Spirituality in the Last Days of Life in Persons Born in Japan

End - of - life care is encumbered with many complex issues that can impede quality of life, especially in populations for which little is known. This study addresses spirituality and preferences for last days of life in persons born in Japan and living in eastern and south central Texas. Descriptive, qualitative methods were used for data collection and data analysis. Two major themes emerged for spirituality: Spirituality as Culture and Universality of Spirituality, and three major themes reflected preferences for the last days of life: Environmental Peace and Comfort, Interconnectedness, and Communication is Key. Nurses and health care providers can use this evidence to facilitate quality of life for these persons and their loved ones to achieve a peaceful an d dignified death. K

Attitudes About and Preferences for End-of-Life Care in Persons of the Reform Jewish Faith

This poster was presented at the Great Plains Honors Conference in Siloam Springs, Arkansashttps://scholarworks.uttyler.edu/student_posters/1002/thumbnail.jp

Awareness of Dying and Conflict Resolution: Texas Asian Perspectives

Individuals in the end-of-life (EOL) period may not be fully aware of their prognosis or know they are facing a terminal illness. As Asian beliefs and cultural tendencies intersect with Western values, health care practitioners may find their assumptions about disclosing an EOL prognosis differs from patients and their family members. Disagreements among family members regarding the disclosure of EOL to their terminally ill loved one can result in conflict—making difficult and sensitive times more burdensome. Little scientific evidence is known about first generation Asians who live in the United States (US) regarding their practices with disclosing EOL and how they handle conflict resolution when a family member is terminally ill. The purposes of this descriptive qualitative study were to explore issues surrounding patient awareness of dying and explore approaches to conflict resolution in EOL situations for first generation Japanese, Chinese and Vietnamese persons living in the south central, south eastern and northeastern parts of Texas. Face-to-face audio-recorded interviews were conducted and transcribed verbatim. Thematic analysis elicited three awareness and three conflict resolution overarching themes across all ethnic groups. Health care practitioners must be cognizant that assumed acculturation does not always coincide with Western beliefs regarding disclosure of the prognosis at the EOL. In order to provide culturally and ethically sound EOL care for the patient and their loved ones, clinicians must be mindful of the need to sensitively assess their patient’s beliefs and understand the importance of compassionate and diplomatic approaches for conflict resolution in Asian cultures

Military nurses caring for the enemy

Purpose: This phenomenological study described the lived experience and aftermath of U.S. military nurses assigned enemy detainees during Operation Iraqi Freedom/Operation Enduring Freedom. Two themes emerged: Insurgent Assignments (subthemes included identification of and interactions with insurgents; training, precautions, and ethical issues, thoughts and feelings, coping, and meanings of insurgent care) and The Aftermath (subthemes were mental, emotional, personal, professional, and positive). Conclusions: Insurgent assignments caused ethical dilemmas and challenged theoretical constructs related to caring. Formal training is needed to prepare nurses for the practicalities of and responses to insurgent assignments. This work is the dissertation manuscript of Sharon Thompson, completed by faculty members in the School of Nursing at The University of Texas at Tyler. A final, published version of this article can be viewed at: https://doi.org/10.20467/1091-5710-18.2.6

The therapeutic efficacy and macrofilaricidal activity of doxycycline for the treatment of river blindness

Background. Onchocerca volvulus and lymphatic filariae, causing river blindness and elephantiasis, depend on endosymbiotic Wolbachia bacteria for growth, development, fertility, and survival. Clinical trials have shown that doxycycline treatment eliminates Wolbachia, causing long-term sterilization of adult female filariae and effecting potent macrofilaricidal activity. The continual reinfection by drug-naive worms that occurs in these trial settings dilutes observable anti-Wolbachia and antifilarial effects, making it difficult to estimate therapeutic efficacy and compare different doxycycline regimens, evaluated at different times after treatment. Methods. A meta-analytical modeling framework is developed to link all usable data collected from clinical trials measuring the Wolbachia status and viability of individual female adult worms collected at various times after treatment with 4, 5, or 6 weeks of daily 100 or 200 mg oral doxycycline. The framework is used to estimate efficacy parameters that are not directly measurable as trial outcomes. Results. The estimated efficacy of doxycycline (the maximum proportional reduction in the percentage of adult female O. volvulus positive for Wolbachia) is 91%–94% on average, irrespective of the treatment regimen. Efficacy is >95% in the majority of trial participants. The life span of Wolbachia-depleted worms is reduced by 70%–80%, from approximately 10 years to 2–3 years. Conclusions. The efficacy parameters are pertinent to the prospects of using doxycycline on a “test and treat” basis for onchocerciasis control and confirm doxycycline as a potent macrofilaricidal therapy. The modeling approach is more generally relevant to the design and evaluation of clinical trials for antifilarial drugs conducted in endemic settings

Genome-wide analysis of ivermectin response by Onchocerca volvulus reveals that genetic drift and soft selective sweeps contribute to loss of drug sensitivity

Treatment of onchocerciasis using mass ivermectin administration has reduced morbidity and transmission throughout Africa and Central/South America. Mass drug administration is likely to exert selection pressure on parasites, and phenotypic and genetic changes in several Onchocerca volvulus populations from Cameroon and Ghana-exposed to more than a decade of regular ivermectin treatment-have raised concern that sub-optimal responses to ivermectin's anti-fecundity effect are becoming more frequent and may spread.Pooled next generation sequencing (Pool-seq) was used to characterise genetic diversity within and between 108 adult female worms differing in ivermectin treatment history and response. Genome-wide analyses revealed genetic variation that significantly differentiated good responder (GR) and sub-optimal responder (SOR) parasites. These variants were not randomly distributed but clustered in ~31 quantitative trait loci (QTLs), with little overlap in putative QTL position and gene content between the two countries. Published candidate ivermectin SOR genes were largely absent in these regions; QTLs differentiating GR and SOR worms were enriched for genes in molecular pathways associated with neurotransmission, development, and stress responses. Finally, single worm genotyping demonstrated that geographic isolation and genetic change over time (in the presence of drug exposure) had a significantly greater role in shaping genetic diversity than the evolution of SOR.This study is one of the first genome-wide association analyses in a parasitic nematode, and provides insight into the genomics of ivermectin response and population structure of O. volvulus. We argue that ivermectin response is a polygenically-determined quantitative trait (QT) whereby identical or related molecular pathways but not necessarily individual genes are likely to determine the extent of ivermectin response in different parasite populations. Furthermore, we propose that genetic drift rather than genetic selection of SOR is the underlying driver of population differentiation, which has significant implications for the emergence and potential spread of SOR within and between these parasite populations

Stephen F Austin State University Journal of Education Vol. 2 No. 1

https://scholarworks.sfasu.edu/edjournal/1001/thumbnail.jp