Evaluation of a Palliative Care Initiative on the African Continent: Responsibly Improving Access to Pain Treatment

The African continent today faces a crisis of inadequate palliative care, in spite of the growing level of suffering of its citizens who are faced with debilitating diseases and injuries. Much of this problem stems from deeply ingrained attitudes towards opioids: while the American continent grapples with the effects of opioid overprescribing, physicians trained in Africa are taught that opioids are inappropriate for virtually all scenarios, and therefore they come to fear and avoid their use or simply remain untrained on them altogether. Patients fail to advocate for themselves out of submission to the doctor’s authority, governments remain apathetic to the situation, and as a result thousands of Africans die every year in agonizing and completely preventable pain. Recognizing this growing problem, American Cancer Society (ACS) has partnered with African governments and hospice organizations to create an initiative known as “Treat the Pain.” The main focus of the program is on in-house production of an oral morphine solution that is cheap to make, simple to administer, and highly effective at treating pain. The program has been implemented in 5 different African countries (Uganda, Kenya, Rwanda, Nigeria, and Swaziland), and several other countries have expressed interest and are currently receiving “technical support” from ACS. Due to a scarcity of high-quality data, attempts at program evaluation have been limited and it is not known whether the initiative is having its intended effect. This capstone represents a first attempt at utilizing the available information to determine whether countries implementing “Treat the Pain” have indeed increased their consumption of opioids, specifically morphine. Utilizing a United Nations report on opioid consumption, I have attempted to determine whether there is a difference in reported morphine consumption after the date of program implementation when compared to the years before, and also in comparison to countries not participating in the initiative. Using a time series regression and difference-in-differences analysis, I found no statistically significant impact on morphine consumption due to program implementation. Given that there are few instances of the program and that the morphine consumption data is deeply flawed, I recommend continued controlled implementation of the program, and emphasize improved data collection going forward

Abundance Uncertainties Obtained With the PizBuin Framework For Monte Carlo Reaction Rate Variations

Uncertainties in nucleosynthesis models originating from uncertainties in astrophysical reaction rates were estimated in a Monte Carlo variation procedure. Thousands of rates were simultaneously varied within individual, temperature-dependent errors to calculate their combined effect on final abundances. After a presentation of the method, results from application to three different nucleosynthesis processes are shown: the $\gamma$-process and the s-process in massive stars, and the main s-process in AGB stars (preliminary results). Thermal excitation of nuclei in the stellar plasma and the combined action of several reactions increase the final uncertainties above the level of the experimental errors. The total uncertainty, on the other hand, remains within a factor of two even in processes involving a large number of unmeasured rates, with some notable exceptions for nuclides whose production is spread over several stellar layers and for s-process branchings.Comment: 8 pages, 4 figures; Proceedings of OMEG 2017, Daejeon, Korea, June 27-30, 2017; to appear in AIP Conf. Pro

Morte misteriosa del veratro bianco

Quest’anno in Svizzera non si è visto un solo esemplare di veratro bianco in fiore

La mort silencieuse du vératre blanc

Aucun vératre blanc n’a fleuri cette année en Suisse

The s-process nucleosynthesis : Impact of the uncertainties in the nuclear physics determined by monte carlo variations

We investigated the impact of uncertainties in neutron-capture and weak reactions (on heavy elements) on the s-process nucleosynthesis in low-mass stars and massive stars using a Monte-Carlo based approach. We performed extensive nuclear reaction network calculations that include newly evaluated temperature-dependent upper and lower limits for the individual reaction rates. We found β-decay rate uncertainties affect only a few nuclei near s-process branchings, whereas most of the uncertainty in the final abundances is caused by uncertainties in the neutron capture rates. We suggest a list of uncertain rates as candidates for improved measurement by future experiments.Peer reviewe

Geheimnisvoller Tod des Weissen Germers

Geheimnisvoller Tod des Weissen Germers

Uncertainties in the Production of p Nuclides in SN Ia Determined by Monte Carlo Variations

© Springer Nature Switzerland AG 2019Several thousand tracers from a 2D model of a thermonuclear supernova were used in a Monte Carlo post-processing approach to determine p-nuclide abundance uncertainties originating from nuclear physics uncertainties in the reaction rates.Final Accepted Versio

Intermittent convection, mixed boundary conditions and the stability of the thermohaline circulation

Intermittent convection and its consequences on the stability of the thermohaline circulation are investigated with an oceanic global circulation model (OGCM) and simple box models. A two-box model shows that intermittency is a consequence of the non-linearity of the equation of state and of the ratio of heat and freshwater fluxes at surface versus the fluxes at depth. Moreover, it only occurs in areas, where the instability of the water column is caused by temperature or by salinity. Intermittency is not necessarily suppressed by long restoring times. Because intermittent convection causes temporal variations of the ocean-atmosphere fluxes, an OGCM cannot reach an exact equilibrium. After a switch to mixed boundary conditions, changes of the convective activity occur in areas where intermittency is observed. Intermittent convection becomes either continuous or is stopped depending on the method used for calculating the freshwater fluxes. Advective and diffusive fluxes between these regions and their surroundings change in order to balance the altered convective fluxes. A comparison between the OGCM and a six-box model illustrates that this may lead to an alteration of adjacent deep convection and of the related deep water formation