Differences in Veterans' and Nonveterans' End-of-Life Preferences: A Pilot Study

Background: Investigators conducting focus groups on end-of-life preferences noted that veterans voiced opinions that strongly differed from those of nonveterans. Objective: The objective of this study was to further explore differences between veterans' and nonveterans' end-of-life preferences. Methods: Ten focus groups and a pilot survey were conducted. Setting and sample: The focus groups consisted of Arab Muslims, Arab Christians, Hispanics, blacks, and whites stratified by gender (n = 73). Fifteen male veterans were included across all five racial groups. Measures: A moderator discussion guide was used to lead the focus groups and a pilot survey asked about demographic information and end-of-life preferences. Results: Veterans were more likely to be married (p < 0.05) and less connected to their cultural group (p < 0.05) than nonveterans. The focus group results indicated that veterans in this study were more likely to oppose the use of heroic measures compared to nonveterans. More so than nonveterans, veterans felt that their doctors should be frank and open (p < 0.05) were strongly in favor of do-not-resuscitate (DNR) orders (p < 0.10), yet were less likely to have a proxy (p < 0.10) or durable power of attorney p < 0.01). Comparing end-of-life preferences, veterans felt less strongly than nonveterans about remembering personal accomplishments (p < 0.05), being listened to (p < 0.05), being with friends (p < 0.01), or being comfortable with their nurse (p < 0.05), but did want to be around their pets at the end of life p < 0.10). Implications: The Department of Veterans Affairs is in a unique position to improve endof- life care for veterans. Providing end-of-life care that is congruent with the veteran's wishes can improve satisfaction and increase cost effectiveness by eliminating unacceptable services.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63253/1/jpm.2006.9.1099.pd

Geodynamics and Rate of Volcanism on Massive Earth-like Planets

We provide estimates of volcanism versus time for planets with Earth-like composition and masses from 0.25 to 25 times Earth, as a step toward predicting atmospheric mass on extrasolar rocky planets. Volcanism requires melting of the silicate mantle. We use a thermal evolution model, calibrated against Earth, in combination with standard melting models, to explore the dependence of convection-driven decompression mantle melting on planet mass. Here we show that (1) volcanism is likely to proceed on massive planets with plate tectonics over the main-sequence lifetime of the parent star; (2) crustal thickness (and melting rate normalized to planet mass) is weakly dependent on planet mass; (3) stagnant lid planets live fast (they have higher rates of melting than their plate tectonic counterparts early in their thermal evolution) but die young (melting shuts down after a few Gyr); (4) plate tectonics may not operate on high mass planets because of the production of buoyant crust which is difficult to subduct; and (5) melting is necessary but insufficient for efficient volcanic degassing - volatiles partition into the earliest, deepest melts, which may be denser than the residue and sink to the base of the mantle on young, massive planets. Magma must also crystallize at or near the surface, and the pressure of overlying volatiles must be fairly low, if volatiles are to reach the surface. If volcanism is detected in the Tau Ceti system, and tidal forcing can be shown to be weak, this would be evidence for plate tectonics.Comment: Revised version, accepted by Astrophysical Journa

Update to the Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) protocol: statistical analysis plan for a prospective, multicenter, double-blind, adaptive sample size, randomized, placebo-controlled, clinical trial.

BACKGROUND: Observational research suggests that combined therapy with Vitamin C, thiamine and hydrocortisone may reduce mortality in patients with septic shock. METHODS AND DESIGN: The Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) trial is a multicenter, double-blind, adaptive sample size, randomized, placebo-controlled trial designed to test the efficacy of combination therapy with vitamin C (1.5 g), thiamine (100 mg), and hydrocortisone (50 mg) given every 6 h for up to 16 doses in patients with respiratory or circulatory dysfunction (or both) resulting from sepsis. The primary outcome is ventilator- and vasopressor-free days with mortality as the key secondary outcome. Recruitment began in August 2018 and is ongoing; 501 participants have been enrolled to date, with a planned maximum sample size of 2000. The Data and Safety Monitoring Board reviewed interim results at N = 200, 300, 400 and 500, and has recommended continuing recruitment. The next interim analysis will occur when N = 1000. This update presents the statistical analysis plan. Specifically, we provide definitions for key treatment and outcome variables, and for intent-to-treat, per-protocol, and safety analysis datasets. We describe the planned descriptive analyses, the main analysis of the primary end point, our approach to secondary and exploratory analyses, and handling of missing data. Our goal is to provide enough detail that our approach could be replicated by an independent study group, thereby enhancing the transparency of the study. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03509350. Registered on 26 April 2018

The genome sequence of <i>Trypanosoma brucei gambiense</i>, causative agent of chronic Human African Trypanosomiasis

&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; &lt;i&gt;Trypanosoma brucei gambiense&lt;/i&gt; is the causative agent of chronic Human African Trypanosomiasis or sleeping sickness, a disease endemic across often poor and rural areas of Western and Central Africa. We have previously published the genome sequence of a &lt;i&gt;T. b. brucei&lt;/i&gt; isolate, and have now employed a comparative genomics approach to understand the scale of genomic variation between &lt;i&gt;T. b. gambiense&lt;/i&gt; and the reference genome. We sought to identify features that were uniquely associated with &lt;i&gt;T. b. gambiense&lt;/i&gt; and its ability to infect humans.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Methods and findings:&lt;/b&gt; An improved high-quality draft genome sequence for the group 1 &lt;i&gt;T. b. gambiense&lt;/i&gt; DAL 972 isolate was produced using a whole-genome shotgun strategy. Comparison with &lt;i&gt;T. b. brucei&lt;/i&gt; showed that sequence identity averages 99.2% in coding regions, and gene order is largely collinear. However, variation associated with segmental duplications and tandem gene arrays suggests some reduction of functional repertoire in &lt;i&gt;T. b. gambiense&lt;/i&gt; DAL 972. A comparison of the variant surface glycoproteins (VSG) in &lt;i&gt;T. b. brucei&lt;/i&gt; with all &lt;i&gt;T. b. gambiense&lt;/i&gt; sequence reads showed that the essential structural repertoire of VSG domains is conserved across &lt;i&gt;T. brucei&lt;/i&gt;.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Conclusions:&lt;/b&gt; This study provides the first estimate of intraspecific genomic variation within &lt;i&gt;T. brucei&lt;/i&gt;, and so has important consequences for future population genomics studies. We have shown that the &lt;i&gt;T. b. gambiense&lt;/i&gt; genome corresponds closely with the reference, which should therefore be an effective scaffold for any &lt;i&gt;T. brucei&lt;/i&gt; genome sequence data. As VSG repertoire is also well conserved, it may be feasible to describe the total diversity of variant antigens. While we describe several as yet uncharacterized gene families with predicted cell surface roles that were expanded in number in &lt;i&gt;T. b. brucei&lt;/i&gt;, no &lt;i&gt;T. b. gambiense&lt;/i&gt;-specific gene was identified outside of the subtelomeres that could explain the ability to infect humans.&lt;/p&gt

Perioperative passport: empowering people with diabetes along their surgical journey

© 2017 Diabetes UK Aim: To determine whether a handheld ‘perioperative passport’ could improve the experience of perioperative care for people with diabetes and overcome some of the communication issues commonly identified in inpatient extracts. Methods: Individuals with diabetes undergoing elective surgery requiring at least an overnight stay were identified via a customized information technology system. Those allocated to the passport group were given the perioperative passport before their hospital admission. A 26-item questionnaire was completed after surgery by 50 participants in the passport group (mean age 69 years) and by 35 participants with diabetes who followed the usual surgical pathway (mean age 70 years). In addition, the former group had a structured interview about their experience of the passport. Results: The prevalence of those who reported having received prior information about their expected diabetes care was 35% in the control group vs 92% in the passport group (

Type Ia supernovae and the ^{12}C+^{12}C reaction rate

The experimental determination of the cross-section of the ^{12}C+^{12}C reaction has never been made at astrophysically relevant energies (E<2 MeV). The profusion of resonances throughout the measured energy range has led to speculation that there is an unknown resonance at E\sim1.5 MeV possibly as strong as the one measured for the resonance at 2.14 MeV. We study the implications that such a resonance would have for the physics of SNIa, paying special attention to the phases that go from the crossing of the ignition curve to the dynamical event. We use one-dimensional hydrostatic and hydrodynamic codes to follow the evolution of accreting white dwarfs until they grow close to the Chandrasekhar mass and explode as SNIa. In our simulations, we account for a low-energy resonance by exploring the parameter space allowed by experimental data. A change in the ^{12}C+^{12}C rate similar to the one explored here would have profound consequences for the physical conditions in the SNIa explosion, namely the central density, neutronization, thermal profile, mass of the convective core, location of the runaway hot spot, or time elapsed since crossing the ignition curve. For instance, with the largest resonance strength we use, the time elapsed since crossing the ignition curve to the supernova event is shorter by a factor ten than for models using the standard rate of ^{12}C+^{12}C, and the runaway temperature is reduced from \sim8.14\times10^{8} K to \sim4.26\times10^{8} K. On the other hand, a resonance at 1.5 MeV, with a strength ten thousand times smaller than the one measured at 2.14 MeV, but with an {\alpha}/p yield ratio substantially different from 1 would have a sizeable impact on the degree of neutronization of matter during carbon simmering. We conclude that a robust understanding of the links between SNIa properties and their progenitors will not be attained until the ^{12}C+^{12}C reaction rate is measured at energies \sim1.5 MeV.Comment: 15 pages, 6 tables, 10 figures, accepted for Astronomy and Astrophysic

Telomeric expression sites are highly conserved in trypanosoma brucei

Subtelomeric regions are often under-represented in genome sequences of eukaryotes. One of the best known examples of the use of telomere proximity for adaptive purposes are the bloodstream expression sites (BESs) of the African trypanosome Trypanosoma brucei. To enhance our understanding of BES structure and function in host adaptation and immune evasion, the BES repertoire from the Lister 427 strain of T. brucei were independently tagged and sequenced. BESs are polymorphic in size and structure but reveal a surprisingly conserved architecture in the context of extensive recombination. Very small BESs do exist and many functioning BESs do not contain the full complement of expression site associated genes (ESAGs). The consequences of duplicated or missing ESAGs, including ESAG9, a newly named ESAG12, and additional variant surface glycoprotein genes (VSGs) were evaluated by functional assays after BESs were tagged with a drug-resistance gene. Phylogenetic analysis of constituent ESAG families suggests that BESs are sequence mosaics and that extensive recombination has shaped the evolution of the BES repertoire. This work opens important perspectives in understanding the molecular mechanisms of antigenic variation, a widely used strategy for immune evasion in pathogens, and telomere biology

Critical Review of Theoretical Models for Anomalous Effects (Cold Fusion) in Deuterated Metals

We briefly summarize the reported anomalous effects in deuterated metals at ambient temperature, commonly known as "Cold Fusion" (CF), with an emphasis on important experiments as well as the theoretical basis for the opposition to interpreting them as cold fusion. Then we critically examine more than 25 theoretical models for CF, including unusual nuclear and exotic chemical hypotheses. We conclude that they do not explain the data.Comment: 51 pages, 4 Figure

Triple-Antiretroviral Prophylaxis to Prevent Mother-To-Child HIV Transmission through Breastfeeding—The Kisumu Breastfeeding Study, Kenya: A Clinical Trial

Timothy Thomas and colleagues report the results of the Kisumu breastfeeding study (Kenya), a single-arm trial that assessed the feasibility and safety of a triple-antiretroviral regimen to suppress maternal HIV load in late pregnancy