Opieka paliatywna oraz opieka końcowego okresu życia u chorych na ciężką postać POChP

Przewlekła obturacyjna choroba płuc (POChP) jest jedną z głównych przyczyn chorobowości i umieralności. U wielu chorych maksymalne leczenie POChP pozwala osiągnąć jedynie niewielką lub niepełną poprawę objawów chorobowych, które znacznie pogarszają jakość życia. Pomimo wysokiej chorobowości i umieralności związanej z ciężką postacią POChP, wielu chorych nie otrzymuje właściwego leczenia paliatywnego. Wynika to z kilku powodów. Po pierwsze, komunikacja między lekarzem a chorym, dotycząca opieki paliatywnej oraz opieki końcowego okresu życia, jest zwykle sporadyczna i złej jakości. Po drugie, niepewność dotycząca dalszego rokowania u chorych na POChP dodatkowo utrudnia komunikację w końcowym okresie życia. W rezultacie chorzy i ich bliscy często nie rozumieją, że ciężka postać POChP jest z reguły postępującą i śmiertelną chorobą. Celem niniejszego przeglądu jest podsumowanie ostatnich badań dotyczących opieki paliatywnej oraz opieki końcowego okresu życia chorych na POChP. Wyniki niedawnych badań dostarczają nowych zaleceń postępowania w poprawianiu komunikacji między lekarzem a pacjentem dotyczącej leczenia w końcowym okresie życia. Dzięki przestrzeganiu tych zaleceń poprawia się także jakość leczenia paliatywnego oraz leczenia końcowego okresu życia chorych na POChP. Szczególną uwagę zwrócono na dwa obszary, które mogą wpływać na poprawę jakości leczenia paliatywnego i leczenia końcowego okresu życia: 1) rolę smutku i depresji, częstych problemów chorych na POChP; oraz 2) potrzebę wczesnego planowania opieki nad chorym. Poprawa komunikacji między chorym a lekarzem jest istotna dla jakości opieki paliatywnej

A Comprehensive Survey of Brane Tilings

An infinite class of $4d$ $\mathcal{N}=1$ gauge theories can be engineered on the worldvolume of D3-branes probing toric Calabi-Yau 3-folds. This kind of setup has multiple applications, ranging from the gauge/gravity correspondence to local model building in string phenomenology. Brane tilings fully encode the gauge theories on the D3-branes and have substantially simplified their connection to the probed geometries. The purpose of this paper is to push the boundaries of computation and to produce as comprehensive a database of brane tilings as possible. We develop efficient implementations of brane tiling tools particularly suited for this search. We present the first complete classification of toric Calabi-Yau 3-folds with toric diagrams up to area 8 and the corresponding brane tilings. This classification is of interest to both physicists and mathematicians alike.Comment: 39 pages. Link to Mathematica modules provide

Can natural flavorings enhance the flavor of low-fat ground beef?

Natural flavorings were evaluated for use in low-fat ground beef, which frequently lacks flavor intensity. Three lean sources, A-maturity (young), E-maturity (mature cow), and imported (cow) beef round muscles, were used to formulate 7% and 25% fat ground beef. A-maturity fat was added to adjust fat levels. Controls (no added flavors) were prepared for each lean source. No additives were used in 25% fat controls, but 7% fat controls contained water (10%), carrageenan (.5%), and encapsulated salt (.38%). Four natural flavorings; Dried Cream Extract (DCE, Cumberland Packing Co., Inc.); Natural Prime Beef Base WONF #224545 and #224546 (224545, 224546, Tastemaker); and Hydrolyzed Vegetable Protein (HVP, A.C. Legg, Inc.) were added to 7% fat ground beef at recommended levels. A- and E-maturity domestic 25% fat controls were scored higher (P\u3c.05) for ground beef flavor intensity and lower (P\u3c.05) for off-flavors than 25% fat patties from imported beef. The 7% fat patties from imported lean had greater (P\u3c.05) beef flavor intensity and reduced off-flavors (P\u3c.05) when flavorings 224545, 224546, and HVP were added. These flavorings also enhanced the beef flavor intensity of low-fat patties from A-maturity lean to a level similar to that of the 25% fat control. Beef flavor intensity after a 60-min holding period was not enhanced by the natural flavorings, except when 224546 was added to E-maturity domestic lean. Therefore, the natural flavorings were most beneficial with imported lean

The Quark Propagator from the Dyson-Schwinger Equations: I. the Chiral Solution

Within the framework of the Dyson-Schwinger equations in the axial gauge, we study the effect that non-perturbative glue has on the quark propagator. We show that Ward-Takahashi identities, combined with the requirement of matching perturbative QCD at high momentum transfer, guarantee the multiplicative renormalisability of the answer. Technically, the matching with perturbation theory is accomplished by the introduction of a transverse part to the quark-gluon vertex. We show that this transverse vertex is crucial for chiral symmetry breaking, and that massless solutions exist below a critical value of the strong coupling constant. Using the gluon propagator that we previously calculated, we obtain small corrections to the quark propagator, which keeps a pole at the origin in the chiral phase.Comment: 21 pages, 6 figures; McGill/94-24, SHEP 93/94-26 We generalise our results by showing that they are not sensitive to the specific choice that we make for the transverse vertex. We illustrate that fact in two new figure

Ralgro-implanted bulls: Performance, carcass characteristics, longissimus palatability and carcass electrical stimulation

Twenty of 40 Angus bulls were implanted (I) five times with 36 mg of Ralgro| at average intervals of 106 d, beginning near birth. All bulls and their dams were on bluestem pasture initially and, at an average age of 320 d bulls were fed a concentrate diet until they were slaughtered, weighing either 454 or 499 kg. One side of each carcass was electrically stimulated. Average daily gain and feed efficiency of I bulls improved 6.5 to 10.4% and 7.9 to 8.1%, respectively, depending upon the end point comparison with nonimplanted (NI) bulls. Implanted bulls attained their slaughter weights 42 d sooner than did NI bulls. Implantation decreased (P<.05) penis weight and length, testicle weight, volume and density, but did not affect (P>.05) seminal vesicle and pituitary weights. Carcasses from I bulls had more (P<.05) skeletal ossification and were fatter than carcasses from NI bulls. Marbling scores, quality grades and longissimus cooking losses and juiciness scores were not affected (P>.05) by implantation. Taste panel flavor intensity and detectable connective tissue scores were higher (P<.05) for steaks from I bulls than from NI bulls. Longissimus steak tenderness evaluations were higher (P<.05) for both I slaughter groups than for the NI light-weight group and were higher (P<.05) for the I lightweight group than for the NI heavy-weight group. Longissimus tenderness tended (P = .11) to be higher for steaks from the I heavy-weight group than those from the NI heavy-weight group. Electrical stimulation produced (P<.05) a softer, coarser textured lean, but it did not affect lean color, marbling or quality grade. Steaks from electrically stimulated sides tended to have higher (P = .09) myofibrillar tenderness scores and lower (P = .06) flavor scores than steaks from nonstimulated sides

Assessment of Discordance Between Physicians and Family Members Regarding Prognosis in Patients With Severe Acute Brain Injury.

Shared decision-making requires key stakeholders to align in perceptions of prognosis and likely treatment outcomes. For patients with severe acute brain injury, the objective of this study was to better understand prognosis discordance between physicians and families by determining prevalence and associated factors. This mixed-methods cross-sectional study analyzed a cohort collected from January 4, 2018, to July 22, 2020. This study was conducted in the medical and cardiac intensive care units of a single neuroscience center. Participants included families, physicians, and nurses of patients admitted with severe acute brain injury. Severe acute brain injury was defined as stroke, traumatic brain injury, or hypoxic ischemic encephalopathy with a Glasgow Coma Scale score less than or equal to 12 points after hospital day 2. Prognosis discordance was defined as a 20% or greater difference between family and physician prognosis predictions; misunderstanding was defined as a 20% or greater difference between physician prediction and the family's estimate of physician prediction; and optimistic belief difference was defined as any difference (&gt;0%) between family prediction and their estimate of physician prediction. Logistic regression was used to identify associations with discordance. Optimistic belief differences were analyzed as a subgroup of prognosis discordance. Among 222 enrolled patients, prognostic predictions were available for 193 patients (mean [SD] age, 57 [19] years; 106 men [55%]). Prognosis discordance occurred for 118 patients (61%) and was significantly more common among families who identified with minoritized racial groups compared with White families (odds ratio [OR], 3.14; CI, 1.40-7.07, P = .006); among siblings (OR, 4.93; 95% CI, 1.35-17.93, P = .02) and adult children (OR, 2.43; 95% CI, 1.10-5.37; P = .03) compared with spouses; and when nurses perceived family understanding as poor compared with good (OR, 3.73; 95% CI, 1.88-7.40; P &lt; .001). Misunderstanding was present for 80 of 173 patients (46%) evaluated for this type of prognosis discordance, and optimistic belief difference was present for 94 of 173 patients (54%). In qualitative analysis, faith and uncertainty emerged as themes underlying belief differences. Nurse perception of poor family understanding was significantly associated with misunderstanding (OR, 2.06; 95% CI, 1.07-3.94; P = .03), and physician perception with optimistic belief differences (OR, 2.32; 95% CI, 1.10-4.88; P = .03). Results of this cross-sectional study suggest that for patients with severe acute brain injury, prognosis discordance between physicians and families was common. Efforts to improve communication and decision-making should aim to reduce this discordance and find ways to target both misunderstanding and optimistic belief differences

Mathematical modelling of contact dermatitis from nickel and chromium

Dermal exposure to metal allergens can lead to irritant (ICD) and allergic contact dermatitis (ACD). In this paper we present a mathematical model of the absorption of metal ions, hexavalent chromium and nickel, into the viable epidermis and compare the localised irritant and T-lymphocyte (T-cell) mediated immune responses. The model accounts for the spatial-temporal variation of skin health, extra and intracellular allergen concentrations, innate immune cells, T-cells, cytokine signalling and lymph node activity up to about 6 days after contact with these metals; repair processes associated with withdrawal of exposure to both metals is not considered in the current model, being assumed secondary during the initial phases of exposure. Simulations of the resulting system of PDEs are studied in one-dimension, i.e. across skin depth, and three-dimensional scenarios with the aim of comparing the responses to the two ions in the cases of first contact (no T-cells initially present) and second contact (T-cells initially present). The results show that on continuous contact, chromium ions elicit stronger skin inflammation, but for nickel, subsequent re-exposure stimulates stronger responses due to an accumulation of cytotoxic T-cell mediated responses which characterise ACD. Furthermore, the surface area of contact to these metals has little effect on the speed of response, whilst sensitivity is predicted to increase with the thickness of skin. The modelling approach is generic and should be applicable to describe contact dermatitis from a wide range of allergens

Nonperturbative Renormalization and the QCD Vacuum

We present a self consistent approach to Coulomb gauge Hamiltonian QCD which allows one to relate single gluon spectral properties to the long range behavior of the confining interaction. Nonperturbative renormalization is discussed. The numerical results are in good agreement with phenomenological and lattice forms of the static potential.Comment: 23 pages in RevTex, 4 postscript figure