Accuracy of prognosis estimates by four palliative care teams: a prospective cohort study

BACKGROUND: Prognosis estimates are used to access services, but are often inaccurate. This study aimed to determine the accuracy of giving a prognosis range. METHODS AND MEASUREMENTS: A prospective cohort study in four multi-professional palliative care teams in England collected data on 275 consecutive cancer referrals who died. Prognosis estimates (minimum – maximum) at referral, patient characteristics, were recorded by staff, and later compared with actual survival. RESULTS: Minimum survival estimates ranged <1 to 364 days, maximum 7 – 686 days. Mean patient survival was 71 days (range 1 – 734). In 42% the estimate was accurate, in 36% it was over optimistic and in 22% over pessimistic. When the minimum estimate was less than 14 days accuracy increased to 70%. Accuracy was related, in multivariate analysis, to palliative care team and (of borderline significance) patient age. CONCLUSIONS: Offering a prognosis range has higher levels of accuracy (about double) than traditional estimates, but is still very often inaccurate, except very close to death. Where possible clinicians should discuss scenarios with patients, rather than giving a prognosis range

Women and work in India: (Re)engaging *class, careers, and occupations in a globalizing economy

This study investigates work lives and careers of Indian women within a historical context. This context is seen as being influenced symbiotically by India\u27s cultural and traditional realities as well as the contemporary phenomenon of globalization. Using feminist standpoint theory as its theoretical lens, the study explored how women (de)(co)(re)construct and develop knowledges about their worlds of work as embedded within and influenced by the intersections of class, caste, society, socialization, and individual agency. Meaning(s) women associate with their work as well as Indian women\u27s definition of a career in 21st century globalizing India are other important areas of exploration. ^ Feminist face-to-face interviewing was conducted either in English and/or Marathi in the western city of Pune in the state of Maharashtra, India, with 77 women across caste, class, income, occupation, and generational categories. Accumulated data were analyzed and interpreted using qualitative software NVivo and manually. Findings from the study indicate that social practices such as caste-based quota-reservation system in higher education and employment continue to color women\u27s work worlds. Women understand that Indian society discriminates, as well as accepts working women depending on the spatial and temporal distinctions of societal members, and have developed strategies to negotiate this contradictory public space. Parental influences through direct and indirect communication and role modeling; as well as the support and encouragement of extended family members such as in-laws, significantly affected how women came to understand and process information regarding work values, career options, and post organizational entry workplace behaviors. Women show considerable agency in pursuing their own education, pursuing career interests, and in furthering advancement opportunities. Women also believe in having careers in communion, and display a strong sense of responsibility toward their familial roles, responsibilities, and obligations.^ The findings of this study contribute to the literature on vocational anticipatory socialization, career studies and communication, meanings of work, and feminist standpoint theory. This study contributes to an emerging internationalization agenda within organizational communication. Finally, the study also answers several recent calls (e.g. Broadfoot & Munshi, 2007; Cheney, 2000; Thomas & Inkson, 2007; Zoller, 2006) simultaneously, while addressing the accusations of individualism and parochialism levied on organizational communication and career studies.

The Complete Genome Sequence of Roseobacter denitrificans Reveals a Mixotrophic Rather than Photosynthetic Metabolism

Purple aerobic anoxygenic phototrophs (AAPs) are the only organisms known to capture light energy to enhance growth only in the presence of oxygen but do not produce oxygen. The highly adaptive AAPs compose more than 10% of the microbial community in some euphotic upper ocean waters and are potentially major contributors to the fixation of the greenhouse gas CO(2). We present the complete genomic sequence and feature analysis of the AAP Roseobacter denitrificans, which reveal clues to its physiology. The genome lacks genes that code for known photosynthetic carbon fixation pathways, and most notably missing are genes for the Calvin cycle enzymes ribulose bisphosphate carboxylase (RuBisCO) and phosphoribulokinase. Phylogenetic evidence implies that this absence could be due to a gene loss from a RuBisCO-containing α-proteobacterial ancestor. We describe the potential importance of mixotrophic rather than autotrophic CO(2) fixation pathways in these organisms and suggest that these pathways function to fix CO(2) for the formation of cellular components but do not permit autotrophic growth. While some genes that code for the redox-dependent regulation of photosynthetic machinery are present, many light sensors and transcriptional regulatory motifs found in purple photosynthetic bacteria are absent

Figure 1

<p>Phylogenetic relationships among the seven <i>Y. pestis</i> SNP genotypes identified in this study. Neighbor-joining tree was created using the data presented in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0000220#pone-0000220-t003" target="_blank">Table 3</a> and MEGA2 software <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0000220#pone.0000220-Kumar1" target="_blank">[23]</a>, and was rooted on genotype 0, as this genotype was assigned to the two outgroup isolates (see text). The position of the 19 SNPs (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0000220#pone-0000220-t001" target="_blank">Table 1</a>) are indicated below the tree. Individual genotypes or nodes were named based upon their position relative to genotype 0.</p

Twenty-four <i>Yersinia</i> spp. strains used to screen FV-1/CO92 SNPs.

a<p>IP, Institute Pasteur; Dugway, Dugway Proving Grounds; CDH, California Department of Health Services; USAMRIID, United States Army Medical Research Institute of Infectious Diseases; ADHS, Arizona Department of Health Services; NAU, Northern Arizona University.</p>b<p>Molecular groups of <i>Y. pestis</i> based upon Achtman <i>et al.</i><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0000220#pone.0000220-Achtman2" target="_blank">[5]</a></p>c<p>See <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0000220#pone-0000220-t003" target="_blank">Table 3</a> and <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0000220#pone-0000220-g001" target="_blank">Figure 1</a>.</p

Seven SNP genotypes identified in this study.

a<p>Genotypes are named based upon their phylogenetic position (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0000220#pone-0000220-g001" target="_blank">Figure 1</a>).</p>b<p>See <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0000220#pone-0000220-t001" target="_blank">Table 1</a>.</p>c<p>Number of screening isolates assigned to each genotype (24 total; see text).</p

19 SNPs discovered in the comparison of the CO92 and FV-1 genome sequences.

<p>Bold = transversion mutation</p

Niche adaptation and genome expansion in the chlorophyll d-producing cyanobacterium Acaryochloris marina

Acaryochloris marina is a unique cyanobacterium that is able to produce chlorophyll d as its primary photosynthetic pigment and thus efficiently use far-red light for photosynthesis. Acaryochloris species have been isolated from marine environments in association with other oxygenic phototrophs, which may have driven the niche-filling introduction of chlorophyll d. To investigate these unique adaptations, we have sequenced the complete genome of A. marina. The DNA content of A. marina is composed of 8.3 million base pairs, which is among the largest bacterial genomes sequenced thus far. This large array of genomic data is distributed into nine single-copy plasmids that code for >25% of the putative ORFs. Heavy duplication of genes related to DNA repair and recombination (primarily recA) and transposable elements could account for genetic mobility and genome expansion. We discuss points of interest for the biosynthesis of the unusual pigments chlorophyll d and α-carotene and genes responsible for previously studied phycobilin aggregates. Our analysis also reveals that A. marina carries a unique complement of genes for these phycobiliproteins in relation to those coding for antenna proteins related to those in Prochlorococcus species. The global replacement of major photosynthetic pigments appears to have incurred only minimal specializations in reaction center proteins to accommodate these alternate pigments. These features clearly show that the genus Acaryochloris is a fitting candidate for understanding genome expansion, gene acquisition, ecological adaptation, and photosystem modification in the cyanobacteria