
Extreme value statistics and return intervals in long-range correlated uniform deviates
We study extremal statistics and return intervals in stationary long-range
correlated sequences for which the underlying probability density function is
bounded and uniform. The extremal statistics we consider e.g., maximum relative
to minimum are such that the reference point from which the maximum is measured
is itself a random quantity. We analytically calculate the limiting
distributions for independent and identically distributed random variables, and
use these as a reference point for correlated cases. The distributions are
different from that of the maximum itself i.e., a Weibull distribution,
reflecting the fact that the distribution of the reference point either
dominates over or convolves with the distribution of the maximum. The
functional form of the limiting distributions is unaffected by correlations,
although the convergence is slower. We show that our findings can be directly
generalized to a wide class of stochastic processes. We also analyze return
interval distributions, and compare them to recent conjectures of their
functional form
Late-Time Optical and UV Spectra of SN 1979C and SN 1980K
A low-dispersion Keck I spectrum of SN 1980K taken in August 1995 (t = 14.8
yr after explosion) and a November 1997 MDM spectrum (t = 17.0 yr) show broad
5500 km s^{-1} emission lines of H\alpha, [O I] 6300,6364 A, and [O II]
7319,7330 A. Weaker but similarly broad lines detected include [Fe II] 7155 A,
[S II] 4068,4072 A, and a blend of [Fe II] lines at 5050--5400 A. The presence
of strong [S II] 4068,4072 A emission but a lack of [S II] 6716,6731 A emission
suggests electron densities of 10^{5-6} cm^{-3}. From the 1997 spectra, we
estimate an H\alpha flux of 1.3 \pm 0.2 \times 10^{-15} erg cm^{-2} s^{-1}
indicating a 25% decline from 1987--1992 levels during the period 1994 to 1997,
possibly related to a reported decrease in its nonthermal radio emission.Comment: 21 pages, 8 figures, submitted to the Astronomical Journa
Microstructure identification via detrended fluctuation analysis of ultrasound signals
We describe an algorithm for simulating ultrasound propagation in random
one-dimensional media, mimicking different microstructures by choosing physical
properties such as domain sizes and mass densities from probability
distributions. By combining a detrended fluctuation analysis (DFA) of the
simulated ultrasound signals with tools from the pattern-recognition
literature, we build a Gaussian classifier which is able to associate each
ultrasound signal with its corresponding microstructure with a very high
success rate. Furthermore, we also show that DFA data can be used to train a
multilayer perceptron which estimates numerical values of physical properties
associated with distinct microstructures.Comment: Submitted to Phys. Rev.
COPD exacerbation phenotypes in a real-world five year hospitalisation cohort
INTRODUCTION: COPD exacerbation phenotypes have been defined in research populations by predominantly infective or inflammatory aetiology. We sought to characterise this in patients admitted to our centre. MATERIALS AND METHODS: Case-notes of consecutive patients discharged alive after treatment for acute COPD exacerbations between December 2012 and January 2017 were analysed. Data were collected on treatment, length of stay, C-reactive protein (CRP), eosinophil count and bacterial sputum culture positivity for potentially pathogenic microorganisms (PPM). RESULTS: 1029 exacerbations were included. There was an inverse correlation between CRP and eosinophil count (rho = -0.277, p 100 mg/L (4d [3,8] vs 4d [2,7], p < 0.01) or when given antibiotics (4d [2,8] vs 3d [1,6], p < 0.001) and shorter if receiving corticosteroids (4d [2,6] vs 6d [3,7], p < 0.001). Being sputum culture positive on first exacerbation was associated with sputum culture positivity in subsequent exacerbations. Patients with PPM in sputum culture had a significantly higher median CRP than culture negative patients (38 mg/L [18.75, 57] v 18 mg/L [8.5,45.5] p < 0.05). Length of stay, eosinophil count and CRP were significantly correlated between exacerbation pairs. CONCLUSIONS: This real-world population found eosinophilic and high CRP exacerbations to be distinct and significantly stereotyped within individual patients across recurrent exacerbations. High CRP exacerbations are associated with greater healthcare utilisation and chance of sputum positivity with PPM. Eosinophilic exacerbations were associated with lower rate of readmission. Phenotype-driven treatment warrants further investigation in this population
Quantifying signals with power-law correlations: A comparative study of detrended fluctuation analysis and detrended moving average techniques
Detrended fluctuation analysis (DFA) and detrended moving average (DMA) are
two scaling analysis methods designed to quantify correlations in noisy
non-stationary signals. We systematically study the performance of different
variants of the DMA method when applied to artificially generated long-range
power-law correlated signals with an {\it a-priori} known scaling exponent
and compare them with the DFA method. We find that the scaling
results obtained from different variants of the DMA method strongly depend on
the type of the moving average filter. Further, we investigate the optimal
scaling regime where the DFA and DMA methods accurately quantify the scaling
exponent , and how this regime depends on the correlations in the
signal. Finally, we develop a three-dimensional representation to determine how
the stability of the scaling curves obtained from the DFA and DMA methods
depends on the scale of analysis, the order of detrending, and the order of the
moving average we use, as well as on the type of correlations in the signal.Comment: 15 pages, 16 figure
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