RESUMO
The Marine Isotope Stage (MIS) 11c interglacial and its preceding glacial termination represent an enigmatically intense climate response to relatively weak insolation forcing. So far, a lack of radiometric age control has confounded a detailed assessment of the insolation-climate relationship during this period. Here, we present 230Th-dated speleothem proxy data from northern Italy and compare them with palaeoclimate records from the North Atlantic region. We find that interglacial conditions started in subtropical to middle latitudes at 423.1 ± 1.3 thousand years (kyr) before present, during a first weak insolation maximum, whereas northern high latitudes remained glaciated (sea level ~ 40 m below present). Some 14.5 ± 2.8 kyr after this early subtropical onset, peak interglacial conditions were reached globally, with sea level 6-13 m above present, despite weak insolation forcing. We attribute this remarkably intense climate response to an exceptionally long (~15 kyr) episode of intense poleward heat flux transport prior to the MIS 11c optimum.
Assuntos
Recidiva , Tonsilectomia , Tonsilite , Humanos , Tonsilite/cirurgia , Criança , Resultado do TratamentoAssuntos
Doenças Cardiovasculares , Complicações do Diabetes , Serviços Preventivos de Saúde , Humanos , Diabetes Mellitus , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/normas , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/normas , Complicações do Diabetes/complicações , Complicações do Diabetes/terapiaRESUMO
BACKGROUND: Information on the use of palliative care and aggressive treatments for terminally ill patients who receive care from hospitalists is limited. METHODS: This three-year, retrospective, case-control study was conducted at an academic medical center in Taiwan. Among 7037 patients who died in the hospital, 41.7% had a primary diagnosis of cancer. A total of 815 deceased patients who received hospitalist care before death were compared with 3260 patients who received non-hospitalist care after matching for age, gender, catastrophic illness, and Charlson comorbidity score. Regression models with generalized estimating equations were performed. RESULTS: Patients who received hospitalist care before death, compared to those who did not, had a higher probability of palliative care consultation (odds ratio (OR) = 3.41, 95% confidence interval (CI): 2.63-4.41), and a lower probability to undergo invasive mechanical ventilation (OR = 0.13, 95% CI: 0.10-0.17), tracheostomy (OR = 0.14, 95% CI: 0.06-0.31), hemodialysis (OR = 0.70, 95% CI: 0.55-0.89), surgery (OR = 0.25, 95% CI: 0.19-0.31), and intensive care unit admission (OR = 0.11, 95% CI: 0.08-0.14). Hospitalist care was associated with reductions in length of stay (coefficient (B) = -0.54, 95% CI: -0.62--0.46) and daily medical costs. CONCLUSIONS: Hospitalist care is associated with an improved palliative consultation rate and reduced life-sustaining treatments before death.
