Delirium: assessment and treatment of patients with cancer PART 2

Delirium at the end of life may present significant ethical dilemmas in clinical practice: whether to simply treat it in order to maximise symptom relief, with the resulting side effect being palliative sedation, or to attempt to reverse delirium and risk prolonging suffering. Determining whether the delirium can be reversed involves comprehensive assessment using established tools, which may or may not provide the answer to the question posed. This article examines the evidence surrounding several assessment tools that have been suggested as effective in identifying delirium, and the consequences of various approaches to the management of delirium in a patient with a cancer diagnosis. It also considers the impact delirium may have on the health professional and those close to the patient.N/

Dechlorination Apparatus For Treating Chloride Salt Wastes: System Evaluation And Scale-Up

This paper describes an apparatus used to remove chlorine from chloride salt-based nuclear wastes from electrochemical reprocessing and/or chloride-based molten salt reactors (MSRs) through dechlorination by reacting the salts with ammonium dihydrogen phosphate (NH4H2PO4 or ADP) at temperatures up to 600 °C to produce NH4Cl as a byproduct. The benefits of removing the Cl from these salts include 37Cl recovery from Cl-based MSR salts, formation of UCl3 from the NH4Cl, as well as removal of Cl from the salts and conversion of the salt cations to oxides to allow for immobilization in a chemically durable iron phosphate waste form. This generation-2 system is an improvement over the generation-1 system and provides a means for scaling up salt throughput as well as NH4Cl recovery. The generation-2 system includes a five-zone furnace so the temperature of the four-zone gradient furnace can be tailored to control the location of NH4Cl condensation on a four-piece fused quartz off-gas system. Both ADP and NH4Cl decomposition reactions include the production of NH3 and acids (i.e., H3PO4 and HCl, respectively), so careful temperature control is needed during the ADP-salt reactions to maximize the NH4Cl production and minimize NH4Cl decomposition. In two sets of experiments run in the generation-1 and generation-2 apparatuses, NH4Cl yields were ≥5.5-fold higher for the new system compared to the original prototype system and the batch sizes can be ≥2.5-fold higher. In addition, some thermodynamic experiments evaluating the reactions of ADP + KCl as well as decomposition of pure NH4Cl were performed to assess the temperatures of the reactions and identify off-gas products

A bioarchaeological analysis of burials at the Weaver site, Illinois

Includes bibliographical references.A collection of skeletal material from the Weaver Site in Fulton County, Illinois, was examined to establish the composition and general health status of a sample of a prehistoric Native American population. The sample consisted of 34 individuals from three cultural periods: the Hopewell, Weaver, and Spoon River Mississippian. Individuals were evaluated for sex, age, stature, and dental wear. The presence of pathological conditions as indicated by skeletal markers was recorded. The markers assessed were cribra orbitalia and porotic hyperostosis, periosteal infection, enamel hypoplasias, and dental caries, which are used to ascertain the nutritional and disease stress of a population. Evidence was also assessed for cases of unique, individual pathologies, including a case of scurvy—a disease little known in Midwest Native American populations. While the Weaver sample is too small to derive statistically significant trends, the following conclusions are supported. The Weaver individuals showed lower frequencies of cribra orbitalia, porotic hyperostosis and periostitis than comparative frequencies in contrast populations from the same time period in Illinois. The conditions in the Weaver population were generally of low severity, as well. Mortality age distributions resemble published distributions for this time period. The general good health and resource availability of the Weaver population is supported by its lower frequency and severity of pathological markers, by the fact that 20% in a sample of 34 had an age of 50 years or greater, and by the presence of several very robust males

Amino acids in the uterine luminal fluid reflects the temporal changes in transporter expression in the endometrium and conceptus during early pregnancy in cattle

In cattle, conceptus-maternal interactions are critical for the establishment and maintenance of pregnancy. A major component of this early interaction involves the transport of nutrients and secretion of key molecules by uterine epithelial cells to help support conceptus development during the peri-implantation period of pregnancy. Objectives were to: 1) analyze temporal changes in the amino acid (AA) content of uterine luminal fluid (ULF) during the bovine estrous cycle; 2) understand conceptus-induced alterations in AA content; 3) determine expression of AA transporters in the endometrium and conceptus; and 4) determine how these transporters are modulated by (Progesterone) P4. Concentrations of aspartic acid, arginine, glutamine, histidine, lysine, isoleucine, leucine, phenylalanine and tyrosine decreased on Day 16 of the estrous cycle but increased on Day 19 in pregnant heifers (P < 0.05). Glutamic acid only increased in pregnant heifers on Day 19 (P,0.001). Asparagine concentrations were greater in ULF of cyclic compared to pregnant heifers on Day 7 (P < 0.05) while valine concentrations were higher in pregnant heifers on Day 16 (P < 0.05). Temporal changes in expression of the cationic AA transporters SLC7A1 SLC7A4 and SLC7A6 occurred in the endometrium during the estrous cycle/early pregnancy coordinate with changes in conceptus expression of SLC7A4, SLC7A2 and SLC7A1 (P < 0.05). Only one acidic AA transporter (SLC1A5) increased in the endometrium while conceptus expression of SLC1A4 increased (P < 0.05). The neutral AA transporters SLC38A2 and SLC7A5 increased in the endometrium in a temporal manner while conceptus expression of SLC38A7, SLC43A2, SLC38A11 and SLC7A8 also increased (P < 0.05). P4 modified the expression of SLC1A1, -1A4, -1A5, -38A2 , -38A4, -38A7, -43A2, -6A14, -7A1, -7A5 and -7A7 in the endometrium. Results demonstrate that temporal changes in AA in the ULF reflect changes in transporter expression in the endometrium and conceptus during early pregnancy in cattle, some of which are modified by P4. © 2014 Forde et al

Predicting aged pork quality using a portable Raman device

The utility of Raman spectroscopic signatures of fresh pork loin (1 d & 15 d postmortem) in predicting fresh pork tenderness and slice shear force (SSF) was determined. Partial least square models showed that sensory tenderness and SSF are weakly correlated (R2 = 0.2). Raman spectral data were collected in 6 s using a portable Raman spectrometer (RS). A PLS regression model was developed to predict quantitatively the tenderness scores and SSF values from Raman spectral data, with very limited success. It was discovered that the prediction accuracies for day 15 post mortem samples are significantly greater than that for day 1 postmortem samples. Classification models were developed to predict tenderness at two ends of sensory quality as “poor” vs. “good”. The accuracies of classification into different quality categories (1st to 4th percentile) are also greater for the day 15 postmortem samples for sensory tenderness (93.5% vs 76.3%) and SSF (92.8% vs 76.1%). RS has the potential to become a rapid on-line screening tool for the pork producers to quickly select meats with superior quality and/or cull poor quality to meet market demand/expectations

Time-Dependent Expression of Arc and Zif268 after Acquisition of Fear Conditioning

Memory consolidation requires transcription and translation of new protein. Arc, an effector immediate early gene, and zif268, a regulatory transcription factor, have been implicated in synaptic plasticity underlying learning and memory. This study explored the temporal expression profiles of these proteins in the rat hippocampus following fear conditioning. We observed a time-dependent increase of Arc protein in the dorsal hippocampus 30-to-90-minute post training, returning to basal levels at 4 h. Zif268 protein levels, however, gradually increased at 30-minute post training before peaking in expression at 60 minute. The timing of hippocampal Arc and zif268 expression coincides with the critical period for protein synthesis-dependent memory consolidation following fear conditioning. However, the expression of Arc protein appears to be driven by context exploration, whereas, zif268 expression may be more specifically related to associative learning. These findings suggest that altered Arc and zif268 expression are related to neural plasticity during the formation of fear memory

Analysing the operative experience of basic surgical trainees in Ireland using a web-based logbook

<p>Abstract</p> <p>Background</p> <p>There is concern about the adequacy of operative exposure in surgical training programmes, in the context of changing work practices. We aimed to quantify the operative exposure of all trainees on the National Basic Surgical Training (BST) programme in Ireland and compare the results with arbitrary training targets.</p> <p>Methods</p> <p>Retrospective analysis of data obtained from a web-based logbook (<url>http://www.elogbook.org</url>) for all general surgery and orthopaedic training posts between July 2007 and June 2009.</p> <p>Results</p> <p>104 trainees recorded 23,918 operations between two 6-month general surgery posts. The most common general surgery operation performed was simple skin excision with trainees performing an average of 19.7 (± 9.9) over the 2-year training programme. Trainees most frequently assisted with cholecystectomy with an average of 16.0 (± 11.0) per trainee. Comparison of trainee operative experience to arbitrary training targets found that 2-38% of trainees achieved the targets for 9 emergency index operations and 24-90% of trainees achieved the targets for 8 index elective operations. 72 trainees also completed a 6-month post in orthopaedics and recorded 7,551 operations. The most common orthopaedic operation that trainees performed was removal of metal, with an average of 2.90 (± 3.27) per trainee. The most common orthopaedic operation that trainees assisted with was total hip replacement, with an average of 10.46 (± 6.21) per trainee.</p> <p>Conclusions</p> <p>A centralised web-based logbook provides valuable data to analyse training programme performance. Analysis of logbooks raises concerns about operative experience at junior trainee level. The provision of adequate operative exposure for trainees should be a key performance indicator for training programmes.</p