Admission Decision-Making in Hospital Emergency Departments: the Role of the Accompanying Person

In resource-stretched emergency departments, people accompanying patients play key roles in patients' care. This article presents analysis of the ways health professionals and accompanying persons talked about admission decisions and caring roles. The authors used ethnographic case study design involving participant observation and semi-structured interviews with 13 patients, 17 accompanying persons and 26 healthcare professionals in four National Health Service hospitals in south-west England. Focused analysis of interactional data revealed that professionals’ standardization of the patient-carer relationship contrasted with accompanying persons' varied connections with patients. Accompanying persons could directly or obliquely express willingness, ambivalence and resistance to supporting patients’ care. The drive to avoid admissions can lead health professionals to deploy conversational skills to enlist accompanying persons for discharge care without exploring the meanings of their particular relations with patients. Taking a relationship-centered approach could improve attention to accompanying persons as co-producers of healthcare and participants in decision-making

A Quintet Of Black Hole Mass Determinations

We report five new measurements of central black hole masses based on Space Telescope Imaging Spectrograph and Wide Field Planetary Camera 2 observations with the Hubble Space Telescope (HST) and on axisymmetric, three-integral, Schwarzschild orbit-library kinematic models. We selected a sample of galaxies within a narrow range in velocity dispersion that cover a range of galaxy parameters (including Hubble type and core/power-law surface density profile) where we expected to be able to resolve the galaxy's sphere of influence based on the predicted value of the black hole mass from the M-sigma relation. We find masses for the following galaxies: NGC3585, M(BH) = 3.4(-0.6)(+1.5) x 10(8) M(circle dot;) NGC 3607, M(BH) = 1.2(-0.4)(+0.4) x 10(8) M(circle dot); NGC 4026, M(BH) = 2.1(-0.4)(+0.7) x 10(8) M(circle dot); and NGC 5576, M(BH) = 1.8(-0.4)(+0.3) x 10(8) M(circle dot), all significantly excluding M(BH) = 0. For NGC 3945, M(BH) = 9(-21)(+17) x 10(6) M(circle dot), which is significantly below predictions from M-sigma and M-L relations and consistent with MBH = 0, though the presence of a double bar in this galaxy may present problems for our axisymmetric code.NASA/HST GO-5999, GO-6587, GO-6633, GO-7468, GO-9107NASA NAS 5-26555Astronom

Ultraviolet Imaging Observations of the cD Galaxy in Abell 1795: Further Evidence for Massive Star Formation in a Cooling Flow

We present images from the Ultraviolet Imaging Telescope of the Abell 1795 cluster of galaxies. We compare the cD galaxy morphology and photometry of these data with those from existing archival and published data. The addition of a far--UV color helps us to construct and test star formation model scenarios for the sources of UV emission. Models of star formation with rates in the range \sim5-20M_{\sun}yr$^{-1}$ indicate that the best fitting models are those with continuous star formation or a recent ($\sim4$ Myr old) burst superimposed on an old population. The presence of dust in the galaxy, dramatically revealed by HST images complicates the interpretation of UV data. However, we find that the broad--band UV/optical colors of this cD galaxy can be reasonably matched by models using a Galactic form for the extinction law with $E_{B-V}=0.14$. We also briefly discuss other objects in the large UIT field of view.Comment: To appear in the Astrophysical Journal. 14 AAS preprint style pages plus 7 figure

A Stellar Dynamical Measurement of the Black Hole Mass in the Maser Galaxy NGC 4258

We determine the mass of the black hole at the center of the spiral galaxy NGC 4258 by constructing axisymmetric dynamical models of the galaxy. These models are constrained by high spatial resolution imaging and long-slit spectroscopy of the nuclear region obtained with the {\em Hubble Space Telescope}, complemented by ground-based observations extending to larger radii. Our best mass estimate is \MBH = (3.3 \pm 0.2) \times 10^7 \MSun for a distance of 7.28 Mpc (statistical errors only). This is within 15% of (3.82\pm 0.01) \times 10^7 \MSun, the mass determined from the kinematics of water masers (rescaled to the same distance) assuming they are in Keplerian rotation in a warped disk. The construction of accurate dynamical models of NGC 4258 is somewhat compromised by an unresolved active nucleus and color gradients, the latter caused by variations in the stellar population and/or obscuring dust. These problems are not present in the $\sim 30$ other black hole mass determinations from stellar dynamics that have been published by us and other groups; thus, the relatively close agreement between the stellar dynamical mass and the maser mass in NGC 4258 enhances our confidence in the black hole masses determined in other galaxies from stellar dynamics using similar methods and data of comparable quality.Comment: 58 pages, submitted to ApJ. Some figures excluded due to size. The entire paper is at http://www.noao.edu/noao/staff/lauer/nuker_papers.htm

The M-sigma and M-L Relations in Galactic Bulges and Determinations of their Intrinsic Scatter

We derive improved versions of the relations between supermassive black hole mass (M_BH) and host-galaxy bulge velocity dispersion (sigma) and luminosity (L) (the M-sigma and M-L relations), based on 49 M_BH measurements and 19 upper limits. Particular attention is paid to recovery of the intrinsic scatter (epsilon_0) in both relations. We find log(M_BH / M_sun) = alpha + beta * log(sigma / 200 km/s) with (alpha, beta, epsilon_0) = (8.12 +/- 0.08, 4.24 +/- 0.41, 0.44 +/- 0.06) for all galaxies and (alpha, beta, epsilon_0) = (8.23 +/- 0.08, 3.96 +/- 0.42, 0.31 +/- 0.06) for ellipticals. The results for ellipticals are consistent with previous studies, but the intrinsic scatter recovered for spirals is significantly larger. The scatter inferred reinforces the need for its consideration when calculating local black hole mass function based on the M-sigma relation, and further implies that there may be substantial selection bias in studies of the evolution of the M-sigma relation. We estimate the M-L relationship as log(M_BH / M_sun) = alpha + beta * log(L_V / 10^11 L_sun,V) of (alpha, beta, epsilon_0) = (8.95 +/- 0.11, 1.11 +/- 0.18, 0.38 +/- 0.09); using only early-type galaxies. These results appear to be insensitive to a wide range of assumptions about the measurement errors and the distribution of intrinsic scatter. We show that culling the sample according to the resolution of the black hole's sphere of influence biases the relations to larger mean masses, larger slopes, and incorrect intrinsic residuals.Comment: 27 pages, 18 figures, 7 tables, ApJ accepte

Reproductive Health of Bass in the Potomac, USA, Drainage: Part 1. Exploring the Effects of Proximity to Wastewater Treatment Plant Discharge

Intersex (specifically, testicular oocytes) has been observed in male smallmouth bass (SMB; Micropterus dolomieu) and other centrarchids in the South Branch of the Potomac River, USA, and forks of the Shenandoah River, USA, during the past five years. This condition often is associated with exposure to estrogenic endocrine-disrupting chemicals in some fish species, but such chemicals and their sources have yet to be identified in the Potomac. In an attempt to better understand the plausible causes of this condition, we investigated the reproductive health of bass sampled up- and downstream of wastewater treatment plant (WWTP) effluent point sources on the Potomac River in Maryland, USA. Smallmouth bass were sampled from the Conococheague Creek and the Monocacy River, and largemouth bass (LMB; Micropterus salmoides) were collected near the Blue Plains WWTP on the mainstem of the Potomac River. Chemical analyses of compounds captured in passive samplers at these locations also were conducted. A high prevalence of intersex (82–100%) was identified in male SMB at all sites regardless of collection area. A lower prevalence of intersex (23%) was identified in male LMB collected at the Blue Plains site. When up- and downstream fish were compared, significant differences were noted only in fish from the Conococheague. Differences included condition factor, gonadosomatic index, plasma vitellogenin concentration, and estrogen to testosterone ratio. In general, chemicals associated with wastewater effluent, storm-water runoff, and agriculture were more prevalent at the downstream sampling sites. An exception was atrazine and its associated metabolites, which were present in greater concentrations at the upstream sites. It appears that proximity to effluent from WWTPs may influence the reproductive health of bass in the Potomac watershed, but inputs from other sources likely contribute to the widespread, high incidence of testicular oocytes

Genetic Susceptibility Determines β-Cell Function and Fasting Glycemia Trajectories Throughout Childhood: A 12-Year Cohort Study (EarlyBird 76)

No embargo require

Is There a Black Hole in NGC 4382?

We present Hubble Space Telescope (HST) Space Telescope Imaging Spectrograph observations of the galaxy NGC 4382 (M85) and axisymmetric models of the galaxy to determine mass-to-light ratio ( ##IMG## [http://ej.iop.org/icons/Entities/Upsi.gif] {Upsilon} V ) and central black hole mass ( M BH ). We find ##IMG## [http://ej.iop.org/icons/Entities/Upsi.gif] {Upsilon} V = 3.74 ± 0.1 M _ / L _ and M BH = 1.3 +5.2 – 1.2 _ 10 7 M _ at an assumed distance of 17.9 Mpc, consistent with no black hole. The upper limit, M BH < 9.6 _ 10 7 M _ (2_) or M BH < 1.4 _ 10 8 (3_), is consistent with the current M -_ relation, which predicts M BH = 8.8 _ 10 7 M _ at _ e = 182 km s –1 , but low for the current M - L relation, which predicts M BH = 7.8 _ 10 8 M _ at L V = 8.9 _ 10 10 L _, V . HST images show the nucleus to be double, suggesting the presence of a nuclear eccentric stellar disk, analogous to the Tremaine disk in M31. This conclusion is supported by the HST velocity dispersion profile. Despite the presence of this non-axisymmetric feature and evidence of a recent merger, we conclude that the reliability of our black hole mass determination is not hindered. The inferred low black hole mass may explain the lack of nuclear activity.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90768/1/0004-637X_741_1_38.pd