A Matter of Perspective: Choosing for Others Differs from Choosing for Yourself in Making Treatment Decisions

Many people display omission bias in medical decision making, accepting the risk of passive nonintervention rather than actively choosing interventions (such as vaccinations) that result in lower levels of risk. OBJECTIVE : Testing whether people's preferences for active interventions would increase when deciding for others versus for themselves. RESEARCH DESIGN : Survey participants imagined themselves in 1 of 4 roles: patient, physician treating a single patient, medical director creating treatment guidelines, or parent deciding for a child. All read 2 short scenarios about vaccinations for a deadly flu and treatments for a slow-growing cancer. PARTICIPANTS : Two thousand three hundred and ninety-nine people drawn from a demographically stratified internet sample. MEASURES : Chosen or recommended treatments. We also measured participants' emotional response to our task. RESULTS : Preferences for risk-reducing active treatments were significantly stronger for participants imagining themselves as medical professionals than for those imagining themselves as patients (vaccination: 73% [physician] & 63% [medical director] vs 48% [patient], P s<.001; chemotherapy: 68% & 68% vs 60%, P s<.012). Similar results were observed for the parental role (vaccination: 57% vs 48%, P =.003; chemotherapy: 72% vs 60%, P <.001). Reported emotional reactions were stronger in the responsible medical professional and parental roles yet were also independently associated with treatment choice, with higher scores associated with reduced omission tendencies (OR=1.15 for both regressions, P s<.01). CONCLUSIONS : Treatment preferences may be substantially influenced by a decision-making role. As certain roles appear to reinforce “big picture” thinking about difficult risk tradeoffs, physicians and patients should consider re-framing treatment decisions to gain new, and hopefully beneficial, perspectives.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72417/1/j.1525-1497.2006.00410.x.pd

Développement des unités de croissance de jeunes plants d’essences sahéliennes : Acacia tortilis (Forsk.) Hayne subsp.raddiana (Savi) Brenan, de Balanites aegyptiaca (L.) Del et de Zizyphus mauritiana Lam., (Dakar, Sénégal)

Malgré les usages multiples des plantes ligneuses du Sahel, peu d’études se sont intéressées au suivi de la mise en place des différents segments de tige de jeunes plants de Acacia tortilis (Forsk.) Haynesubsp.raddiana (Savi) Brenan, de Balanites aegyptiaca (L.) Del et de Zizyphus mauritiana Lam. Notre objectif était alors de représenter les différents ordres, leur nombre en fonction de leur période d’apparition et le rapport entre le développement successif des Unités de Croissance (UC) des jeunes plants de A. tortilis, de B. aegyptiaca et de Z. mauritiana a été suivi en milieu semi-contrôlé par une approche visuelle globale à l’échelle du houppier entre octobre 2002 et octobre 2004. Les processus de ramification à l’échelle du houppier révèlent 5 ordres différents d’UC chez A. tortilisà 16 mois, 7 chez B. aegyptiaca à 24 mois et 5 chez Z. mauritiana à 9 mois. Les UC3 et UC4 sont les plus nombreuses chez les jeunes plants de B.aegyptiaca et Z.mauritiana alors que chez ceux de A.tortilis, le nombre des UC2 est nettement supérieur. L’UC1 est la plus longue chez les trois espèces. Le diamètre de l’UC1 à 24 mois est de 79 mm chez B. aegyptiaca, de 39 mm chez Z. mauritiana et de 20 mm chez A. tortilis avec un nombre de noeuds nettement plus important chez A. tortilis. La longueur et le nombre de noeuds feuillés varient d’une espèce à l’autre.Mots-clés : Acaciatortilis, Balanites aegyptiaca, Zizyphusmauritiana, jeune plant, unité de croissance (UC),noeuds

Saguache County, closed basin biological inventory. Volume I: Natural heritage assessment final report

Prepared for: The Nature Conservancy, San Luis Valley program, Saguache, Colorado.February 1998.Includes bibliographical references

Global warming induced hybrid rainy seasons in the Sahel

Open Access JournalThe small rainfall recovery observed over the Sahel, concomitant with a regional climate warming, conceals some drought features that exacerbate food security. The new rainfall features include false start and early cessation of rainy seasons, increased frequency of intense daily rainfall, increasing number of hot nights and warm days and a decreasing trend in diurnal temperature range. Here, we explain these mixed dry/wet seasonal rainfall features which are called hybrid rainy seasons by delving into observed data consensus on the reduction in rainfall amount, its spatial coverage, timing and erratic distribution of events, and other atmospheric variables crucial in agro-climatic monitoring and seasonal forecasting. Further composite investigations of seasonal droughts, oceans warming and the regional atmospheric circulation nexus reveal that the low-to-mid-level atmospheric winds pattern, often stationary relative to either strong or neutral El-Niño-Southern-Oscillations drought patterns, associates to basin warmings in the North Atlantic and the Mediterranean Sea to trigger hybrid rainy seasons in the Sahel. More challenging to rain-fed farming systems, our results suggest that these new rainfall conditions will most likely be sustained by global warming, reshaping thereby our understanding of food insecurity in this region

A New Fossil Amiid from the Eocene of Senegal and the Persistence of Extinct Marine Amiids after the Cretaceous–Paleogene Boundary

We report a new fossil amiid from Eocene rocks of West Africa representing the first record of this clade from Senegal. The new specimen has a maxilla that is very similar in size to that of Amia calva. It is distinctly smaller than reported remains of another West African Eocene taxon, Maliamia gigas. We tentatively refer the Senegal specimen to Vidalamiini because it has the large postmaxillary process diagnostic of this clade; however, it also exhibits anatomical features not previously described in extinct amiids. We recovered the specimen in rocks of the Lam-Lam Formation in Central-Western Senegal that we interpret to have been a shallow marine depositional environment. The occurrence of an Eocene marine amiid contradicts existing hypotheses that marine amiids were generally absent after the Cretaceous– Paleogene boundary having been replaced by freshwater taxa. Research completed since the initial discovery of Maliamia gigas indicates that this Eocene taxon was also found in shallow marine rocks

Infected Necrosis in Severe Pancreatitis - Combined Nonsurgical Multi-Drainage with Directed Transabdominal High-Volume Lavage in Critically Ill Patients

Background: Infection of pancreatic necrosis is a life-threatening complication during the course of acute pancreatitis. In critically ill patients, surgical or extended endoscopic interventions are associated with high morbidity and mortality. Minimally invasive procedures on the other hand are often insufficient in patients suffering from large necrotic areas containing solid or purulent material. We present a strategy combining percutaneous and transgastric drainage with continuous high-volume lavage for treatment of extended necroses and liquid collections in a series of patients with severe acute pancreatitis. Patients and Methods: Seven consecutive patients with severe acute pancreatitis and large confluent infected pancreatic necrosis were enrolled. In all cases, the first therapeutic procedure was placement of a CT-guided drainage catheter into the fluid collection surrounding peripancreatic necrosis. Thereafter, a second endosonographically guided drainage was inserted via the gastric or the duodenal wall. After communication between the separate drains had been proven, an external to internal directed high-volume lavage with a daily volume of 500 ml up to 2,000 ml was started. Results: In all patients, pancreatic necrosis/liquid collections could be resolved completely by the presented regime. No patient died in the course of our study. After initiation of the directed high-volume lavage, there was a significant clinical improvement in all patients. Double drainage was performed for a median of 101 days, high-volume lavage for a median of 41 days. Several endoscopic interventions for stent replacement were required (median 8). Complications such as bleeding or perforation could be managed endoscopically, and no subsequent surgical therapy was necessary. All patients could be dismissed from the hospital after a median duration of 78 days. Conclusion: This approach of combined percutaneous/endoscopic drainage with high-volume lavage shows promising results in critically ill patients with extended infected pancreatic necrosis and high risk of surgical intervention. Neither surgical nor endoscopic necrosectomy was necessary in any of our patients. Copyright (C) 2009 S. Karger AG, Basel and IA