Current dilemmas in the assessment of suffering in palliative care

ABSTRACT: Although relief from suffering is essential in healthcare and palliative care, few efforts have aimed at defining, operationalizing, and developing standards for its detection, assessment, and relief. In order to accurately explore and identify factors that contribute to suffering, more attention needs to be focused on quality assessment and measurement, not only for assessment purposes but also to test the effectiveness of interventions in relieving suffering. The scope of the present paper is to discuss the strategies that aid in the detection and assessment of the suffering experience in patients with chronic illnesses and/or in palliative care settings, and the dilemmas commonly encountered regarding the quality of available assessment measures. Method: A general description of instruments available for suffering assessment is provided. Matters regarding the accuracy of the measures are discussed. Finally, some dilemmas regarding the quality of the measures to screen for and assess suffering are presented. Results: There have been some achievements toward adequate suffering assessment. However, a more robust theoretical background is needed, and empirical evidence aimed at supporting it is required. In addition, further examination of the psychometric characteristics of instruments in different populations and cultural contexts is needed. Significance of results: An interesting number of assessment measures are now available for use in the palliative care setting, employing innovative approaches. However, further examination and validation in different contexts is required to find high-quality tools for detection of suffering and assessment of the results of intervention

Galactic bulge giants: probing stellar and galactic evolution I. Catalogue of Spitzer IRAC and MIPS sources

Aims: We aim at measuring mass-loss rates and the luminosities of a statistically large sample of Galactic bulge stars at several galactocentric radii. The sensitivity of previous infrared surveys of the bulge has been rather limited, thus fundamental questions for late stellar evolution, such as the stage at which substantial mass-loss begins on the red giant branch and its dependence on fundamental stellar properties, remain unanswered. We aim at providing evidence and answers to these questions. Methods: To this end, we observed seven 15 times 15 arcmin^2 fields in the nuclear bulge and its vicinity with unprecedented sensitivity using the IRAC and MIPS imaging instruments on-board the Spitzer Space Telescope. In each of the fields, tens of thousands of point sources were detected. Results: In the first paper based on this data set, we present the observations, data reduction, the final catalogue of sources, and a detailed comparison to previous mid-IR surveys of the Galactic bulge, as well as to theoretical isochrones. We find in general good agreement with other surveys and the isochrones, supporting the high quality of our catalogue.Comment: 21 pages, accepted for publication in A&A. A version with high-resolution figures, as well as the data catalogues (including cross-id with GLIMPSE and GALCEN) and image mosaics are available at the anonymous ftp://ftp.ster.kuleuven.be/dist/stefan/Spitzer

Interstellar Extinction and Long-Period Variables in the Galactic Center

We use the Spitzer IRAC catalogue of the Galactic Center (GC) point sources (Ramirez et al. 2008) and combine it with new isochrones (Marigo et al. 2008) to derive extinctions based on photometry of red giants and asymptotic giant branch (AGB) stars. This new extinction map extends to much higher values of Av than previoulsy available. Our new extinction map of the GC region covers 2.0 x 1.4 degree (280 x 200 pc at a distance of 8 kpc). We apply it to deredden the LPVs found by Glass et al. (2001) near the GC. We make period-magnitude diagrams and compare them to those from other regions of different metallicity. The Glass-LPVs follow well-defined period-luminosity relations (PL) in the IRAC filter bands at 3.6, 4.5, 5.8, and 8.0 micron. The period-luminosity relations are similar to those in the Large Magellanic Cloud, suggesting that the PL relation in the IRAC bands is universal. We use ISOGAL data to derive mass-loss rates and find for the Glass-LPV sample some correlation between mass-loss and pulsation period, as expected theoretically.The GC has an excess of high luminosity and long period LPVs compared to the Bulge, which supports previous suggestions that it contains a younger stellar population.Comment: 12 pages, 11 figures accepted for publication in Astronomy & Astrophysic

Stellar populations in a standard ISOGAL field in the Galactic disk

We aim to identify the stellar populations (mostly red giants and young stars) detected in the ISOGAL survey at 7 and 15micron towards a field (LN45) in the direction l=-45, b=0.0. The sources detected in the survey of the Galactic plane by the Infrared Space Observatory are characterized based on colour-colour and colour-magnitude diagrams. We combine the ISOGAL catalog with the data from surveys such as 2MASS and GLIMPSE. Interstellar extinction and distance are estimated using the red clump stars detected by 2MASS in combination with the isochrones for the AGB/RGB branch. Absolute magnitudes are thus derived and the stellar populations are identified based on their absolute magnitudes and their infrared excess. A standard approach to the analysis of ISOGAL disk observations has been established. We identify several hundred RGB/AGB stars and 22 candidate young stellar objects in the direction of this field in an area of 0.16 deg^2. An over-density of stellar sources is found at distances corresponding to the distance of the Scutum-Crux spiral arm. In addition, we determine mass-loss rates of AGB-stars using dust radiative transfer models from the literature.Comment: 48pages, 38 figures, accepted for publication in A &

Complete Genome of the Xanthomonas euvesicatoria Specific Bacteriophage K Phi 1, Its Survival and Potential in Control of Pepper Bacterial Spot

Xanthomonas euvesicatoria phage K Phi 1, a member of Myoviridae family, was isolated from the rhizosphere of pepper plants showing symptoms of bacterial spot. The phage strain expressed antibacterial activity to all X. euvesicatoria strains tested and did not lyse other Xanthomonas spp., nor other less related bacterial species. The genome of K Phi D1 is double-stranded DNA of 46.077 bp including 66 open reading frames and an average GC content of 62.9%, representing the first complete genome sequence published for a phage infecting xanthomonads associated with pepper or tomato. The highest genome similarity was observed between phage K Phi 1 and the Xanthomonas oryzae pv. oryzae specific phage OP2. On the other hand, when compared with other members of the genus Bcep78virus, the genome similarity was lower. Forty-four (67%) predicted K Phi 1 proteins shared homology with Xanthomonas phage OP2, while 20 genes (30%) were unique to K Phi 1. Phage K Phi 1, which is chloroform resistant and stable in different media and in the pH range 5-11, showed a high titer storage ability for at least 2 years at +4 degrees C. Copper-hydroxide and copper-oxychloride reduced phage activity proportionally to the used concentrations and the exposure time. UV light was detrimental to the phage strain, but skim milk plus sucrose formulation extended its survival in vitro. The phages survived for at least 7 days on the surface of pepper leaves in the greenhouse, showing the ability to persist on the plant tissue without the presence of the host bacterium. Results of three repeated experiments showed that foliar applications of the unformulated K Phi 1 phage suspension effectively controlled pepper bacterial spot compared to the standard treatment and the untreated control. The integration of the phage K Phi 1 and copper-hydroxide treatments resulted in an increased efficacy compared to the copper-hydroxide alone

Interaction of eukaryotic translation initiation factor 4G with the nuclear cap-binding complex provides a link between nuclear and cytoplasmic functions of the m7 guanosine cap

In eukaryotes the majority of mRNAs have an m7G cap that is added cotranscriptionally and that plays an important role in many aspects of mRNA metabolism. The nuclear cap-binding complex (CBC; consisting of CBP20 and CBP80) mediates the stimulatory functions of the cap in pre-mRNA splicing, 3' end formation, and U snRNA export. As little is known about how nuclear CBC mediates the effects of the cap in higher eukaryotes, we have characterized proteins that interact with CBC in HeLa cell nuclear extracts as potential mediators of its function. Using cross-linking and coimmunoprecipitation, we show that eukaryotic translation initiation factor 4G (eIF4G), in addition to its function in the cytoplasm, is a nuclear CBC-interacting protein. We demonstrate that eIF4G interacts with CBC in vitro and that, in addition to its cytoplasmic localization, there is a significant nuclear pool of eIF4G in mammalian cells in vivo. Immunoprecipitation experiments suggest that, in contrast to the cytoplasmic pool, much of the nuclear eIF4G is not associated with eIF4E (translation cap binding protein of eIF4F) but is associated with CBC. While eIF4G stably associates with spliceosomes in vitro and shows close association with spliceosomal snRNPs and splicing factors in vivo, depletion studies show that it does not participate directly in the splicing reaction. Taken together the data indicate that nuclear eIF4G may be recruited to pre-mRNAs via its interaction with CBC and accompanies the mRNA to the cytoplasm, facilitating the switching of CBC for eIF4F. This may provide a mechanism to couple nuclear and cytoplasmic functions of the mRNA cap structure

Sales profession and professionals in the age of digitization and artificial intelligence technologies: concepts, priorities, and questions

Recognizing the rapid advances in sales digitization and artificial intelligence technologies, we develop concepts, priorities, and questions to help guide future research and practice in the field of personal selling and sales management. Our analysis reveals that the influence of sales digitalization technologies, which include digitization and artificial intelligence, is likely to be more significant and more far reaching than previous sales technologies. To organize our analysis of this influence, we discuss the opportunities and threats that sales digitalization technologies pose for (a) the sales profession in terms of its contribution to creating value for customers, organizations, and society and (b) sales professionals, in terms of both employees in organizations and individuals as self, seeking growth, fulfillment, and status in the functions they serve and roles they live. We summarize our discussion by detailing specific research priorities and questions that warrant further study and development by researchers and practitioners alike

Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients with Coronary Artery Disease and Diabetic Nephropathy: A Single Center Experience

Background Patients with diabetic nephropathy (DN) and coronary artery disease (CAD) represent a subset of patients with high cardiovascular morbidity and mortality. The optimal revascularization strategy using either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. The purpose of this study was to compare the clinical outcomes of PCI to CABG in DN patients with CAD. Methods The clinical and angiographic records of DN patients with CAD who underwent either CABG (n=52) or PCI (n=48) were retrospectively analyzed. Results The baseline characteristics were similar in the two groups except for the severity of the CAD. At 30 days, the death rate (PCI: 2.1% vs. CABG: 9.6%, p=0.21) and major adverse cardiac events (MACE) rate (PCI: 2.1% vs. CABG: 9.6%, p=0.21) were similar in comparisons between the PCI and CABG groups. At three years, the death rate (PCI: 18.8% vs. CABG: 19.2%, p=0.94) was similar between the PCI and CABG groups but the MACE rate (PCI: 47.9% vs. CABG: 21.2%, p=0.006) was higher in the PCI group compared to the CABG group. In addition, the repeat revascularization rate was higher in the PCI group compared to the CABG group (PCI: 12.5% vs. CABG: 1.9%, p=0.046). Conclusions The CABG procedure was associated with a lower incidence of MACE and repeat revascularization for up to three years of follow-up in DN patients with CAD. However, the overall survival rate was similar in the CABG and PCI groups. Therefore, CABG may be superior to PCI with regard to MACE and repeat revascularization.ope

1H, 15N, and 13C chemical shift assignments of neuronal calcium sensor-1 homolog from fission yeast

The neuronal calcium sensor (NCS) proteins regulate signal transduction processes and are highly conserved from yeast to humans. We report complete NMR chemical shift assignments of the NCS homolog from fission yeast (Schizosaccharomyces pombe), referred to in this study as Ncs1p. (BMRB no. 16446)

Circumstellar discs: What will be next?

This prospective chapter gives our view on the evolution of the study of circumstellar discs within the next 20 years from both observational and theoretical sides. We first present the expected improvements in our knowledge of protoplanetary discs as for their masses, sizes, chemistry, the presence of planets as well as the evolutionary processes shaping these discs. We then explore the older debris disc stage and explain what will be learnt concerning their birth, the intrinsic links between these discs and planets, the hot dust and the gas detected around main sequence stars as well as discs around white dwarfs.Comment: invited review; comments welcome (32 pages