Enhancing Elderly Advance Care Planning Experience at a Primary Care Clinic

The purpose of the project was to examine if the identification of readiness for an advance care planning (ACP) discussion of elderly participants would enhance the outcomes of participants\u27 satisfaction, improve the likelihood of having an ACP discussion and increase the completion rates of an advance directive (AD) document after an office visit. Forty-four elderly participants, who met the selection criteria, were recruited from a primary clinic in Northern California from October 1, 2017 to December 31, 2017 (Female, n =28). All participants were randomly assigned to either an intervention group (n= 22) or a control group (n =22). Their age ranged from 65 to 89 years (M = 72.89; SD = 7 .31). A pre- and a post-visit self-administrated questionnaire were used for data collection with a follow-up phone call made to the participants post-visit. Project findings indicated that the intervention participants who were ready for an ACP discussion were more likely to have an ACP discussion and complete an AD document than the control participants post-visit (p \u3c.05). Although there were significant differences of some demographic variables between groups to confound the ACP outcomes, findings of this project were clinically significant. In conclusion, the investigator advised that primary care providers should initiate the ACP discussion, document the conversation and complete an AD document when the elderly patients clearly state that they are ready for an ACP discussion

Cdk1 phosphorylation of BubR1 controls spindle checkpoint arrest and Plk1-mediated formation of the 3F3/2 epitope

Accurate chromosome segregation is controlled by the spindle checkpoint, which senses kinetochore– microtubule attachments and tension across sister kinetochores. An important step in the tension-signaling pathway involves the phosphorylation of an unknown protein by polo-like kinase 1/Xenopus laevis polo-like kinase 1 (Plx1) on kinetochores lacking tension to generate the 3F3/2 phosphoepitope. We report here that the checkpoint protein BubR1 interacts with Plx1 and that phosphorylation of BubR1 by Plx1 generates the 3F3/2 epitope. Formation of the BubR1 3F3/2 epitope by Plx1 requires a prior phosphorylation of BubR1 on Thr 605 by cyclin-dependant kinase 1 (Cdk1). This priming phosphorylation of BubR1 by Cdk1 is required for checkpoint-mediated mitotic arrest and for recruitment of Plx1 and the checkpoint protein Mad2 to unattached kinetochores. Biochemically, formation of the 3F3/2 phosphoepitope by Cdk1 and Plx1 greatly enhances the kinase activity of BubR1. Thus, Cdk1-mediated phosphorylation of BubR1 controls checkpoint arrest and promotes the formation of the kinetochore 3F3/2 epitope

Creating Wealth and Welfare

Summaries This article examines the role of China's rural township and village governments in welfare provision. In it, I first describe the role of local officials in the promotion of collective and private enterprise, and the relationship between these entrepreneurial activities and more traditional responsibilities of government, particularly social assistance and welfare provision. The extraordinary development of China's township and village enterprises created resources which have frequently been channelled towards the provision of public goods and welfare. Examination of policy changes and budget allocations for rural welfare highlights the extent to which localities are dependent on their own funding sources. In conclusion, I suggest that new initiatives in fiscal reform may limit the entrepreneurial capacity of local governments, reducing their control over resources and thus their capacity to meet welfare responsibilities

The parentified child in a child psychotherapist: a systematic literature review of the parentified child, exploring its effects on the countertransference process in child psychotherapy

This dissertation explores the countertransference of a child psychotherapist with a history of parentification. Parentified children are those who attempt to fulfill the parental role at the expense of their own developmentally appropriate needs and pursuits. Parentification implies that the process of becoming a parentified child involves subjective distortion of the parent-child relationship, which comprises the parameters of overt role assignment, internalized expectations and commitment characteristics. A modified systematic literature review has been adopted as a research method for this study to explore the internal and interpersonal world of a parentified child. Literature was gathered from a range of theories, such as family system theories, developmental theories, psychoanalytic theories combined with many studies of the parentified child in order to understand the impact of a parentification history on the countertransference of a child psychotherapist. The synthesis of the findings through the reviewing process is represented in three themes, which are: 1. Hiding the true-self or false-self adaptation, 2. Drowning in the emotional sea or putting up the firewall, and 3. The resilience of a parentified therapist. The findings of this study concluded that the parentification process denotes a relationship between a child and a parent, which involves multi-layers of impact on the child’s development. This relationship may easily be revived in the therapeutic process when a parentified therapist is working with a child. The caretaker role seems to be a mechanism of coping with the emotional pain that arises in parentification. While in a therapeutic process with children, a parentified therapist’s emotional pain may easily be triggered in countertransference and the therapist may unknowingly change from a therapist’s role to a caretaker role to defend off the over-identification of the child’s suffering. On the other hand, she may unconsciously dissociate from feeling the pain and focus by intellectually re-parenting the child in the therapeutic process. It is important that a parentified therapist gets enough holding and containment to understand her history of parentification and attune to her own wounds, thus she is able to use this ‘inner ‘parentified child’ wisely to benefit the therapy with children

Will oil price crash destabilize petro-states? : a study of oil price crashes in 1985-1986 and 2014-2015 and the impacts on the political stability of petro-states : Venezuela, Algeria, the Soviet Union/Russia, Saudi Arabia and Indonesia

published_or_final_versionInternational and Public AffairsMasterMaster of International and Public Affair

TOPOLOGY, ANALYSIS, AND CMOS IMPLEMENTATION OF SWITCHED-CAPACITOR DC-DC CONVERTERS

This review highlights various design and realization aspects of three commonly used charge pump topologies, namely, the linear, exponential, and the Fibonacci type of charge pumps. We shall outline the new methods developed recently for analyzing the steady and dynamic performances of these circuits. Some practical issues for the CMOS implementation of these charge pump structures will be critically discussed. Finally, some conventional voltage regulation methods for maintaining a stable output under a large range of loading current and supply voltage fluctuations will be proposed

Attitude, acceptability and knowledge of HPV vaccination among local university students in Hong Kong

© 2016 by the authors; licensee MDPI, Basel, Switzerland. The Human Papillomavirus (HPV) vaccine has the great potential to prevent HPV-related infections for millions of women and men worldwide. However, the success of the vaccine is highly dependent on the vaccination rate. Factors influencing the attitudes of undergraduate students towards HPV vaccination should be studied. This is a cross-sectional survey that was conducted to estimate the HPV vaccination rate among undergraduate students in Hong Kong, and to identify the predictors of their attitude towards HPV vaccination. The results showed that the HPV vaccination rate was 13.3%. Factors related to knowledge of vaccination were the main predictors of the studentsâ attitude towards vaccination (there were seven predictors, with B = 1.36 to 2.30; p < 0.05), followed by gender (B =-1.40; p < 0.05), acceptable maximum price (B = 0.35; p < 0.05), and willingness to receive the HPV vaccine if it can protect against cervical/anal cancer and genital warts (B =-1.90; p < 0.001).Theregressionmodelthatwasdevelopedbasedonthepredictorshadamoderateeffect size (adj-R 2 = 0.33). To conclude, the HPV vaccination rate among undergraduate students in Hong Kong was low. They should be provided with more active education and activities to promote HPV vaccination to improve their knowledge on the subject.Link_to_subscribed_fulltex

Comparison of DNA extraction efficiencies using various methods for the detection of genetically modified organisms (GMOs)

The ability to detect the presence of transgenes in crop-derived foods depends on the quantity and quality of DNA obtained from a product to be analyzed. The efficiency of DNA extraction protocols differs due to the nature of each food product. In this paper, we described two main DNA extraction protocols and their modifications that have been applied and evaluated for DNA extraction from raw and processed food as well as animal feed. The yield and quality for five categories of food and feed samples namely, raw soybean, raw maize, animal feed, smooth tofu and soymilk are discussed. The statistical interaction analyses showed that the cetyltrimethyl ammonium bromide (CTAB) method was proven to be the best method to extract DNA from raw soybean, maize and animal feed samples which not only obtained high DNA yield of 32.7, 28.4 and 33.4 ng DNA/mg sample respectively, but also produced high quality DNA with the absorbance A260/A280 ratio of 1.9, 1.9 and 2.0, respectively. These DNA were suitable for PCR amplification which produced a 164 bp DNA fragment of the lectin gene from soybean, and a 277 bp DNA fragment of the zein gene from maize. In the processed food category, the Wizard isolation method was found to be the best for the extraction of DNA from smooth tofu and soymilk with the yield of 13.2 and 3.4 ng DNA/mg sample, and the quality of the DNA at the absorbance A260/A280 ratio ranged from 1.9 to 1.7. These DNA were successfully amplified using primers specific to the lectin gene of soybean