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Advance care planning (ACP) increases quality of life and satisfaction with care for those with cancer and their families, yet these important conversations often do not occur. Barriers include patients’ and families’ emotional responses to cancer, such as anxiety and sadness, which can lead to avoidance of discussing illness-related topics such as ACP. Interventions that address psychological barriers to ACP are needed. The purpose of this study was to explore the effects of a mindfulness intervention designed to cultivate patient and caregiver emotional and relational capacity to respond to the challenges of cancer with greater ease, potentially decreasing psychological barriers to ACP and enhancing ACP engagement.
The Mindfully Optimizing Delivery of End-of-Life (MODEL) Care intervention provided 12 hours of experiential training to two cohorts of six to seven adults with advanced-stage cancer and their family caregivers (n = 13 dyads). Training included mindfulness practices, mindful communication skills development, and information about ACP. Patient and caregiver experiences of the MODEL Care program were assessed using semistructured interviews administered immediately postintervention and open-ended survey questions delivered immediately and at 4 weeks postintervention. Responses were analyzed using qualitative methods.
Four salient themes were identified. Patients and caregivers reported the intervention (1) enhanced adaptive coping practices, (2) lowered emotional reactivity, (3) strengthened relationships, and (4) improved communication, including communication about their disease.
Significance of results
The MODEL Care intervention enhanced patient and caregiver capacity to respond to the emotional challenges that often accompany advanced cancer and decreased patient and caregiver psychological barriers to ACP.
Valid consent for treatment or research participation requires that an individual has decision-making capacity (DMC), which is the ability to make a specific decision. There is evidence that the psychopathology of schizophrenia can compromise DMC. The objective of this review was to examine the presence or absence of DMC in schizophrenia and the socio-demographic/psychopathological factors associated.
We searched three databases Embase, Ovid MEDLINE(R), and PsycINFO for studies reporting data on the proportion of DMC for treatment and research (DMC-T and DMC-R), and/or socio-demographic/psychopathological associations with ability to make such decisions, in people with schizophrenia and related illnesses.
A total of 40 studies were identified. While high levels of heterogeneity limited direct comparison, meta-analysis of inpatient data showed that DMC-T was present in 48% of people. Insight was strongly associated with DMC-T. Neurocognitive deficits were strongly associated with lack of DMC-R and to a lesser extent DMC-T. With the exception of years of education, there was no evidence for an association with socio-demographic factors.
Insight and neurocognitive deficits are most closely associated with DMC in schizophrenia. The lack of an association with socio-demographic factors dispels common misperceptions regarding DMC and characteristics such as age. Although our results reveal a wide spectrum of DMC-T and DMC-R in schizophrenia, this could be partly due to the complexity of the DMC construct and the heterogeneity of existing studies. To facilitate systematic review research, there is a need for improvement within research study design and increased consistency of concepts and tools.
We describe the performance of the Boolardy Engineering Test Array, the prototype for the Australian Square Kilometre Array Pathfinder telescope. Boolardy Engineering Test Array is the first aperture synthesis radio telescope to use phased array feed technology, giving it the ability to electronically form up to nine dual-polarisation beams. We report the methods developed for forming and measuring the beams, and the adaptations that have been made to the traditional calibration and imaging procedures in order to allow BETA to function as a multi-beam aperture synthesis telescope. We describe the commissioning of the instrument and present details of Boolardy Engineering Test Array’s performance: sensitivity, beam characteristics, polarimetric properties, and image quality. We summarise the astronomical science that it has produced and draw lessons from operating Boolardy Engineering Test Array that will be relevant to the commissioning and operation of the final Australian Square Kilometre Array Path telescope.
This paper describes the system architecture of a newly constructed radio telescope – the Boolardy engineering test array, which is a prototype of the Australian square kilometre array pathfinder telescope. Phased array feed technology is used to form multiple simultaneous beams per antenna, providing astronomers with unprecedented survey speed. The test array described here is a six-antenna interferometer, fitted with prototype signal processing hardware capable of forming at least nine dual-polarisation beams simultaneously, allowing several square degrees to be imaged in a single pointed observation. The main purpose of the test array is to develop beamforming and wide-field calibration methods for use with the full telescope, but it will also be capable of limited early science demonstrations.
There is evidence that epigenetic changes occur early in breast carcinogenesis. We hypothesized that early-life exposures associated with breast cancer would be associated with epigenetic alterations in breast tumors. In particular, we examined DNA methylation patterns in breast tumors in association with several early-life exposures in a population-based case–control study. Promoter methylation of E-cadherin, p16 and RAR-β2 genes was assessed in archived tumor blocks from 803 cases with real-time methylation-specific PCR. Unconditional logistic regression was used for case–case comparisons of those with and without promoter methylation. We found no differences in the prevalence of DNA methylation of the individual genes by age at menarche, age at first live birth and weight at age 20. In case–case comparisons of premenopausal breast cancer, lower birth weight was associated with increased likelihood of E-cadherin promoter methylation (OR = 2.79, 95% CI, 1.15–6.82, for ⩽2.5 v. 2.6–2.9 kg); higher adult height with RAR-β2 methylation (OR = 3.34, 95% CI, 1.19–9.39, for ⩾1.65 v. <1.60 m); and not having been breastfed with p16 methylation (OR = 2.75, 95% CI, 1.14–6.62). Among postmenopausal breast cancers, birth order was associated with increased likelihood of p16 promoter methylation. Being other than first in the birth order was inversely associated with likelihood of ⩾1 of the three genes being methylated for premenopausal breast cancers, but positively associated with methylation in postmenopausal women. These results suggest that there may be alterations in methylation associated with early-life exposures that persist into adulthood and affect breast cancer risk.
We examined the Clostridium difficile infection rate and risk factors in an outpatient dialysis cohort. The Cox proportional hazard for developing C. difficile infection was significantly higher with high comorbidity index and low serum albumin level. Conversely, it was lower for patients who had frequent bloodstream and dialysis access-related infections.
The objectives of this study were, firstly, to characterize the inter-patient variability in the dose of propofol required to achieve a bispectral index <70 and ‘time to eye opening’ following propofol infusion and, secondly, to determine if the pharmacodynamic parameter ‘time to achieve bispectral index <70’ was influenced by genotype of the sex-linked drug receptor gene GABRE or if pharmacokinetic parameters such as clearance and ‘time to eye opening’ were influenced by the genotype of the metabolizing enzyme CYP2B6.
One hundred and fifty patients received a standardized anaesthetic. Apparent systemic clearance values were estimated. Correlation was sought between carriers of different CYP2B6 and GABRE genotypes and apparent systemic clearance, ‘time to achieve bispectral index <70’ and ‘time to eye opening’.
Propofol induction/emergence characteristics varied, with slow recovery times in a subset of males. Time to loss of verbal contact and time to bispectral index <70 varied 6.6- and 4.3-fold, respectively. At emergence, there was a 15.5- to 111-fold variability in the measured time intervals. Clearance varied from 9.1 to 55.8 mL min−1 kg−1. The CYP2B6 C1459T (R487C) genotype frequencies were TT 1%, TC 22% and CC 67%. The three major haplotypes of CYP2B6 (R487C, K262R and Q172H variants) were not significantly associated with time to eye opening or clearance. Clearance was similar in 487C carriers and 487RR genotypes. There was no statistically significant correlation between the four major haplotypes of GABRE variants investigated ([mRNA358]G/T, 20118C/T, 20326C/T and 20502 A/T) and the observed anaesthesia induction time.
Great inter-patient variability exists in the dose of propofol required to achieve bispectral index <70, apparent systemic propofol clearance and time to eye opening. Common haplotypic differences at the CYP2B6 and GABRE genes do not appear to account for the majority of the observed inter-patient variability.
Breast cancer is a multifactorial disease that is triggered by gene–environment interactions. Epidemiological research has identified alcohol consumption as a significant non-hormonal-related and consistent risk factor, and is thus a preventable cause of breast cancer. The reasons why alcohol drinking increase breast cancer risk are unclear, and several hypotheses exist. The perturbation of estrogen metabolism and response appears to one mechanism underlying the association. Alcohol consumption also increases breast density in postmenopausal women and affects sex steroid levels. Other plausible mechanisms include: (1) mutagenesis by acetaldehyde, which is a metabolite of ethanol; (2) by enhancing the susceptibility of the mammary gland to carcinogenesis by affecting DNA repair, stimulating cell proliferation or altering mammary gland structural development; (3) influencing the disposition and function of essential nutrients or dietary factors considered cancer protective (e.g. affecting folate and one-carbon metabolism pathways); (4) inducing genome instability and DNA damage; and (5) inducing oxidative damage via ethanol or estrogen metabolism. To better understand the etiological nature of the effect of alcohol on breast carcinogenesis, further studies at the cellular and molecular levels on the interaction between ethanol and other risk factors, estrogen, carcinogens are needed.
We have used Chandra archival observations of 19 galaxies hosting LINERs to explore the morphology and source population of their inner kiloparsec. Our goal was, in general, to determine the power source behind their nuclear X-ray emission and, in particular, to investigate the presence of an AGN. We find an AGN in 12 of the 19 galaxies in the sample. We also find that diffuse, thermal emission is common with properties very similar to what is found in normal galaxies. In 10 out of the 19 galaxies, the diffuce emission dominates the nuclear X-ray power. The X-ray point-source populations were studied by producing cumulative luminosity functions and their properties are also similar to what is found in normal galaxies.
“President Bush's victory, the approval of every anti-gay marriage amendment on statewide ballots and an emphasis on ‘moral values’ among voters showed the power of churchgoing Americans in this election and threw the nation's religious divide into stark relief.” Associated Press, November 4, 2004
Archean and Proterozoic time scales are currently defined chronometrically, with subdivisions into eras and periods being defined and allocated boundaries in terms of a round number of millions of years before present. Isotope stratigraphy is increasingly used to identify tectonic, chemical, and biological changes. The Neoproterozoic Era is characterized by at least two, and possibly four, severe and extensive glaciogenic events; for this era, chronostratigraphic subdivisions following established Phanerozoic practices are possible.
The “Precambrian” is not a formal stratigraphic term and simply refers to all rocks that formed prior to the beginning of the Cambrian Period. The task of establishing a rigorously defined and globally acceptable time scale for the Precambrian is an exceedingly difficult, and often frustrating, exercise. The reason for this is related to the fact that studying the Earth becomes increasingly difficult and uncertain the further one goes back in geological time.
The lack of a diverse and well-preserved fossil record, the generally decreasing volume of supracrustal rocks, and increasing degree of metamorphism and tectonic disturbance, as well as the uncertainties in the configuration and assembly of the continents, all contribute to making the establishment of a chronostratigraphic time scale beyond the Phanerozoic Eon problematical.
The Phanerozoic Eon broadly coincides with the most recent supercontinent cycle – a relatively well-understood sequence of geological events during which Pangea was assembled and dispersed.
We present the analysis of Hubble Space Telescope blue spectra at intermediate spectral resolution for the nuclei of 23 nearby disk galaxies. These objects were selected to have nebular emission in their nuclei, and span a range of emission-line classifications as well as Hubble types. Here we focus on the stellar population as revealed by the continuum spectral energy distribution measured within the central 0.″13 (∼8 pc) of these galaxies. The data were modeled with linear combinations of single-age stellar population synthesis models. The large majority (∼80%) of the surveyed nuclei have spectra whose features are consistent with a predominantly old ($\gtrsim 5 \times 10^9$ yr) stellar population. Approximately 25% of these nuclei show evidence of a component with age younger than 1 Gyr, with the incidence of these stars related to the nebular classification. Successful model fits imply an average reddening corresponding to AV∼0.4 mag and stellar metallicity of (1–2.5)$Z_\odot$. Our findings reinforce the picture wherein Seyfert nuclei and the majority of low-ionization nuclear emission-line regions (LINERs) are predominantly accretion-powered, and suggest that much of the central star formation in HII nuclei is actually circumnuclear.To search for other articles by the author(s) go to: http://adsabs.harvard.edu/abstract_service.html
The goal of our research is to combine porous silicon and enzymes in order to build hybrid platforms for extremely selective chemical sensing applications. For this, a new synthetic route to covalently anchor bio-molecules on photo-luminescent porous silicon (PL PSi) while preserving the optical properties of the matrix was developed. The hydride terminated porous silicon surface was covalently functionalized with t-butyloxycarbonyl protected amine by light-assisted hydrosysilation. Protein cross-linker chemistry was then used to extend the linker and immobilize various enzymes. The glu-coronidase enzyme/p-nitro-phenyl-beta-glucoronide substrate test system provided a proof of concept for an enzyme-based porous silicon detector. The enzymatic activity and the luminescence of the porous silicon platform were both retained after the functionali-zation procedure and, charge transfer between the products of the enzymatic breakdown and the silicon quantum dots was demonstrated. The organophosphorous hydrolase enzyme OPAA was then immobilized and tested on p-nitrophenyl-soman, a surrogate substrate for soman. The production of the hydrolysis product, p-nitrophenol, correlated with the reversible luminescence quenching of the porous silicon matrix demonstrating the relevance of the enzyme-based platform for detection applications. This detection scheme, although indirect, takes advantage of the extreme specificity of enzymes. The approach is general and can be implemented for a series of target molecules.