Palliative Care: Is Now the Time?

Palliative care is an approach that focuses on optimizing quality of life for patients and families affected by serious illness, regardless of prognosis. It comprises pain and symptom management; psychological, spiritual, and social support; assistance with treatment decision-making; and complex care coordination. Mounting evidence indicates that palliative care reduces symptom burden, improves mood, decreases healthcare utilization, and improves quality of life for both patients with end-stage heart disease and their caregivers. Indeed, there is a consensus among major clinical guidelines of the importance of early integration of palliative care as an essential component of high quality care for patients with heart failure, a growing use of palliative care in patients with end-stage heart disease, and a clear desire of patients for such care

Effect of humidity on transonic flow

An experimental investigation of the effects of humidity-induced condensation on shock/boundary-layer interaction has been conducted in a transonic wind-tunnel test. The test geometry considered was a wall-mounted bump model inserted in the test section of the wind tunnel. The formation of a λ-shape condensation shock wave was shown from schlieren visualization and resulted in a forward movement of the shock wave, reduced shock wave strength, and reduced separation. Empirical correlations of the shock wave strength and humidity/dew point temperature were established. For humidity levels below 0.15 or a dew point temperature of 268 K, the effect of humidity was negligible. The unsteady pressure measurements showed that if a condensation shock wave formed and interacted with a main shock wave, the flow becomes unsteady with periodic flow oscillations occurring at 720 Hz

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Origin of the giant magnetic moments of Fe impurities on and in Cs films

To explore the origin of the observed giant magnetic moments ($\sim 7 \mu_B$) of Fe impurities on the surface and in the bulk of Cs films, we have performed the relativistic LSDA + U calculations using the linearized muffin-tin orbital (LMTO) band method. We have found that Fe impurities in Cs behave differently from those in noble metals or in Pd. Whereas the induced spin polarization of Cs atoms is negligible, the Fe ion itself is found to be the source of the giant magnetic moment. The 3d electrons of Fe in Cs are localized as the 4f electrons in rare-earth ions so that the orbital magnetic moment becomes as large as the spin magnetic moment. The calculated total magnetic moment of $M = 6.43 \mu_B$, which comes mainly from Fe ion, is close to the experimentally observed value.Comment: 4 pages including 3 figures and 1 table. Submitted to PR

A concept analysis of analgesic nonadherence for cancer pain in a time of opioid crisis

Background Pain is one of the most common symptoms identified along the cancer trajectory. Among patients with moderate to severe cancer pain, nonadherence to prescribed analgesics may complicate treatment plans and exacerbate pain severity. Nonadherent behaviors are likely due to a number of individual/family, provider, and system level factors and may lead to negative pain-related outcomes. Purpose The purpose of this concept analysis is to clarify the concept of analgesic nonadherence for cancer pain and qualify its utility in the context of the opioid crisis. Method Walker and Avant's (2019) method for concept analysis was used. We integrated empirical evidence, relevant literature, and sociopolitical considerations related to the opioid crisis to provide critical and timely analysis. Data were collected from a search of PubMed, CINAHL, PsycINFO, and Scopus. The search yielded 418 individual records. Empirical articles using quantitative and qualitative methodologies pertaining to analgesic nonadherence for cancer pain in adult outpatient settings, written in English, with an abstract, and published between 2010 and 2018 were considered. Other relevant literature sources were used if additional criteria were met. A total of 33 records were selected for detailed review. Findings Few studies link analgesic nonadherence to patient outcomes highlighting a significant literature gap. Given the available evidence, a definition for analgesic nonadherence is proposed for future use in research, education, practice, and policy settings. Discussion The paucity of empirical data combined with the implications of the opioid crisis and conflicting pain management guidelines create uncertainty about the utility of analgesic nonadherence. The concept of analgesic nonadherence warrants further normative and empirical research to clarify the role of opioids and the meaning of nonadherence in shaping pain-related outcomes within the current sociopolitical environment

Early Paleogene wildfires in peat-forming environments at Schöningen, Germany

AbstractWildfire activity in early Paleogene greenhouse conditions can be used as an analogue to gauge the effect of future warming trends on wildfire in the current climate system. Inertinite (fossil charcoal in coal) from 11 autochthonous early Paleogene lignite seams from the Schöningen mine (Germany) was quantified using macerations, in situ pillars and industry standard crushed samples. A new three transect method was developed to quantify in situ charcoal. The combination of in situ pillars and crushed samples accounts for temporal and spatial variation in charcoal through a stratigraphically oriented pillar, whilst maintaining comparability with industry standards and previous work. Charcoal occurs as a range of randomly distributed particle sizes, indicating that fires were burning locally in the Schöningen peat-forming environment and in the surrounding areas, but according to petrological data, not in an episodic or periodic pattern. Although charcoal abundance is low (relative to previous high fire worlds such as the Cretaceous), three quantitative and semi-quantitative methods show increased wildfire activity (relative to the modern world) in the warmest parts of the early Paleogene. As atmospheric oxygen levels stabilised to modern values and precipitation and humidity became the main control on wildfire, increased rainfall followed by drier intervals would have created an environment rich in dry fuel in which wildfires could easily propagate if humidity was low enough. In the later part of the Early Eocene (Ypresian) charcoal abundance fell to levels similar to those found in modern peats. This indicates that the transition to the modern low fire world occurred within the Early Eocene, earlier than previous records suggest

Palliative Care in Heart Failure: Rationale, Evidence, and Future Priorities

Patients with heart failure (HF) and their families experience stress and suffering from a variety of sources over the course of the HF experience. Palliative care is an interdisciplinary service and an overall approach to care that improves quality of life and alleviates suffering for those living with serious illness, regardless of prognosis. In this review, we synthesize the evidence from randomized clinical trials of palliative care interventions in HF. While the evidence base for palliative care in HF is promising, it is still in its infancy and requires additional high-quality, methodologically sound studies to clearly elucidate the role of palliative care for patients and families living with the burdens of HF. Yet, an increase in attention to primary palliative care (e.g., basic physical and emotional symptom management, advance care planning), provided by primary care and cardiology clinicians, may be a vehicle to address unmet palliative needs earlier and throughout the illness course

The Fate of Children with Microdeletion 22q11.2 Syndrome and Congenital Heart Defect: Clinical Course and Cardiac Outcome

Background: This study aimed to evaluate the cardiac outcome for children with microdeletion 22q11.2 and congenital heart defect (CHD). Methods: A total of 49 consecutive children with 22q11.2 and CHD were retrospectively identified. The CHD consisted of tetralogy of Fallot and variances (n = 22), interrupted aortic arch (n = 10), ventricular septal defect (n = 8), truncus arteriosus (n = 6), and double aortic arch (n = 1). Extracardiac anomalies were present in 46 of 47 children. Results: The median follow-up time was 8.5 years (range, 3 months to 23.5 years). Cardiac surgical repair was performed for 35 children, whereas 5 had palliative surgery, and 9 never underwent cardiac surgery. The median age at repair was 7.5 months (range, 2 days to 5 years). The mean hospital stay was 35 days (range, 7-204 days), and the intensive care unit stay was 15 days (range, 3-194 days). Significant postoperative complications occurred for 26 children (74%), and surgery for extracardiac malformations was required for 21 patients (43%). The overall mortality rate was 22% (11/49), with 1-year survival for 86% and 5-year survival for 80% of the patients. A total of 27 cardiac reinterventions were performed for 16 patients (46%) including 15 reoperations and 12 interventional catheterizations. Residual cardiac findings were present in 25 patients (71%) at the end of the follow-up period. Conclusions: Children with microdeletion 22q11.2 and CHD are at high risk for mortality and morbidity, as determined by both the severity of the cardiac lesions and the extracardiac anomalies associated with the microdeletio

VLA OH and H I Zeeman Observations of the NGC 6334 Complex

We present OH and H I Zeeman observations of the NGC 6334 complex taken with the Very Large Array. The OH absorption profiles associated with the complex are relatively narrow (del-v_FWHM ~ 3 km s^1) and single-peaked over most of the sources. The H I absorption profiles contain several blended velocity components. One of the compact continuum sources in the complex (source A) has a bipolar morphology. The OH absorption profiles toward this source display a gradient in velocity from the northern continuum lobe to the southern continuum lobe; this velocity gradient likely indicates a bipolar outflow of molecular gas from the central regions to the northern and southern lobes. Magnetic fields of the order of 200 microG have been detected toward three discrete continuum sources in the complex. Virial estimates suggest that the detected magnetic fields in these sources are of the same order as the critical magnetic fields required to support the molecular clouds associated with the sources against gravitational collapse.Comment: 14 pages, 9 postscript figures, accepted for publication in the Astrophysical Journal (ApJ), tentatively scheduled for vol. 533, Apr. 20, 2000; also available at http://www.pa.uky.edu/~sarma/RESEARCH/aps_research.htm