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Most patients prefer to die at home, but barely 30% do so. This study examines the variables contributing to dying at home.
The participants were 326 cancer patients, of both genders, with a mean age of 63.25 years, who died from 2000 to 2008 and were treated by the palliative care unit of the Barzilai Hospital. Some 65.7% died at home and 33.4% in a hospital. The data were extracted from patient files. The examined variables were demographic (e.g., age, gender, marital status, ethnic background, number of years in Israel until death), medical (e.g., age at diagnosis, diagnosis, nature of last treatment, patient received nursing care, patient given the care of a social worker, patient had care of a psychologist, family received care of a social worker, patient had a special caregiver), and sociological (e.g., having insurance, having worked in Israel, living alone or with family, living with one's children, living in self-owned or rented house, family members working).
The findings indicate that the chances of dying at home are higher if the patient is non-Ashkenazi, the family got social worker care, the patient lived in a self-owned house, the patient lived with his family, the family members worked, and the patient's stay in Israel since immigration was longer. Logistic regression showed that all the predictors together yielded a significant model accounting for 10.9–12.3% of the variance.
Significance of results:
The findings suggest that dying at home requires maintaining continued care for the patient and family in a community context.
This chapter presents an overview and practical approach to conceptualize manifestations of cerebellar lesions and outlines the principles that govern the cerebellar contribution to cognition and emotion as well as to sensorimotor function. Lesions of the cerebellum have been regarded as producing motor impairments. The cerebellar motor syndrome is characterized by wide-based and unsteady, or ataxic, gait; incoordination, or dysmetria, of the arms and legs; articulation impairment, or dysarthria; and eye movement abnormalities that disturb vision. The cerebellar cognitive affective syndrome (CCAS) results from lesions of the posterior lobe, characterized by clinically relevant deficits in executive function, visual spatial performance, linguistic processing, and dysregulation of affect. The connections of the cerebellum with brain circuits are implicated in psychiatric illness. Applying repetitive transcranial magnetic stimulation (TMS) to the limbic cerebellum in the vermis improves psychiatric disorders such as schizophrenia by upregulating cerebellar modulation of cerebrocerebellar circuits engaged in cognition and emotion.
The earliest cognitive deficits observed in amnestic mild cognitive impairment (aMCI) appear to center on memory tasks that require relational memory (RM), the ability to link or integrate unrelated pieces of information. RM impairments in aMCI likely reflect neural changes in the medial temporal lobe (MTL) and posterior parietal cortex (PPC). We tested the hypothesis that individuals with aMCI, as compared to cognitively normal (CN) controls, would recruit neural regions outside of the MTL and PPC to support relational memory. To this end, we directly compared the neural underpinnings of successful relational retrieval in aMCI and CN groups, using event-related functional magnetic resonance imaging (fMRI), holding constant the stimuli and encoding task. The fMRI data showed that the CN, compared to the aMCI, group activated left precuneus, left angular gyrus, right posterior cingulate, and right parahippocampal cortex during relational retrieval, while the aMCI group, relative to the CN group, activated superior temporal gyrus and supramarginal gyrus for this comparison. Such findings indicate an early shift in the functional neural architecture of relational retrieval in aMCI, and may prove useful in future studies aimed at capitalizing on functionally intact neural regions as targets for treatment and slowing of the disease course. (JINS, 2012, 18, 1–12)
Martin Heidegger's Kant-interpretation is important and deeply intertwined with the existential phenomenology of Being and Time that it is impossible to understand one without the other. For an analysis of the positive content of Heidegger's Kant-interpretation, the reflections on the supposed violence of Heidegger's appropriation of Kant imply the following. First, one gets a more complete idea of the significance of Heidegger's recasting of Kantian themes by understanding how Heidegger's phenomenological interpretation of Kant at the same time undermines neo-Kantian epistemological readings. Second, much of the positive content of Heidegger's work on Kant shows up as Kant-inspired arguments in Being and Time; in particular Heidegger's analysis of originary temporality can only be understood in light of his analysis of Kant's transcendental deduction. Finally, this substantial overlap is bounded by a fundamental criticism that Heidegger levels against Kant's notion of the self.
There are currently two optical interferometry recombiners that can provide spectral resolutions better than 10000, AMBER/VLTI operating in the H-K bands, and VEGA/CHARA, recently commissioned, operating in the visible. These instruments are well suited to study the wind activity of the brightest AB supergiants in our vicinity, in lines such as Hα or Brγ. We present here the first observations of this kind, performed on Rigel (B8Ia) and Deneb (A2Ia). Rigel was monitored by AMBER in two campaigns, in 2006-2007 and 2009-2010, and observed in 2009 by VEGA; whereas Deneb was monitored in 2008-2009 by VEGA. The extension of the Hα and Brγ line forming regions were accurately measured and compared with CMFGEN models of both stars. Moreover, clear signs of activity were observed in the differential visibility and phases. These pioneer observations are still limited, but show the path for a better understanding of the spatial structure and temporal evolution of localized ejections using optical interferometry.
Observations of light elements in hot massive stars are limited to few transitions of boron in the satellite-ultraviolet; lithium and beryllium are not observable at all. But because of its high sensitivity to the effects of rotational mixing, boron abundance determinations in massive stars have excelled as the definite test for evolutionary models with rotation. In this paper the observational evidence for rotational mixing in massive stars is reviewed and alternative interpretations are discussed.
Alzheimer's disease is a progressive condition characterized by a loss of cognition, altered behavior, and a loss of functional ability, such as bathing, dressing, toileting, and organizing finances. Family and friends provide nearly three quarters of all care for patients with Alzheimer's disease. This informal care results in significant burden to caregivers. Caregiver burden is the set of physical, psychological or emotional, social, and financial problems that family members may experience when caring for impaired older adults. Caregivers of Alzheimer's disease patients report higher rates of physical symptoms, mortality, depression, and fatigue, as well as adverse effects on employment compared with those who are not caregivers for Alzheimer's disease patients. In many cases, the same family members are responsible for both out-of-pocket expenditures and caregiving duties. For this article, a MEDLINE search using the key words “caregiver and Alzheimer's disease” and “cost and Alzheimer's disease” was performed. The purpose of this article is to review the literature on caregiver burden, the components of caregiver burden, effects of caregiving on the health of caregivers, the cost of Alzheimer's disease on the caregiver and society, and the benefits attainable with treatment.
This monograph summarizes the proceedings of a roundtable meeting convened to discuss pseudobulbar affect (PBA). Two didactic lectures were presented, followed by a moderated discussion among 11 participants. Post-meeting manuscript development synthesized didactic- and discussion-based content and incorporated additional material from the neuroscience literature. A conceptual framework with which to distinguish between disorders of mood and affect is presented first, and disorders of affect regulation are then reviewed briefly. A detailed description of the most common of these disorders, PBA, is the focus of the remainder of the monograph. The prevalence, putative neuranatomic and neurochemical bases of PBA are reviewed, and current and emerging methods of evaluation and treatment of persons with PBA are discussed. The material presented in this monograph will help clinicians better recognize, diagnose, and treat PBA, and will form a foundation for understanding and interpreting future studies of this condition.
A-type supergiants are the primary targets for the quantitative spectroscopy of individual stars in nearby galaxies because of their intrinsic brightness. An overview is given on the non-LTE techniques required for their analysis. Applications concentrate on placing observational constraints on evolutionary models for massive stars and their host galaxies by detailed abundance analyses. Results from high-resolution studies of A-type supergiants in Local Group galaxies and from intermediate-resolution multi-object spectroscopy of supergiants far beyond the Local Group are summarised.To search for other articles by the author(s) go to: http://adsabs.harvard.edu/abstract_service.html
The transit of the planet orbiting HD209458 has been observed using VLT/UVES, in search for faint signatures of an extended envelope of gas possibly surrounding the planet, called exosphere. Preliminary results are shown and described. They show no evidence so far of exospheric signatures.
Luminous Blue Variables (LBVs or S Dor Variables) are showing characteristic variability of very long timescales of a decade and more. During their expansion and contraction phases, they move across a wide part of the H-R diagram with dramatic changes of their stellar wind characteristics, radius and temperature. We present results of our long-term spectroscopic monitoring campaigns for the galactic star HR Car with optical spectra taken over 13 years and two minimum and maximum phases observed during this time.
The relative abundances of elements in galaxies can provide valuable information on the stellar and chemical evolution of a galaxy. While nebulae can provide abundances for a variety of light elements, stars are the only way to directly determine the abundances of iron-group and s-process and r-process elements in a galaxy. The new 8m and 10m class telescopes and high-efficiency spectrographs now make high-quality spectral observations of bright supergiants possible in dwarf galaxies in the Local Group. We have been concentrating on elemental abundances in the metal-poor dwarf irregular galaxies, NGC 6822, WLM, Sextants A, and GR 8. Comparing abundance ratios to those predicted from their star formation histories, determined from color-magnitude diagrams, and comparing those ratios between these galaxies can give us new insights into the evolution of these dwarf irregular galaxies. Iron-group abundances also allow us to examine the metallicities of the stars in these galaxies directly, which affects their inferred mass loss rates and predicted stellar evolution properties.