Using Geriatric Assessment Strategies to Lead End-of-Life Care Discussions

Abstract

End-of-life discussions with geriatric oncology patients are a vital part of the comprehensive care of the senior adult patient. Developing a roadmap for these conversations can be challenging. Patients and caregivers may have expectations that are not concordant with what is reasonably achievable if the patient is frail. Measuring baseline cognition, nutritional status, and physical function and discussing goals of care are all essential pieces of information that can be obtained through a comprehensive geriatric assessment (CGA). Objective findings from the CGA can be crucial in developing end-of-life care plans that reflect both the patient's health status and personal values.

Kleeman, Terry F., Celestial Masters: History and Ritual in Early Daoist Communities

Extending Compassion

Studies on acute and chronic toxicity of cadmium to freshwater snail Lymnaea acuminata (Lamarck) with special reference to behavioral and hematological changes

Abstract

Molluscs have long been regarded as promising bioindicator and biomonitoring subjects for heavy metals as molluscs are highly tolerant to heavy metals and exhibit high accumulation in their body. In spite of several previous studies about the impact of cadmium on molluscs, little information exists in literatures concerning the toxic effects of cadmium on Lymnaea acuminata, especially pertaining to behavioral and hematological changes as these are considered effective bioindicators and biomonitoring variables for detecting heavy metals in polluted water bodies. In the present study, the median lethal concentrations of cadmium chloride to snail, Lymnaea acuminata, were estimated to be 9.66, 7.69, 6.26, and 5.54 mg/L at 24, 48, 72, and 96 h, respectively. For behavioral studies, variable test concentrations of cadmium from 0.00 to 10 mg/L were used. The clumping tendency, crawling activity, and touch reflex in the exposed snails were gradually decreased with higher concentrations at 72 and 96 h. For measuring the hemocyte numbers in the circulating hemolymph of snail during chronic cadmium exposure, two sublethal doses of cadmium (10 and 20% 96-h LC₅₀—0.55 and 1.11 mg/L, respectively) were used. A significant variation (p < 0.05) from the control at all exposure times (7, 14, 21, and 28 days) was recorded at 1.11 mg/L concentration. The total count of circulating hemocytes was significantly reduced (p < 0.05) compared to the controls at both concentrations of cadmium exposure at all time periods except 14 and 21 days exposure at 0.55 mg/L where values were non-significantly increased. In comparison between two sublethal doses, blood cells were significantly (p < 0.05) lowered at 1.11 mg/L cadmium treatment. Considering the behavioral and hematological data, it seems possible to forecast the physiological state of snails in cadmium-contaminated water bodies and these findings can be used in determining the safe disposal level of cadmium in aquatic ecosystem.

Fractions and transformation of organic phosphorus in sediments from a eutrophic lake in China

Abstract

Several organic phosphorus compounds (Po) in sediment from a representative eutrophic lake were surveyed using a sequential fractionation procedure, which included microbial biomass phosphorus (Biomass-P), fulvic acid phosphorus (FA-P), humic acid phosphorus (HU-P), and residual phosphorus (Res-P). In addition, several organic compounds including orthophosphate monoesters, orthophosphate diesters, and pyrophosphate were simultaneously measured using ³¹P nuclear magnetic resonance (³¹P NMR). Results showed that Po contributed over 50% of total phosphorus (TP), and the average concentration of Po species generally decreased from Res-P > FA-P > HU-P > Biomass-P. Additionally, the relative proportions of phosphorus compounds in the sediment followed the decreasing order of orthophosphate monoesters > orthophosphate diesters > pyrophosphate. In general, Po was the dominant phosphorus species. Residual P was not a single species but comprised of a group of species, and tended to be stable. Although orthophosphate monoesters had the highest concentrations and ratios in Po, orthophosphate diesters displayed a more distinct remineralization trend. Principal component analysis (PCA) coupled with correlation analysis suggested that a greater amount of orthophosphate diesters resided in Res-P, than HU-P or FA-P.

Organic ligand induced release of vanadium from the dissolution of stone coal oxide ore

Abstract

The effects of low-molecular-weight dissolved organic matters (LMWDOMs) on the release of vanadium (V) under environmental conditions are part of a broader study on the environmental geochemistry behavior of V. Eight typical naturally occurring LMWDOMs with carboxyl, hydroxyl, and amidogen groups were chosen: citric acid, oxalic acid, EDTA, salicylic acid, catechol, glycine, cysteine, and glucose. The results showed that the release of V was largely promoted by LMWDOMs with carboxyl functional groups under acidic conditions and with catechol under basic conditions. In the presence of citric acid, oxalic acid, or EDTA at pH 4.0, the initial release rates of V were approximately 25–39 times greater than the rates in the control experiments; the steady release rates were 164, 95, and 49 times than the rates in the control experiments, respectively. For catechol, the release rate at pH 8.0 was approximately 20 times the rate at pH 4.0. Amino acids and alcohols had a minimal effect on the release of V. Ligand-promoted release rates of V were found primarily due to the faster detachment of surface complexes, the protonated sites from the mineral surface and the reduction of dissolved V (V) in the presence of citric acid, oxalic acid, EDTA, and catechol. This study helps understand the pollution risk of V in some mine areas and the fate of V in the environment.

How to write a Critically Appraised Topic: evidence to underpin routine clinical practice

Summary

Critically appraised topics (CATs) are essential tools for busy clinicians who wish to ensure that their daily clinical practice is underpinned by evidence-based medicine. CATs are short summaries of the most up-to-date, high-quality available evidence that is found using thorough structured methods. They can be used to answer specific, patient-orientated questions that arise recurrently in real-life practice. This article provides readers with a detailed guide to performing their own CATs. It is split into four main sections reflecting the four main steps involved in performing a CAT: formulation of a focused question, a search for the most relevant and highest-quality evidence, critical appraisal of the evidence and application of the results back to the patient scenario. As well as helping to improve patient care on an individual basis by answering specific clinical questions that arise, CATs can help spread and share knowledge with colleagues on an international level through publication in the evidence-based dermatology section of the British Journal of Dermatology.

T cells responding to Trypanosoma cruzi detected by membrane TNF-α and CD154 in chagasic patients

Abstract

Introduction

Chagas disease is a parasitic infection whose pathogenesis is related to parasite persistence and a dysfunctional cellular immune response. Variability in cytokine secretion among chronic Trypanosoma cruzi-infected patients might preclude the identification of the pool of antigen specific T cells. The goal of this study was to determine the fraction of T cells responding to T. cruzi antigen measured by the expression of membrane TNF-α and CD154.

Methods

A total of 21 chagasic patients, 11 healthy and 5 non-chagasic cardiomyopathy controls were analyzed. PBMCs were short-term cultured in the presence of anti-CD28, anti-CD49d, anti-TNF-α, and TACE (TNF-α converting enzyme) inhibitor either under T. cruzi-lysate or polyclonal stimuli. Cells were stained with anti-CD3, anti-CD4, anti-CD8, and anti-CD154, and analyzed with flow cytometry.

Results

CD4+ and CD8+ T cells in chagasic patients displayed higher percentages of membrane-bound TNF-α+ and CD154+ compared with controls after T. cruzi-antigen stimulation. Both markers displayed a positive correlation in the T cell subpopulations analyzed. Symptomatic chagasic patients were differentiated from asymptomatic patients based on the expression of CD154 and membrane TNF-α in TCD4+ and TCD8+ compartments, respectively.

Conclusions

These results show that both markers could be useful for assessing the pool of antigen-specific T cells in chronic chagasic patients.

The goal of this study was to determine the fraction of T cells responding to T. cruzi antigen measured by the expression of membrane TNF-α and CD154. The main findings of our study are (1) CD4+ and CD8+ T cells in chagasic patients displayed higher percentages of membrane-bound TNF-α+ and CD154+ compared with controls after T. cruzi-antigen stimulation; (2) both markers displayed a positive correlation in the T cell subpopulations analyzed; (3) symptomatic chagasic patients were differentiated from asymptomatic patients based on the expression of CD154 and membrane TNF-α in TCD4+ and TCD8+ compartments, respectively. These results show that both markers could be useful for assessing the pool of antigen-specific T cells in chronic chagasic patients.