Step Backwards Research Articles

The Mammoth in the Room

Ad Libitum1 December 2015The Mammoth in the RoomDaniel Goodenberger, MDDaniel Goodenberger, MDFrom St. Louis, Missouri.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-1586 Audio Reading - “The Mammoth in the Room” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "The Mammoth in the Room," by D. Goodenberger. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail At the elevator, waiting, aged hip unquiet, urging patience. He approaches—didn'tI see you in the GI lab when I had my colonoscopy, talking to Dr. D?Ah—probably about shared ultrasound, uncovering cancer high and low, between us. Here to see him?No, my first chemo. Colon? Lung, in the center of my chest, like my fist, they can't remove it.Testing—Alk1 negative, awaiting … EGFR? Hope the side effects are not too bad.Buttercups froze in my mouth as Berezovska's malignant chill embraced us;Freezing the smile upon my face, making solid his brittle hope, and erasing my arthritic pain. Author, Article, and Disclosure InformationAffiliations: From St. Louis, Missouri.Current Author Address: Daniel Goodenberger, MD; e-mail, daniel.[email protected]gov. PreviousarticleNextarticle Advertisement Audio Reading - “The Mammoth in the Room” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "The Mammoth in the Room," by D. Goodenberger. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 1 December 2015Volume 163, Issue 11Page: 835KeywordsColonColonoscopyEstimated glomerular filtration rateHipLungsMouthThoraxUltrasound imaging ePublished: 1 December 2015 Issue Published: 1 December 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Errant gull

Ad Libitum17 November 2015errant gullD.A. Frater, MDD.A. Frater, MDFrom Dallas, Texas.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-0239 Audio Reading - “errant gull” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "errant gull," by D.A. Frater. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail the sun is once again behind me and Ihave come a long way to see you as Ithought I had once before and again theday is ending with you hidden from mysightstanding by the sea wall arms elbowstucked in tightly scanning thebrightening waves the light ready todepart lifts from the ground around meand cuts slowly through thetrees behind before it catches the tallerwaves the further breaches warm breaks inthe gray as your dancing brethren wheellike golden kites hoping to hide you frommy sweeping gazehad actually seen you the telltale ... Author, Article, and Disclosure InformationAffiliations: From Dallas, Texas.Current Author Address: D.A. Frater, MD; e-mail, [email protected]md. PreviousarticleNextarticle Advertisement Audio Reading - “errant gull” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "errant gull," by D.A. Frater. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 17 November 2015Volume 163, Issue 10Page: 746KeywordsElbowHand strengthVision ePublished: 17 November 2015 Issue Published: 17 November 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

The quiet room

Ad Libitum17 November 2015the quiet roomD.A. Frater, MDD.A. Frater, MDFrom Dallas, Texas.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-0591 Audio Reading - “the quiet room” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "the quiet room," by D.A. Frater. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In the quietquiet roomwhere she diedI looked forclues shemight haveleft beforesucceedingat whatonce beforeshe hadonly triedI found stillrestingin her bedan imprinther questionmark bodycurledat the kneesthe hips bentthe elbow thepoint of hershoulder ahint incloth ofher faceto onesideI sat atthe edge ofthat finalempty momenteyes closedto see hercurled insomethingelsebesidesthe endand laidmy handto herphantom hipwantingto softenso thehard sadconfusionand gentlyrub toolate Iknowa softtouchupon herheartand yetstilltriedto fathomthe depthof herspiritsinkingprayingthat shetouchedbottomfinallyupon ahoped forcalmandwas notalone inher restingplacethat theeaseupon herface wastherefair andsincereand despitemy hidingfears didnot hersecretdreadbelie(For PMF) Author, Article, and Disclosure InformationAffiliations: From Dallas, Texas.Current Author Address: D.A. Frater, MD; e-mail, [email protected]md. PreviousarticleNextarticle Advertisement Audio Reading - “the quiet room” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "the quiet room," by D.A. Frater. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 17 November 2015Volume 163, Issue 10Page: 808KeywordsElbowFearHeartHipKneesShouldersTouch ePublished: 17 November 2015 Issue Published: 17 November 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Special Delivery

Ad Libitum20 October 2015Special DeliveryAdam Possner, MDAdam Possner, MDFrom George Washington University, Washington, DC.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-1651 Audio Reading - “Special Delivery” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Special Delivery," by A. Possner. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail One day, my child, when you aremuch older, you'll want to knowwhere babies come from, to whichI'm not sure what your motherand I will say, probablywe won't tell you storks, althoughI will always remembersix months before you were bornthe day your mother and Iopened our front door to findsitting on the stoop a whiteenvelope, graceful, wings closed,carrying beneath its beaka sleeping letter conceivedfrom a feather of blood pluckedfrom your mother's arm, swaddledin disclaimers, a letterbearing the news of your sex.Adam Possner, MDGeorge Washington UniversityWashington, DC Author, Article, and Disclosure InformationAffiliations: From George Washington University, Washington, DC.Current Author Address: Adam Possner, MD, Assistant Professor, General Internal Medicine, Medical Faculty Associates, George Washington University, 2150 Pennsylvania Ave NW, Suite 5-516 North, Washington, DC 20037; e-mail, [email protected]gwu.edu. PreviousarticleNextarticle Advertisement Audio Reading - “Special Delivery” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Special Delivery," by A. Possner. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics Cited byBacteriophage Treatment before Chemical Disinfection Can Enhance Removal of Plastic-Surface-Associated Pseudomonas aeruginosa 20 October 2015Volume 163, Issue 8Page: 607KeywordsBlood ePublished: 20 October 2015 Issue Published: 20 October 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

The Biopsy Room: Prostate

Ad Libitum6 October 2015The Biopsy Room: ProstateJack Coulehan, MD, MPHJack Coulehan, MD, MPHFrom Setauket, New York.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-1467 Audio Reading - “The Biopsy Room: Prostate” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "The Biopsy Room: Prostate," by J. Coulehan. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Each punch of the devicethuds in my boggy braina fraction of a secondafter its teeth bitea sliver of prostate—a miniature dragonattacks my rectum,a white-clad assistantslips fragments of tissueinto labeled containers.Twelve punches, a dozenvicious bites, the twelvegreat labors of Hercules,especially his captureof Cerberus, three-headedsentry of the underworld,the twelve apostles of Christ,especially the last, Jude,patron of impossiblecauses, the twelve Knightsof Camelot, especiallyGawain, the purest of heartwho lopped off the headof the Green Knight,but found forgiveness,the twelve Olympian gods,especially Apollo,my protector, the zodiac'stwelve constellations,including Libra, whichaugurs balance and grace—The last punch reminds meof Cancer, its sharp pincerswon't let go.Jack Coulehan, MD, MPHSetauket, ... Author, Article, and Disclosure InformationAffiliations: From Setauket, New York.Current Author Address: Jack Coulehan, MD, MPH; e-mail, John.[email protected]edu PreviousarticleNextarticle Advertisement Audio Reading - “The Biopsy Room: Prostate” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "The Biopsy Room: Prostate," by J. Coulehan. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 6 October 2015Volume 163, Issue 7Page: 536KeywordsBiopsyBrainHead and neck cancersHeartRectum ePublished: 6 October 2015 Issue Published: 6 October 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Predictive Value

Ad Libitum6 October 2015Predictive ValueNeil Skolnik, MDNeil Skolnik, MDFrom Jenkintown, Pennsylvania.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-0226 Audio Reading - “Predictive Value” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Predictive Value," by N. Skolnik. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail (In blessed memory of Jinny Skolnik)I had waited for yearsFor the call:“A spot on the lung,”I was sure they'd say,“She had been coughing,So we ordered the x-ray,”And, then—A hesitation.I rehearsed in my mindHow I'd feelHow many times I'd triedTo convince herTo stop, to give upsmoking. Wasted effort, perhapsBut no effortDone with love is wasted.Then last weekThe call came:Her bone marrow biopsy,Performed after a randomCBC—done for no known reasonShowed low Red cells,White cells, and Platelets:“Acute Myelogenous Leukemia,”The doctor said,Then he continued,“Prognosis: Weeks,Maybe months.”A week later we ... Author, Article, and Disclosure InformationAffiliations: From Jenkintown, Pennsylvania.Current Author Address: Neil Skolnik, MD; e-mail, [email protected]net PreviousarticleNextarticle Advertisement Audio Reading - “Predictive Value” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Predictive Value," by N. Skolnik. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 6 October 2015Volume 163, Issue 7Page: 553KeywordsBiopsyBone marrowCancer chemotherapyCellsChemotherapyCoughingEmotionsLungsMemoryPlatelets ePublished: 6 October 2015 Issue Published: 6 October 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Theories of the Soul

Ad Libitum6 October 2015Theories of the SoulJack Coulehan, MD, MPHJack Coulehan, MD, MPHFrom Setauket, New York.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-1470 Audio Reading - “Theories of the Soul” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Theories of the Soul," by J. Coulehan. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Twenty Cases Suggestive of Reincarnation—Ian Stevenson, 1918–2007The soul I grew up onbegan at conceptionwith a one way ticket,perdition or heaven.The scientific versiondisintegrates at deathwithout a suggestionof recurrence or wrath.Your children remembera life before this one,their traumatic encountersin village and home.Is my soul's appearance,too, a hundredth edition?Do my genes' adaptationsaccount for nothing?Consciousness suppressedby an erasing machine,I began as a blank,unaware my return wasneither given for goodnessnor exacted for shame,by an improbable wizardbehind the curtain.Jack Coulehan, MD, MPHSetauket, New York Author, Article, and Disclosure InformationAffiliations: From Setauket, New York.Current Author Address: Jack Coulehan, MD, MPH; e-mail, John.[email protected]edu. PreviousarticleNextarticle Advertisement Audio Reading - “Theories of the Soul” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Theories of the Soul," by J. Coulehan. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 6 October 2015Volume 163, Issue 7Page: 563KeywordsChildrenConsciousness ePublished: 6 October 2015 Issue Published: 6 October 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Unsettled Weather

Ad Libitum15 September 2015Unsettled WeatherJack Coulehan, MD, MPHJack Coulehan, MD, MPHFrom Setauket, New York.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-1164 Audio Reading - “Unsettled Weather” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Unsettled Weather," by J. Coulehan. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The hostile wind is at its worst tonight.Rain is fierce and thunder jars cement.Upstairs, a woman who should have diedlast week—she did, but medics came—slips backward and sheds an interior layer,like the beach of a barrier islandwhen a hurricane carries it under.Above the entry wound, my patient's cheekis swollen purple, her zygomatic archturned citrus tense. A sister from Wyandanchrests her fingers on an arm that's overripe.No, we can never give up. Scars constrictthe patient's lungs from too much care.The only secret that remains is her.Jack Coulehan, MD, MPHSetauket, New York Author, Article, and Disclosure InformationAffiliations: From Setauket, New York.Current Author Address: Jack Coulehan, MD, MPH; e-mail, John.[email protected]edu. PreviousarticleNextarticle Advertisement Audio Reading - “Unsettled Weather” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Unsettled Weather," by J. Coulehan. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 15 September 2015Volume 163, Issue 6Page: 471KeywordsLungsScars ePublished: 15 September 2015 Issue Published: 15 September 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

A Giant Step Backwards? Opinion 2/13 on the Eu's Accession to the European Convention on Human Rights

On 18 December 2014, the Court of Justice of the European Union delivered Opinion 2/13 on whether the Draft Agreement on the European Union’s Accession to the European Convention on Human Rights is compatible with EU law. The Court found that the Agreement did not sufficiently take into account the specific nature of the European Union, and that it in many ways violated the ‘autonomy’ of the EU legal order. This Working Paper examines the Court’s findings in Opinion 2/13 and the reasons why it rejected the draft Accession Agreement. It focuses on the most troubling finding: that that the Strasbourg Court’s jurisdiction over the EU’s Common Foreign and Security Policy in the fails to have regard to the specific features of EU law. The Working Paper concludes by looking at the next steps that could be taken in order for the EU to accede to the Convention.

Golden Weekend

Ad Libitum1 September 2015Golden WeekendJessica Giacinto Lawrence, MDJessica Giacinto Lawrence, MDFrom Manhasset, New York.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-1332 Audio Reading - “Golden Weekend” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Golden Weekend," by J.G. Lawrence. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The kids play in the yardTrying to get a kite in the air;It won't fly, but they sure have fun trying.Birds chatter on a bush by the fence.I wander over to investigate.Bulbs of luscious ocean blueDangle from the branches.It's summertime in New York.I take one and gently pull it off with a snap.I close my eyes and taste,The sweet crisp explosion, the essence of summer cool.The warm breeze blows,The air is filled with children's laughter.BEEP BEEP BEEPMy pager quivers and pulls me away from my midsummer night's dream.“Medicine, returning a page.”Jessica Giacinto Lawrence, MDManhasset, New York Author, Article, and Disclosure InformationAffiliations: From Manhasset, New York.Current Author Address: Jessica Giacinto Lawrence, MD, 300 Community Drive, Manhasset, NY 11030; e-mail, jessica.[email protected]com. PreviousarticleNextarticle Advertisement Audio Reading - “Golden Weekend” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Golden Weekend," by J.G. Lawrence. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 1 September 2015Volume 163, Issue 5Page: 346KeywordsChildrenTaste ePublished: 1 September 2015 Issue Published: 1 September 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Navigation Strategies of Motor Proteins on Decorated Tracks.

Motor proteins display widely different stepping patterns as they move on microtubule tracks, from the deterministic linear or helical motion performed by the protein kinesin to the uncoordinated random steps made by dynein. How these different strategies produce an efficient navigation system needed to ensure correct cellular functioning is still unclear. Here, we show by numerical simulations that deterministic and random motor steps yield different outcomes when random obstacles decorate the microtubule tracks: kinesin moves faster on clean tracks but its motion is strongly hindered on decorated tracks, while dynein is slower on clean tracks but more efficient in avoiding obstacles. Further simulations indicate that dynein’s advantage on decorated tracks is due to its ability to step backwards. Our results explain how different navigation strategies are employed by the cell to optimize motor driven cargo transport.

One Step Forward, Two Steps Backward? Difficulties and Dilemmas With Connecting Hate Crime Policy and Research

This article will assess the difficulties and misunderstandings that prevent hate crime academics and practitioners from working together more productively. It will be argued that many of these problems stem from the different occupational cultures across the two spheres, which can generate varying expectations, values, and practices that exacerbate problems in working relationships. Some of these difficulties relate to differing understandings of what hate crime actually is and how to counter it. The article suggests that by gaining in-depth knowledge of each other’s working methods and outputs, perhaps by being involved in formal and informal joint projects that necessitate flexibility and the development of shared approaches, academics and practitioners can devise more nuanced interventions that deal with the harms of hate crime more effectively.

The disappearing

Ad Libitum18 August 2015the disappearingAndrew Thurston, MDAndrew Thurston, MDFrom Pittsburgh, Pennsylvania.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-0593 Audio Reading - “the disappearing” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "the disappearing," by A. Thurston. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail I.The horse was blind from cataract and scar—the brittleness of bone spread through his knees.He stopped feeding,and never ventured far.He spent the afternoons beneath the treesby the old brown fence that marked the northernland line, staring at the wood as though he—through the burning of a glare—could turnthe thing to ash, and escape.And go free.I woke one morning, young, and looked around—saw nothing standing but the fence outside;the hoof-prints—horseless—in the clotting ground."He's done it—see! He's disappeared!" I cried.And mother pulled the fiber from the corn.And father washed the sweaterhe had worn.II.I ... Author, Article, and Disclosure InformationAffiliations: From Pittsburgh, Pennsylvania.Current Author Address: Andrew Thurston, MD; e-mail, [email protected]edu. PreviousarticleNextarticle Advertisement Audio Reading - “the disappearing” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "the disappearing," by A. Thurston. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 18 August 2015Volume 163, Issue 4Page: 310KeywordsBoneForecastingKneesScars ePublished: 18 August 2015 Issue Published: 18 August 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Access to Justice in Environmental Cases after the Rulings of the Court of Justice of 13 January 2015: Kafka Revisited?

By ratifying the Aarhus Convention in 2005 the EU committed itself to guaranteeing broad access to justice in environmental matters both at the national and the EU level. Yet, in spite of the clear-cut obligations incumbent upon the EU, EU courts have consistently rebuked pleas for a softening of the standing requirements in the context of direct actions against EU acts that might have an impact on the environment and/or public health. In addition, the internal review procedure set out by the 2006 Aarhus Regulation has been interpreted so restrictively by the EU institutions that that its added value in the stride toward better access to courts in environmental matters remains ephemeral at best. This led the General Court to finding that the Aarhus Regulation, by excluding general EU acts from the scope of internal review, was in breach of Article 9(3) of the Aarhus Convention. In its recent rulings of 13 January 2015, however, the Court of Justice of the EU (CJEU) overruled the General Court by holding that the Aarhus Regulation could not be reviewed in light of the Aarhus Convention. With its refusal to use Article 9(3) of the Aarhus Convention as a reference criterion for the purpose of reviewing the EU’s compliance with the Aarhus Convention’s obligations, the CJEU avoided tackling the unsatisfactory level of judicial protection in environmental cases at the EU level. This paper argues that the rulings of the CJEU are to be qualified as a significant step backwards for judicial protection in environmental matters at the EU level. It is established that, instead of addressing the current failings of the EU with respect to access to justice in environmental cases, the CJEU’s hands-off approach paves the way for yet another decade of non-compliance by the EU in the realm of access to justice in environmental cases.

One Step Backward Is Two Steps Forward: Enhancing the Hydrolysis Rate of UiO-66 by Decreasing [OH–

The rapid destruction of chemical threats, such as phosphate-based nerve agents, is of considerable current interest. The hydrolysis of the nerve-agent simulant methylparaoxon, as catalyzed by UiO-66 and UiO-67, was examined as a function of pH. Surprisingly, even though typical phosphate–ester hydrolysis mechanisms entail nucleophilic attack of the simulant by aqueous hydroxide, the rate of hydrolysis accelerates as the solution pH is lowered. The unexpected behavior is attributed to a pH-dependent composition change followed by ligand substitution at the Zr6-based node.

Brilliant light

Ad Libitum7 July 2015brilliant lightD.A. Frater, MDD.A. Frater, MDFrom Dallas, Texas.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-0240 Audio Reading - “brilliant light” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "brilliant light," by D.A. Frater. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail I remember the brilliant light thatlast cool day before summer whenrebellion against life took yourbreath away and you let me makeyou hostage to my favorite place forthe day aware of my intent remindingme that color blind men were not movedby paint-splashed canvas even lessby fields of bluebonnets and marigoldsthan the rest of us so first we listenedas I tried to fill in the gray outlinethe sound of the marsh its cacophony itscounterpoint harmony absent scorelessline added upon line the dickcissels repeatinglight percussions the blackbirds trilling inreturn to ... Author, Article, and Disclosure InformationAffiliations: From Dallas, Texas.Current Author Address: D.A. Frater, MD; e-mail, [email protected]md. PreviousarticleNextarticle Advertisement Audio Reading - “brilliant light” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "brilliant light," by D.A. Frater. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics Cited byHighest Priority Health and Health Care Concerns of Transgender and Nonbinary Individuals in a Southern State 7 July 2015Volume 163, Issue 1Page: 13KeywordsFearMarshesSafetyStroke ePublished: 7 July 2015 Issue Published: 7 July 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Loving Her

Ad Libitum7 July 2015Loving HerLawrence J. Hergott, MDLawrence J. Hergott, MDFrom Center for Bioethics and Humanities, University of Colorado School of Medicine, Denver, Colorado.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-0536 Audio Reading - “Loving Her” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Loving Her," by L.J. Hergott. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail I had a patient who,for yearsafter his wife of many yearsdied,went to her grave daily.He didn't go there to visit herand then get on with his day.Visiting her was his day,and he spent it sitting in a chairnear her,or what was left of her,in the groundand in his heart.He must have spoken to herthroughout the day—would that be monologue or soliloquy?I'm sure to him it was a conversation.Why did he do it?I never asked,perhaps assuming I understood.Whatever his reasons,he described his days contentedly.Clinical concerns aside,loving you as I do,I was happy for him.Lawrence J. Hergott, ... Author, Article, and Disclosure InformationAffiliations: From Center for Bioethics and Humanities, University of Colorado School of Medicine, Denver, Colorado.Current Author Address: Lawrence J. Hergott, MD; e-mail, [email protected]net. PreviousarticleNextarticle Advertisement Audio Reading - “Loving Her” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Loving Her," by L.J. Hergott. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 7 July 2015Volume 163, Issue 1Page: 51KeywordsHeart ePublished: 7 July 2015 Issue Published: 7 July 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Giving Bad News Reminds Me of You

Ad Libitum16 June 2015Giving Bad News Reminds Me of YouDoug HesterDoug HesterFrom Nashville, Tennessee.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-0397 Audio Reading - “Giving Bad News Reminds Me of You” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Giving Bad News Reminds Me of You," by D. Hester. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Storms rise, releasing an old memoryof your death. But this time I'm the giverof rites, sitting in my scrubs and white coat.The rusty words sound familiar as theyrain down on his newborn widow. I wantto tell her about you, to tell her Iburied a spouse, but instead I stare atthe plastic roses backlit by lightning.Here with her I hear thunder, lumberingand jagged, fracture and grind as the stormreels outside the Family Room's windows.Dry-eyed, she looks through me before stumblingbeyond sound, clutching each breath in fear hismemories will flee in exhalation.Doug HesterNashville, Tennessee Author, Article, and Disclosure InformationAffiliations: From Nashville, Tennessee.Current Author Address: Doug Hester; e-mail, doug.[email protected]edu. PreviousarticleNextarticle Advertisement Audio Reading - “Giving Bad News Reminds Me of You” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Giving Bad News Reminds Me of You," by D. Hester. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 16 June 2015Volume 162, Issue 12Page: 859KeywordsFearMemoryStorms ePublished: 16 June 2015 Issue Published: 16 June 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Time capsule

Ad Libitum5 May 2015time capsuleAkshay Pendyal, MDAkshay Pendyal, MDFrom Portland, Oregon.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-0193 Audio Reading - “time capsule” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "time capsule," by A. Pendyal. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail after the new hearthas been interredinto the chest'sempty crucible,it is restarted.slowly at first,but then building steam,allowing its accumulated contentsto seepinto unaccustomed earth.memories (like that of the tin lunchbox,caked with sand andcarrying the afternoon's spoils,briny seashells and smoothed pebbles;or of popsicles whose juice wassticky on interlocked fingers)flow in rivulets,terminating in capillary bedsand laying dormant.so that years later,after the graft had taken holdand was now firmly your own,you abruptly felton the back of your tongue,in your nostrils,against your skinsalta soft breezethe sun's warmth—sensations both unfamiliarand as old as time.Akshay Pendyal, MDPortland, Oregon Author, Article, and Disclosure InformationAffiliations: From Portland, Oregon.Current Author Address: Akshay Pendyal, MD; e-mail, akshay.[email protected]com. PreviousarticleNextarticle Advertisement Audio Reading - “time capsule” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "time capsule," by A. Pendyal. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 5 May 2015Volume 162, Issue 9Page: 667KeywordsCapillariesHeartMemorySaltsThoraxTongue ePublished: 5 May 2015 Issue Published: 5 May 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Ebb Tide

Ad Libitum7 April 2015Ebb TideRichard Bronson, MDRichard Bronson, MDFrom Stony Brook, New York.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-0112 Audio Reading - “Ebb Tide” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Ebb Tide," by R. Bronson. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Little by littlethey drifted into dream,left behindtheir world of joys and sorrows,family, friends,entered an inner life.We tried to call them backthrough music, verse,and momentarily,they looked around,smiled at familiar faces,stamped their feetto the beat of a remembered tune—when they had danced with a wife,taken a husband by the hand.The crueltyfor those left behind—who could not follow themto wherever they went,could not knowthe inner lives of their secret worldsfrom which there would be no waking.Richard Bronson, MDStony Brook, New York Author, Article, and Disclosure InformationAffiliations: From Stony Brook, New York.Current Author Address: Richard Bronson, MD; e-mail, Richard.[email protected]edu. PreviousarticleNextarticle Advertisement Audio Reading - “Ebb Tide” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Ebb Tide," by R. Bronson. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 7 April 2015Volume 162, Issue 7Page: 525 ePublished: 7 April 2015 Issue Published: 7 April 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...