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After miscarrying in the hospital at eleven weeks, a patient gratefully accepts the hospital's offer to take advantage of a program for low-income patients that provides burial for fetal remains and a memorial plaque for the gravesite. However, a hospital employee accidentally incinerates the remains, and the error is not discovered until after the ashes are discarded. Two commentaries offer opposing arguments in response to the question whether, to avoid adding to the patient's grief, it is ethically permissible for the clinicians not to disclose the error to her and to proceed with having the name put on a plaque at the burial ground.

Atrial fibrillation (AF) is a major cause of preventable strokes. Screening asymptomatic individuals for AF may increase anticoagulant use for stroke prevention.To evaluate 2 home-based AF screening interventions.This multicenter randomized clinical trial recruited individuals from primary care practices aged 75 years or older with hypertension and without known AF. From April 5, 2015, to March 26, 2019, 856 participants were enrolled from 48 practices.The control group received standard care (routine clinical follow-up plus a pulse check and heart auscultation at baseline and 6 months). The screening group received a 2-week continuous electrocardiographic (cECG) patch monitor to wear at baseline and at 3 months, in addition to standard care. The screening group also received automated home blood pressure (BP) machines with oscillometric AF screening capability to use twice-daily during the cECG monitoring periods.With intention-to-screen analysis, the primary outcome was AF detected by cECG monitoring or clinically within 6 months. Secondary outcomes included anticoagulant use, device adherence, and AF detection by BP monitors.Of the 856 participants, 487 were women (56.9%); mean (SD) age was 80.0 (4.0) years. Median cECG wear time was 27.4 of 28 days (interquartile range [IQR], 18.4-28.0 days). In the primary analysis, AF was detected in 23 of 434 participants (5.3%) in the screening group vs 2 of 422 (0.5%) in the control group (relative risk, 11.2; 95% CI, 2.7-47.1; P = .001; absolute difference, 4.8%; 95% CI, 2.6%-7.0%; P .001; number needed to screen, 21). Of those with cECG-detected AF, median total time spent in AF was 6.3 hours (IQR, 4.2-14.0 hours; range 1.3 hours-28 days), and median duration of the longest AF episode was 5.7 hours (IQR, 2.9-12.9 hours). Anticoagulation was initiated in 15 of 20 patients (75.0%) with cECG-detected AF. By 6 months, anticoagulant therapy had been prescribed for 18 of 434 participants (4.1%) in the screening group vs 4 of 422 (0.9%) in the control group (relative risk, 4.4; 95% CI, 1.5-12.8; P = .007; absolute difference, 3.2%; 95% CI, 1.1%-5.3%; P = .003). Twice-daily AF screening using the home BP monitor had a sensitivity of 35.0% (95% CI, 15.4%-59.2%), specificity of 81.0% (95% CI, 76.7%-84.8%), positive predictive value of 8.9% (95% CI, 4.9%-15.5%), and negative predictive value of 95.9% (95% CI, 94.5%-97.0%). Adverse skin reactions requiring premature discontinuation of cECG monitoring occurred in 5 of 434 participants (1.2%).In this randomized clinical trial, among older community-dwelling individuals with hypertension, AF screening with a wearable cECG monitor was well tolerated, increased AF detection 10-fold, and prompted initiation of anticoagulant therapy in most cases. Compared with continuous ECG, intermittent oscillometric screening with a BP monitor was an inferior strategy for detecting paroxysmal AF. Large trials with hard clinical outcomes are now needed to evaluate the potential benefits and harms of AF screening.ClinicalTrials.gov Identifier: NCT02392754.

where I•=•/Vol2/2•:. Repeating he xample in the appendix; i.e., where/•=5 km,/2=5 km V0=7 cm/yr, T•=I.0, To=0.0, and •:= 10 -6 m 2 s 'z, we find that Tin=0.73. This shows that such a high velocity impinging on a stationary region can lead to high temperatures at the interface. In contrast, the mantle flow in a subduction zone impinges on a moving slab; it is the downward advection of cold lithosphere by the subducting slab that is critical in reducing the interface temperatue in this region. The above error does not affect any of the results or conclusions in the body of the paper, since the body of the paper is independent of Appendix A. In section A.2 of Appendix A, the axis convention should read "the x axis is perpendicular to the slab (negative out into the wedge)". Figure 7c has a younger oceanic plate than Figure 7d, so it is not strictly an enlargement of Figure 7d, as stated in the figure caption. The temperatures in the regions of interest, the slabwedge interface and the mantle wedge, are virtually unaffected by the age of the subducting plate as stated in the paper. The temperature of the subducting plate though does depend upon its age, but since the temperatures in the slab were subsolidus, their exact values had no bearing on the discussion of magmatism and the conclusions. We would like to acknowledge K. Bose, who pointed out the convention error in Appendix A.2 and the error in the figure caption of Figure 7.

Author(s): Gregg, Edward W; Duru, O Kenrik; Shi, Lizheng; Mangione, Carol M; Siegel, Karen R; Ramsay, Andrea; Thornton, Pamela L; Clauser, Steve; Ali, Mohammed K