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To measure and assess differences by educational level in the place of death for cancer patients, and to determine whether patterns of geographical disparities are associated with access to palliative care services in the municipality of residence.

Compared to aquatic ecosystem, terrestrial systems have been subjected to fewer investigations on the exposure to halogenated flame retardants (HFRs). Our study utilized peregrine falcon eggs collected from multiple habitats across North America to retrospectively explore both spatial distribution and temporal changes in legacy (e.g., polybrominated diphenyl ethers) and alternative HFRs over a 30 year period (1984–2016). The results reveal intensive HFR exposure in terrestrial ecosystems and chemical-specific spatiotemporal distribution patterns. The correlations between egg levels of the selected HFRs and human population density clearly illustrated a significant urban influence on the exposure of this wildlife species to these HFRs and subsequent maternal transfer to their eggs. Temporal analyses suggest that, unlike aquatic systems, terrestrial ecosystems may undergo continual exposure to consistently high levels of legacy HFRs for a long period of time. Our findings collectively highlight the effectiveness of using peregrine eggs to monitor terrestrial exposure to HFRs and other bioaccumulative chemicals and the need for continuous monitoring of HFRs in terrestrial ecosystems.

La planificación de la cardiología en España requiere el conocimiento de los recursos disponibles y las necesidades, no sólo presentes, sino también futuras. En el presente informe se recogen los resultados de un estudio llevado a cabo por la Sociedad Española de Cardiología sobre la necesidad y la disponibilidad de cardiólogos. La situación actual en España presenta un desequilibrio entre el número de cardiólogos en activo y los que serían necesarios, desequilibrio que oscila en torno al 14%. La pirámide poblacional refleja una población envejecida y mayoritariamente masculina. Las previsiones futuras indican que la situación empeorará desde ahora hasta el año 2020. La corrección de este desequilibrio requiere el desarrollo de alternativas diferentes de las actuales en formación y/o organización de los servicios asistenciales. Algunas de estas alternativas se recogen en la parte final de este documento, en forma de propuestas abiertas al debate.

Objective. Recent cardiac arrest resuscitation guidelines have recommended the esophageal tracheal Combitube (ETC) as an advanced airway management alternative for individuals who infrequently perform endotracheal intubation (ETI). This study attempted to analyze basic (nonparamedic) ambulance attendant success rates at ETI and ETC insertion as well as their continuing skill competency over time and whether ongoing practice on mannequins improved skill performance. Methods. Three hundred fifty-seven adult patients in cardiorespiratory arrest were treated by 81 basic ambulance attendants. Original study design called for the analysis of two treatment options in three patient groups: ETC insertion, ETI insertion with mannequin practice (ETI-MP), and ETI insertion without mannequin practice (ETI-NMP). The main outcome measures were: (1) successful insertion and ventilation with ETC or ETI, assessed by receiving physicians; and (2) differences in successful insertion/ventilation between the MP and NMP groups. Results. Successful insertion (intent-to-treat) for the ETI-NMP group was 70 of 111 (63%; 95% confidence interval [CI], 54-73%); ETI-MP success was 105 of 139 (76%; 95% CI, 67-84%); ETC-NMP success was 26 of 42 (62%; 95% CI, 49-75%); and ETC-MP success was 36 of 53 (68%; 95% CI, 54-82%). Continuing mannequin practice appeared to improve ETI success (as-treated): MP 75% versus NMP 61% (odds ratio, 2.1; 95% CI, 1.11-3.94). Conclusions. There were similar rates of successful insertion/ventilation with the ETC and ETI. ETI insertion success was lower without mannequin practice. ETI skill erosion was partially mitigated by additional field experience.

We studied 46 living-related primary renal allograft recipients between June 1980 and Jan 1988 to determine if enhancement of allograft survival by donor specific transfusions requires a major histocompatibility complex mismatch between the blood/kidney donor and the recipient. Recipients were matched for a single HLA haplotype, but differed at various HLA loci on the unshared haplotype. DST (200 ml) was administered either 3 times at two-week intervals pretransplant (n=17), or once 3–4 weeks pretransplant, together with oral azathioprine (1 mg/kg/day/28 days) (n=29). Patients were followed for at least 1 year and all clinical rejection episodes were confirmed histologically. Enhanced graft survival by DST was defined as a rejection-free post-transplant course. Incompatibility for class II determinants on the unshared haplotype of donor had a beneficial effect. A significantly greater proportion of recipients had stable, rejection-free, allograft function if incompatible for the DR locus (80 vs. 44, P=0.012), for class II public determinants (100 vs. 58, P=0.013), or for at least one of the class II gene products (DR, DQ, class II public) (81 vs. 40, P=0.006). Graft loss occurred in 7 of 46 (15); 6 of the 7 recipients were HLA class II—compatible with their blood/kidney donor. Mismatches for HLA class I private or public determinants and other factors known to affect graft outcome did not influence the results. We conclude that enhanced

Presents letters to the editor about foreign correspondents and communication.

This article focuses on the favorite live recordings of gay musician Patricia Barber. She is a bold and brilliant jazz pianist who also, in equal measure, sings, writes, and makes no bones about being gay. She took a couple of years off from recording when she was awarded a 2003 Guggenheim Fellowship in order to write a song cycle based on Ovid's Metamorphoses. She is without doubt the only performer ever to be summed up by Time magazine as a cross between Diana Krall and Susan Sontag. Barber reemerges with Live: A Fortnight in France, recorded with her longtime quartet in March and April 2004. Among the live recordings which inspired her are: Return to Forever Live, Sunday at the Village Vanguard by Bill Evans, Live in Montreux by Elis Regina, Shadows and Light by Joni Mitchell, and Nina Simone at Town Hall.