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To examine factors that influence decision-making, preferences, and plans related to advance care planning (ACP) and end-of-life care among persons with dementia and their caregivers, and examine how these may differ by race.
13 geographically dispersed Alzheimer’s Disease Centers across the United States.
431 racially diverse caregivers of persons with dementia.
Survey on “Care Planning for Individuals with Dementia.”
The respondents were knowledgeable about dementia and hospice care, indicated the person with dementia would want comfort care at the end stage of illness, and reported high levels of both legal ACP (e.g., living will; 87%) and informal ACP discussions (79%) for the person with dementia. However, notable racial differences were present. Relative to white persons with dementia, African American persons with dementia were reported to have a lower preference for comfort care (81% vs. 58%) and lower rates of completion of legal ACP (89% vs. 73%). Racial differences in ACP and care preferences were also reflected in geographic differences. Additionally, African American study partners had a lower level of knowledge about dementia and reported a greater influence of religious/spiritual beliefs on the desired types of medical treatments. Notably, all respondents indicated that more information about the stages of dementia and end-of-life health care options would be helpful.
Educational programs may be useful in reducing racial differences in attitudes towards ACP. These programs could focus on the clinical course of dementia and issues related to end-of-life care, including the importance of ACP.
Shunt-related adverse events are frequent in infants after modified Blalock–Taussig despite use of acetylsalicylic acid prophylaxis. A higher incidence of acetylsalicylic acid-resistance and sub-therapeutic acetylsalicylic acid levels has been reported in infants. We evaluated whether using high-dose acetylsalicylic acid can decrease shunt-related adverse events in infants after modified Blalock–Taussig.
In this single-centre retrospective cohort study, we included infants ⩽1-year-old who underwent modified Blalock–Taussig placement and received acetylsalicylic acid in the ICU. We defined acetylsalicylic acid treatment groups as standard dose (⩽7 mg/kg/day) and high dose (⩾8 mg/kg/day) based on the initiating dose.
There were 34 infants in each group. Both groups were similar in age, gender, cardiac defect type, ICU length of stay, and time interval to second stage or definitive repair. Shunt interventions (18 versus 32%, p=0.16), shunt thrombosis (14 versus 17%, p=0.74), and mortality (9 versus 12%, p=0.65) were not significantly different between groups. On multiple logistic regression analysis, single-ventricle morphology (odds ratio 5.2, 95% confidence interval of 1.2–23, p=0.03) and post-operative red blood cells transfusion ⩾24 hours [odds ratio 15, confidence interval of (3–71), p<0.01] were associated with shunt-related adverse events. High-dose acetylsalicylic acid treatment [odds ratio 2.6, confidence interval of (0.7–10), p=0.16] was not associated with decrease in these events.
High-dose acetylsalicylic acid may not be sufficient in reducing shunt-related adverse events in infants after modified Blalock–Taussig. Post-operative red blood cells transfusion may be a modifiable risk factor for these events. A randomised trial is needed to determine appropriate acetylsalicylic acid dosing in infants with modified Blalock–Taussig.
Feathers are a waste product generated in large quantities from commercial poultry processing. Recycling of feathers is an interesting subject among animal nutritionists, because of its potential as a cheap and alternative protein feedstuff. Although feathers are deficient in certain essential amino acids such as methionine, lysine, histidine and tryptophan, they contain other amino acids such as arginine, and threonine (Onifade et al., 1998). Feather waste has been used as feedstuff for poultry and livestock. Without appropriate processing, feather meal has little nutritive value because keratin is not degraded by most proteolytic enzymes. The proteolytic resistance of keratin results from its structural features tight packing of protein chains, hydrogen bonding among polypeptides, and hydrophobic interaction and stabilization of the super-coiled polypeptide chains (Onifade et al., 1998). Many treatments have been developed to increase the digestibility of feather meal and are usually categorized into two groups: hydrothermal treatments and microbial keratinolysis (Onifade et al., 1998). Food irradiation has been recognized as a reliable and safe method for preservation, improve hygienic quality and improve the nutritional value of foods (Diehl, 2002). Lee (1962) observed that sulfhydryl and disulphide groups in proteins are apparently highly susceptible to irradiation and destruction of disulphide bonds improves digestibility of proteins.
Canola meal (the oil-free residue of low glucosinolate, low erucic acid rapeseed) is a good source of protein for animals and is a particularly rich source of the sulphur containing amino acids, methionine and cystine. Canola meal has some antinutritional factors that they may be responsible for low utilisation of nutrients in the canola meal. These antinutritional factors are glucosinolates, erucic acid, phytic acid and high levels of fibre. Removal of undesirable components is essential to improve the nutritional quality of meals and effectively utilise their full potential as animal feed. Several conventional food processing methods such as germination, soaking, cooking and fermentation are known to reduce antinutritional factors and upgrade the nutritional quality of feeds of plant-origin. However, most of these treatments adversely affect the sensory characteristics of the final product. Food irradiation has been recognised as a reliable and safe method for preservation, improving hygienic quality and improving the nutritional quality of foods (Diehl, 2002).