MATERNAL RADIATION AND MONGOLISM

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/32318/1/0000386.pd

Demokratie auf dem Rückzug? Zur Konfrontation zwischen amerikanischem Präsidenten und Kongress über einen Truppenabzug aus dem Irak

Im US-Präsidentschaftswahlkampf 2008 ist der Irakkrieg eines der wichtigsten Themen. Die Amerikaner sind allmählich kriegsmüde und die Mehrheit befürwortet einen Truppenrückzug aus dem Irak. Das brachten bereits der Ausgang der Kongresswahlen im Jahr 2006 sowie regelmäßige Meinungsumfragen zum Ausdruck. Es ist nun anzunehmen, dass in der ältesten Demokratie der Welt Volkes Wille direkten Einfluss auf die Politik haben müsste. Doch dies ist nur bedingt der Fall. Besonders Präsident George W. Bush hat wiederholt klargestellt, dass die Stimmung in der Bevölkerung für ihn in der Irakfrage nicht maßgebend sei. Für ihn zähle vielmehr, wie die Generäle vor Ort die aktuelle Sicherheitslage und die Fortschritte einschätzen. Dagegen versucht der seit Ende 2006 von Demokraten dominierte Kongress immer wieder, Rückzugspläne mit festen Fristen zu etablieren. Bislang ist sein Erfolg jedoch bescheiden. Vor allem die fehlende Unterstützung der Republikaner im Kongress und die Blockadepolitik des Präsidenten waren dafür verantwortlich. Hinter der Konfrontation steht eine tiefergehende Auseinandersetzung über die Kompetenzverteilung zwischen Präsident und Kongress bei Kriegsentscheidungen, die in der US-Verfassung in einer Grauzone bleibt. Stephanie Sohnius verknüpft vor diesem verfassungsrechtlichen Hintergrund die Aufarbeitung der aktuell wichtigsten USaußenpolitischen Debatte mit der Frage, ob sich die Demokratie in den USA in der Ära des „Krieges gegen den Terrorismus“ (weiterhin) auf dem Rückzug befindet

The intrafamilial transmission of rheumatoid arthritis--VIII : Summary of findings

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/32911/1/0000291.pd

The intrafamilial transmission of rheumatoid arthritis: An unusual study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/32903/1/0000283.pd

The intrafamilial transmission of rheumatoid arthritis--I : Design of the study

A sampling of 49 family clusters consisting of a key person with arthritis, his spouse, a sibling and the sibling's spouse, 2 cousins and an unrelated individual have been interviewed 3 times with regard to their arthritis and a variety of social and psychological factors. The sample has been drawn in part from a national random sample and in part from an arthritis clinic. The two subsamples have been found sufficiently homogeneous for combination and some of the strengths and limitations of the design have been discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/32904/1/0000284.pd

Prospective Validation of the Emergency Heart Failure Mortality Risk Grade for Acute Heart Failure: The ACUTE Study

Background: Improved risk stratification of acute heart failure in the emergency department may inform physicians\u27 decisions regarding patient admission or early discharge disposition. We aimed to validate the previously-derived Emergency Heart failure Mortality Risk Grade for 7-day (EHMRG7) and 30-day (EHMRG30-ST) mortality. Methods: We conducted a multicenter, prospective validation study of patients with acute heart failure at 9 hospitals. We surveyed physicians for their estimates of 7-day mortality risk, obtained for each patient before knowledge of the model predictions, and compared these with EHMRG7 for discrimination and net reclassification improvement. We also prospectively examined discrimination of the EHMRG30-ST model, which incorporates all components of EHMRG7 as well as the presence of ST-depression on the 12-lead ECG. Results: We recruited 1983 patients seeking emergency department care for acute heart failure. Mortality rates at 7 days in the 5 risk groups (very low, low, intermediate, high, and very high risk) were 0%, 0%, 0.6%, 1.9%, and 3.9%, respectively. At 30 days, the corresponding mortality rates were 0%, 1.9%, 3.9%, 5.9%, and 14.3%. Compared with physician-estimated risk of 7-day mortality (PER7; c-statistic, 0.71; 95% CI, 0.64-0.78) there was improved discrimination with EHMRG7 (c-statistic, 0.81; 95% CI, 0.75-0.87; P=0.022 versus PER7) and with EHMRG7 combined with physicians\u27 estimates (c-statistic, 0.82; 95% CI, 0.76-0.88; P=0.003 versus PER7). Model discrimination increased nonsignificantly by 0.014 (95% CI, -0.009-0.037) when physicians\u27 estimates combined with EHMRG7 were compared with EHMRG7 alone (P=0.242). The c-statistic for EHMRG30-ST alone was 0.77 (95% CI, 0.73-0.81) and 30-day model discrimination increased nonsignificantly by addition of physician-estimated risk to 0.78 (95% CI, 0.73-0.82; P=0.187). Net reclassification improvement with EHMRG7 was 0.763 (95% CI, 0.465-1.062) when assessed continuously and 0.820 (0.560-1.080) using risk categories compared with PER7. Conclusions: A clinical model allowing simultaneous prediction of mortality at both 7 and 30 days identified acute heart failure patients with a low risk of events. Compared with physicians\u27 estimates, our multivariable model was better able to predict 7-day mortality and may guide clinical decisions. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02634762

The Impact of Inpatient Boarding on ED Efficiency: A Discrete-Event Simulation Study

In this study, a discrete-event simulation approach was used to model Emergency Department’s (ED) patient flow to investigate the effect of inpatient boarding on the ED efficiency in terms of the National Emergency Department Crowding Scale (NEDOCS) score and the rate of patients who leave without being seen (LWBS). The decision variable in this model was the boarder-released-ratio defined as the ratio of admitted patients whose boarding time is zero to all admitted patients. Our analysis shows that the Overcrowded+ (a NEDOCS score over 100) ratio decreased from 88.4% to 50.4%, and the rate of LWBS patients decreased from 10.8% to 8.4% when the boarder-released-ratio changed from 0% to 100%. These results show that inpatient boarding significantly impacts both the NEDOCS score and the rate of LWBS patient and this analysis provides a quantification of the impact of boarding on emergency department patient crowding

Atomic-scale confinement of optical fields

In the presence of matter there is no fundamental limit preventing confinement of visible light even down to atomic scales. Achieving such confinement and the corresponding intensity enhancement inevitably requires simultaneous control over atomic-scale details of material structures and over the optical modes that such structures support. By means of self-assembly we have obtained side-by-side aligned gold nanorod dimers with robust atomically-defined gaps reaching below 0.5 nm. The existence of atomically-confined light fields in these gaps is demonstrated by observing extreme Coulomb splitting of corresponding symmetric and anti-symmetric dimer eigenmodes of more than 800 meV in white-light scattering experiments. Our results open new perspectives for atomically-resolved spectroscopic imaging, deeply nonlinear optics, ultra-sensing, cavity optomechanics as well as for the realization of novel quantum-optical devices

Structural and Electronic Decoupling of C_(60) from Epitaxial Graphene on SiC

We have investigated the initial stages of growth and the electronic structure of C_(60) molecules on graphene grown epitaxially on SiC(0001) at the single-molecule level using cryogenic ultrahigh vacuum scanning tunneling microscopy and spectroscopy. We observe that the first layer of C_(60) molecules self-assembles into a well-ordered, close-packed arrangement on graphene upon molecular deposition at room temperature while exhibiting a subtle C_(60) superlattice. We measure a highest occupied molecular orbital–lowest unoccupied molecular orbital gap of ~ 3.5 eV for the C_(60) molecules on graphene in submonolayer regime, indicating a significantly smaller amount of charge transfer from the graphene to C_(60) and substrate-induced screening as compared to C_(60) adsorbed on metallic substrates. Our results have important implications for the use of graphene for future device applications that require electronic decoupling between functional molecular adsorbates and substrates