995 resultados para 759


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von Mendelssohn commentirt ; übersetzt und mit einem Wortregister versehen von Salomon Heilberg

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J. Bondi

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von Joseph Unna

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von Israel Finkelscherer

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von J. Muenz

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There have been three medical malpractice insurance "crises" in the United States over a time spanning roughly the past three decades (Poisson, 2004, p. 759-760). Each crisis is characterized by a number of common features, including rapidly increasing medical malpractice insurance premiums, cancellation of existing insurance policies, and a decreased willingness of insurers to offer or renew medical malpractice insurance policies (Poisson, 2004, p. 759-760). Given the recurrent "crises," many sources argue that medical malpractice insurance coverage has become too expensive a commodity—one that many physicians simply cannot afford (U.S. Department of Health and Human Services [HHS], 2002, p. 1-2; Physician Insurers Association of America [PIAA], 2003, p. 1; Jackiw, 2004, p. 506; Glassman, 2004, p. 417; Padget, 2003, p. 216). ^ The prohibitively high cost of medical liability insurance is said to limit the geographical areas and medical specializations in which physicians are willing to practice. As a result, the high costs of medical liability insurance are ultimately said to affect whether or not people have access to health care services. ^ In an effort to control the medical liability insurance crises—and to preserve or restore peoples' access to health care—every state in the United States has passed "at least some laws designed to reduce medical malpractice premium rates" (GAO, 2003, p.5-6). More recently, however, the United States has witnessed a push to implement federal reform of the medical malpractice tort system. Accordingly, this project focuses on federal medical malpractice tort reform. This project was designed to investigate the following specific question: Do the federal medical malpractice tort reform bills which passed in the House of Representatives between 1995 and 2005 differ in respect to their principle features? To answer this question, the text of the bills, law review articles, and reports from government and private agencies were analyzed. Further, a matrix was compiled to concisely summarize the principle features of the proposed federal medical malpractice tort reform bills. Insight gleaned from this investigation and matrix compilation informs discussion about the potential ramifications of enacting federal medical malpractice tort reform legislation. ^

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Purpose. To evaluate the prognostic factors in desmoid tumors in the light of its possible use in standardizing the treatment strategy of an individual patient. ^ Patients and methods. A retrospective review of 189 consecutive patients who were treated at MD Anderson Cancer Center (MDACC) from January 1995 to December 2005 was done. Univariate and multivariate analysis of different prognostic factors was done on all patients, patients treated with surgery alone, subset of patients who came to MDACC with primary tumor. The median follow up was 63 months. Also the analysis of 189 desmoid patients treated at MDACC between 1995 and 2005 was compared to results of 189 desmoid patients treated at MDACC from 1965-1994 using data retrieved from a 150 field prospective relational soft tissue tumor database. ^ Results. 5-, and 10-year overall survival rate were 0.976 (95%CI 0.952, 0.999), and 0.966 (95% CI 0.935, 0.996), respectively. 5-, and 10-year recurrence free rate were 0.803 (95%CI 0.738, 0.868), and 0.793 (95% CI 0.726, 0.860), respectively. 5 year recurrence free survival for surgery alone, radiotherapy alone, chemotherapy alone and combination regimen were 0.759, 0.625, 0.933, and 0.802 respectively. Age (>30 vs. <=30) and primary tumor site (extremity vs visceral) were two prognostic factors significantly associated with local recurrence in all of the patients. ^ Conclusion. An increased awareness of the complex multidisciplinary management needed for successful control of desmoid tumor may underlie a significantly increased number of desmoid referrals, especially primary untreated desmoids, to UTMDACC. The careful prospective integration of multiple therapies has led to a significant recent improvement in desmoid patient outcome. These trends should be supported, particularly if personalized molecular-based therapies are to be rapidly and effectively deployed for the benefit of those afflicted by this rare and potentially devastating disease.^

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The ice cover of the Arctic Ocean has been changing dramatically in the last decades and the consequences for the sea-ice associated ecosystem remain difficult to assess. Algal aggregates underneath sea ice have been described sporadically but the frequency and distribution of their occurrence is not well quantified. We used upward looking images obtained by a remotely operated vehicle (ROV) to derive estimates of ice algal aggregate biomass and to investigate their spatial distribution. During the IceArc expedition (ARK-XXVII/3) of RV Polarstern in late summer 2012, different types of algal aggregates were observed floating underneath various ice types in the Central Arctic basins. Our results show that the floe scale distribution of algal aggregates in late summer is very patchy and determined by the topography of the ice underside, with aggregates collecting in dome shaped structures and at the edges of pressure ridges. The buoyancy of the aggregates was also evident from analysis of the aggregate size distribution. Different approaches used to estimate aggregate biomass yield a wide range of results. This highlights that special care must be taken when upscaling observations and comparing results from surveys conducted using different methods or on different spatial scales.

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The amount of solar radiation transmitted through Arctic sea ice is determined by the thickness and physical properties of snow and sea ice. Light transmittance is highly variable in space and time since thickness and physical properties of snow and sea ice are highly heterogeneous on variable time and length scales. We present field measurements of under-ice irradiance along transects under undeformed land-fast sea ice at Barrow, Alaska (March, May, and June 2010). The measurements were performed with a spectral radiometer mounted on a floating under-ice sled. The objective was to quantify the spatial variability of light transmittance through snow and sea ice, and to compare this variability along its seasonal evolution. Along with optical measurements, snow depth, sea ice thickness, and freeboard were recorded, and ice cores were analyzed for chlorophyll a and particulate matter. Our results show that snow cover variability prior to onset of snow melt causes as much relative spatial variability of light transmittance as the contrast of ponded and white ice during summer. Both before and after melt onset, measured transmittances fell in a range from one third to three times the mean value. In addition, we found a twentyfold increase of light transmittance as a result of partial snowmelt, showing the seasonal evolution of transmittance through sea ice far exceeds the spatial variability. However, prior melt onset, light transmittance was time invariant and differences in under-ice irradiance were directly related to the spatial variability of the snow cover.

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Sites 759 through 764 were drilled during Ocean Drilling Program Leg 122 on the Exmouth and Wombat plateaus off northwest Australia, eastern Indian Ocean. Radiolarian recovery was generally poor due to unsuitable lithofacies. A few Quaternary radiolarian faunas were recovered from most of the sites. Rare and poorly preserved Oligocene and Eocene radiolarian faunas were recovered from Holes 760A, 761B, 761C, and 762B. Poorly preserved Cretaceous radiolarians occur in samples from Holes 761B, 762C, 763B, and 763C. Chert intervals from Cores 122-761B-28X, 122-761C-5R, and 122-761C-6R contain moderately well-preserved Cretaceous radiolarian faunas (upper Albian, mid- to upper Cenomanian, and mid-Albian, respectively). Rare fragments of Upper Triassic radiolarians were recovered from sections in Holes 759B, 760B, and 764A. The only well-preserved pre-Quaternary radiolarians are in lower and upper Paleocene faunas (Bekoma campechensis Zone) recovered from Site 761, Sections 122-761B-16X-1 to 122-761C-19X-CC. The composition of these faunas differs somewhat from that of isolated coeval Paleocene faunas from Deep Sea Drilling Project sites in the Atlantic, Gulf of Mexico, tropical Pacific, eastern Indian Ocean, and near Spain and North Africa, as well as from several on-land sites in North America, Cuba, and the USSR.

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The euphotic depth (Zeu) is a key parameter in modelling primary production (PP) using satellite ocean colour. However, evaluations of satellite Zeu products are scarce. The objective of this paper is to investigate existing approaches and sensors to estimate Zeu from satellite and to evaluate how different Zeu products might affect the estimation of PP in the Southern Ocean (SO). Euphotic depth was derived from MODIS and SeaWiFS products of (i) surface chlorophyll-a (Zeu-Chla) and (ii) inherent optical properties (Zeu-IOP). They were compared with in situ measurements of Zeu from different regions of the SO. Both approaches and sensors are robust to retrieve Zeu, although the best results were obtained using the IOP approach and SeaWiFS data, with an average percentage of error (E) of 25.43% and mean absolute error (MAE) of 0.10 m (log scale). Nevertheless, differences in the spatial distribution of Zeu-Chla and Zeu-IOP for both sensors were found as large as 30% over specific regions. These differences were also observed in PP. On average, PP based on Zeu-Chla was 8% higher than PP based on Zeu-IOP, but it was up to 30% higher south of 60°S. Satellite phytoplankton absorption coefficients (aph) derived by the Quasi-Analytical Algorithm at different wavelengths were also validated and the results showed that MODIS aph are generally more robust than SeaWiFS. Thus, MODIS aph should be preferred in PP models based on aph in the SO. Further, we reinforce the importance of investigating the spatial differences between satellite products, which might not be detected by the validation with in situ measurements due to the insufficient amount and uneven distribution of the data.