How well do POLST forms assure that patients get the end-of-life care they requested?

Q: How well do POLST forms assure that patients get the end-of-life care they requested? A: quite well, for cardiopulmonary resuscitation (CPR). Most patients (91%-100%) who select "do not resuscitate" (DNR) on their physician's orders for life-sustaining treatment (POLST) forms are allowed a natural death without attempted CPR across a variety of settings (community, skilled nursing facilities, emergency medical services, and hospice). Few patients (6%) who select "comfort measures only" die in the hospital, whereas more (22%) who choose "limited interventions," and still more (34%) without a POLST form, die in the hospital (strength of recommendation [SOR]: B, large, consistent cross-sectional and cohort studies). Most patients (84%) who select "attempt resuscitation" receive resuscitation for out-of-hospital cardiac arrest in emergency services settings (SOR: B, small retrospective cohort study). POLST orders declining other services (intravenous fluids, intensive care, intubation, feeding tubes) are carried out in most (84%-100%) cases. POLST orders regarding antibiotic treatments are less effectively implemented (SOR: B, moderate-sized retrospective chart review).Authors: Jordan Collier, DO; Gary Kelsberg, MD Valley Family Medicine Residency, Renton, Wash; Sarah Safranek, MLIS University of Washington Health Sciences Library, Seattl

Paint Stripper Composition Having Reduced Volatility Containing Decanolactone, N-methylpyrrolidone and Butyrolactone and Method of Use

An improved composition of matter and method of use for removing cured coatings of paint or varnish or other similar coatings from substrates. The composition comrpises chlorinated solvent paint strippers (especially methylene chloride (CH2CI2)), waxes and an additive selected from the group consisting of decanolactone (C10H18O2), N-methylpyrrolidone (CH3NCH2CH2CH2CH2) and butyrolactone (OCH2CH2CH2CO). The additive retards the evaporation of the solvent resulting in a composition that is environmentally less hazardous to a user and also resulting in improved stripping effectiveness

Anthropometric Differences between HIV-Infected Individuals Prior to Antiretroviral Treatment and the General Population from 1998–2007: The AIDS Clinical Trials Group Longitudinal Linked Randomized Trials (ALLRT) Cohort and NHANES

Objective: To assess differences in body circumferences and body mass index (BMI, kg/m2) between antiretroviral treatment (ART) naïve HIV-infected and HIV-uninfected persons. Methods: Waist, arm, and thigh circumferences and BMI were measured within the ALLRT and NHANES cohorts between 1998 and 2007. ALLRT is a prospective, longitudinal study of U.S. participants enrolled in randomized HIV treatment studies conducted by the AIDS Clinical Trials Group (ACTG). NHANES is a representative group of the US population. The cohorts were analyzed in two time periods, to account for trends towards increased adiposity. Anthropometrics were displayed in percentiles by age and sex. Multiple linear regression models examined differences between cohorts. Results: ALLRT had more males (82% versus 48%, p<0.0001), more black participants (32% versus 23%, p<0.0001), and less Hispanics (21% versus 30%, p<0.0001) than NHANES. Mean BMI was smaller in ALLRT males and females compared to NHANES by 1.6–2.4 kg/m2 (p<0.0001). Mean waist and arm circumferences in both sexes and time periods were significantly smaller in ALLRT than in NHANES (p<0.0001). Mean thigh circumference in ALLRT was also smaller than NHANES among males (p<0.0001 in both time periods) and females (p = 0.01 in the early time period). Conclusions: Differences in anthropometrics existed prior to ART initiation, in this large national cohort of HIV-infected individuals, compared to a representative HIV-uninfected cohort, indicating that HIV and its complications have important effects on body shape. Further longitudinal examination of anthropometrics in this HIV-infected cohort may provide additional insight into disease risk. Trial Registration NCT00001137 at www.clinicaltrials.gov

Chemical and Physicochemical Pretreatment of Lignocellulosic Biomass: A Review

Overcoming the recalcitrance (resistance of plant cell walls to deconstruction) of lignocellulosic biomass is a key step in the production of fuels and chemicals. The recalcitrance is due to the highly crystalline structure of cellulose which is embedded in a matrix of polymers-lignin and hemicellulose. The main goal of pretreatment is to overcome this recalcitrance, to separate the cellulose from the matrix polymers, and to make it more accessible for enzymatic hydrolysis. Reports have shown that pretreatment can improve sugar yields to higher than 90% theoretical yield for biomass such as wood, grasses, and corn. This paper reviews different leading pretreatment technologies along with their latest developments and highlights their advantages and disadvantages with respect to subsequent hydrolysis and fermentation. The effects of different technologies on the components of biomass (cellulose, hemicellulose, and lignin) are also reviewed with a focus on how the treatment greatly enhances enzymatic cellulose digestibility

ASCENT Program

The ASCENT program solves the three-dimensional motion and attendant structural loading on a flexible vehicle incorporating, optionally, an active analog thrust control system, aerodynamic effects, and staging of multiple bodies. ASCENT solves the technical problems of loads, accelerations, and displacements of a flexible vehicle; staging of the upper stage from the lower stage; effects of thrust oscillations on the vehicle; a payload's relative motion; the effect of fluid sloshing on vehicle; and the effect of winds and gusts on the vehicle (on the ground or aloft) in a continuous analysis. The ATTACH ASCENT Loads program reads output from the ASCENT flexible body loads program, and calculates the approximate load indicators for the time interval under consideration. It calculates the load indicator values from pre-launch to the end of the first stage

Concepts and Measurement in Multimethod Research

This article argues that concept misformation and conceptual stretching undermine efforts to combine qualitative and quantitative methods in multimethod research (MMR). Two related problems result from the mismatch of qualitatively and quantitatively construed concepts. Mechanism muddling occurs when differences in the connotation of qualitatively and quantitatively construed concepts embed different causal properties into conceptual definitions. Conceptual slippage occurs when qualitatively and quantitatively construed concepts use incompatible nominal, ordinal, or radial scales. Instead of gaining leverage from the synthesis of large- and small-N analysis, these problems can push MMR in two diametrically opposed directions, emphasizing one methodological facet at the cost of the other.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Risk Tolerance, Self-Interest, and Social Preferences

We use an experimental method to investigate whether systematic relationships exist across distinct aspects of individual preferences: risk aversion in monetary outcomes, altruism in a twoperson context, and social preferences in a larger group context. Individual preferences across these three contexts are measured, and there is no possibility for risk sharing, wealth effects, or updating expectations of the population choices. We find that social preferences are related to demographic variables, including years of education, gender, and age. Perhaps most importantly, self allocation in a two-person dictator game is related to social preferences in a group context. Participants who are more generous in a dictator game are more likely to vote against their selfinterest in a group decision-making task which we interpret to be expressions of social preferences

Safety and immunogenicity of therapeutic DNA vaccination in individuals treated with antiretroviral therapy during acute/early HIV-1 infection

Background: An effective therapeutic vaccine that could augment immune control of HIV-1 replication may abrogate or delay the need for antiretroviral therapy. AIDS Clinical Trials Group (ACTG) A5187 was a phase I/II, randomized, placebo-controlled, double-blinded trial to evaluate the safety and immunogenicity of an HIV-1 DNA vaccine (VRC-HVDNA 009-00-VP) in subjects treated with antiretroviral therapy during acute/early HIV-1 infection. (clinicaltrials.gov NCT00125099) Methods: Twenty healthy HIV-1 infected subjects who were treated with antiretroviral therapy during acute/early HIV-1 infection and had HIV-1 RNA<50 copies/mL were randomized to receive either vaccine or placebo. The objectives of this study were to evaluate the safety and immunogenicity of the vaccine. Following vaccination, subjects interrupted antiretroviral treatment, and set-point HIV-1 viral loads and CD4 T cell counts were determined 17–23 weeks after treatment discontinuation. Results: Twenty subjects received all scheduled vaccinations and discontinued antiretroviral therapy at week 30. No subject met a primary safety endpoint. No evidence of differences in immunogenicity were detected in subjects receiving vaccine versus placebo. There were also no significant differences in set-point HIV-1 viral loads or CD4 T cell counts following treatment discontinuation. Median set-point HIV-1 viral loads after treatment discontinuation in vaccine and placebo recipients were 3.5 and 3.7 log[sub]10 HIV-1 RNA copies/mL, respectively. Conclusions: The HIV-1 DNA vaccine (VRC-HIVDNA 009-00-VP) was safe but poorly immunogenic in subjects treated with antiretroviral therapy during acute/early HIV-1 infection. Viral set-points were similar between vaccine and placebo recipients following treatment interruption. However, median viral load set-points in both groups were lower than in historical controls, suggesting a possible role for antiretroviral therapy in persons with acute or early HIV-1 infection and supporting the safety of discontinuing treatment in this group. Trial Registration: Clinicaltrials.gov NCT0012509