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It has been suggested that psychosocial factors are related to survival time of inpatients with cancer. However, there are not many studies examining the relationship between spiritual well-being (SWB) and survival time among countries. This study investigated the relationship between SWB and survival time among three East Asian countries.
This international multicenter cohort study is a secondary analysis involving newly admitted inpatients with advanced cancer in palliative care units in Japan, South Korea, and Taiwan. SWB was measured using the Integrated Palliative Outcome Scale (IPOS) at admission. We performed multivariate analysis using the Cox proportional hazards model to identify independent prognostic factors.
A total of 2,638 patients treated at 37 palliative care units from January 2017 to September 2018 were analyzed. The median survival time was 18.0 days (95% confidence interval [CI] 16.5–19.5) in Japan, 23.0 days (95% CI 19.9–26.1) in Korea, and 15.0 days (95% CI 13.0–17.0) in Taiwan. SWB was a significant factor correlated with survival in Taiwan (hazard ratio [HR] 1.27; 95% CI 1.01–1.59; p = 0.04), while it was insignificant in Japan (HR 1.10; 95% CI 1.00–1.22; p = 0.06), and Korea (HR 1.02; 95% CI 0.77–1.35; p = 0.89).
Significance of results
SWB on admission was associated with survival in patients with advanced cancer in Taiwan but not Japan or Korea. The findings suggest the possibility of a positive relationship between spiritual care and survival time in patients with far advanced cancer.
The 14C peak in AD 775 (M12) has been measured and confirmed globally in several studies since it was first measured in annual tree rings by Miyake et al. (2012). However, M12 data measurements in early- and latewood are limited. This paper presents the Δ14C values in early- and latewood from AD 762–776 Zelkova serrata tree rings from Bangu-dong, Ulsan, South Korea (35°33′N, 129°20′E). The results indicate no early rise in Δ14C values in the latewood of AD 774 in this sample located at mid-latitude. A comparison of the results of this and previous studies suggests latitude dependence (Büntgen et al. 2018); that is, the early rise of Δ14C in AD 774 was not observed at mid-latitudes in South Korea but was observed at high latitudes in Finland. The half-oxidation time of 14C was estimated from a detailed analysis of a small bomb peak in AD 1962. Based on the half-oxidation time, the Δ14C rise in the latewood, but not in the earlywood, of AD 774 in Finland, and the absence of a Δ14C rise in both the early- and latewood of AD 774 in South Korea, the 14C spike was estimated to have been produced from late April to mid-June in AD 774.
Chapter Eight investigates what role the accents plays in exegesis of the Hebrew Bible and suggests that the accents can help clarify ambiguous meanings, emphasize certain words or phrases, and create dramatic effect in biblical narrative. The various examples provided clearly demonstrate that the masoretic accents can have significant bearing on the exegesis of the biblical text. By paying close attention to the accentual divisions of the text, our understanding of the biblical text is enhanced and we can attain insights that Hebrew syntax alone may not provide.
Chapter Two investigates the hierarchy and dichotomy rules that govern the function of the disjunctive accents as well as the features of the final disjunctives. Disjunctive accents function as separators in the hierarchical order, whereas conjunctives serve as connectors between disjunctive accents. The disjunctive force of a disjunctive accent is relative to the context, but the hierarchical order among the disjunctive accents is almost absolute within a verse. The dichotomy rule states that a domain governed by a disjunctive accent is divided by other disjunctive accents of a grade below in a dichotomic way. In light of the dichotomy rule, it is helpful to divide the disjunctive accents in terms of four different levels ranging from D0 to D3. The level 0 accent indicates the strongest major break found in the verse, whereas the level 3 accent indicates the weakest. It is important to learn how to diagram a Hebrew verse by using these two rules. The three steps presented for diagramming are: 1) determine all the disjunctive accents in a given verse, 2) group the disjunctive accents according to their hierarchical level from D0 to D3, and 3) draw a dividing line for each domain.
Chapter Five explores the conjunctive accents and their connectivity preferences. Specifically, the rules about which conjunctive accents are placed in a sequence before a disjunctive accent are investigated. Conjunctive accents function as a connector between disjunctive accents and do not exhibit any hierarchical order. This means certain conjunctives prefer to stand before certain disjunctives. Furthermore, secondary accents are examined. In addition to primary stress, some marks are used to stress syllables that are placed neither on the ultima nor on the penultima. These marks are called secondary accents. Their main purpose is to slow down the reading of the syllable either phonetically or musically. The most common secondary accent is Metheg. There are two groups of Metheg: Musical Metheg and Phonetic Metheg. In phonetic Metheg, there are three Methegs: Major Metheg, Minor Metheg, and Shewa Metheg.
Chapter Four continues to investigate substitutions of disjunctive accents and conditions under which these substitutions occur at the D2 and D3 levels. At the D2 level, the disjunctive accent at the D2 level is Rebia, and there are three final disjunctive accents of this level (D2f): Pashta (before Little Zaqeph), Zarqa (before Segolta) and Tebir (before Tiphcha). All these accents govern Geresh as the near subordinate segment and Pazer or Great Telisha, Pazer’s substitute, as the remote subordinate segment. There are three substitutions in this level: substitution of Yethib for Pashta, substitution of Pashta for Rebia, and substitution of Zarqa or Tebir for Rebia. At the D3 level, The disjunctive accent at the D3 level is Pazer, and the final disjunctive accents of this level (D3f) is Geresh. In this level, there are three substitutions and one interchange: substitution of Garshaim for Geresh, interchange of Great Telisha with Geresh, substitution of Great Telisha for Pazer, and substitution of Great Pazer for Pazer.
Chapter Six examines several minor rules of Hebrew accents that are mainly related to deviations from the basic subdivison unit and stress crash. The simplification and division rules (deviations from the basic subdivision unit), the spirantization (sandhi) rule, and the nesiga rule (stress crash) are investigated. The simplification process usually occurs under three conditions: 1) when the disjunctive accent is a final disjunctive that may be replaced by a conjunctive, 2) when the domain of that final disjunctive consists of two words, and 3) when the final disjunctive immediately precedes its greater terminal disjunctive accents. The division process is in fact the opposite of the simplification process. A unit of two words with disjunctive accents results from a division process in which a disjunctive accent appears in place of a conjunctive accent. If a vowel-final word carries a disjunctive accent, spirantization does not occur because that disjunctive functions as a separator. However, if a vowel-end word carries a conjunctive accent, spirantization does occur. The nesiga rule is to retract the main stress on the first word when two accents appear adjacently.
Chapter Seven discusses scholars’ long-standing debates about what the divisions marked by the disjunctive accents represent linguistically. They offer at least three primary suggestions, all of which have validity: 1) to mark stress, 2) to provide musical notations, and 3) to express syntax. Thus, the linguistic representation of the divisions marked by the disjunctive accents is examined from the word level through the sentence level and some related topics, specifically prosodic analysis of the accentual divisions and performance structure are also discussed. This chapter demonstrates that the divisions marked by the Tiberian accents correspond with prosodic divisions and suggested three criteria for delimitation: 1) major disjunctive accents (Silluq, Athnach, Little Zaqeph, Rebia, and rarely Segolta) function as major delimiters, 2) final disjunctives have no dividing force, and 3) a disjunctive accent on the initial word in a phrase or a sentence does not have dividing force. Notably, these accentual divisions correspond with performance structure in light of pausal duration on speech. This shows that the primary purpose of the accents is to mark the proper recitation of the text.
Chapter Three examines various dichotomy patterns with substitutions. These substitutions are not exceptional cases but were designed to present variegated musical neumes (i.e., a group of successive music pitches) in accordance with combinations of accents in the Tiberian tradition. This chapter discusses substitutions of disjunctive accents at the D0 and D1 levels. At the D1 level, three substitutions of disjunctive accents are discussed. Those are substitution of Great Zaqeph for Little Zaqeph, Segolta for Little Zaqeph, and Shalsheleth for Segolta. These substitutions usually occur when a domain under the D1 level consists of only one word or a one-word unit.
Chapter One lays a foundation for understanding the masoretic accentuation system. There are three masoretic traditions: Babylonian, Palestinian, and Tiberian. Each tradition has different graphemes for the vowel and accent signs. The Babylonian and Palestinian traditions were eventually supplanted by the Tiberian system, considered the best tradition because its system of vocalization and accentuation is the most comprehensive and sophisticated of the three. A brief overview of the masoretic traditions and two kinds of Hebrew accents, disjunctive and conjunctive accents, in the Twenty-One Books are introduced. The twenty-eight Hebrew accents’ names and their accentual positions are also introduced.