Lt. Colonel Rachel (Rae) Diane Landy papers undated, 1913-2000

Rachel Diane Landy Papers consist of correspondence, reminiscences, legal documents, journal, newspaper and magazine articles and color Xerox copies of photographs as well as original photographs. This collection is of value to researchers studying the history of Hadassah and the living conditions and state of medical care in Palestine during the second decade of the 20th century. It is also of interest to researchers studying women in America during the first half of the 20th century who were able to pursue a challenging and productive career and become a leader and innovator in their chosen field. In addition it will be of interest to those researching the graduates of the Cleveland public and professional schools at the end of the 19th and beginning of the 20th centuries, and the Cleveland Jewish community and the George Crile U.S. Army Hospital in Cleveland during the 1940's.

Baron de Hirsch Fund records undated, 1870-1991.

Contains Deed of Trust, By-Laws, Annual Reports, Corporation Minutes (1909, 1913-1919, 1923-1924, 1926-1933), Minutes of the Board of Trustees (1893, 1899, 1907, 1910, 1915-1916, 1918, 1923, 1926-1927, 1930-1933), and the minutes, correspondence, and reports of the various national and local committees. Financial materials include income and expenditure records (1891-1933), audits (1919-1923, 1926-1928), the records of agricultural loans and mortgages, bond and real estate holdings, and bequests. Includes also correspondence and other materials regarding the establishment of the Fund, correspondence of and other papers concerning the Baron and Baroness de Hirsch, and several histories of the Fund. Included in the wide range of activities are material on the work of the Agriculture Bureau and the Jewish Agriculture Society, Housing, English Classes, Immigration (including monthly reports for several ports of entry 1885-1916) and Immigrant Aid, German Refugee Aid in the early years of the Holocaust, Kings Park, N.Y. Test Farm, the Laundry Project, Peekskill Farm, Public Baths, Student Loans, the Baron de Hirsch Trade School, and the Woodbine Colony and Baron De Hirsch Agricultural & Industrial School. Contains also materials on the Colonization attempts made in Colorado, Connecticut, Florida, Louisiana, Michigan, Minnesota, North Dakota, New Jersey, New York, Pennsylvania, South Dakota, Galveston, Texas, The Southwest, Washington, Canada, and Mexico.

[The Rosenthal family from Münchholzhausen] 1868-1957

Vital records (originals and translations) and a family tree of the descendents of the cobbler Moses Rosenthal (1820-1896) and his wife Hannchen Stern (1815-1868) from Münchholzhausen, Germany.

Negative photo map of Jewish settlements in the Krivoy Rog district

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Sugarcane productivity response to different fallow and soybean residue management practices in the Bundaberg district

GRAIN LEGUME ROTATIONS underpin the sustainability of the Australian sugarcane farming system, offering a number of soil health and environmental benefits. Recent studies have highlighted the potential for these breaks to exacerbate nitrous oxide (N2O) emissions. An experiment was implemented in 2012 to evaluate the impact of two fallow management options (bare fallow and soybean break crop) and different soybean residue management practices on N2O emissions and sugarcane productivity. The bare fallow plots were conventionally tilled, whereas the soybean treatments were either tilled, not tilled, residue sprayed with nitrification inhibitor (DMPP) prior to tillage or had a triticale ‘catch crop’ sown between the soybean and sugarcane crops. The fallow plots received either no nitrogen (N0) or fully fertilised (N145) whereas the soybean treatments received 25 kg N/ha at planting only. The Fallow N145 treatment yielded 8% more cane than the soybean tilled treatment. However there was no statistical difference in sugar productivity. Cane yield was correlated with stalk number that was correlated to soil mineral nitrogen status in January. There was only 30% more N/ha in the above-ground biomass between the Fallow N145 and the Fallow N0 treatment; highlighting poor fertiliser nitrogen use efficiency. Supplying adequate nitrogen to meet productivity requirements without causing environmental harm remains a challenge for the Australian sugar industry. The soybean direct drill treatment significantly reduced N2O emissions and produced similar yields and profitability to the soybean tilled treatment (outlined in a companion paper by Wang et.al. in these proceedings). Furthermore, this study has highlighted that the soybean direct drill technique provides an opportunity to enable grain legume cropping in the sugarcane farming system to capture all of the soil health/environmental benefits without exacerbating N2O emissions from Australian sugarcane soils.

Scheme of the land section colony "Ratendorf" N 8, Kherson district

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Erwin Gruen Collection 1945-1995

Various clippings and articles about the work of Erwin Gruen and his Jewish-German background (1965-1993); Letter by Gruen describing his experiences during the Nazi period.

Acute fluid shifts influence the assessment of serum vitamin D status in critically ill patients

Introduction Recent reports have highlighted the prevalence of vitamin D deficiency and suggested an association with excess mortality in critically ill patients. Serum vitamin D concentrations in these studies were measured following resuscitation. It is unclear whether aggressive fluid resuscitation independently influences serum vitamin D. Methods Nineteen patients undergoing cardiopulmonary bypass were studied. Serum 25(OH)D3, 1α,25(OH)2D3, parathyroid hormone, C-reactive protein (CRP), and ionised calcium were measured at five defined timepoints: T1 - baseline, T2 - 5 minutes after onset of cardiopulmonary bypass (CPB) (time of maximal fluid effect), T3 - on return to the intensive care unit, T4 - 24 hrs after surgery and T5 - 5 days after surgery. Linear mixed models were used to compare measures at T2-T5 with baseline measures. Results Acute fluid loading resulted in a 35% reduction in 25(OH)D3 (59 ± 16 to 38 ± 14 nmol/L, P < 0.0001) and a 45% reduction in 1α,25(OH)2D3 (99 ± 40 to 54 ± 22 pmol/L P < 0.0001) and i(Ca) (P < 0.01), with elevation in parathyroid hormone (P < 0.0001). Serum 25(OH)D3 returned to baseline only at T5 while 1α,25(OH)2D3 demonstrated an overshoot above baseline at T5 (P < 0.0001). There was a delayed rise in CRP at T4 and T5; this was not associated with a reduction in vitamin D levels at these time points. Conclusions Hemodilution significantly lowers serum 25(OH)D3 and 1α,25(OH)2D3, which may take up to 24 hours to resolve. Moreover, delayed overshoot of 1α,25(OH)2D3 needs consideration. We urge caution in interpreting serum vitamin D in critically ill patients in the context of major resuscitation, and would advocate repeating the measurement once the effects of the resuscitation have abated.

Carabid beetles (Coleoptera, Carabidae) as indicators of environmental change in Ranomafana National Park, Madagascar

Growing human populations and increasing exploitation of natural resources threaten nature all over the world. Tropical countries are especially vulnerable to human impact because of the high number of species, most of these endemic and still unknown. Madagascar is one of the centers of high biodiversity and renowned for its unique species. However, during the last centuries many endemic species have gone extinct and more are endangered. Because of high natural values, Madagascar is one of the global conservation priorities. The establishment of Ranomafana National Park (RNP) was intended to preserve the unique nature of Madagascar. Containing several endemic and threatened species, Ranomafana has been selected as one of UNESCO’s World Natural Heritage sites. However, due to strong human pressures the region immediately surroundings the protected area has severely degraded. Aims of this thesis were to inventory carabid fauna in RNP and evaluate their use as indicators of the environmental change. Carabid beetles were collected from protected area (secondary and primary forests) and from its degraded surrounding area. Collecting was mostly conducted by hand during years 2000-2005. Species compositions between the protected area and its surroundings were compared, and species habitat preferences and seasonal variations were studied. In total, 4498 individuals representing 127 carabid species (of which 38 are new species) were collected. Species compositions within and outside of the protected area were markedly different. Most of the species preferred forest as their primary habitat and were mainly collected from trees and bushes. Their value as indicators is based on their different habitat requirements and sensitivity to environmental variables. Some of the species were found only in the protected forest, some occupied also the degraded forests and some preferred open areas. Carabid fauna is very species rich in Ranomafana and there are still many species to be found. Most of the species are arboreal and probably cannot survive in the deforested areas outside the park. This is very likely also the case for other species. Establishment and continued protection of RNP is probably the only way to conserve this globally important area. However, new occupations and land use methods are urgently needed by the local people for improving their own lives while maintaining the forest intact.

Functional and work disability and treatment received by patients with major depressive disorder

This study is one part of a collaborative depression research project, the Vantaa Depression Study (VDS), involving the Department of Mental and Alcohol Research of the National Public Health Institute, Helsinki, and the Department of Psychiatry of the Peijas Medical Care District (PMCD), Vantaa, Finland. The VDS includes two parts, a record-based study consisting of 803 patients, and a prospective, naturalistic cohort study of 269 patients. Both studies include secondary-level care psychiatric out- and inpatients with a new episode of major depressive disorder (MDD). Data for the record-based part of the study came from a computerised patient database incorporating all outpatient visits as well as treatment periods at the inpatient unit. We included all patients aged 20 to 59 years old who had been assigned a clinical diagnosis of depressive episode or recurrent depressive disorder according to the International Classification of Diseases, 10th edition (ICD-10) criteria and who had at least one outpatient visit or day as an inpatient in the PMCD during the study period January 1, 1996, to December 31, 1996. All those with an earlier diagnosis of schizophrenia, other non-affective psychosis, or bipolar disorder were excluded. Patients treated in the somatic departments of Peijas Hospital and those who had consulted but not received treatment from the psychiatric consultation services were excluded. The study sample comprised 290 male and 513 female patients. All their psychiatric records were reviewed and each patient completed a structured form with 57 items. The treatment provided was reviewed up to the end of the depression episode or to the end of 1997. Most (84%) of the patients received antidepressants, including a minority (11%) on treatment with clearly subtherapeutic low doses. During the treatment period the depressed patients investigated averaged only a few visits to psychiatrists (median two visits), but more to other health professionals (median seven). One-fifth of both genders were inpatients, with a mean of nearly two inpatient treatment periods during the overall treatment period investigated. The median length of a hospital stay was 2 weeks. Use of antidepressants was quite conservative: The first antidepressant had been switched to another compound in only about one-fifth (22%) of patients, and only two patients had received up to five antidepressant trials. Only 7% of those prescribed any antidepressant received two antidepressants simultaneously. None of the patients was prescribed any other augmentation medication. Refusing antidepressant treatment was the most common explanation for receiving no antidepressants. During the treatment period, 19% of those not already receiving a disability pension were granted one due to psychiatric illness. These patients were nearly nine years older than those not pensioned. They were also more severely ill, made significantly more visits to professionals and received significantly more concomitant medications (hypnotics, anxiolytics, and neuroleptics) than did those receiving no pension. In the prospective part of the VDS, 806 adult patients were screened (aged 20-59 years) in the PMCD for a possible new episode of DSM-IV MDD. Of these, 542 patients were interviewed face-to-face with the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN), Version 2.0. Exclusion criteria were the same as in the record-based part of the VDS. Of these, 542 269 patients fulfiled the criteria of DSM-IV MDE. This study investigated factors associated with patients' functional disability, social adjustment, and work disability (being on sick-leave or being granted a disability pension). In the beginning of the treatment the most important single factor associated with overall social and functional disability was found to be severity of depression, but older age and personality disorders also significantly contributed. Total duration and severity of depression, phobic disorders, alcoholism, and personality disorders all independently contributed to poor social adjustment. Of those who were employed, almost half (43%) were on sick-leave. Besides severity and number of episodes of depression, female gender and age over 50 years strongly and independently predicted being on sick-leave. Factors influencing social and occupational disability and social adjustment among patients with MDD were studied prospectively during an 18-month follow-up period. Patients' functional disability and social adjustment were alleviated during the follow-up concurrently with recovery from depression. The current level of functioning and social adjustment of a patient with depression was predicted by severity of depression, recurrence before baseline and during follow-up, lack of full remission, and time spent depressed. Comorbid psychiatric disorders, personality traits (neuroticism), and perceived social support also had a significant influence. During the 18-month follow-up period, of the 269, 13 (5%) patients switched to bipolar disorder, and 58 (20%) dropped out. Of the 198, 186 (94%) patients were at baseline not pensioned, and they were investigated. Of them, 21 were granted a disability pension during the follow-up. Those who received a pension were significantly older, more seldom had vocational education, and were more often on sick-leave than those not pensioned, but did not differ with regard to any other sociodemographic or clinical factors. Patients with MDD received mostly adequate antidepressant treatment, but problems existed in treatment intensity and monitoring. It is challenging to find those at greatest risk for disability and to provide them adequate and efficacious treatment. This includes great challenges to the whole society to provide sufficient resources.

Determinants of outcome in critically ill patients

Assessment of the outcome of critical illness is complex. Severity scoring systems and organ dysfunction scores are traditional tools in mortality and morbidity prediction in intensive care. Their ability to explain risk of death is impressive for large cohorts of patients, but insufficient for an individual patient. Although events before intensive care unit (ICU) admission are prognostically important, the prediction models utilize data collected at and just after ICU admission. In addition, several biomarkers have been evaluated to predict mortality, but none has proven entirely useful in clinical practice. Therefore, new prognostic markers of critical illness are vital when evaluating the intensive care outcome. The aim of this dissertation was to investigate new measures and biological markers of critical illness and to evaluate their predictive value and association with mortality and disease severity. The impact of delay in emergency department (ED) on intensive care outcome, measured as hospital mortality and health-related quality of life (HRQoL) at 6 months, was assessed in 1537 consecutive patients admitted to medical ICU. Two new biological markers were investigated in two separate patient populations: in 231 ICU patients and 255 patients with severe sepsis or septic shock. Cell-free plasma DNA is a surrogate marker of apoptosis. Its association with disease severity and mortality rate was evaluated in ICU patients. Next, the predictive value of plasma DNA regarding mortality and its association with the degree of organ dysfunction and disease severity was evaluated in severe sepsis or septic shock. Heme oxygenase-1 (HO-1) is a potential regulator of apoptosis. Finally, HO-1 plasma concentrations and HO-1 gene polymorphisms and their association with outcome were evaluated in ICU patients. The length of ED stay was not associated with outcome of intensive care. The hospital mortality rate was significantly lower in patients admitted to the medical ICU from the ED than from the non-ED, and the HRQoL in the critically ill at 6 months was significantly lower than in the age- and sex-matched general population. In the ICU patient population, the maximum plasma DNA concentration measured during the first 96 hours in intensive care correlated significantly with disease severity and degree of organ failure and was independently associated with hospital mortality. In patients with severe sepsis or septic shock, the cell-free plasma DNA concentrations were significantly higher in ICU and hospital nonsurvivors than in survivors and showed a moderate discriminative power regarding ICU mortality. Plasma DNA was an independent predictor for ICU mortality, but not for hospital mortality. The degree of organ dysfunction correlated independently with plasma DNA concentration in severe sepsis and plasma HO-1 concentration in ICU patients. The HO-1 -413T/GT(L)/+99C haplotype was associated with HO-1 plasma levels and frequency of multiple organ dysfunction. Plasma DNA and HO-1 concentrations may support the assessment of outcome or organ failure development in critically ill patients, although their value is limited and requires further evaluation.

Too ill to will? deathbed wills: assessing testamentary capacity near the end of life

Assessing testamentary capacity in the terminal phase of an illness or at a person's deathbed is fraught with challenges for both doctors and lawyers. Numerous issues need to be considered when assessing capacity for a will. These issues are exacerbated when such an assessment needs to be undertaken at the bedside of a dying patient. The nature and severity of the illness, effects on cognition of the terminal illness, effects of medication, urgency, psychological and emotional factors, interactions with carers, family and lawyers, and a range of other issues confound and complicate the assessment of capacity. What is the doctor's role in properly assessing capacity in this context and how does this role intersect with the legal issues? Doctors will play an increasing role in assessing testamentary capacity in this setting. The ageing of society, more effective treatment of acute illness and, often, the prolongation of dying are only some of the factors leading to this increasing need. However, despite its importance and increasing prevalence, the literature addressing this challenging practical area is scarce and offers limited guidance. This paper examines these challenges and discusses some practical approaches.

Acute renal failure in critically ill patients : With special reference to prediction of outcome

Acute renal failure (ARF) is a clinical syndrome characterized by rapidly decreasing glomerular filtration rate, which results in disturbances in electrolyte- and acid-base homeostasis, derangement of extracellular fluid volume, and retention of nitrogenous waste products, and is often associated with decreased urine output. ARF affects about 5-25% of patients admitted to intensive care units (ICUs), and is linked to high mortality and morbidity rates. In this thesis outcome of critically ill patients with ARF and factors related to outcome were evaluated. A total of 1662 patients from two ICUs and one acute dialysis unit in Helsinki University Hospital were included. In study I the prevalence of ARF was calculated and classified according to two ARF-specific scoring methods, the RIFLE classification and the classification created by Bellomo et al. (2001). Study II evaluated monocyte human histocompatibility leukocyte antigen-DR (HLA-DR) expression and plasma levels of one proinflammatory (interleukin (IL) 6) and two anti-inflammatory (IL-8 and IL-10) cytokines in predicting survival of critically ill ARF patients. Study III investigated serum cystatin C as a marker of renal function in ARF and its power in predicting survival of critically ill ARF patients. Study IV evaluated the effect of intermittent hemodiafiltration (HDF) on myoglobin elimination from plasma in severe rhabdomyolysis. Study V assessed long-term survival and health-related quality of life (HRQoL) in ARF patients. Neither of the ARF-specific scoring methods presented good discriminative power regarding hospital mortality. The maximum RIFLE score for the first three days in the ICU was an independent predictor of hospital mortality. As a marker of renal dysfunction, serum cystatin C failed to show benefit compared with plasma creatinine in detecting ARF or predicting patient survival. Neither cystatin C nor plasma concentrations of IL-6, IL-8, and IL-10, nor monocyte HLA-DR expression were clinically useful in predicting mortality in ARF patients. HDF may be used to clear myoglobin from plasma in rhabdomyolysis, especially if the alkalization of diuresis does not succeed. The long-term survival of patients with ARF was found to be poor. The HRQoL of those who survive is lower than that of the age- and gender-matched general population.

Essential nursing care of the critically ill patient

This chapter is about essential nursing care. Because it is often referred to as basic nursing, nurses may not always perceive it as deserving of priority. Yet, how well patients are cared for has a direct effect on their sense of wellbeing and their recovery. ‘Interventional patient hygiene’ is a systematic, evidence-based approach to nursing actions designed to improve patient outcomes using a framework of hygiene, catheter care, skin care, mobility and oral care.1 This chapter focuses on the physical care, infection control, preventative therapies and transport of critically ill patients. The first two areas are closely linked: poor-quality physical care increases the risk of infection. The final areas are essential features of critical care nursing.