Standardizing Documentation of Patients’ Measurable Decline to Increase Medicare Compliance in the Hospice Setting

Problem: Staff nurses have difficulties standardizing documentation of patients’ measurable decline during the admission and recertification process to justify the need for hospice services. Context: According to Murrin (2016), the average Medicare compliance rate of hospice organizations is 86%. This quality improvement (QI) project aims to increase an outpatient hospice organization’s Medicare compliance rate of 66% to the average, nationwide level through standardization of documentation (Frontz, 2021). Interventions: The proposed intervention is to implement a QI project of the following assessment tools: Palliative Performance Scale (PPS), Functional Assessment Staging Tool (FAST) and Mid-Upper Arm Circumference (MUAC). Clinical nurses will attend a one–hour training class on tool implementation. Measures Post implementation, bi-weekly chart audits were conducted over the course of three months. In addition, bi-weekly check-ins were conducted at staff meetings to answer any questions and provide opportunities for feedback. Results The quality report revealed that of the 84 admission notes audited, 78 notes were found to include the three proposed assessment tools. Thus resulting in a successful implementation rate of 88.6%. Conclusions Given the actual implementation rate was 2.6% higher than the project goal of 86%, the assessment tool bundle may be useful in thorough, standardized hospice documentation. Moving forward, further research is necessary in other hospice organizations to correlate the assessment tool findings and mortality rates

Imbalance of p75(NTR)/TrkB protein expression in Huntington's disease: Implication for neuroprotective therapies

Neuroprotective therapies based on brain-derived neurotrophic factor (BDNF) administration have been proposed for Huntington's disease (HD) treatment. However, our group has recently reported reduced levels of TrkB in HD mouse models and HD human brain suggesting that besides a decrease on BDNF levels a reduction of TrkB expression could also contribute to diminished neurotrophic support in HD. BDNF can also bind to p75 neurotrophin receptor (p75(NTR)) modulating TrkB signaling. Therefore, in this study we have analyzed the levels of p75(NTR) in several HD models, as well as in HD human brain. Our data demonstrates a p75(NTR)/TrkB imbalance in the striatum of two different HD mouse models, Hdh(Q111/111) homozygous knockin mice and R6/1 mice that was also manifested in the putamen of HD patients. The imbalance between TrkB and p75(NTR) levels in a HD cellular model did not affect BDNF-mediated TrkB activation of prosurvival pathways but induced activation of apoptotic cascades as demonstrated by increased JNK phosphorylation. Moreover, BDNF failed to protect mutant huntingtin striatal cells transfected with p75(NTR) against NMDA-mediated excitotoxicity, which was associated with decreased Akt phosphorylation. Interestingly, lack of Akt activation following BDNF and NMDA treatment correlated with increased PP1 levels. Accordingly, pharmacological inhibition of PP1 by okadaic acid (OA) prevented mutant huntingtin striatal cell death induced by NMDA and BDNF. Altogether, our findings demonstrate that the p75(NTR)/TrkB imbalance induced by mutant huntingtin in striatal cells associated with the aberrant activity of PP1 disturbs BDNF neuroprotection likely contributing to increasing striatal vulnerability in HD. On the basis of this data we hypothesize that normalization of p75(NTR) and/or TrkB expression or their signaling will improve BDNF neuroprotective therapies in HD. Cell Death and Disease (2013) 4, e595; doi:10.1038/cddis.2013.116; published online 18 April 201

Positive zeta potential of nanodiamonds

In this paper, the origin of positive zeta potential exhibited by nanodiamond particles is explained. Positive zeta potentials in nano-structured carbons can be explained by the presence of graphitic planes at the surface, which leave oxygen-free Lewis sites and so promotes the suppression of acidic functional groups. Electron Microscopy and Raman Spectroscopy have been used to show that positive zeta potential of nanodiamond is only exhibited in the presence of sp2 carbon at the surface

Tailored two-dimensional finite-element formulations for ad-hoc analysis of waveguiding and mode-matching problems

The analysis of homogeneous closed waveguides is known to be one of the first, if not the very first, problems to be addressed with the finite element method (P. Silvester, “Finite element solution of homogeneous waveguide problems”, Alta Frequenza, vol. 38, pp. 313–317, 1969) in the framework of computational electromagnetics. Since this two-dimensional scalar case, many developments have followed: extension to three-dimensional analysis, derivation of curlconforming edge and higher-order elements, domain decomposition approaches, hybridization with other numerical or analytical methods, etc. This has led the finite element method to be considered one of the most well-established, reliable techniques to address cutting-edge problems in computational electromagnetics, with many reference books (G. Pelosi, R. Coccioli, S. Selleri, Quick Finite Elements for Electromagnetic Waves, Norwood, MA, USA: Artech House, 2009; J. Jin, The Finite Element Method in Electromagnetics, Hoboken, NJ, USA: Wiley, 2015). Despite these long-known advancements, resorting to solving the afore-mentioned (and, at first glance, simple) problem of computing the modes in any waveguiding cross-section still plays a key role in computer-aided design methodologies that rely on the modal description of the fields, as is the case of the mode-matching method. In this case, not only an accurate calculation of these modal fields is required, but also the capability to compute as many modes (without skipping a single one) as necessary to ensure convergence. If the problem demands for it, it is also imperative to have a straightforward division into different classes or types of modes according to symmetries and possible excitations, as well as a proper identification of degenerate modes. In this work, we will review some strategies and tailored two-dimensional finite-element formulations proposed by the authors to address some of the issues arising when analyzing waveguiding structures, especially focusing on obtaining proper modal decompositions of the fields to be used in further computer-aided design of waveguide devices through mode-matching techniques. Some of these strategies and formulations include the comparison of different types of meshes (structured quadrilateral vs. unstructured triangular) when the waveguide cross-sections have 90º corners, as well as the development of specific boundary conditions to model novel materials enclosing the waveguide (such as graphene) or to account for higher-order symmetries (such as rotational ones) in structures with a high number of degenerate modes. In the latter case, this is especially useful for devices conceived to operate with circular polarization

The Broad Concept of "Spasticity-Plus Syndrome" in Multiple Sclerosis: A Possible New Concept in the Management of Multiple Sclerosis Symptoms

Multiple sclerosis (MS) pathology progressively affects multiple central nervous system (CNS) areas. Due to this fact, MS produces a wide array of symptoms. Symptomatic therapy of one MS symptom can cause or worsen other unwanted symptoms (anticholinergics used for bladder dysfunction produce impairment of cognition, many MS drugs produce erectile dysfunction, etc.). Appropriate symptomatic therapy is an unmet need. Several important functions/symptoms (muscle tone, sleep, bladder, pain) are mediated, in great part, in the brainstem. Cannabinoid receptors are distributed throughout the CNS irregularly: There is an accumulation of CB1 and CB2 receptors in the brainstem. Nabiximols (a combination of THC and CBD oromucosal spray) interact with both CB1 and CB2 receptors. In several clinical trials with Nabiximols for MS spasticity, the investigators report improvement not only in spasticity itself, but also in several functions/symptoms mentioned before (spasms, cramps, pain, gait, sleep, bladder function, fatigue, and possibly tremor). We can conceptualize and, therefore, hypothesize, through this indirect information, that it could be considered the existence of a broad "Spasticity-Plus Syndrome" that involves, a cluster of symptoms apart from spasticity itself, the rest of the mentioned functions/symptoms, probably because they are interlinked after the increase of muscle tone and mediated, at least in part, in the same or close areas of the brainstem. If this holds true, there exists the possibility to treat several spasticity-related symptoms induced by MS pathology with a single therapy, which would permit to avoid the unnecessary adverse effects produced by polytherapy. This would result in an important advance in the symptomatic management of MS

High-throughput nitrogen-vacancy center imaging for nanodiamond photophysical characterization and pH nanosensing

The fluorescent nitrogen-vacancy (NV) defect in diamond has remarkable photophysical properties, including high photostability which allows stable fluorescence emission for hours; as a result, there has been much interest in using nanodiamonds (NDs) for applications in quantum optics and biological imaging. Such applications have been limited by the heterogeneity of NDs and our limited understanding of NV photophysics in NDs, which is partially due to the lack of sensitive and high-throughput methods for photophysical analysis of NDs. Here, we report a systematic analysis of NDs using two-color wide-field epifluorescence imaging coupled to high-throughput single-particle detection of single NVs in NDs with sizes down to 5–10 nm. By using fluorescence intensity ratios, we observe directly the charge conversion of single NV center (NV− or NV0) and measure the lifetimes of different NV charge states in NDs. We also show that we can use changes in pH to control the main NV charge states in a direct and reversible fashion, a discovery that paves the way for performing pH nanosensing with a non-photobleachable probe

Store-Operated Calcium Entry in Breast Cancer Cells Is Insensitive to Orai1 and STIM1 N-Linked Glycosylation.

N-linked glycosylation is a post-translational modification that affects protein function, structure, and interaction with other proteins. The store-operated Ca2+ entry (SOCE) core proteins, Orai1 and STIM1, exhibit N-glycosylation consensus motifs. Abnormal SOCE has been associated to a number of disorders, including cancer, and alterations in Orai1 glycosylation have been related to cancer invasiveness and metastasis. Here we show that treatment of non-tumoral breast epithelial cells with tunicamycin attenuates SOCE. Meanwhile, tunicamycin was without effect on SOCE in luminal MCF7 and triple negative breast cancer (TNBC) MDA-MB-231 cells. Ca2+ imaging experiments revealed that expression of the glycosylation-deficient Orai1 mutant (Orai1N223A) did not alter SOCE in MCF10A, MCF7 and MDA-MB-231 cells. However, expression of the non-glycosylable STIM1 mutant (STIM1N131/171Q) significantly attenuated SOCE in MCF10A cells but was without effect in SOCE in MCF7 and MDA-MB-231 cells. In non-tumoral cells impairment of STIM1 N-linked glycosylation attenuated thapsigargin (TG)-induced caspase-3 activation while in breast cancer cells, which exhibit a smaller caspase-3 activity in response to TG, expression of the non-glycosylable STIM1 mutant (STIM1N131/171Q) was without effect on TG-evoked caspase-3 activation. Summarizing, STIM1 N-linked glycosylation is essential for full SOCE activation in non-tumoral breast epithelial cells; by contrast, SOCE in breast cancer MCF7 and MDA-MB-231 cells is insensitive to Orai1 and STIM1 N-linked glycosylation, and this event might participate in the development of apoptosis resistance

Higher education and unemployment in Europe : an analysis of the academic subject and national effects

This paper examines the impact of an academic degree and field of study on short and long-term unemployment across Europe (EU15). Labour Force Survey (LFS) data on over half a million individuals are utilised for that purpose. The harmonized LFS classification of level of education and field of study overcomes past problems of comparability across Europe. The study analyses (i) the effect of an academic degree at a European level, (ii) the specific effect of 14 academic subjects and (iii) country specific effects. The results indicate that an academic degree is more effective on reducing the likelihood of short-term than long-term unemployment. This general pattern even though it is observed for most of the academic subjects its levels show significant variation across disciplines and countries

Surface Zeta Potential and Diamond Seeding on Gallium Nitride Films.

The measurement of ζ potential of Ga-face and N-face gallium nitride has been carried out as a function of pH. Both of the faces show negative ζ potential in the pH range 5.5-9. The Ga-face has an isoelectric point at pH 5.5. The N-face shows a more negative ζ potential due to larger concentration of adsorbed oxygen. The ζ potential data clearly showed that H-terminated diamond seed solution at pH 8 will be optimal for the self-assembly of a monolayer of diamond nanoparticles on the GaN surface. The subsequent growth of thin diamond films on GaN seeded with H-terminated diamond seeds produced fully coalesced films, confirming a seeding density in excess of 1011 cm-2. This technique removes the requirement for a low thermal conduction seeding layer like silicon nitride on GaN